Printer Friendly

Risk Factors Associated with Severity of Nongenetic Intellectual Disability (Mental Retardation) among Children Aged 2-18 Years Attending Kenyatta National Hospital.

1. Introduction

Intellectual disability (ID), formerly known as "mental retardation," is a condition characterized by significant below average intellectual functioning and impairment in adaptive behaviors, manifested before age 18 years. The degrees of intellectual disability include mild, moderate, and severe and profound intellectual disability [1, 2]. Intellectual disability is a public concern due to the number of people affected by this condition with consideration of the increased demand of specialized medical, psychosocial, and educational services required to improve their quality of life [3]. According to recent reviews and meta-analysis, globally, about 1% of general population is affected by intellectual disability [4, 5]. Child/adolescent population has higher prevalence (18.30/1000) than the adult population (4.94/1000) [5]. Furthermore, it is estimated that about 1% of children between the ages 3 and 10 years are affected by intellectual disability worldwide [6].

Intellectual disability is associated with multicausal risk factors including genetic and nongenetic or acquired causes. But in some cases, the aetiology is unknown [7]. Genetic factors such as chromosomal abnormalities, inherited genetic traits, and single gene disorders are the major causes accounting for 30% to 50% of all intellectual disability cases. Nongenetic causes comprise prenatal, perinatal, postnatal, and environmental factors [8]. Most prevalent reported nongenetic prenatal risk factors include maternal conditions such as asthma, diabetes, hypertension, renal conditions, and epilepsy [8, 9]. Other factors are tobacco or alcohol use, parental advanced age, low maternal education, multiparity, and maternal black race [8]. Main perinatal factors are low birth weight, preterm birth, birth complications, and perinatal infections [8, 10]. Postnatal infections, exposure to toxicants like lead or mercury, developmental disorders, central nervous system malignancies, and chronic severe malnutrition have been reported as postnatal factors [7, 8]. These associated factors of intellectual disability are in interactive complexity with environmental factors and sociodemographic and socioeconomic characteristics of population [9,11]. It is that many of the factors and causes of nongenetic intellectual disability are preventable, if early detection is done and timely interventions are taken [6,12].

Most of the studies regarding risk factors of intellectual disability have been conducted in developed countries, with limited information from developing countries [3]. In Kenya, information on incidence, prevalence, and associated factors of intellectual disability is scarce. Studies are needed to establish more information on the burden of this condition in Kenya. Furthermore, little is known on the magnitude of potential nongenetic risk factors contributing to development of intellectual disability among children affected with this condition in Kenya. Given the paucity of epidemiological information on the causal risk factors associated with intellectual disability in Kenya, the aim of this study was to explore potential risk factors associated with development of severe/profound nongenetic intellectual disability among children presenting with this condition at Kenyatta National Hospital (KNH).

2. Methods

2.1. Study Setting and Design. This study was a hospital-based, descriptive cross-sectional study conducted over period from March, 2017, to June, 2017, in the pediatric and mental health departments of Kenyatta National Hospital (KNH). KNH is the biggest national referral hospitals in Kenya located in Nairobi, capital city of Kenya. This hospital is located in Upper-Hill area along hospital road, off-Ngong' road, Nairobi. Its total bed capacity is 2000. KNH has 50 inpatient wards and different outpatient and specialized clinics, among them are pediatric department and mental health department. The mental health department provides different services, among them are child psychiatric clinic and youth mental health clinic, both working on outpatient basis. Patients with mental health problems requiring inpatient care were being admitted to the general pediatric-medical wards. At KNH, children with intellectual disability with age of up to 12 years are followed up at the child psychiatric clinic and at pediatric neurologic outpatient clinic while the adolescents aged from 13 years are followed up at the youth mental health clinic.

2.2. Study Participants. Children/adolescents between the ages of 2 and 18 years and diagnosed with intellectual disability without underlying known genetic cause were recruited consecutively from pediatric wards, pediatric outpatient clinics, and mental health department of KNH, over a period of 4 months. The age group (2 to 18 years) of children was chosen based on the fact that DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria specify that diagnosis of intellectual disability is made during development period, before age of 18 years [1]. Participants were selected after the confirmation of the diagnosis of intellectual disability by a pediatrician and clinical psychologist. Children who were identified with genetic conditions known to lead to intellectual disability were excluded from the study. Those who were critically ill were also excluded from the study. Using purposive sampling method, a total of 97 patients with nongenetic intellectual disability were consecutively recruited as study participants over the 4-month period of data collection.

2.3. Data Collection and Analysis. Data was collected from consenting parents and through desk reviews of patient files. The details on degree of intellectual disability were obtained from the patient's medical records. Using semistructured questionnaire, data on child and parental sociodemographic characteristics, pregnancy, birth history, postnatal history, medical and nutritional histories, and environmental exposure were collected from the child's parents. This was supplemented by data from desk reviews. Information on the comorbid conditions was also checked from the medical records.

Data was analyzed using Statistical Package for Social Sciences (SPSS) 23.0 version (IBM SPSS Statistics v23). The relationships between the individual factors and severity of intellectual disability were evaluated using crude odds ratio for bivariate and adjusted odds ratio for multivariate logistic regression models. Significance of statistical association was tested using confidence interval (CI) of 95% and P value < 0.05.

2.4. Ethical Consideration. The ethical approval and permission to conduct the study was granted by the Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (KNH/UON-ERC) (Approval number: P961/12/2016). The permission to collect data was provided by the Kenyatta National Hospital (KNH) administration. Written parental permission/informed consent was obtained from the parents of children with intellectual disability attending KNH. Assent was also obtained from adolescent without profound intellectual disability.

3. Results

3.1. Sociodemographic Characteristics of the Children and Parents. Of 97 children/adolescents included in the study, the mean age was 5.6 years (SD [+ or -] 3.6 years), majority were males 61.9%), and most (74.2%) were living with both of their parents. Table 1 provides details on the sociodemographic characteristics of the children.

Table 2 shows the distribution of selected sociodemographic and socioeconomic characteristics among the parents. Majority of children's parents (mothers (82.5%) and fathers (58.7%)) were in middle ages between 21 and 35 years. The highest percentage (47.4%) of mothers were casual workers and only 31% were regularly employed, while about 21.6% were unemployed. More than half of the fathers were having regular employment. Majority of the mothers (57.7%) and fathers (58.7%) had attained secondary school education. 29.3% of fathers were smokers. Majority 53.6% of parents reported earning between 21,000 and 50.000 Kenyan Shillings as their monthly family income.

3.2. Bivariate Analysis of Factors Associated with Severity of Nongenetic Intellectual Disability among Children. There was more proportion of severe/profound intellectual disability among children of single mothers (38.9%) compared to those children raised by both parents (23.4%). However, this was not statistically significant [OR = 2.08; 95% CI = 0.69-6.31; P = 0.196]. The study showed no significant association between the other sociodemographic characteristics of children and severity of intellectual disability (Table 3).

Table 4 shows the relationship between sociodemographic and economic characteristics of parents and severity of nongenetic intellectual disability. Even though mothers aged above 35 years had increased proportion of children with severe/profound nongenetic intellectual disability (46.7%) compared to those aged between 21 and 35 years (21.7%), this was not statistically significant [OR = 3.15; 95% CI = 0.98-10.09; P = 0.053]. Children of unemployed mothers and those of fathers with regular employment were having increased odds of severe/profound intellectual disability compared to others; however, this was not statistically significant [OR = 2; 95% CI = 0.56-7.09; P = 0.283 and OR = 2.60; 95% CI = 0.82-8.20; P = 0.096, resp.]. Similarly, there was no significant association between severity of nongenetic intellectual disability and other parental sociodemographic characteristics.

The relationship between pregnancy-related factors and severity of intellectual disability was analyzed. On the variable "took any drugs during pregnancy," there is a significant increase in the number of children with mild/moderate intellectual disability in mothers who denied having taken drugs during pregnancy. In the case of the severe/profound intellectual disability, the number of cases was the same to the mothers who did not take drugs. There were more children with intellectual disability, born of mothers who had indicated "living in environment where people smoke" than those who reported otherwise, and this was significant [OR = 0.18; 95% CI: 0.06-0.55; P = 0.001] (Table 5).

Table 6 shows the relationship between birth history of the children and severity of intellectual disability. Children born through labor complications had significantly more proportion of severe/profound intellectual disability (39.1%) [OR = 5.46; 95% CI = 1.66-18.02; P = 0.003] compared to those children without labor complications (10.5%). There was significantly higher proportion of severe/profound intellectual disability among children delivered by caesarean section (50.0%) [OR = 4.64; 95% CI = 1.61-13.38; P = 0.005] than those children delivered through spontaneous vaginal delivery (17.7%) and this was statistically significant. Apgar score at birth was also significantly associated with severity of intellectual disability among children. Children with Apgar score lower than 7 out of ten significantly suffered severe/profound intellectual disability (38.6%) [OR = 4.41; 95% CI = 1.44-13.46; P = 0.007] more than children who scored above 7 out of ten (12.5%). Similarly children who were resuscitated at birth had significantly higher proportion of severe/profound intellectual disability (40.0%) [OR = 4.22; 95% CI = 1.45-12.29; P = 0.006] than those who were not (13.6%).

There was significantly increased proportion of severe/profound intellectual disability among children who had any neonatal difficulties (36.5%) [OR = 5.57; 95% CI = 1.49-20.75; P = 0.006] than those children without (9.4%). Children who were admitted to NICU during neonatal period had significantly more proportion of severe/profound intellectual disability (41.9%) [OR = 6.66; 95% CI = 2.01-22.03; P = 0.001] compared to those children that have never been admitted in NICU during neonatal period (9.8%). Similarly, those children with neonatal breathing difficulties (37.8%) had higher proposition of severe/profound intellectual disability than others without neonatal breathing difficulties (17.0%) and this was significant [OR = 2.97; 95% CI = 1.08-8.15; P = 0.031]. There was also significant association between neonatal feeding difficulties and severe/profound intellectual disability where children with neonatal feeding difficulties had significantly more severe/profound intellectual disability (50.0%) [OR = 3.86; 95% CI = 1.23-12.09; P = 0.016] compared to those children without (20.6%). No statistical significant relationship was found in the factors such as neonatal seizures, neonatal infection, and neonatal jaundice (Table 7). There was no statistically significant association observed between infant and childhood medical and severity of intellectual disability among the children (Table 8).

Table 9 shows the bivariate analysis of relationship between preexisting/comorbid and severity of intellectual disability. Children with cerebral palsy were significantly more likely to suffer severe/profound intellectual disability [OR = 18.18; 95% CI = 3.88-85.14; P < 0.001] compared to those children without. There was no statistically significant association observed in other variables.

3.3. Multivariate Analysis of Factors Associated with Severity of Nongenetic Intellectual Disability among Children. Binary logistic regression analysis was applied to identify the variables independently associated with severity of intellectual disability among children aged 2 to 18 years. Eleven (11) factors were considered in the analysis including labor complications, mode of delivery, APGAR score at birth, whether the baby was resuscitated at birth, any neonatal difficulties, whether the baby was admitted in NICU, neonatal breathing difficulty, neonatal feeding difficulties, cerebral palsy, using drugs during pregnancy, and living in environment where people smoke. Upon fitting these factors using binary logistic regression and by specifying "backward LR" method with removal at P < 0.05, three (3) factors remained in the final analysis (Table 10). Severe/profound intellectual disability was about 10 times more among children with labor complications during birth [AOR = 9.45; 95% CI = 1.23-113.29; P = 0.036] compared to those children without labor complications. Children who were admitted to nursery during neonatal period had 8 times more likely to have severe/profound intellectual disability [AOR = 8.09; 95% CI = 2.11-31.07; P = 0.002] compared to those children that have been never admitted in nursery during neonate. Children with cerebral palsy were 21-fold more likely to have severe/profound intellectual disability [AOR = 21.18; 95% CI = 4.18-107.40; P < 0.001] compared to those children without cerebral palsy.

4. Discussion

The study findings indicate that mean age of study population was 5.6 years with a standard deviation of 3.6 years. Male children were more affected than females; this finding is in agreement with the results from other studies which reported male predominance [4, 5, 13]. Current findings show that high proportion (40%) of children were suffering moderate intellectual disability. This result agrees with a similar study conducted in India [14] where 40% of children had moderate intellectual disability. This high proportion of moderate intellectual disability could be attributed to referrals as KNH serves as a referral hospital. Children with moderate intellectual disability tend to have remarkable limitations in meeting expected standards of personal independence and social responsibility in different aspects of daily life, especially when they start school. Therefore, when child starts to show slow academic achievements, he/she is referred for psychological evaluation. Logistic regressions analysis did not reveal any significant association of child sociodemographic variables (including age, gender, family set-up, and number of children in family) and severity of intellectual disability. This result is similar to the findings of a study done in India [14] which examined correlation of sociodemographic variables of patients with intellectual disability and types of intellectual disability.

In the present study, mothers aged 35 years and above were having increased proportion of children with severe-profound intellectual disability compared to those aged 21-35 years. However, there was no statistically significant relationship between parental age and severity of intellectual disability. An early study done by Drews et al. [15] and a recent systemic review and meta-analysis done by Huang et al. [8] reported a positive association between advanced parental age and intellectual disability though these studies were combining both genetic and nongenetic cases. The present study included only children with intellectual disability that is considered nongenetic, with exclusion of those who were having genetic disorders known to lead to intellectual disability. This fact may explain the predominance of parents with middle ages in this study. No relationship was revealed between parental level of education and severity of intellectual disability. However, a review and meta-analysis by Huang et al. reported positive association of lack of maternal education with intellectual disability [8]. Moreover, one of the findings from a study carried out in Utah, America, indicated a significant association between intellectual disability (with exclusion of genetic cases) and maternal education though that was not significant on paternal education [10].

Even though socioeconomic status of the parents did not show any statistically significant relationship with the severity of intellectual disability, great proportion of children with severe-profound intellectual disability were found among mothers who were unemployed compared to those with employment. Comparable findings were reported in Indian study in which no significant association of intellectual disability severity and socioeconomic status was found [14]. A cohort study done in Brazil reported also lack of association between socioeconomic status and groups with intellectual disability [16]. On the contrary, a study done in Australia found positive relationship of socioeconomic disadvantage and increased risk of intellectual disability [17]. Probably, this difference may be due to the fact that the latter studies used different methods and large population compared to the present study.

Tobacco smoking and use of alcohol during pregnancy was found to be a major risk factor for developing intellectual disability in the offspring [4, 8]. In this study, no association was found between alcohol use or tobacco smoking during pregnancy and severity of intellectual disability. O'Leary et al., in their population based study to examine the association of maternal alcohol use disorder and intellectual disability, found that children of mothers with an alcohol-related diagnosis recorded during pregnancy had three times increased risk of intellectual disability than others [18]. Unexpectedly, inverse association with severity of intellectual disability was found in mothers who reported living in the environment where people smoke.

In this study, no significant association was found between severity of intellectual disability and place of delivery or gestational age. Bivariate analysis demonstrated significant association of delivery through caesarean section and intellectual disability severity, though this lost its significance in multivariate analysis. This quietly corroborate results reported by Langridge et al. in which there was an increased risk of intellectual disability (ID) in children born via caesarean section compared to those delivered through a spontaneous vaginal birth [19] and the study by Bilder et al. which found significant association of primary/repeat caesarean sections and intellectual disability [10]. The present study did not establish what are the indications of caesarean sections. It is however difficult to conclude from this study whether merely caesarean section as mode of delivery is a risk factor for intellectual disability. It is therefore necessary to further examine the relationship between the various indications of caesarean section with the incidence of intellectual disability.

The children born through complicated labor had increased likelihood of severe/profound intellectual disability; they had about 10 times risk of severe/profound intellectual disability compared to others without history of labor complications. This compares with the findings from other studies that report positive and significant association of labor and delivery complications and degrees of intellectual disability [5, 19]. Labor and delivery complications lead to complications such fetal distress and birth asphyxia and intracranial hemorrhage leading to poor neonatal outcomes which later affect child brain development due to damage resulting from hypoxia related to these complications.

Low Apgar score is risk factor for intellectual disability [10]. In this study, bivariate analyses, children with histories of lower Apgar score, neonatal complications, and resuscitation at birth had increased risks of having severe-profound intellectual disability compared to their counterparts without these histories, though this association lost its significance after multivariate regressions analysis. The histories of perinatal difficulties and neonatal resuscitation required at birth were distinctly shown to be associated with increased in intellectual disability [19]. Low Apgar scores indicate poor birth outcomes with need of neonatal resuscitation, thus increasing probability of neonatal sequelae which expose the child to develop intellectual disability during development period. This is supported by evidence from cohort study conducted in Brazil where 13.2% of intellectual disability cases were attributed to neonatal sequelae [16].

Karam et al. noted that some of the neonatal complications and problems may cause neonatal sequelae resulting in intellectual disability [16]. In this study, children with history of neonatal breathing difficulty and those with neonatal feeding difficulties, respectively, had three and four odds of having severe-profound intellectual disability compared to their counterparts. However, these associations were not significant in multivariate logistic regressions. Children who were admitted to neonatal intensive care unit (NICU) were having 8 times risk of having severe-profound intellectual disability compared to their counterparts not admitted in NICU. This could be attributed to the fact that labor complications lead to birth difficulties and neonatal complications which increase the probability of being admitted in neonatal intensive care unit. Being born with birth complications suggests increased risk of debilitating conditions which predict likelihood to be affected with intellectual disability. Maulik et al. indicated neonatal infections among the common postnatal causes [5]. The present study did not find any significant association between severity of intellectual disability and medical histories of neonatal seizures, neonatal infection, and neonatal jaundice.

Children were reviewed for presence of any coexisting medical and mental-psychiatric comorbid conditions. Children with cerebral palsy were twenty-one-fold more likely to have severe-profound intellectual disability compared to others without it. This result is supported by early findings which also observed an increased risk of intellectual disability in children with cerebral palsy [20]. There was no statistical significant relationship found between severity of intellectual disability and other comorbid conditions.

5. Conclusions

Severity of intellectual disability is positively and significantly associated with environmental factors. Perinatal and postnatal insults including labor complications and being admitted to neonatal intensive care unit during neonatal period were significantly associated with increased risk of severe/profound intellectual disability. Children with cerebral palsy were at a more risk of having severe/profound intellectual disability than those without it.

6. Study Limitations

Being a hospital-based, descriptive cross-sectional study, this study included only study participants attending KNH; therefore findings may not reflect actual factors from general population in the country, and so results might not be generalizable. Because of the nature of study design, being a cross-sectional study, it limits its utility for causal inference.

https://doi.org/10.1155/2018/6956703

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this article.

Acknowledgments

The authors acknowledge valuable contributions provided by Mr. Michael Habtu in statistical analysis. Special thanks are due to the Kenyatta National Hospital administration for providing permission to conduct this study and staff from mental and pediatric departments and Dr. Josephine Omondi for their cooperation and assistance in collecting data.

References

[1] American Psychiatric Association (APA), Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), American Psychiatric Publishing, Washington, DC, USA, 5th edition, 2013.

[2] World Health Organization (WHO), ICD-10 Guide for Mental Retardation, Division of Mental Health and Prevention of Substance Abuse, World Health Organization, Geneva, Switzerland, 1996.

[3] P. K. Maulik and C. K. Harbour, "Epidemiology of intellectual disability," International Encyclopedia of Rehabilitation, 2010, http://cirrie.buffalo.edu/encyclopedia/en/article/144.

[4] D. N. Goli, F. S. Moniri, and R. Z. Wilhelm, "Intellectual disability in children; a systematic review," International Archives of Health Sciences, vol. 3, no. 2, pp. 27-36, 2016.

[5] P. K. Maulik, M. N. Mascarenhas, C. D. Mathers, T. Dua, and S. Saxena, "Prevalence of intellectual disability: a meta-analysis of population-based studies," Research in Developmental Disabilities, vol. 32, no. 2, pp. 419-436, 2011.

[6] H. D. Pratt and D. E. Greydanus, "Intellectual disability (mental retardation) in children and adolescents," Primary Care--Clinics in Office Practice, vol. 34, no. 2, pp. 375-386, 2007.

[7] V. Armatas, "Mental retardation: definitions, etiology, epidemiology and diagnosis," Journal of Sport and Health Research, vol. 1, no. 2, pp. 112-122, 2009.

[8] J. Huang, T. Zhu, Y. Qu, and D. Mu, "Prenatal, perinatal and neonatal risk factors for intellectual disability: A systemic review and meta- Analysis," PLoS ONE, vol. 11, no. 4, Article ID e0153655, 2016.

[9] H. Leonard, N. D. Klerk, J. Bourke, and C. Bower, "Maternal health in pregnancy and intellectual disability in the offspring: a population-based study," Annals of Epidemiology, vol. 16, no. 6, pp. 448-454, 2006.

[10] D. A. Bilder, J. Pinborough-Zimmerman, A. V. Bakian et al., "Prenatal and perinatal factors associated with intellectual disability.," American Journal on Intellectual and Developmental Disabilities, vol. 118, no. 2, pp. 156-176, 2013.

[11] S. Sharma, S. K. Raina, A. K. Bhardwaj, S. Chaudhary, V. Kashyap, and V. Chander, "Socio demography of mental retardation: A community-based study from a goitre zone in rural sub-Himalayan India," Journal of Neurosciences in Rural Practice, vol. 6, no. 2, pp. 165-169, 2015.

[12] D. A. Chapman, K. G. Scott, and C. A. Mason, "Early risk factors for mental retardation: role of maternal age and maternal education," American Journal on Intellectual and Developmental Disabilities, vol. 107, no. 1, pp. 46-59, 2002.

[13] S. Sharma, S. K. Raina, A. K. Bhardwaj, S. Chaudhary, V. Kashyap, and V. Chander, "Prevalence of mental retardation in urban and rural populations of the goiter zone in Northwest India," Indian Journal of Public Health, vol. 60, no. 2, pp. 131-137, 2016.

[14] S. Naskar and K. Nath, "A clinical study on intellectual disability in northeastern India: insight into the sociodemographic risk factors of a developing country," International Journal of Medical Science and Public Health, vol. 5, no. 9, pp. 1789-1797, 2016.

[15] C. D. Drews, M. Yeargin-Allsopp, P. Decoufle, and C. C. Murphy, "Variation in the influence of selected sociodemographic risk factors for mental retardation," American Journal of Public Health, vol. 85, no. 3, pp. 329-334, 1995.

[16] S. M. Karam, A. J. D. Barros, A. Matijasevich et al., "Intellectual disability in a birth cohort: prevalence, etiology, and determinants at the age of 4 years," Public Health Genomics, vol. 19, pp. 290-297, 2016.

[17] H. Leonard, B. Petterson, N. De Klerk et al., "Association of sociodemographic characteristics of children with intellectual disability in Western Australia," Social Science & Medicine, vol. 60, no. 7, pp. 1499-1513, 2005.

[18] C. O'Leary, H. Leonard, J. Bourke, H. D'Antoine, A. Bartu, and C. Bower, "Intellectual disability: population-based estimates of the proportion attributable to maternal alcohol use disorder during pregnancy," Developmental Medicine & Child Neurology, vol. 55, no. 3, pp. 271-277, 2013.

[19] A. T. Langridge, E. J. Glasson, N. Nassar et al., "Maternal conditions and perinatal characteristics associated with autism spectrum disorder and intellectual disability," PLoS ONE, vol. 8, no. 1, Article ID e50963, 2013.

[20] B. W. Camp, S. H. Broman, P. L. Nichols, and M. Leff, "Maternal and neonatal risk factors for mental retardation: defining the 'atrisk' child," Early Human Development, vol. 50, no. 2, pp. 159173, 1998.

Mathieu Nemerimana, (1,2) Margaret Njambi Chege, (1) Eunice Ajode Odhiambo (1)

(1) School of Nursing Sciences, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya

(2) Department of Nursing and Midwifery, Kibogora Polytechnic, P.O. Box 31, Rusizi, Rwanda

Correspondence should be addressed to Mathieu Nemerimana; matnemer@gmail.com

Received 23 October 2017; Revised 24 February 2018; Accepted 12 March 2018; Published 18 April 2018

Academic Editor: Mamede de Carvalho
Table 1: Distribution sociodemographic characteristics among the
children.

Variable                                       N = 97   %

Age in years
2 to 3                                         31       32
4 to 5                                         31       32
6 and above                                    35       36
Mean ([+ or -] SD) = 5.6 ([+ or -] 3.6)
Gender
Male                                           60       62
Female                                         37       38
Family setup
Both parents                                   72       74
Single mother                                  23       24
Orphan/adopted                                 1        1
Abandoned                                      1        1
Number of children in the family
1 child                                        55       57
2 children                                     25       26
3 children                                     14       14
4 children                                     3        3
Siblings' history of intellectual disability
Yes                                            5        5
No                                             92       95
Degree of intellectual disability (ID)
Mild ID                                        23       24
Moderate ID                                    39       40
Severe/profound ID                             22       23
Unspecified ID                                 13       13

Table 2: Selected sociodemographic and economic characteristics
of mothers.

Variable                                        N = 97   %

Age of the mother

21-35 years                                     80       82.5
[greater than or equal to] 36 years             17       17.5
Age of the mother at the time of child's
  birth

Below 20 years                                  6        6.2
21-35 years                                     84       86.6
[greater than or equal to] 36 years             7        7.2

Age of the father

21-35 years                                     54       58.7
[greater than or equal to] 36 years             38       41.3
Missing                                         5

Age of the father at the time of birth of the
child

21-35 years                                     68       73.9
[greater than or equal to] 36 years             24       26.1
Missing                                         5

Highest level of education of the mother

Primary level                                   31       32
Secondary level                                 56       57.7
College/university Level                        10       10.3

Highest level of education of the father

No formal education                             2        2.2
Primary level                                   8        8.7
Secondary level                                 54       58.7
College/university Level                        28       30.4
Missing                                         5

Occupation of the mother

Regular employment                              30       30.9
Casual employment                               46       47.4
Unemployed                                      21       21.6

Occupation of the father

Regular employment                              48       52.2
Casual employment                               42       45.7
Unemployed                                      2        2.2
Missing                                         5

Whether the father smokes

Yes                                             27       29.3
No                                              65       70.7
Missing                                         5

Average monthly income in the family in
Kenyan Shillings

More than 50,000                                4        4.1
21,000 to 50,000                                52       53.6
11,000 to 20,000                                38       39.2
Less than 10,000                                3        3.1

Table 3: Relationship between sociodemographic characteristics of
children and severity of intellectual disability.

Variables                          Severe/      Mild/        OR
                                   profound     moderate

                                   N    %       N    %

Age in years

2 to 3                             8    42.1%   11   57.9%   2.10
4 to 5                             5    16.7%   25   83.3%   0.58
6 and above                        9    25.7%   26   74.3%   1.00

Gender

Male                               12   23.5%   39   76.5%   0.71
Female                             10   30.3%   23   69.7%   1.00

Family setup

Both parents                       15   23.4%   49   76.6%   1.00
Single mother                      7    38.9%   11   61.1%   2.08

Number of children in the family

1 child                            9    19.1%   38   80.9%   1.00
2 children                         6    28.6%   15   71.4%   1.69
3-4 children                       7    43.8%   9    56.3%   3.28

Siblings' history of
intellectual disability

Yes                                1    25.0%   3    75.0%   0.94
No                                 21   26.3%   59   73.8%   1.00

Variables                          95% CI
                                                   [chi square]
                                   Lower   Upper   test P value

Age in years

2 to 3                             0.64    6.87    0.219
4 to 5                             0.17    1.96    0.379
6 and above

Gender

Male                               0.26    1.90    0.490
Female

Family setup

Both parents
Single mother                      0.69    6.31    0.196

Number of children in the family

1 child
2 children                         0.51    5.57    0.389
3-4 children                       0.96    11.19   0.057

Siblings' history of
intellectual disability

Yes                                0.09    9.50    0.956
No

OR = odds ratio; CI = confidence interval; [chi square] = Chi-square.

Table 4: Association between sociodemographic and economic
characteristics of mothers and severity of intellectual disability.

Variables                    Severe/      Mild/        OR
                             profound     moderate

                             N    %       n    %

Age of the mother

21-35 years                  15   21.7%   54   78.3%   1.00
[greater than or equal       7    46.7%   8    53.3%   3.15
  to] 36 years

Age of the mother at the
time of birth of the child

Below 20 years               2    33.3%   4    66.7%   1.25
21-35 years                  18   25.4%   53   74.6%   0.85
> 36 years                   2    28.6%   5    71.4%

Age of the father

21-35 years                  8    17.4%   38   82.6%   0.44
> 36 years                   11   32.4%   23   67.6%   1.00

Age of the father at the
time of birth of the child

21-35 years                  12   20.7%   46   79.3%   0.56
> 36 years                   7    31.8%   15   68.2%   1.00

Highest level of education
of the mother

Primary level                8    30.8%   18   69.2%   0.74
Secondary level              11   22.0%   39   78.0%   0.47
College/university Level     3    37.5%   5    62.5%   1.00

Highest level of education
of the father

Primary level                2    28.6%   5    71.4%   0.90
Secondary level              9    20.0%   36   80.0%   0.56
College/university Level     8    30.8%   18   69.2%   1.00

Occupation of the mother

Regular employment           8    30.8%   18   69.2%   1.00
Casual employment            6    14.6%   35   85.4%   0.39
Unemployed                   8    47.1%   9    52.9%   2.00

Occupation of the father

Regular employment           13   30.2%   30   69.8%   2.60
Casual employment            5    14.3%   30   85.7%   1.00
Unemployed

Whether the father smokes

Yes                          3    12.0%   22   88.0%   0.33
No                           16   29.1%   39   70.9%   1.00

Average monthly income in
  the family (in KES)

<21,000                      8    23.5%   26   76.5%   0.79
21,000 and more              14   28.0%   36   72.0%   1.00

Variables                    95% CI          [chi
                                             square]
                                             test
                             Lower   Upper   P value

Age of the mother

21-35 years
[greater than or equal       0.98    10.09   0.053
  to] 36 years

Age of the mother at the
time of birth of the child

Below 20 years               0.12    13.24   0.853
21-35 years                  0.15    4.76    0.852
>36 years

Age of the father

21-35 years                  0.15    1.26    0.120
> 36 years

Age of the father at the
time of birth of the child

21-35 years                  0.19    1.68    0.296
> 36 years

Highest level of education
of the mother

Primary level                0.14    3.88    0.722
Secondary level              0.10    2.28    0.349
College/university Level

Highest level of education
of the father

Primary level                0.14    5.66    0.911
Secondary level              0.19    1.70    0.309
College/university Level

Occupation of the mother
Regular employment

Casual employment            0.12    1.28    0.120
Unemployed                   0.56    7.09    0.283

Occupation of the father

Regular employment           0.82    8.20    0.096
Casual employment
Unemployed

Whether the father smokes

Yes                          0.09    1.27    0.096
No

Average monthly income in
the family (in KES)

<21,000                      0.29    2.16    0.647
21,000 and more

OR = odds ratio; CI = confidence interval; [chi square] = chi-square.

Table 5: Relationship between pregnancy-related factors and severity
of intellectual disability.

Variables                    Severe/      Mild/         OR
                             profound     moderate

                             n    %       N    %

Attending ANC during
pregnancy of the child

Yes                          22   27.2%   59   72.8%    1.00
No                           0    0.0%    3    100.0%   UD

Frequency of attending ANC

1-2 times                    3    16.7%   15   83.3%    0.46
3-4 times                    19   30.2%   44   69.8%    1.00

Took any drugs during
pregnancy

Yes                          11   47.8%   12   52.2%    4.17
No                           11   18.0%   50   82.0%    1.00

Smoking during pregnancy

Yes                          1    10.0%   9    90.0%    0.28
No                           21   28.4%   53   71.6%    1.00

Living in environment
where people smoke

Yes                          12   18.2%   54   81.8%    0.18
No                           10   55.6%   8    44.4%    1.00

Using alcohol during this
pregnancy

Yes                          5    35.7%   9    64.3%    1.73
No                           17   24.3%   53   75.7%    1.00

Variables                      95% CI
                                             [chi square]
                             Lower   Upper   test P value

Attending ANC during
pregnancy of the child

Yes
No                           UD      UD      0.293

Frequency of attending ANC

1-2 times                    0.12    1.79    0.256
3-4 times

Took any drugs during
pregnancy

Yes                          1.46    11.87   0.006
No

Smoking during pregnancy

Yes                          0.03    2.35    0.215
No

Living in environment
where people smoke

Yes                          0.06    0.55    0.001
No

Using alcohol during this
pregnancy

Yes                          0.51    5.88    0.375
No

OR = odds ratio; CI = confidence interval; [chi square] = chi-square;
UD = undefined.

Table 6: Association between birth history of the children and
severity of intellectual disability.

Variables                             Severe/      Mild/         OR
                                      profound     moderate

                                      N    %       N    %

Place of deliver for the baby

Health facility                       22   28.6%   55   71.4%    1.00
Home                                  0    0.0%    7    100.0%   UD

Gestational age when the child born

From 33-37 weeks                      7    31.8%   15   68.2%    1.43
Over 37 weeks                         15   24.6%   46   75.4%    1.00

Labor complications

Yes                                   18   39.1%   28   60.9%    5.46
No                                    4    10.5%   34   89.5%    1.00

Mode of delivery

Spontaneous vaginal delivery          11   17.7%   51   82.3%    1.00
Cesarean section                      11   50.0%   11   50.0%    4.64

Birth weight

<2.5 kg                               5    27.8%   13   72.2%    1.11
2.5 Kg and above                      17   25.8%   49   74.2%    1.00

Apgar score at birth

<7/10 (did not cry)                   17   38.6%   27   61.4%    4.41
>7/10 (cried immediately)             5    12.5%   35   87.5%    1.00

Whether the baby was resuscitated
at birth

Yes                                   16   40.0%   24   60.0%    4.22
No                                    6    13.6%   38   86.4%    1.00

Variables                               95% CI
                                                      [chi square]
                                      Lower   Upper   test P value

Place of deliver for the baby

Health facility
Home                                  UD      UD      0.100

Gestational age when the child born

From 33-37 weeks                      0.49    4.17    0.510
Over 37 weeks

Labor complications

Yes                                   1.66    18.02   0.003
No

Mode of delivery

Spontaneous vaginal delivery
Cesarean section                      1.61    13.38   0.005

Birth weight

<2.5 kg                               0.34    3.57    0.863
2.5 Kg and above

Apgar score at birth

<7/10 (did not cry)                   1.44    13.46   0.007
>7/10 (cried immediately)

Whether the baby was resuscitated
at birth

Yes                                   1.45    12.29   0.006
No

OR = odds ratio; CI = confidence interval; [chi square] = chi-square;
UD = undefined.

Table 7: Association between neonatal medical history of the children
and severity of intellectual disability.

Variables                       Severe/      Mild/        OR
                                profound     moderate

                                N    %       N    %

Any neonatal difficulties

Yes                             19   36.5%   33   63.5%   5.57
No                              3    9.4%    29   90.6%   1.00

Whether the baby was admitted

in NICU
Yes                             18   41.9%   25   58.1%   6.66
No                              4    9.8%    37   90.2%   1.00

Neonatal breathing difficulty

Yes                             14   37.8%   23   62.2%   2.97
No                              8    17.0%   39   83.0%   1.00

Neonatal seizures

Yes                             6    30.0%   14   70.0%   1.29
No                              16   25.0%   48   75.0%   1.00

Neonatal infection

Yes                             4    20.0%   16   80.0%   0.64
No                              18   28.1%   46   71.9%   1.00

Neonatal jaundice

Yes                             3    27.3%   8    72.7%   1.07
No                              19   26.0%   54   74.0%   1.00

Neonatal feeding difficulties

Yes                             8    50.0%   8    50.0%   3.86
No                              14   20.6%   54   79.4%   1.00

Variables                          95% CI
                                                [chi square]
                                Lower   Upper   test P value

Any neonatal difficulties

Yes                             1.49    20.75   0.006
No

Whether the baby was admitted
in NICU

Yes                             2.01    22.03   0.001
No

Neonatal breathing difficulty

Yes                             1.08    8.15    0.031
No

Neonatal seizures

Yes                             0.42    3.91    0.657
No

Neonatal infection

Yes                             0.19    2.17    0.471
No

Neonatal jaundice

Yes                             0.26    4.44    0.930
No

Neonatal feeding difficulties

Yes                             1.23    12.09   0.016
No

OR = odds ratio; CI = confidence interval; [chi square] = chi-square;
UD = undefined.

Table 8: Association of infant and childhood medical history with
severity of intellectual disability.

Variables                        Severe/      Mild/         OR
                                 profound     moderate

                                 N    %       n    %

Immunization history

Fully immunized                  20   25.0%   60   75.0%    1.00
Not fully immunized              2    50.0%   2    50.0%    3.00

Suffer from any disease

Yes                              10   22.7%   34   77.3%    0.69
No                               12   30.0%   28   70.0%

History of meningitis

Yes                              6    20.0%   24   80.0%    0.59
No                               16   29.6%   38   70.4%

History of encephalitis

Yes                              0    0.0%    6    100.0%   UD
No                               22   28.2%   56   71.8%    1.00

History of cerebral malaria

Yes                              2    66.7%   1    33.3%    6.10
No                               20   24.7%   61   75.3%    1.00

History of head injury

Yes                              2    18.2%   9    81.8%    0.59
No                               20   27.4%   53   72.6%    1.00

History of severe malnutrition

Yes                              3    23.1%   10   76.9%    0.82
No                               19   26.8%   52   73.2%    1.00

Breastfeeding history

Breastfeed < 1 month             1    33.3%   2    66.7%    1.14
Breastfeed 1-24 months           13   22.8%   44   77.2%    0.68
Breastfeed > 24 months           7    30.4%   16   69.6%    1.00

Variables                        95% CI
                                                 [chi square]
                                 Lower   Upper   test P value

Immunization history

Fully immunized
Not fully immunized              0.40    22.71   0.287

Suffer from any disease

Yes                              0.26    1.82    0.449
No

History of meningitis

Yes                              0.20    1.73    0.336
No

History of encephalitis

Yes                              UD      UD      0.130
No

History of cerebral malaria

Yes                              0.53    70.90   0.104
No

History of head injury
Yes                              0.12    2.96    0.571
No

History of severe malnutrition
Yes                              0.20    3.31    0.781
No

Breastfeeding history

Breastfeed < 1 month             0.09    14.78   0.919
Breastfeed 1-24 months           0.23    1.99    0.477
Breastfeed > 24 months

OR = odds ratio; CI = confidence interval; [chi square] = chi-square.

Table 9: Relationship between pre-existing/co-morbid and severity of
intellectual disability.

Variables                        Severe/      Mild/        OR
                                 profound     moderate

                                 N    %       n    %

Cerebral palsy

Yes                              20   47.6%   22   52.4%   18.18
No                               2    4.8%    40   95.2%   1.00

Convulsive disorders

Yes                              19   27.5%   50   72.5%   1.52
No                               3    20.0%   12   80.0%   1.00

Cardiovascular disease

Yes                              1    50.0%   1    50.0%   2.91
No                               21   25.6%   61   74.4%   1.00

Asthma

Yes                              1    50.0%   1    50.0%   2.91
No                               21   25.6%   61   74.4%   1.00

Pneumonia

Yes                              6    26.1%   17   73.9%   0.99
No                               16   26.2%   45   73.8%   1.00

Malnutrition

Yes                              3    33.3%   6    66.7%   1.47
No                               19   25.3%   56   74.7%

Rickets

Yes                              1    25.0%   3    75.0%   0.94
No                               21   26.3%   59   73.8%   1.00

Autism Spectrum Disorder (ASD)

Yes                              1    10.0%   9    90.0%   0.28
No                               21   28.4%   53   71.6%   1.00

Attention Deficit/
Hyperactivity Disorder (ADHD)

Yes                              2    22.2%   7    77.8%   0.79
No                               20   26.7%   55   73.3%

Variables                        95% CI
                                                 [chi square]
                                 Lower   Upper   test P value

Cerebral palsy

Yes                              3.88    85.14   <0.001
No

Convulsive disorders

Yes                              0.39    5.99    0.547
No

Cardiovascular disease

Yes                              0.17    48.53   0.438
No

Asthma

Yes                              0.17    48.53   0.438
No

Pneumonia

Yes                              0.33    2.96    0.989
No

Malnutrition

Yes                              0.34    6.48    0.606
No

Rickets

Yes                              0.09    9.50    0.956
No

Autism Spectrum Disorder (ASD)

Yes                              0.03    2.35    0.215
No

Attention Deficit/
Hyperactivity Disorder (ADHD)

Yes                              0.15    4.10    0.774
No

OR = odds ratio; CI = confidence interval; [chi square] = chi-square.

Table 10: Factors associated with severity of intellectual disability
among children.

Variable                       COR     95% CI          P
                                       Lower   Upper   value

Labor complications

Yes                            5.46    1.66    18.02   0.003
No                             1.00

Mode of delivery

Spontaneous vaginal delivery   1.00
Cesarean section               4.64    1.61    13.38   0.005

APGAR score at birth

<7/10                          4.41    1.44    13.46   0.007
>7/10                          1.00

Whether the baby was
resuscitated at birth

Yes                            4.22    1.45    12.29   0.006
No                             1.00

Any neonatal difficulties/
complications at birth

Yes                            5.57    1.49    20.75   0.006
No                             1.00

Whether the baby was
admitted in NICU

Yes                            6.66    2.01    22.03   0.001
No                             1.00

Neonatal breathing
difficulty

Yes                            2.97    1.08    8.15    0.031
No                             1.00

Neonatal feeding
difficulties

Yes                            3.86    1.23    12.09   0.016
No                             1.00

Cerebral palsy

Yes                            18.18   3.88    85.14   0.001
No                             1.00

Took any drugs during
pregnancy

Yes                            4.17    1.46    11.87   0.006
No                             1.00

Living in environment where
people smoke

Yes                            0.18    0.06    0.55    0.001
No                             1.00

Variable                       AOR     95% CI           P
                                       Lower   Upper    value

Labor complications

Yes                            9.45    1.23    113.29   0.036
No                             1.00

Mode of delivery

Spontaneous vaginal delivery   1.00
Cesarean section               3.48    0.59    20.56    0.169

APGAR score at birth

<7/10                          9.15    0.47    179.54   0.145
>7/10                          1.00

Whether the baby was
resuscitated at birth

Yes                            0.08    0.00    3.37     0.186
No                             1.00

Any neonatal difficulties/
complications at birth

Yes                            2.13    0.10    46.61    0.631
No                             1.00

Whether the baby was
admitted in NICU

Yes                            8.09    2.11    31.07    0.002
No                             1.00

Neonatal breathing
difficulty

Yes                            0.26    0.02    2.92     0.272
No                             1.00

Neonatal feeding
difficulties

Yes                            0.52    0.09    3.23     0.486
No                             1.00

Cerebral palsy

Yes                            21.18   4.18    107.40   <0.001
No                             1.00

Took any drugs during
pregnancy

Yes                            3.92    0.70    21.97    0.120
No                             1.00

Living in environment where
people smoke

Yes                            0.09    0.11    1.31     0.092
No                             1.00

COR = crude odds ratio; CI = confidence interval; AOR = adjusted odds
ratio.
COPYRIGHT 2018 Hindawi Limited
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2018 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Research Article
Author:Nemerimana, Mathieu; Chege, Margaret Njambi; Odhiambo, Eunice Ajode
Publication:Neurology Research International
Date:Jan 1, 2018
Words:7479
Previous Article:Maximizing the Survival of Amyotrophic Lateral Sclerosis Patients: Current Perspectives.
Next Article:Serotonin Reuptake Inhibitors in Obstructive Sleep Apnea: Associations in People with and without Epilepsy.
Topics:

Terms of use | Privacy policy | Copyright © 2020 Farlex, Inc. | Feedback | For webmasters