Prevalence and associated factors of neurodevelopmental disability among infants in eastern Uganda: a population based study

Namazzi, Gertrude; Hildenwall, Helena; Mubiri, Paul; Hanson, Claudia; Nalwadda, Christine; Nampijja, Margaret; Kakooza‐Mwesige, Angelina; Waiswa, Peter; Tumwine, James

doi:10.1186/s12887-019-1769-z

Cited by 20 publications

(22 citation statements)

References 30 publications

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“…However, in that study social development of those infants was not reported, probably due to the limitations of the assessment tool that was used. In our study, developmental disability among term infants was mainly in the social behavioral domain which is consistent with the findings of our population-based study, confirming that parent–child interactions for optimal development are a challenge in this setting [ 31 ].…”

Section: Discussionsupporting

confidence: 91%

“…The MDAT tool was validated in Malawi and has sensitivity and specificity of 97% and 82%, respectively, of identifying NDD among children aged 0–6 years in a rural African setting. The research assistants had previously used the MDAT tool for neurodevelopmental assessment in a community-based survey by our team [ 31 ], and an intervention study funded by Saving Brains of Grand Challenges Canada [ 28 ]. In both studies, the same research assistants were trained on how to conduct neurodevelopmental assessment by experts in that field.…”

Section: Data Collectionmentioning

confidence: 99%

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Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

Namazzi

Tumwine

Hildenwall

et al. 2020

Global Health Action

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Background Complications due to prematurity are a threat to child survival and full developmental potential particularly in low-income settings. Objective The aim of the study was to determine the neurodevelopmental outcomes among preterm infants and identify any modifiable factors associated with neurodevelopmental disability (NDD) Methods We recruited 454 babies (242 preterms with birth weight <2.5 kg, and 212 term babies) in a cohort study at birth from Iganga hospital between May and July 2018. We followed up the babies at an average age of 7 months (adjusted for prematurity) and assessed 211 preterm and 187 term infants for neurodevelopmental outcomes using the Malawi Developmental Assessment tool. Mothers were interviewed on care practices for the infants. Data were analyzed using STATA version 14. Results The study revealed a high incidence of NDD of 20.4% (43/211) among preterm infants compared to 7.5% (14/187) among the term babies, p < 0.001, of the same age. The most affected domain was fine motor (11.8%), followed by language (9.0%). At multivariate analysis, malnutrition and Kangaroo Mother Care (KMC) at home after discharge were the key factors that were significantly associated with NDD among preterm babies. The prevalence of malnutrition among preterm infants was 20% and this significantly increased the odds of developing NDD, OR = 2.92 (95% CI: 1.27–6.71). KMC practice at home reduced the odds of developing NDD, OR = 0.46, (95% CI: 0.21–1.00). Re-admission of preterm infants after discharge (a sign of severe illness) increased the odds of developing NDD but this was not statistically significant, OR = 2.33 (95% CI: 0.91–5.94). Conclusion Our study has shown that preterm infants are at a high risk of developing NDD, especially those with malnutrition. Health system readiness should be improved to provide follow-up care with emphasis on improving nutrition and continuity of KMC at home.

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Section: Discussionsupporting

confidence: 91%

Section: Data Collectionmentioning

confidence: 99%

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

Namazzi

Tumwine

Hildenwall

et al. 2020

Global Health Action

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“…The participants for this study were the caretakers of babies with NDD identified from a previous cross-sectional population-based study conducted by the same research group [18]. That study assessed 487 children aged 9-12 months to establish the prevalence and associated factors of NDD at population level in the HDSS.…”

Section: Study Setting Design and Participantsmentioning

confidence: 99%

Caring for children with neurodevelopmental disability: Experiences from caretakers and health workers in rural eastern Uganda

et al. 2020

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Background Long term outcomes of children with neurodevelopmental disability are influenced by the condition itself, available health services and caretakers' coping ability to nurture the children which may be related to their beliefs and experiences. Most children with neurodevelopmental disabilities live in resource constrained settings. To inform design of contextually appropriate interventions, this study explored health workers' and caretakers' experiences in caring for infants with neurodevelopmental disability in rural eastern Uganda. Methods A qualitative case study was carried out in December 2017 and involved in-depth interviews with 14 caretakers of infants with severe neurodevelopmental disability, and five health workers in Iganga/Mayuge Demographic Surveillance Site in eastern Uganda. The interviews with caretakers were conducted in Lusoga, the local language, and in English for the health workers, using a predetermined open-ended interview guide. Data were analyzed using latent content analysis. Results Caretakers described the experience of caring for children with neurodevelopmental disability as impoverishing and 'imprisoning' due to high care costs, inability to return to income generating activities and nursing challenges. The latter resulted from failure in body control and several aspects of nutrition and maintaining vital functions, coupled with limited support from the community and the health system. Many caretakers expressed beliefs in supernatural causes of neurodevelopmental disability though they reported about complications

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“…Although institutional deliveries in Uganda have increased from 42% in 2006 to 73% in 2016, this has not translated into reduction of neonatal mortality estimated to be 28/1000 in 2006 and 27/1000 live births in 2016 [ 29 , 30 ]. Recent studies also indicate that there is a high prevalence of NDD in the country, and most of the associated factors including asphyxia, post-neonatal complications, and malnutrition among preterm infants are preventable [ 13 , 31 ]. There is currently an increased scale up of neonatal care units in the country but the quality of care provided for management of HRBs to prevent mortality and NDD is not clear.…”

Section: Introductionmentioning

confidence: 99%

Health facility readiness to care for high risk newborn babies for early childhood development in eastern Uganda

Namazzi

Hildenwall

Ndeezi

et al. 2022

BMC Health Serv Res

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Background The neonatal mortality rate in Uganda has barely changed over the past decades, estimated at 28/1000 and 27/1000 live births in 2006 and 2016 respectively. The survivors have a higher risk of developing neurodevelopmental disabilities (NDD) due to brain insults from perinatal complications related to poor quality of health services during pregnancy, around the time of birth, and during the postnatal period. This study aimed to assess health facility readiness to care for high risk newborn babies in order to inform programming that fosters early childhood development in eastern Uganda. Methods A cross sectional study of 6 hospitals and 10 higher level health centers that offer comprehensive maternal and newborn care was carried out in February 2020 in eastern Uganda. A World Health Organization Service Availability and Readiness Assessment tool (SARA) was adapted and used to assess the health facility readiness to manage maternal and neonatal conditions that are related to NDD. In addition, 201 mothers of high risk newborn babies were interviewed on their satisfaction with health services received. Readiness scores were derived from percentage average facilities with available infrastructure and essential medical commodities to manage neonatal complications. Descriptive statistics were computed for client satisfaction with service provision, and p values used to compare private not for profit to public health facilities. Results There was limited availability in numbers and skilled human resource especially the neonatal nurses. Hospitals and health centers scored least in preterm and hypothermia care, with averages of 38% and 18% respectively. The highest scores were in essential newborn care, with readiness of 78% and 85% for hospitals and health centers, followed by resuscitation at 78% and 77%, respectively. There were no guidelines on positive interaction with newborn babies to foster neurodevelopment. The main cause of admission to neonatal care units was birth asphyxia followed by prematurity, indicative of intrapartum care challenges. The overall client satisfaction with health services was higher in private not for profit facilities at 91% compared to public hospitals at 73%, p = 0.017. Conclusion Health facility readiness was inadequate in management of preterm complications. Efforts should, therefore, be geared to improving availability of inputs and quality of emergency obstetric and newborn care in order to manage high risk newborns and reduce the burden of NDD in this setting.

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Prevalence and associated factors of neurodevelopmental disability among infants in eastern Uganda: a population based study

Cited by 20 publications

References 30 publications

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

Caring for children with neurodevelopmental disability: Experiences from caretakers and health workers in rural eastern Uganda

Health facility readiness to care for high risk newborn babies for early childhood development in eastern Uganda

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