Behavioural and emotional comorbidities in school-aged children with neurological conditions in Kilifi, Kenya, and their long-term consequences

listen audio

Study Justification:
This study aimed to investigate the association between neurological conditions and behavioral and emotional problems in school-aged children in Kilifi, Kenya. The prevalence and risk factors of these problems were also examined, along with their long-term consequences. The study was conducted in a rural area with a high population of children, and it focused on an understudied population in low- and middle-income countries. By understanding the impact of neurological conditions on mental health and long-term outcomes, the study aimed to inform the development of preventive and therapeutic measures to improve the well-being of these children.
Highlights:
– The study found that children with neurological conditions had a higher prevalence of mental health problems compared to those without.
– Specific impairments, such as cognitive, motor, hearing, and epilepsy, were associated with mental health problems.
– The prevalence of any mental health problem was 15%, with externalizing problems being more common than internalizing problems.
– Longitudinal follow-up showed that these disorders had an impact on future schooling, occupation, and access to household assets.
Recommendations:
Based on the findings, the study recommends the following:
– Implement preventive measures to reduce the risk of neurological conditions in children.
– Develop therapeutic interventions to address mental health problems in children with neurological conditions.
– Improve access to education and support for children with cognitive impairments.
– Enhance occupational opportunities for individuals with mental health problems.
– Provide resources and support for households affected by epilepsy.
Key Role Players:
To address these recommendations, key role players may include:
– Government health departments and policymakers
– Healthcare providers and clinicians
– Educators and school administrators
– Mental health professionals
– Community organizations and support groups
Cost Items for Planning Recommendations:
While the actual cost will depend on the specific interventions and strategies implemented, some potential cost items to consider in planning the recommendations include:
– Training and capacity building for healthcare providers and educators
– Development and implementation of preventive programs
– Provision of therapeutic services and mental health support
– Educational resources and accommodations for children with cognitive impairments
– Awareness campaigns and community outreach initiatives
– Monitoring and evaluation of interventions
Please note that the above cost items are estimates and may vary based on local context and resources available.

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong, as it presents data from a large sample size and uses standardized tools and clinical examinations. The study also includes longitudinal follow-up data to assess long-term consequences. However, to improve the evidence, the study could include a control group without neurological conditions for comparison, and use more rigorous statistical analysis techniques such as adjusting for potential confounding variables.

Background: Neurological conditions and mental health problems are common in children in low- and middle-income countries, but the risk factors and downstream impact of these problems on children with neurological conditions are not reported. Objective: To determine the association of neurological conditions with behavioural and emotional problems in children, the prevalence and risk factors of behavioural and emotional problems, and long-term impact of these conditions. Methods: Data on multiple neurological conditions and mental health problems were available for 1,616 children (aged 6–9 years) from Kilifi, Kenya. Neurological conditions were diagnosed using standardised tools and clinical examination. Behavioural and emotional problems assessed using Child Behaviour Questionnaire for Parents. Long-term outcomes were obtained from census data of the Kilifi Health and Demographic Surveillance System. Logistic and linear regression were used to measure associations. Results: Mental health problems were higher in those with any neurological condition compared to those without (24% vs. 12%, p < 0.001). Cognitive (odds ratio (OR) = 2.39; 95% CI: 1.59–3.59), motor (OR = 3.17; 95% CI: 1.72–5.82), hearing (OR = 2.07; 95% CI:1.12–3.83) impairments, and epilepsy (OR = 4.18; 95% CI: 2.69–6.48), were associated with mental health problems. Prevalence of any mental health problem was 15%, with externalizing problems more common than internalizing problems (21% vs. 17%, p = 0.004). Longitudinal follow-up indicated that the disorders affected an individual’s future schooling (e.g. OR = 1.25; 95% CI: 0.14–1.46 following cognitive impairments), occupation (OR = 2.44; 95% CI: 1.09–5.44 following mental health problems), and access to household assets (OR = 2.78; 95% CI: 0.99–7.85 following epilepsy). Conclusions: Neurological conditions in school-aged children in Kilifi are associated with mental health problems, and both disorders have long-term consequences. Preventive and therapeutic measures for these conditions are needed to improve outcomes of these children.

An epidemiological survey was carried out between June 2001 to March 2002 on neurological disabilities, impairments, and mental health problems in children aged 6–9 years in a rural area in Kilifi County [9]. The county is located along the coast of Kenya and the area residents are mainly Mijikenda, a Bantu group of nine tribes with the Giriama dominating. Kilifi County has a population distribution of 1.5 million residents, whereby 0–14 year olds constitute 42% of the total population [14]. In this study, we selected children aged 6 years and above owing to the difficulty in identifying and assessing mental and neurological disorders in younger children especially hearing, visual, and cognitive impairments. Additionally, having survived early childhood, which is a period associated with high adversity and mortality in sub-Saharan Africa [15], studying children above 6 years of age enabled understanding the impact of early-life negative impacts of neurological conditions, including being able to access education. Assessments were performed in two stages during the 2001 epidemiological survey (Figure S1). To screen for neurological impairment and epilepsy in stage I, five trained field interviewers fluent in the local Kigiryama language administered Ten Questions Questionnaire (TQQ) [16], to parents or guardians of 10,218 children who agreed to participate. The TQQ consists of ten items (with a yes or no response) designed to detect moderate-to-severe impairments and disorders; including five questions addressing cognitive development, two questions relating to motor ability, and one question each regarding vision, hearing, and seizures. Those who tested positive on the TQQ, and a random sample of those who tested negative (10.3%), were invited to participate in stage II. In this stage, a team of clinicians and psychological assessors performed clinical history, examination, and psychological assessments to detect cognitive, motor, hearing, visual impairments, and epilepsy (Table S1). Perinatal and postnatal adverse occurrences were documented from medical history and maternal recall of pregnancy and delivery events, a method that was shown to be relatively reproducible and accurate in previous reports [17,18]. Data on perinatal events included pregnancy complications, place and mode of delivery, and birth trauma/difficulties, while postnatal occurrences assessed were history of neonatal insults, neonatal jaundice, developmental problems, child’s immunization, and neurological deficit. During assessments in stage II, a Child Behaviour Questionnaire for Parents (CBQFP) was administered to assess behavioural and emotional problems in the children. The CBQFP was administered to a parent or guardian in a conversational manner comprising of 15 items to assess various aspects of behaviour and emotion including reaction to change, independence, mood, worries, fears, and habits. The severity and frequency of behaviour described in the questionnaire were rated and scored depending on the parents’ response with a higher overall score signifying a higher level of total behaviour or emotional problems [19]. The CBQFP had been previously adapted and validated for use in this setting, demonstrating a high degree of interrater reliability (r = 0.92), and fair internal reliability (standardized item α = 0.61) in the assessment of neuropsychological outcomes of cerebral malaria [19]. Questions in the CBQFP on anxiety, temper, mood, worries, fears, and empathy were classified as indicators for internalizing or emotional problems; while those on the child’s concentration span, social relationships, social dependency, and behaviour in public assessed for externalizing problems. Assessment data from questions on appetite, habits, self-care, and wetting/soiling oneself were not included in the analysis as they were not categorized as indicators for internalizing or externalizing problems. We followed up the children assessed in stage II through the Kilifi Health and Demographic Surveillance System (KHDSS) from June 2001 to May 2008, to assess any long-term consequences of neurological conditions, behavioural and emotional problems on their education and socio-economic status. The KHDSS is a database that was established to create longitudinal community-based records of births, deaths, pregnancies, migration events, and additional sociodemographic information including socio-economic status and educational achievement [20]. The surveillance region includes an estimated population of 280,000 residents [21] living in an area covering 891 km2, which is in reference to the area served by the county’s main referral hospital. Follow-up of the participants was done through 4-monthly household visits during which data on their schooling, education level and years completed, economic status (measured by access to a source of lighting), assets acquired (e.g. a working mobile phone, radio) at a household level, and occupation were collected by trained field workers using standardised data collection tools. All statistical analyses were performed using STATA version 15 (StataCorp, College Station, TX, USA). Demographic characteristics between those who tested positive or negative on the TQQ test were compared using Pearson χ2 test (for categorical measures) and Student’s t-test (for continuous measures). Associations between neurological conditions and total mental health problems were illustrated using Pearson χ2 test, while Fisher’s exact test was used for comparison of infrequent observations [22]. The associations were further evaluated through building of age and sex adjusted linear and logistic regression models. The cut-off score for behavioural and emotional problems was derived from the 90th percentile of total behavioural and emotional scores among children who screened negative for neurological conditions, with the resultant cut-off of the mental health problems applied to all participants in the dataset. This was done following guidelines provided by Richman et al [23], and similar criteria were used to derive cut-offs for internalizing and externalizing problems, respectively. Age and sex stratified prevalence of total behavioural and emotional problems were computed, and linear regression applied to identify significant risk factors for total mental health problems scores, total internalizing, and externalizing scores. A logistic regression model was also used to determine potential risk factors associated with internalizing and externalizing problems as categorical variables, and in determining long-term impact of neurological conditions and mental health problems on schooling, occupation, and asset ownership. Risk factors with a univariable p ≤ 0.25 were fitted into a sex and age adjusted multivariable linear and logistic regression model to further identify independent factors.

Based on the information provided, here are some potential innovations that could be used to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can allow pregnant women in remote areas to access healthcare professionals and receive prenatal care through virtual consultations. This can help overcome geographical barriers and improve access to maternal health services.

2. Mobile health (mHealth) applications: Developing mobile applications that provide educational resources, appointment reminders, and personalized health information can empower pregnant women to take control of their own health and access important maternal health services.

3. Community health workers: Training and deploying community health workers who can provide basic prenatal care, education, and support to pregnant women in underserved areas can help improve access to maternal health services, especially in areas where healthcare facilities are limited.

4. Transportation solutions: Implementing transportation solutions such as mobile clinics or ambulance services can help pregnant women in remote areas reach healthcare facilities for prenatal care, delivery, and postnatal care.

5. Financial incentives: Providing financial incentives, such as cash transfers or subsidies, to pregnant women in low-income communities can help reduce financial barriers and improve access to maternal health services.

6. Public awareness campaigns: Conducting public awareness campaigns to educate communities about the importance of maternal health and the available services can help increase demand for and utilization of maternal health services.

7. Collaborations and partnerships: Establishing collaborations and partnerships between healthcare providers, non-profit organizations, and government agencies can help pool resources and expertise to improve access to maternal health services in underserved areas.

It’s important to note that these are just potential recommendations and would need to be further evaluated and tailored to the specific context and needs of the community in Kilifi, Kenya.
AI Innovations Description
The recommendation to improve access to maternal health based on the provided information is to implement preventive and therapeutic measures for neurological conditions and mental health problems in school-aged children. This can help improve the outcomes of these children in terms of their future schooling, occupation, and access to household assets.

Specifically, the following actions can be taken:

1. Increase awareness and education: Raise awareness among parents, caregivers, and communities about the importance of early detection and intervention for neurological conditions and mental health problems in children. Provide education on the signs and symptoms of these conditions and the available resources for diagnosis and treatment.

2. Strengthen healthcare systems: Improve the capacity of healthcare systems in low- and middle-income countries to diagnose and manage neurological conditions and mental health problems in children. This includes training healthcare providers on the identification and treatment of these conditions, as well as ensuring the availability of necessary diagnostic tools and medications.

3. Integrate mental health services: Integrate mental health services into existing maternal health programs and services. This can be done by training maternal health providers to identify and address mental health problems in pregnant women and new mothers, and by establishing referral pathways to mental health specialists when needed.

4. Provide support for children with neurological conditions: Develop support programs and services for children with neurological conditions, including access to specialized education, therapy, and assistive devices. This can help mitigate the long-term consequences of these conditions on their education and socio-economic status.

5. Strengthen data collection and research: Collect and analyze data on the prevalence, risk factors, and long-term impact of neurological conditions and mental health problems in children. This can help inform policy and program development, as well as identify gaps in knowledge and areas for further research.

By implementing these recommendations, access to maternal health can be improved by addressing the mental health and neurological needs of children, ultimately leading to better outcomes for both mothers and children.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthening healthcare infrastructure: Investing in the development and improvement of healthcare facilities, including hospitals, clinics, and maternity centers, can help increase access to maternal health services. This includes ensuring that these facilities are well-equipped, staffed with trained healthcare professionals, and easily accessible to pregnant women.

2. Mobile health (mHealth) interventions: Utilizing mobile technology to provide maternal health information, reminders, and support can help overcome barriers to access. This can include sending SMS messages with important health tips, appointment reminders, and emergency contact information. Mobile apps can also be developed to provide educational resources and tools for pregnant women.

3. Community-based interventions: Implementing community-based programs that focus on maternal health education, awareness, and support can help reach women who may have limited access to healthcare facilities. This can involve training community health workers to provide basic prenatal care, conduct health education sessions, and facilitate referrals to healthcare facilities when necessary.

4. Financial incentives and subsidies: Providing financial incentives, such as cash transfers or subsidies, can help reduce the financial burden of seeking maternal healthcare services. This can encourage pregnant women to seek timely and appropriate care, especially in low-income settings where cost can be a significant barrier.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population group that the recommendations aim to reach, such as pregnant women in a particular region or community.

2. Collect baseline data: Gather data on the current access to maternal health services, including factors such as healthcare facility availability, utilization rates, distance to facilities, and financial barriers. This can be done through surveys, interviews, or existing data sources.

3. Develop a simulation model: Create a mathematical or computational model that simulates the impact of the recommendations on access to maternal health. This model should consider factors such as population size, geographical distribution, healthcare infrastructure, and the effectiveness of the proposed interventions.

4. Input intervention parameters: Define the specific parameters of each recommendation, such as the number of healthcare facilities to be improved, the frequency and content of mobile health interventions, or the amount of financial incentives to be provided. These parameters should be based on evidence-based practices and expert recommendations.

5. Run simulations: Use the simulation model to run multiple scenarios, varying the intervention parameters to assess their impact on access to maternal health. This can include measuring changes in healthcare facility utilization rates, reduction in travel distances, increase in knowledge and awareness, or improvements in financial affordability.

6. Analyze results: Analyze the simulation results to determine the potential impact of the recommendations on improving access to maternal health. This can involve comparing different scenarios, identifying key factors that contribute to improved access, and assessing the cost-effectiveness of the interventions.

7. Refine and validate the model: Continuously refine and validate the simulation model based on real-world data and feedback from stakeholders. This will help ensure the accuracy and reliability of the model’s predictions and recommendations.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of different interventions on improving access to maternal health and make informed decisions on resource allocation and implementation strategies.

Yabelana ngalokhu:
Facebook
Twitter
LinkedIn
WhatsApp
Email