Date of Award

3-3-2020

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr. Muhammad Imran Nisar

Second Advisor

Dr. Benazir Balouch

Third Advisor

Dr. Batool Fatima

Department

Community Health Sciences

Abstract

Introduction It is estimated that nearly 13% of 6–9-year-old children in South Asia are affected by a Neurodevelopmental (ND) delay. Concomitantly there is a high burden of early childhood infections resulting in significant morbidity and mortality. The relationship between infections in early infancy and long-term neurodevelopmental delays are not well understood.
Methods This study was carried out in a low socioeconomic peri urban community in Karachi, Pakistan. Leveraged a larger study (Aetiology of Neonatal Infections in South Asia i.e. ANISA from Jan 2012-Dec 2013) to nest a case-cohort of 241 children diagnosed as having a possible serious bacterial infection in the first 2 months of life (exposed group) in the ANISA study. We additionally followed up 157 children who did not have any illness during the same period (unexposed group) in the ANISA cohort. Following tools were administered to assess current delays in neurodevelopment: 1) Ten Questions Screen (TQS); 2) Strengths and Difficulties Questionnaire (SDQ) 3) Parent’s Evaluation of Developmental Stage Assessment Level (PEDS-DM-AL). Other sociodemographic, perinatal, household and anthropometric measurements were also taken. A Generalized Structural Equation Model was fitted to quantify the association between infections in early infancy with physical & neurological development. Akaike Information Criteria (AIC) was used for model adequacy comparisons. All analysis was done using Stata version 16.0.
Results The mean TQS score in children exposed to early infancy infections was significantly lower than healthy children (9.1 vs. 9.4; p-value 0.01). In SDQ, 41.5% of children in infection group had abnormal scores compared to 33.1% in comparison group although results were not statistically significant. In PEDS-DM-AL, age standardized percentage of skills attained in fine motor (78.4% vs. 83.2%, p value 0.02) and cognitive domains (86.6% vs. 88.6%, one sided p-value 0.04) were significantly lower in the infection group , while there were no differences in any other domain . The height for age Z score was 0.2 SD lower (p value 0.046) in children exposed to infections in early infancy as compared to unexposed children. Parents’ education, time to nearest health facility and school admission were significantly associated with physical outcomes (weight, height, MUAC). Infection in early infancy (46% increased odds, p value 0.04) and place of birth (48% increased odds for delay, p value 0.01) were associated with delayed motor milestones reported in TQS. School admission and time to nearest health facility were significantly associated with both physical and neurodevelopmental outcomes. Gestational age at birth, weight at birth, breastfeeding, mental trauma risk factors and number of members in household were significantly associated with social-emotional domain. Ability to read/write, caregiver reported physical abuse to child, and age at weaning were associated with receptive language domain.
Conclusion Infections in early infancy are associated with increased delays or abnormalities in motor, social emotional and physical development of children. An array of other factors were also found to feed into delays in neurological or physical development and can be packaged into a preventive package.

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1

Last Page

81

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