Neurological impairment and disability in children in rural Kenya

Aim: To investigate geographical change over time in the burden of neurological impairments in school-aged children in a demographic surveillance area. Method: We investigated changes in neurological impairment prevalence in five domains (epilepsy and cognitive, hearing, vision, and motor impairments) using similar two-phase surveys conducted in 2001 (n=10 218) and 2015 (n=11 223) and determined changes in location-level prevalence, geographical clustering, and significant risk factors for children aged 6 to 9 years (mean7y 6mo, SD1y) of whom 50.4% were males. Admission trends for preterm birth, low birthweight (LBW), and encephalopathy were determined using admission data to a local hospital. Results: Overall prevalence for any neurological impairment decreased from 61 per 1000 (95% confidence interval [CI]48.0–74.0) in 2001 to 44.7 per 1000 (95% CI40.9–48.6) in 2015 (p<0.001). There was little evidence of geographical variation in the prevalence of neurological impairments in either survey. The association between neurological impairments and some risk factors changed significantly with year of survey; for example, the increased association of adverse perinatal events with hearing impairments (exponentiated coefficient for the interaction=5.94, p=0.03). Annual admission rates with preterm birth (rate ratio1.08, range1.07–1.09), LBW (rate ratio1.08, range1.06–1.10), and encephalopathy (rate ratio1.08, range1.06–1.09) significantly increased between 2005 and 2016 (p<0.001). Interpretation: There was a significant decline in the prevalence of neurological impairments and differential changes in the associations of some risk factors with neurological impairments over the study period. Limited geographical variation suggests that similar interventions are appropriate across the defined area.