American Journal of Epidemiology Vol. 152, No. 11 : 1024-1033
Copyright © 2000 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Prenatal and Postnatal Risk Factors for Mental Retardation among Children in Bangladesh
1 Division of Epidemiology, Joseph L. Mailman School of Public Health, and G. H. Sergievsky Center, Columbia University, New York, NY.
2 New York State Psychiatric Institute, New York, NY.
3 Bangladesh Institute of Child Health, Dhaka Shishu (Children's) Hospital, Dhaka, Bangladesh.
4 National Perinatal Epidemiology Unit, Oxford University, Oxford, England.
5 Department of Special Education, Institute of Education and Research, University of Dhaka, Dhaka, Bangladesh.
6 Kalyani Special School, Bangladesh Protibondhi Foundation, Dhaka, Bangladesh.
7 BASICS, Dhaka, Bangladesh.
This study evaluated the contribution of prenatal, perinatal, neonatal, and postnatal factors to the prevalence of cognitive disabilities among children aged 2–9 years in Bangladesh. A two-phase survey was implemented in 1987–1988 in which 10,299 children were screened for disability. In multivariate analyses, significant independent predictors of serious mental retardation in rural and urban areas included maternal goiter (rural odds ratio (OR) = 5.14, 95% confidence interval (CI): 1.23, 21.57; urban OR = 4.82, 95% CI: 2.73, 8.50) and postnatal brain infections (rural OR = 29.24, 95% CI: 7.17, 119.18; urban OR = 13.65, 95% CI: 4.69, 39.76). In rural areas, consanguinity (OR = 15.13, 95% CI: 3.08, 74.30) and landless agriculture (OR = 6.02, 95% CI: 1.16, 31.19) were also independently associated with the prevalence of serious mental retardation. In both rural and urban areas, independent risk factors for mild cognitive disabilities included maternal illiteracy (OR = 2.48, 95% CI: 0.86, 7.12), landlessness (OR = 4.27, 95% CI: 1.77, 10.29), maternal history of pregnancy loss (OR = 2.61, 95% CI: 0.95, 7.12), and small for gestational age at birth (OR = 3.86, 95% CI: 1.56, 9.55). Interventions likely to have the greatest impact on preventing cognitive disabilities among children in Bangladesh include expansion of existing iodine supplementation, maternal literacy, and poverty alleviation programs as well as prevention of intracranial infections and their consequences. Further population-based studies are needed to confirm and understand the association between consanguinity and serious cognitive disability.
child; consanguinity; development disorders; infant; newborn; diseases; mental retardation; nutrition disorders; poverty; prevalence
Abbreviations: CI, confidence interval; IQ, intelligence quotient; OR, odds ratio
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