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

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Arora, Narendra K., Nair, M. K. C., Gulati, Sheffali, Deshmukh, Vaishali, Mohapatra, Archisman, Mishra, Devendra, Patel, Vikram, Pandey, Ravindra M., Das, Bhagabati C., Divan, Gauri, Murthy, G. V. S., Sharma, Thakur D., Sapra, Savita, Aneja, Satinder, Juneja, Monica, Reddy, Sunanda K., Suman, Praveen, Mukherjee, Sharmila B., Dasgupta, Rajib, Tudu, Poma, Das, Manoja K., Bhutani, Vinod K., Durkin, Maureen S., Pinto-Martin, Jennifer, Silberberg, Donald H., Sagar, Rajesh, Ahmed, Faruqueuddin, Babu, Nandita, Bavdekar, Sandeep, Chandra, Vijay, Chaudhuri, Zia, Dada, Tanuj, Dass, Rashna, Gourie-Devi, M., Remadevi, S., Gupta, Jagdish C., Handa, Kumud K., Kalra, Veena, Karande, Sunil, Konanki, Ramesh, Kulkarni, Madhuri, Kumar, Rashmi, Maria, Arti, Masoodi, Muneer A., Mehta, Manju, Mohanty, Santosh Kumar, Nair, Harikumaran, Natarajan, Poonam, Niswade, A. K., Prasad, Atul, Rai, Sanjay K., Russell, Paul S. S., Saxena, Rohit, Sharma, Shobha, Singh, Arun K., Singh, Gautam B., Sumaraj, Leena, Suresh, Saradha, Thakar, Alok, Parthasarathy, Sujatha, Vyas, Bhadresh, Panigrahi, Ansuman, Saroch, Munish K., Shukla, Rajan, Rao, K. V. Raghava, Silveira, Maria P., Singh, Samiksha, Vajaratkar, Vivek·2018·PLOS Medicine
DOI 10.1371/journal.pmed.1002615PMC PMC6057634
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Abstract

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.

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  1. MG Suchithra, 1990, Linguistic profile test-normative data for children in grades I–V, Journal of All India Institute of Speech and Hearing, 21, 14
  2. Bharatraj J. Vineland social maturity scale and manual. Indian Adaptation by A.J. Malin, enlarged edition. Syamsidtha Prakasan, Mysore. 1992.

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Authors
Arora, N. K., Nair, M. K. C., Gulati, S., Deshmukh, V., Mohapatra, A., Mishra, D., Patel, V., Pandey, R. M., Das, B. C., Divan, G., Murthy, G. V. S., Sharma, T. D., Sapra, S., Aneja, S., Juneja, M., Reddy, S. K., Suman, P., Mukherjee, S. B., Dasgupta, R., Tudu, P., Das, M. K., Bhutani, V. K., Durkin, M. S., Pinto-Martin, J., Silberberg, D. H., Sagar, R., Ahmed, F., Babu, N., Bavdekar, S., Chandra, V., Chaudhuri, Z., Dada, T., Dass, R., Gourie-Devi, M., Remadevi, S., Gupta, J. C., Handa, K. K., Kalra, V., Karande, S., Konanki, R., Kulkarni, M., Kumar, R., Maria, A., Masoodi, M. A., Mehta, M., Mohanty, S. K., Nair, H., Natarajan, P., Niswade, A. K., Prasad, A., Rai, S. K., Russell, P. S. S., Saxena, R., Sharma, S., Singh, A. K., Singh, G. B., Sumaraj, L., Suresh, S., Thakar, A., Parthasarathy, S., Vyas, B., Panigrahi, A., Saroch, M. K., Shukla, R., Rao, K. V. R., Silveira, M. P., Singh, S., & Vajaratkar, V.
Affiliations
  • INCLEN Trust International (IN)
  • Kerala University of Health Sciences (IN)
  • All India Institute of Medical Sciences (IN)
  • Maulana Azad Medical College (IN)
  • Harvard University (US)
  • Sangath (IN)
  • Lady Hardinge Medical College (IN)
  • Sir Ganga Ram Hospital (IN)
  • Jawaharlal Nehru University (IN)
  • Lucile Packard Children's Hospital (US)
  • University of Wisconsin–Madison (US)
  • University of Pennsylvania (US)
  • Integral University (IN)
  • University of Delhi (IN)
  • King Edward Memorial Hospital and Seth G.S. Medical College (IN)
  • Paras Hospitals (IN)
  • Medanta The Medicity (IN)
  • Indraprastha Apollo Hospitals (IN)
  • Rainbow Children's Hospital (IN)
  • King George's Medical University (IN)
  • Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital (IN)
  • Government Medical College (IN)
  • Government of India (IN)
  • Christian Medical College, Vellore (IN)
  • Ministry of Health and Family Welfare (IN)
  • Samarth (IN)
  • Hospital for Sick Children (CA)
  • M. P. Shah Medical College (IN)
  • Dr. Rajendra Prasad Government Medical College (IN)
  • Goa Medical College (IN)
Corresponding author
Arora, Narendra K.
ORCID
Venue
PLOS Medicine
Publisher
Public Library of Science (PLoS)
Published
2018-07-24
Volume
15
Issue
7
Pages
e1002615
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1002615
PMC
PMC6057634
OpenAlex
W2884694394
Cited by
342
References
48
Citations by year
2026: 39 · 2025: 57 · 2024: 51 · 2023: 52 · 2022: 50 · 2021: 47 · 2020: 22 · 2019: 16 · 2018: 2
FWCI
12.95
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • National Institute of Health (NIH) through Fogarty International Center (FIH) (NIH 1R21-HD53057-01A1)
  • Autism Speaks (USA)
  • The National Trust, Ministry of Social Justice and Empowerment, Government of India
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Keywords
neurodevelopmental disorders, prevalence, India, autism spectrum disorder, intellectual disability, attention deficit hyperactivity disorder, learning disabilities, cerebral palsy, hearing loss, visual impairment, speech and language disorders, epilepsy, neuromotor impairment, urban-rural differences, district-level estimates, disease burden
MeSH terms
Child, Child Behavior, Child Development, Child, Preschool, Cross-Sectional Studies, Female, Health Surveys, Humans, India, Male, Risk Factors, Prevalence, Age Distribution, Risk Assessment, Neurodevelopmental Disorders

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