Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions

Software Review - Compu-Consults

Compu- Consults are a series of medical software programs developed by Mayer Zev Enterprises (MZE) Ltd. with the aim of providing assistance to clinicians in private practice regarding diagnosis and management of patients with new, emerging and challenging medical problems. The various disorders listed include Infectious Diseases, Cardiovascular diseases, Neurological, Rheumatological, Psychiatric, Respiratory, Gastrointestinal and Endocrinological diseases. Conditions such as Hepatitis B, HIV and AIDS and Hepatitis C are discussed separately considering their importance

Software Review - Compu-Consults

Compu- Consults are a series of medical software programs developed by Mayer Zev Enterprises (MZE) Ltd. with the aim of providing assistance to clinicians in private practice regarding diagnosis and management of patients with new, emerging and challenging medical problems. The various disorders listed include Infectious Diseases, Cardiovascular diseases, Neurological, Rheumatological, Psychiatric, Respiratory, Gastrointestinal and Endocrinological diseases. Conditions such as Hepatitis B, HIV and AIDS and Hepatitis C are discussed separately considering their importance

Editorial - Antibiotic Resistance: Unless we act soon!

Today, several health-related issues are crying for attention. The spread of HIV infection, the continuing surge of lifestyle illnesses, the perceived threat of bioterrorism, the continuing scourge of malnutrition and infectious diseases afflicting children in the developing countries and the under-privileged sections the world over finding the healthcare system inaccessible, are some of them. Spread of anti-microbial resistance is one such issue that has the potential of diminishing, if not nullifying, the benefits that mankind has reaped through the use of anti-microbial agents

Authorship issues

Authorship is a highly sought attribute, as it is associated with recognition for creativity. In addition, it is associated with multiple benefits such as peer recognition, better evaluation and financial gains. These possibilities spur scientists to author articles, but some take recourse to unethical practice of honorary authorships. Another unethical practice is that of ghostwriting. It is a phenomenon wherein individuals who write the articles are not named as authors and are not even acknowledged to be associated with the manuscript. Reputed and renowned scientists, who have not participated in the conduct of the study or in the manuscript preparation, are enrolled by the industry to allow their names to be mentioned as authors. This phenomenon is harmful not only because it suppresses the contribution of ghost-authors but also because the guest “authors” bestow underserved credibility upon an “industry-written” paper. The readers have no way of knowing the bias that may have crept in. The journal editors, institution, and government agencies need to come together to ensure that these malpractices are curbed by employing various measures such as creating awareness amongst authors, academicians, and administrators; enunciating and implementing policies to dissuade unethical behavior, protecting whistle-blowers, and providing punishments to those indulging in malpractices. All of us should remember that if unchecked, these deviant behaviors have the potential to compromise the credibility of scientific research and scientific publications