Search

Introduction: A majority of neonates present with histories of brain insult in the antenatal, natal and post-natal periods. Identification, appropriate assessment and intervention are crucial for best neurodevelopmental outcomes. In DSH the Pediatric Neuroscience Department (PND) is working in this regard in the neonatal ward as well as in its Child Development Center (CDC) with a multi-disciplinary team of professionals. Objectives: To describe the activities of PND in the management of high risk neonates. Methods: This was an observational study. From July 2017- December 2017every high risk neonate admitted in the neonatology department of Dhaka Shishu Hospital, the largest children hospital was assessed for neurodevelopmental assessment by the Rapid Neurodevelopmental Assessment (RNDA) tool by a Developmental Therapist. RNDA is a validated tool for neurodevelopmental assessment applied for ages between 0-16 Years. Different domains like gross motor, fine motor, vision, hearing, speech, cognition, behavior and seizures are seen and categorized into normal, mild, moderate and severe impairments. Neonates with moderate to severe impairments are then referred to the CDC for a general developmental assessment under the supervision of a pediatric neurologist; with regular follow ups. Interventions for different comorbidities are provided nutritional and feeding advice. Mild groups are also followed up by developmental therapists up to a maximum of 2 years. In the walk-in OPD of the department this same protocol is followed. Result: Approximately 650 patients were seen; among them 220 needed general developmental assessment on the basis of moderate to severe impairment. Among the impaired and non-impaired group there were difference in Term, preterm, birth weight and gestational age, Soocoidemography showed irregular antenatal care, bad obstetrical history and malnutrition has important impact. Conclusion: Every neonate who is at high risk needs assessment, evaluation

BackgroundTopical treatment with sunflower seed oil (SSO) or Aquaphor® reduced sepsis and neonatal mortality in hospitalized preterm infants Methods497 infants were randomized to receive SSO, Aquaphor®, or neither through the neonatal period or hospital discharge. 159 infant survivors were enrolled in the longitudinal follow-up study using a validated Rapid Neurodevelopmental Assessment tool and the Bayley Scales of Infant Development II (BSID II) administered at three-monthly intervals for the first year and thereafter at six-monthly intervals. Lowess smoothing was used to display neurodevelopmental status across multiple domains by age and treatment group, and Generalized Estimating Equations (GEE) were used to compare treatment groups across age points.Results123 children completed at least one follow-up visit. Lowess graphs suggest that lower proportions of children who received massage with either SSO or Aquaphor® had neurodevelopmental delays than control infants in a composite outcome of disabilities. In GEE analysis, infants receiving SSO showed a significant protective effect on the development of fine motor skills [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.86–0.98,p=0.006]. The Psychomotor Development Index (PDI) in the BSID II showed significantly lower disability rates in the Aquaphor group (23.6%) compared to the control (55.2%) (OR 0.21, 95% CI 0.06–0.72,p=0.004).ConclusionsEmollient massage of very preterm, hospitalized newborn infants improved some child neurodevelopmental outcomes over the first 2 years of follow-up. Findings warrant further confirmatory research.Trial registrationClinicalTrials.gov(98-04-21-03-2) under weblinkhttps://clinicaltrials.gov/ct2/show/NCT00162747

Background: Autism is a complex disorder resulting from the combination of genetic and environmental factors. Though various genetic factors are involved in expression of autism, exogenous factor can modify and control gene expression. Objectives: To find out the socio-environmental factors which may contribute to early development and expressions of autism in children of Bangladesh. Materials &Methods: Autism cases (n=652) were diagnosed clinically and by applying ICD10 criterions in Child Development Centers (CDCs) of 15 tertiary medical college hospitals of Bangladesh. A retrospective analysis was done on collected data of detailed history and clinical notes of those children. Results: Among total 652 children with autism, 71.9% were from 2-5 years’ age group at diagnosis, with a male predominance (79%). Seventy-two percent were from middle to higher income family groups, 68% from urban areas and maximum children from nuclear families (77.5%). ‘Less interactive family’ was found in 67.50%. Play opportunity was absent in 60.60%. All the children watched TV and 85.6% watched TV for more than 2 hours/day. Conclusion: Children from urban area, higher income and nuclear family, lack of interactive play opportunity may play important role to develop autism in Bangladeshi children. Bangladesh J Child Health 2020; VOL 44 (2) :78-81

Population-based studies employing standardized diagnostics are needed to determine the burden of autism spectrum disorder (ASD) in low-resource settings. A community-based study was conducted among 8-11 year old children in rural, northwestern Bangladesh to establish the prevalence of ASD. A standardized screening and diagnosis protocol was adapted and deployed comprising the social communication questionnaire (SCQ), and the autism diagnostic observation schedule 2, (ADOS-2), and the autism diagnostic interview, revised (ADI-R), respectively. A year-long research training was conducted for a clinical psychologist to be certified to administer ADOS-2 and ADI-R. Over 8000 children were visited at home and administered the SCQ leading to some, based on their score, being further evaluated using the ADOS-2 and ADI-R by the clinical psychologist. Based on ADOS-2 applying the diagnoses of autism or autism spectrum, the prevalence was 40 (95% CI: 27, 54) per 10,000. Autistic disorder using ADI-R was found at 12 (95% CI: 5, 20) per 10,000. Boys were at a higher risk than girls with the rates among boys being 46 (95% CI: 25, 67) using ADOS-2 and 19 (95% CI:6, 33) using ADI-R. Among girls the rates were 34 (95% CI:16, 52) and 5 (95% CI:0, 12) per 10,000, respectively. Challenges to undertaking ASD research in a rural South Asian context are discussed. There was a low-to-moderate prevalence of ASD in a rural, child population in Bangladesh. Future research is needed to estimate rates of ASD and its causes and socioeconomic consequences in rural and urban settings of South Asia. LAY SUMMARY: In a study of over 8000, 8-11 year old children in a rural area of Bangladesh, two to four out of 1000 had ASD. Boys more than girls had ASD. Conducting ASD assessment in this setting was difficult, but more such research is needed to understand what causes ASD and its consequences for the individual, families and the society in rural and urban areas of low-income countries.

Background: Among term infants, hypoxic-ischemic encephalopathy due to acute perinatal asphyxia remains an important cause of neurodevelopmental deficits in childhood. Treatment is currently limited to supportive intensive care, without any specific brain-oriented therapy. Objective: To determine whether the risk of death or moderate/severe neurodevelopmental impairment in term infants with hypoxic-ischemic encephalopathy increases with relatively high skin or rectal temperature between 12 and 72 hours of birth. Materials and Methods: This was a prospective observational study. Asphyxiated newborns who came within 12 hours of birth were enrolled in this study. Both axillary and rectal temperature were recorded 6 hourly for 72 hours and each infant`s temperature for each site were rank ordered. Then mean of all axillary and rectal temperatures of each neonate was calculated. Outcomes were related to temperatures in logistic regression analyses for the elevated/relatively high temperatures and normal/low temperatures group, with adjustment of the level of encephalopathy and gender. Results: The mean axillary temperature was 36.07 ± 6.10C and in 25.71%, 11.92% and 6.32% cases axillary temperatures were >370C, >37.50C and >380C respectively. The mean rectal temperature was 36.8 ± 60C, and in 43.53%, 30.02% and 19.97% cases rectal temperatures were >370C, >37.50C and >380C respectively. Mean ambient temperature was 26.170C. There was significant correlation between axillary and rectal temperatures (r=0.889). For elevated temperature, the odds of death or moderate to severe impairment increased 8.9-fold (CI 0.906–88.18) and the odds of death alone increased 4.6-fold (CI 0.373–56.83). The odds of impairment increased 1.84-fold (CI 0.45– 7.50). Conclusion: Relatively high temperature during usual care after hypoxic-ischemia in term neonates was associated with adverse neurodevelopmental outcomes. J Enam Med Col 2019; 9(3): 160-165

The 2017 political violence against the Rohingya people in the state of Rakhine resulted in a large influx of displaced populations into Bangladesh. Given harsh conditions and experiences in Myanmar, and the harrowing journey to the border, raised levels of child neurodevelopmental disorders (NDDs) and mental health problems were expected.A team of child development professionals, physicians, psychologists, and developmental therapists screened 622 children in clinics within the refugee camps using the Developmental Screening Questionnaire (DSQ; 0-2 years), and the Ten Questions Plus (TQP) for NDDs, and Strengths and Difficulties Questionnaire (SDQ; 2-16 years) for mental health problems. Any child positive on the DSQ or the TQP was assessed for NDDs.Only 4.8% children aged 0-2 years and 7.3% children aged2-16 years screened positive for NDDs, comparable with a local Bangladesh population. However, 52% of children were in the abnormal range for emotional symptoms on the SDQ, and 25% abnormal for peer problems. Significant risk factors were being parentless and having lost one or more family members in the recent crisis.This screening study provides objective evidence of the urgent need for psychosocial support of Rohingya children within camps, with special attention to those without parents, including monitoring of their well-being and counselling of families and other care providers.

Background: Both clinical audits within hospitals, and population-based surveys of childhood disability in Bangladesh, have shown that large numbers of children have speech and language difficulties. This study determined the improvement of language skills of children presenting with difficulties to the Speech, Language and Communication (SLC) clinic of the Child Development Center (CDC) in Dhaka Shishu (Children) Hospital (DSH). Methodology: This is a retrospective study where records of children enrolled from April 2009 to March 2014, who had visited the SLC Clinic at least 3 times over a span of 6 months were analyzed. Preverbal language skills, comprehension, and expressive language levels were measured informally based upon play and interactive sessions and observation of function. Interventions involved training parents on informal intervention techniques following some international standard guidelines. Pre and post-intervention observations on preverbal, comprehensive, and expressive language skills were recorded to determine outcomes. Results: Of the 706 enrolled children 11.0%, 79.2%, 9.5%, .3% were 0-5-9 and 10-16 years old, respectively. 69.5% of children were males. Preverbal skills (attention span, awaiting, eye contact, attention sharing, turn-taking, copying), comprehension, and expressive language status showed significant improvement between the first and last visit (p= 0.000) Conclusions: Interactive play, music, books, etc. are important means of improving communication between parents and children. Professionals working with developmentally delayed children need to be trained to utilize these strategies, with the provision of appropriate facilities within clinical settings. A large majority of children can be assisted to overcome delays and optimize their potential.

Background: Preterm infants are at risk for long term neurodevelopmental impairements. Neurodevelopmental assessment at early months of infancy has been proposed as a valuable tool for prediction of neurodevelopmental outcomes in this population. Objective : The present study attempted to find the neurodevelopmental impairments in preterm infants and thus to identify the at risk infants for follow up and subsequent therapeutic intervention. Methodology : This prospective cross-sectional observational study was conducted in Dhaka Shishu (Children) Hospital from October 2011 to March, 2012. A total 103 preterm neonates who met the inclusion criteria underwent rapid neurodevelopmental assessment (RNDA) at neonatal period and again at their 3 months of age to find the at risk infants for long term neurodevelopmental impairments. Results : Among the enrolled 103 preterm infants during RNDA at neonatal period, abnormal domains found in primitive reflexes 41(39.7%), gross motor 42(40.7%), fine motor 32(31%), vision 40(38.7%), hearing 32 (31%), speech 40(38.7%), cognition 3(2.8%), behavior 3 (2.8%) and 3(2.8%) had seizure. Again in RNDA at 3 months of age, the no. of preterm infants having abnormal developmental domains are: gross motor 49(47.5%), fine motor 19(18.3), vision 9(8.6%), hearing 16(15.4%), speech 15 (14.5%), cognition 6(5.7%), speech 15 (14.5%), cognition 6(5.7%), behavior 11(10.6%) and 3 (2.9%) had seizure. Conclusion : The identification of neurodevelopmental impairments in early months of preterm infants should offer a valuable complement to tools for identification of at risk infants for long term sequlae (in neurodevelopmental impairment). Bangladesh J Child Health 2016; VOL 40 (1) :5-11

In advance of the 2019 INSAR Conference in Montreal, Quebec, Canada, I asked the members of the Autism Research Editorial Board and the Associate Editors to write short (approximately 300 word) mini‐commentaries on what they considered to be the current gaps in research on autism spectrum disorder. The responses and styles were diverse and reflect research gaps ranging from basic biology to treatment trials to services for transition to adulthood. They reflect thoughts from countries around the world. While each of the contributions was done entirely independently, it is interesting how the theme of heterogeneity is found in many of them. There is also increasing concern over the lack of research on socioeconomic and cultural factors related to the diagnosis and treatment of autism spectrum disorder. We hope that these comments will provide food for thought.

BACKGROUND Autism spectrum disorder (ASD) is currently diagnosed using qualitative methods that measure between 20-100 behaviors, can span multiple appointments with trained clinicians, and take several hours to complete. In our previous work, we demonstrated the efficacy of machine learning classifiers to accelerate the process by collecting home videos of US-based children, identifying a reduced subset of behavioral features that are scored by untrained raters using a machine learning classifier to determine children’s “risk scores” for autism. We achieved an accuracy of 92% (95% CI 88%-97%) on US videos using a classifier built on five features. OBJECTIVE Using videos of Bangladeshi children collected from Dhaka Shishu Children’s Hospital, we aim to scale our pipeline to another culture and other developmental delays, including speech and language conditions. METHODS Although our previously published and validated pipeline and set of classifiers perform reasonably well on Bangladeshi videos (75% accuracy, 95% CI 71%-78%), this work improves on that accuracy through the development and application of a powerful new technique for adaptive aggregation of crowdsourced labels. We enhance both the utility and performance of our model by building two classification layers: The first layer distinguishes between typical and atypical behavior, and the second layer distinguishes between ASD and non-ASD. In each of the layers, we use a unique rater weighting scheme to aggregate classification scores from different raters based on their expertise. We also determine Shapley values for the most important features in the classifier to understand how the classifiers’ process aligns with clinical intuition. RESULTS Using these techniques, we achieved an accuracy (area under the curve [AUC]) of 76% (SD 3%) and sensitivity of 76% (SD 4%) for identifying atypical children from among developmentally delayed children, and an accuracy (AUC) of 85% (SD 5%) and sensitivity of 76% (SD 6%) for identifying children with ASD from those predicted to have other developmental delays. CONCLUSIONS These results show promise for using a mobile video-based and machine learning–directed approach for early and remote detection of autism in Bangladeshi children. This strategy could provide important resources for developmental health in developing countries with few clinical resources for diagnosis, helping children get access to care at an early age. Future research aimed at extending the application of this approach to identify a range of other conditions and determine the population-level burden of developmental disabilities and impairments will be of high value.

Background: Autism spectrum disorder (ASD) is currently diagnosed using qualitative methods that measure between 20-100 behaviors, can span multiple appointments with trained clinicians, and take several hours to complete. In our previous work, we demonstrated the efficacy of machine learning classifiers to accelerate the process by collecting home videos of US-based children, identifying a reduced subset of behavioral features that are scored by untrained raters using a machine learning classifier to determine children’s “risk scores” for autism. We achieved an accuracy of 92% (95% CI 88%-97%) on US videos using a classifier built on five features. Objective: Using videos of Bangladeshi children collected from Dhaka Shishu Children’s Hospital, we aim to scale our pipeline to another culture and other developmental delays, including speech and language conditions. Methods: Although our previously published and validated pipeline and set of classifiers perform reasonably well on Bangladeshi videos (75% accuracy, 95% CI 71%-78%), this work improves on that accuracy through the development and application of a powerful new technique for adaptive aggregation of crowdsourced labels. We enhance both the utility and performance of our model by building two classification layers: The first layer distinguishes between typical and atypical behavior, and the second layer distinguishes between ASD and non-ASD. In each of the layers, we use a unique rater weighting scheme to aggregate classification scores from different raters based on their expertise. We also determine Shapley values for the most important features in the classifier to understand how the classifiers’ process aligns with clinical intuition. Results: Using these techniques, we achieved an accuracy (area under the curve [AUC]) of 76% (SD 3%) and sensitivity of 76% (SD 4%) for identifying atypical children from among developmentally delayed children, and an accuracy (AUC) of 85% (SD 5%) and sensitivity of 76% (SD 6%) for identifying children with ASD from those predicted to have other developmental delays. Conclusions: These results show promise for using a mobile video-based and machine learning–directed approach for early and remote detection of autism in Bangladeshi children. This strategy could provide important resources for developmental health in developing countries with few clinical resources for diagnosis, helping children get access to care at an early age. Future research aimed at extending the application of this approach to identify a range of other conditions and determine the population-level burden of developmental disabilities and impairments will be of high value.

OBJECTIVE To validate a Rapid Neurodevelopmental Assessment (RNDA) tool for use by child health professionals to determine neurodevelopmental impairments (NDIs) in young adolescents aged 10-16 years in Bangladesh. STUDY DESIGN In a convenience sample of community children (n = 47), inter-rater reliability was determined between four testers, and concurrent validity was determined by simultaneous administration of an intelligence quotient (IQ) test (Wechsler Intelligence Scale for Children, Revised) by a child psychologist. RESULTS Inter-rater reliability was excellent between the testers on the 47 children administered the RNDA (kappa = 1.00). Significantly lower IQ scores were obtained in those identified with 'any (>1) NDI' (n = 34) compared with those with no NDI (n = 13) on Verbal IQ (P-value < 0.0001), Performance IQ (P-value < 0.0001) and Full-scale IQ (P-value < 0.0001) scores on the Wechsler Intelligence Scale for Children, Revised. CONCLUSION The RNDA shows promise as a tool for use by child health professionals for identifying NDIs in young adolescents aged 10-16 years. A larger study sample is needed to determine its usefulness for identification of some impairments not found in the study population, i.e. gross motor, fine motor, hearing and seizures.

Background: Newborns with Hypoxic Ischemic Encephalopathy (HIE) are at risk of neuro-developmental disabilities. Early identification of their neuro-developmental impairments (NDI), immediate intervention and reassessment might be a useful method to measure and prevent major disability. This study was performed to identify impairment in different developmental domains among the babies admitted with moderate to severe degree HIE, and evaluate their outcomes after intervention with developmental therapy and stimulation.Methodology: The exploratory case control study was conducted during April 2008 till February 2012. We enrolled 81 full-term babies admitted to the special care neonate unite with HIE as ‘case’. The ‘control’ group included age and sex matched 81 babies who did not have HIE. Neurodevelopmental assessment was performed using age specific rapid neurodevelopmental assessment tool (RNDA) by trained developmental therapists (DT). Intervention with developmental therapy and stimulation was provided for every child. Those who had assessment at least twice, (at entry and after 1 year age) were included for this study.Results: Male were predominating (66.7%). Mean age was 18 and 19 days on the 1st ; 17 and18 months on last assessment day in case and control group respectively. NDI was identified in 89% and 35% in case and control group respectively. On last assessment, 42% developed disability (permanent functional deficit), 35.8% achieved age appropriate developmental skills, 20% were lost to follow up, and 2 children died among the case group. These were 16% (13/81), 72% and 12% respectively among the control group. Significant correlation was found between the 1st and last assessment result among the case and control group.Conclusion: Early identification of NDI using a valid assessment tool and immediate intervention could probably reduce the disability in babies with HIE. A long time evaluation of this cohort would provide valuable information.Bangladesh J Child Health 2015; VOL 39 (1) :6-13

Background : Neurometabolic disorders (NMD) in children may present at any age with a wide range of clinical manifestations. Unexplained or intractable seizure is one of the important associations. Consanguinity, regression of development and sibling death are the clues to suspect neurometabolic disorders when laboratory support is limited. Laboratory findings however, provide the confirmatory diagnosis which is unavailable in Bangladesh. Objectives : To determine the association of consanguinity, regression of development, seizures, EEG findings and other laboratory investigations in children suspected to have neurometabolic disorders and to aid clinicians working in resourcepoor countries. Methodology : A retrospective analysis was done from the records of the patients suspected to have neurometabolic disorders admitted in the department of Neurosciences, Dhaka Shishu Hospital, Dhaka during the period of July 2007 to February 2011. Tandem Mass Spectrometry (TMS), biotinidase activity and other enzyme assay were done through a private laboratory in New Delhi, India. Results : Total 128 children were studied and the parents of 39 (31%) had history of consanguineous marriage. Seizure was associated with 96 (75%) children and abnormal EEG findings were recorded in 83 (65%). Plasma ammonia was done in 98 cases and found to be increased in 53 (54%) cases. Plasma lactate was done in 94 cases and found high in 40 (43%). TMS were done in 111 (85%) children and abnormality were found in 70 (63%) cases. Serum biotinidase activity was advised for 41 children as per TMS result and measured in 25 children of which deficient activity was found in 17(68%); borderline in 4 (16%) and normal activity in 4 (16%) cases. Conclusion: Background history and clinical presentation followed by stepwise laboratory investigation is necessary to identify neurometabolic disorders. Early and appropriate intervention can reduce neurodisability in many situations. Bangladesh J Child Health 2015; VOL 39 (1) :24-29

Background : Preterm birth is associated with variable degree of brain injury and adverse neurodevelopmental outcomes. Therefore, screening of these infants is required to assess further neurodevelopmental abnormalities. Cranial ultrasound finding has been a predictor of outcome in this population. Objective : The present study was carried out to find cranial ultrasound abnormalities in preterm neonates to aid in screening at risk infants for long term neurodevelopmenal impairment. Materials and Methods : This observational study was conducted in Dhaka Shishu (Children) Hospital from October 2011 to March 2012. Total 103 preterm neonates who met the inclusion criteria were enrolled in the study. The neonates underwent cranial ultrasound (cUS) scan just after admission and before discharge for screening at risk infants. Results : Total 103 neonates were enrolled with mean age of 7.67 days in neonates with normal cUS findings and 7.23 days in neonates with abnormal cUS findings. Mean gestational age was 31.94 weeks in neonates with normal cUS and 31.85 weeks in neonates with abnormal cUS findings with mean weight 1.83 and 1.81 kg respectively. Among the neonates, 64 (62.1%) were males and 39 (37.9%) were females. Before discharge, out of 103 preterm neonates, 56 (54.3%) had normal cUS and 47 (45.7%) had abnormal cUS findings of which 22 (21.4%) had cerebral edema, 17 (16.5%) IVH and 8 (7.8%) had ventricular dilatation. Conclusion : Routine cranial ultrasound scanning of preterm neonates may aid in identifying at risk infants for long term neurodevelopmental impairments. J Enam Med Col 2016; 6(1): 28-32

Introduction Cerebral palsy (CP) is the most common childhood physical disability, with 80% estimated to be in low-middle-income countries. This study aims to (1) determine the accuracy of General Movements (GMs)/Hammersmith Infant Neurological Examination (HINE) for detecting CP at 18 months corrected age (CA); (2) determine the effectiveness of a community-based parent-delivered early intervention for infants at high risk of CP in West Bengal, India (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP). Methods This study comprises two substudies: (1) a study of the predictive validity of the GMs and HINE for detecting CP; (2) randomised, double-blinded controlled trial of a novel intervention delivered through peer trainers (Community Disability Workers, CDW) compared with health advice (15 fortnightly visits). 142 infants at high risk of CP (‘absent fidgety’ GMs; ‘high risk score’ on HINE) aged 12–40 weeks CA will be recruited to the intervention substudy, with infants randomised based on a computer-generated sequence. Researchers will be masked to group allocation, and caregivers and CDWs naive to intervention status. Visits will include therapeutic modules (goal-directed active motor/cognitive strategies and LEAP-CP games) and parent education. Health advice is based on the Integrated Management of Childhood Illness, WHO. Infants will be evaluated at baseline, post intervention and 18 months CA. The primary hypothesis is that infants receiving LEAP-CP will have greater scaled scores on the Pediatric Evaluation of Disability Inventory—Computer Adaptive Test (mobility domain) at 18 months compared with health advice. Secondary outcomes include infant functional motor, cognitive, visual and communication development; infant growth; maternal mental health. Ethics and dissemination This study is approved through appropriate Australian and Indian ethics committees (see in text) with families providing written informed consent. Findings from this trial will be disseminated through peer-reviewed journal publications and conference presentations. Trial registration number 12616000653460p; Pre-results.

Background Timely detection of neurodevelopmental impairments in children can prompt referral for critical services that may prevent permanent disability. However, screening of impairments is a significant challenge in low-resource countries. We adapted and validated the rapid neurodevelopmental assessment (RNDA) instrument developed in Bangladesh to assess impairment in nine domains: primitive reflexes, gross and fine motor development, vision, hearing, speech, cognition, behaviour and seizures. Methods We conducted a cross-sectional study of 77 infants (0–12 months) in rural Guatemala in July 2012 and July 2013. We assessed inter-rater reliability and predictive validity between the 27-item RNDA and the 325-item Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and concurrent validity based on chronic malnutrition, a condition associated with neurodevelopmental impairments. For both RNDA and BSID-III, standardized scores below 80 were defined as borderline impairment. Results Children came from rural households (92%), were born to indigenous women of Mayan descent (73%) and had moderate or severe growth stunting (43%). Inter-rater reliability for eight RNDA domains was of moderate to high reliability (weighted κ coefficients, 0.49–0.99). Children screened positive for impairment in fine motor (17%) and gross motor (14%) domains using the RNDA. The RNDA had good concurrent ability; infants who were growth stunted had higher mean levels of impairment in gross motor, speech and cognition domains (all p

not available DOI: http://dx.doi.org/10.3329/bjch.v38i3.22830 Bangladesh J Child Health 2014; VOL 38 (3) :169-172

The purpose of this study was to culturally adapt the items of Bayley Scales of Infant Development?II (BSID?II) for administration upon Bangladeshi infants. The adaptation procedure was conducted by following four steps: (i) field survey on normative sample, (ii) national expertise opinion, (iii) international expertise consultancy and (iv) picture sensitivity review. The culture based problems of the original BSID?II were identified from the initial field survey. Major problems identified by the examiners were unfamiliarity of the children with the items (pictures, words and materials). These assessments were evaluated by the national and international consultants. The uncommon items were changed to culturally recognizable ones while Bangla words were replaced to make the test culture?fair. At last, the adapted test was given to 22 healthy children to assess picture sensitivity of the test and found suitable where the infants attentively responded to the items. DOI: http://dx.doi.org/10.3329/dujbs.v23i2.20099 Dhaka Univ. J. Biol. Sci. 23(2): 187-195, 2014

OBJECTIVE: Validate a tool to determine neurodevelopmental impairments (NDIs) in >2- to 5-year-old children in a country with limited child development expertise. METHODS: Rapid Neurodevelopmental Assessment (RNDA) is a tool designed to detect functional status and NDIs across multiple neurodevelopmental domains. Validity was determined in 77 children enrolled by door-to-door sampling in Dhaka and who were administered the RNDA by 1 of 6 testers (4 developmental therapists, 2 special education teachers) and simultaneously administered a test of adaptive behavior (AB; Independent Behavior Assessment Scale) and intelligence quotient (IQ) tests (Bayley Scales of Infant Development II, Stanford Binet Intelligence Scale, Wechsler Preschool and Primary Scales of Intelligence) by psychologists. RESULTS: Interrater reliability ranged from good to excellent. There were significant differences in AB in mean percentile scores on the Independent Behavior Assessment Scale for motor (P = .0001), socialization (P = .001), communication (P = .001), and full-scale (P = .001) scores in children with ≥1 NDI (“any NDI”) versus no NDI. Significant differences in those with versus those without “any NDI” were found on IQ scores. Sensitivity and specificity for “significant difficulties” (defined as AB z-scores < −2 SDs and/or IQ CONCLUSIONS: The RNDA validity results are promising for use by child care professionals in field and clinical settings, but the tool needs further replication and refinement for assessment of specific impairments of vision, hearing, and seizures.

Aim To identify predictors of seizure control in newly presenting children with epilepsy in countries with limited resources. Method Three hundred and ninety children (273 males, 117 females) aged 2 months to 15 years with newly diagnosed epilepsy were enrolled prospectively at first visit to the multidisciplinary clinic at the children’s hospital in Dhaka, Bangladesh. Data about seizures, motor disability, psychomotor development, and electroencephalography were obtained. Regular monitoring of antiepileptic drug treatment was continued at least for one year. Associations between seizure control and potential predictors were determined by multivariate analysis. Results Three hundred and ninety children were enrolled in 6 months, of whom over 60% were from low-income families, 60% had onset at under 1 year, 74% had more than one seizure per week, 69% a single-seizure type, and 38% a history of delayed onset of breathing at birth. Cognitive deficits (IQ

Background Home-based screening to identify young children at risk for neurodevelopmental impairments (NDIs) is needed to guide the targeting of child neurodevelopmental intervention services in Bangladesh. This study aimed to validate such a tool for children under age 2 years. Methods A Developmental Screening Questionnaire was administered to mothers of children aged 0–

Rationale: Cytomegalovirus (CMV) infection is a common cause for neurodisability among poor populations in developing countries, including Bangladesh. Some studies have shown that ganciclovir therapy is effective in reducing neurodevelopmental morbidity; while others remain equivocal. Objective : The objective of this study was to evaluate neurodevelopmental outcome of children with symptomatic CMV treated with ganciclovir compared to matched control. Methods: Out of 218 children seropositive for CMV admitted into the neurology ward between 2003-2006, 91 were treated with intravenous ganciclovir for 2-3 weeks; of whom 43 came for follow-up at an interval of 3 months to 1 year. At each visit neurodevelopmental status was recorded for cognition, vision and hearing. 41 untreated age-matched cases with follow-up records were retrospectively enrolled as control. Results: Among treated children compared to untreated controls, there was significant improvement in hearing (58% vs. 27%; p value=.012). Improvement remained consistent, without statistical significance, for vision (53% vs. 39%; p value=.071)) and cognition (51% vs. 54%; p value=.344). Conclusion: Ganciclovir treatment improved neurodevelopmental outcomes of very young children with symptomatic CMV infection. In a country where limited resources are available for children with disability, early recognition and treatment of CMV infection is recommended. DOI: http://dx.doi.org/10.3329/bjch.v35i3.10498 Bangladesh J Child Health 2011; Vol 35 (3): 97-101

Background The majority of children with cerebral palsy have feeding difficulties, which, if not managed, result in stressful mealtimes, chronic malnutrition, respiratory disease, reduced quality of life for caregiver and child, and early death. In well-resourced countries, high- and low-cost medical interventions, ranging from gastrostomy tube feeding to caregiver training, are available. In resource-poor countries such as Bangladesh, the former is not viable and the latter is both scarce and its effectiveness not properly evaluated. The aim of this study was to evaluate the effectiveness of a low-cost, low-technology intervention to improve the feeding practices of carers of children with moderate–severe cerebral palsy and feeding difficulties in Bangladesh. Methods An opportunistic sample of 37 caregivers and their children aged 1–11 years were invited to a six-session training programme following an initial feeding assessment with brief advice. During home visits, pre- and post-measures of nutritional status, chest health and feeding-related stress were taken and feeding practices were observed. A control phase was evaluated for 20 of the participant pairs following initial assessment with advice, while awaiting full training. Results A minimum of four training sessions showed significant improvements in the children's respiratory health (P= 0.005), cooperation during mealtimes (P= 0.003) and overall mood (P < 0.001). Improvements in growth were inconsistent. Dramatic reductions were observed in caregiver stress (P < 0.001). A significant difference in the outcomes following advice only compared with advice plus training was also observed. Conclusions In situations of poverty, compliance is restricted by lack of education, finances and time. Nonetheless, carers with minimal formal education, living in conditions of extreme poverty were able to change feeding practices after a short, low-cost training intervention, with highly positive consequences. The availability of affordable food supplementation for this population, however, requires urgent attention.

OBJECTIVE: The objective of this study was to determine the reliability and validity of a comprehensive assessment procedure for ascertaining neurodevelopmental status of children aged 0 to 24 months for use by multidisciplinary professionals in a developing country. METHODS: We developed the Rapid Neurodevelopmental Assessment (RNDA) to determine functional status in the following domains: primitive reflexes, gross motor, fine motor, vision, hearing, speech, cognition, behavior, and seizures. Reliability was determined for 50 children who were aged RESULTS: Mean κ coefficients of agreement among professionals in overall and individual domains in the 2 age groups ranged from good to excellent. For both younger and older children, there was good concurrent validity (ie, significantly lower mean Mental Development Index and Psychomotor Development Index scores) for children with ≥1 neurodevelopmental impairment and for children with impairments in most functional domains, compared with children with no impairments. Significantly more impairments were found in children from disadvantaged compared with socioeconomically more advantaged communities, indicating good discriminant validity. CONCLUSIONS: The RNDA can be used by professionals from a range of backgrounds with high reliability and validity for determining functional status of children who are younger than 2 years. The study findings have important practical implications for early identification and intervention to mitigate neurodevelopmental impairments in large populations that live in developing countries where professional expertise is sparse.

Background. Evaluation of the long-term impact of pneumococcal meningitis on surviving children and their families is critical to fully comprehending the burden of pneumococcal disease and to facilitating an evidence-based decision for the introduction of pneumococcal vaccine. This study was an investigation of the short- and long-term impacts of pneumococcal meningitis among Bangladeshi children. Methods. Case patients with pneumococcal meningitis who were hospitalized between January 2006 and March 2007 were subjected to short-term follow-up within 30-40 days of discharge. Case patients discharged prior to January 2005 were selected for long-term follow-up at 6-24 months after the date of discharge. Both cohorts were enrolled from Dhaka Shishu Hospital, a pediatric hospital in Bangladesh. Healthy children matched for age, sex, socioeconomic status, and area of residence were recruited from the community as control subjects. During follow-up visits, case patients and control subjects were assessed for their physical and neurodevelopmental status by use of a standardized protocol. The impact of pneumococcal meningitis on siblings and the family as a whole was assessed by means of qualitative interviews. Results. Neurodevelopmental assessments of the short-term follow-up cohort (n = 51) revealed hearing, vision, mental, and psychomotor deficits in 33%, 8%, 41%, and 49% of the case patients, respectively. These deficits were 18%, 4%, 41%, and 35% in the long-term follow-up cohort (n = 51), respectively. Such deficits were seen in only 2% of the control subjects, none of whom had vision or hearing deficits. Conclusions. In addition to the risk of death, pneumococcal meningitis in children causes severe disabilities among survivors, as well as disruption of the life of other siblings and family members. This study demonstrated that high rates of sequelae are associated with pneumococcal meningitis. Neurodevelopmental assessment during follow-up of patients with meningitis is critical to our understanding of the burden of the adverse consequences of pneumococcal disease. These data, along with the fact of poor access to health care, provide a compelling argument in favor of the introduction of pneumococcal vaccine, specifically in a setting where access to health care is poor and disabled children remain incapacitated because of a lack of resources and facilities.

Bangladesh has a high child mortality rate. However, little is known about the outcome for young children who have cerebral palsy (CP). Ninety-two children with CP with a mean age of 3 years 3 months at entry into the study were followed for up to 3 years as part of an intervention study. Eight children died: two of 49 (4%) from an urban area and six of 43 (14%) from a rural area. Extrinsic factors such as infections and drug reactions preceded all the deaths, but those who died were mostly severely malnourished and among the more severely disabled of the total group. Eighty-nine percent of rural children in the study were from low-income families. Intervention programmes for severely disabled children in developing countries must include primary health care and feeding programmes as well as rehabilitation services to address both the needs of the child and empowerment of the mother and the family.Most children with disabilities live in developing countries. A large epidemiological study of children with disabilities aged 2-9 years in Bangladesh indicated a prevalence rate of 6.8% for all grades and types of disabilities, and of 1.5% for serious disabilities. This paper presents findings from the assessment of the death rate of 92 children with cerebral palsy (CP) aged 16-67 months, of mean age 39 months, at entry into the study who were followed for up to 3 years as part of an intervention study. 8 children died: 2 of 49 (4%) from an urban area and 6 of 43 (14%) from a rural area. Factors such as infections and drug reactions preceded all of the deaths, but the children who died were mostly severely malnourished and among the more severely disabled of the overall group. 89% of rural children in the study were from low-income families. Intervention programs for severely disabled children in developing countries must include primary health care and feeding programs as well as rehabilitation services.

Summary Background: Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants. Increased survival of extremely low birth weight infants following advances in antenatal and neonatal care has resulted in a population of infants at high risk of developing ROP. Long term morbidity of ROP has a spectrum ranging from myopia to blindness. Screening programs and early intervention can provide enormous economic and social benefits. Materials and Methods: Preterm infants of gestational age

Quinolone-induced arthropathic toxicity in weight-bearing joints observed in juvenile animals during preclinical testing has largely restricted the routine use of ciprofloxacin in the pediatric age group. As histopathologic radiologic and magnetic resonance imaging monitoring evidence has gathered supporting the safety of fluoroquinolones in children many pediatricians have started to prescribe quinolones to some patients on a compassionate basis. The objective of this study was to ascertain the safety of ciprofloxacin in preterm neonates < 33 weeks gestational age treated at Dhaka Shishu (Children) Hospital in Bangladesh. Long-term follow up was done to monitor the growth and development of preterm infants who were administered intravenous ciprofloxacin in the neonatal period. Ciprofloxacin was used only as a life-saving therapy in cases of sepsis produced by bacterial agents resistant to other antibiotics. Another group of preterm neonates with septicemia who were not exposed to ciprofloxacin but effectively treated with other antibiotics and followed up were matched with cases for gender gestational age and birth weight and included as a comparison group. Forty-eight patients in the ciprofloxacin group and 66 patients in the comparison group were followed up for a mean of 24.7 ± 18.5 months and 21.6 ± 18.8 months respectively. No osteoarticular problems or joint deformities were observed in the ciprofloxacin group during treatment or follow up. No differences in growth and development between the groups were found. Ciprofloxacin is a safe therapeutic option for newborns with sepsis produced by multiply resistant organisms. (authors)

Summary Objective The purpose of this study was to determine a feasible strategy for screening young children in rural Bangladesh for hearing impairments. Methods Trained community health workers (CHWs) screened 4003 children between the ages of 2 and 9 years using conditioned play audiometry (CPA) and a subset of 569 of these children (ages 2–5 years), using physiologic (otoacoustic emissions [OAEs] and tympanometry). Measures of frequency and cross-tabulations are presented to describe results. Results Hearing screening using CPA was feasible for most children in the 6–9 years age range, but not for the younger children due to shyness and lack of cooperation. More than two thirds of the younger children were untestable on CPA. In response to this limitation, OAEs and tympanometry, requiring less cooperation on the part of the child, was implemented for a sample of younger children. Of the 569 children who received both CPA and OAE/tympanometry, 69% were untestable using CPA and 8.9% were untestable using OAE and tympanometry. Conclusions These results suggest that hearing screening using CPA for older (6–9 years) and OAE/tympanometry for younger (2–5 years) children is feasible. Using the physiologic measures of OAE/tympanometry significantly reduced the number of untestable children, resulting in fewer referrals for diagnostic assessments. Thus, if only one methodology could be implemented, physiologic measure would be preferred. This is important because trained audiologists are scarce in Bangladesh. Technology is available and feasible for hearing screening in developing countries. Focus needs now to center on increasing the number of trained audiologists in developing countries to ensure better follow-up and accessibility to audiological services.

Given the numbers of disabled children in Bangladesh and the lack of trained professionals, innovative forms of service delivery are required. The Bangladesh Protibondhi Foundation has developed an outreach parent training service based at two centres, one urban and one rural. Mothers are shown how to use pictorially based Distance Training Packages (DTP), which they take home. This paper presents findings concerning factors which seem to affect mothers' attendance with their children at DTP advisory sessions. The study followed 47 children with cerebral palsy, aged between 2 and 5.5 years, over a period of around 18 months. The main factors predicting higher attendance were the child's sex (i.e. boys were brought back more often), particularly in the rural area, and lower adaptation to the child reported by the mother. The problems described by mothers in using the DTP advisory service were economic (such as transport costs), cultural (such as mothers not being permitted out alone), and medical (such as the child having repeated fits). The implications for future service development are discussed.

This study evaluated the contribution of prenatal perinatal neonatal and postnatal factors to the prevalence of cognitive disabilities among children aged 2-9 years in Bangladesh. A two-phase survey was implemented in 1987-88 in which 10299 children were screened for disability. In multivariate analyses significant independent predictors of serious mental retardation in rural and urban areas included maternal goiter (rural odds ratio (OR) = 5.14 95% confidence interval (CI): 1.23 21.57; urban OR = 4.82 95% CI: 2.73 8.50) and postnatal brain infections (rural OR = 29.24 95% CI: 7.17 119.18; urban OR = 13.65 95% CI: 4.69 39.76). In rural areas consanguinity (OR = 15.13 95% CI: 3.08 74.30) and landless agriculture (OR = 6.02 95% CI: 1.16 31.19) were also independently associated with the prevalence of serious mental retardation. In both rural and urban areas independent risk factors for mild cognitive disabilities included maternal illiteracy (OR = 2.48 95% CI: 0.86 7.12) landlessness (OR = 4.27 95% CI: 1.77 10.29) maternal history of pregnancy loss (OR = 2.61 95% CI: 0.95 7.12) and small for gestational age at birth (OR = 3.86 95% CI: 1.56 9.55). Interventions likely to have the greatest impact on preventing cognitive disabilities among children in Bangladesh include expansion of existing iodine supplementation maternal literacy and poverty alleviation programs as well as prevention of intracranial infections and their consequences. Further population-based studies are needed to confirm and understand the association between consanguinity and serious cognitive disability. (authors)

Objective: To identify the stress experienced by mothers of young children with cerebral palsy in Bangladesh and to determine predictive factors. Methods: We recruited 91 mothers of children with cerebral palsy ages 1.5 to 5 years as they sought services at an urban and a rural center for their children. Mothers were interviewed with the Self-Report Questionnaire and other family background and child behavior measures. The children were examined by a pediatrician and by a psychologist. Results: Out of 91, 38 (41.8%) mothers were at risk for psychiatric morbidity. Significantly associated factors included living in the rural area within a poor family, with a relatively older child. The strongest predictor of maternal stress in multivariate analysis was child behavior problems, especially those related to burden of caring. Conclusions: Ensuring practical help for mothers and advice on managing common behavior problems are important components of intervention, as they may directly help to relieve stress on mothers of young disabled children in developing countries.

The objective of this study was to validate retrospective caregiver interviews for diagnosing major causes of severe neonatal illness and death. A convenience sample of 149 infants aged28 days with one or more suspected diagnoses of interest (low birthweight/severe malnutrition, preterm birth, birth asphyxia, birth trauma, neonatal tetanus, pneumonia, meningitis, septicaemia, diarrhoea, congenital malformation or injury) was taken from patients admitted to two hospitals in Dhaka, Bangladesh. Study paediatricians performed a standardised history and physical examination and ordered laboratory and radiographic tests according to study criteria. With a median interval of 64.5 days after death or hospital discharge, caregivers of 118 (79%) infants were interviewed about their child's illness. Using reference diagnoses based on predefined clinical and laboratory criteria, the sensitivity and specificity of particular combinations of signs (algorithms) reported by the caregivers were ascertained. Sufficient numbers of children with five reference standard diagnoses were studied to validate caregiver reports. Algorithms with sensitivity and specificity80% were identified for neonatal tetanus, low birthweight/severe malnutrition and preterm delivery. Algorithms with specificities80% for birth asphyxia and pneumonia had sensitivities70%, or alternatively had high sensitivity with lower specificity. In settings with limited access to medical care, retrospective caregiver interviews provide a valid means of diagnosing several of the most common causes of severe neonatal illness and death.This study aimed to validate retrospective caregiver interviews for diagnosing major causes of several neonatal illness and death in Dhaka, Bangladesh. The sample consisted of 149 infants aged 28 days with one or more suspected diagnoses of low birth weight (LBW)/severe malnutrition, preterm birth, birth asphyxia, birth trauma, neonatal tetanus, pneumonia, meningitis, septicemia, diarrhea, congenital malformation or injury. The study pediatricians performed a standardized history and physical examination and ordered laboratory and radiographic tests according to study criteria. Overall, LBW/severe malnutrition, premature birth and tetanus can be detected in newborn infants by caregiver interview with high sensitivity and specificity, whereas the diagnoses of pneumonia and birth asphyxia are more difficult but still feasible. Algorithms with sensitivity and specificity 80% were identified for neonatal tetanus, LBW/severe malnutrition and preterm delivery. Algorithms with specificities 80% for birth asphyxia and pneumonia had sensitivities 70%, or alternatively had high sensitivity with lower specificity. In settings with limited access to medical care, retrospective caregiver interviews provide a valid means of diagnosing several of the most common causes of severe neonatal illness and death.

Objective To measure physical and neurologic impact of Haemophilus influenzae type b (Hib) meningitis on surviving children through short- and long-term follow-up. Study design Cases of Hib meningitis, diagnosed at a tertiary level pediatric hospital, were subjected to short- and long-term follow-up and compared with age, sex, and area of residence matched healthy controls. Follow-up assessments included thorough physical and neurodevelopmental assessments using a standardized protocol by a multidisciplinary team. Results Assessments of short-term follow-up cohort (n = 64) revealed hearing, vision, mental, and psychomotor deficits in 7.8%, 3%, 20%, and 25% of the cases, respectively. Deficits were 10%, 1.4%, 21%, and 25% in long-term follow-up cohort (n = 71), in that order. Mental and psychomotor deficits were found in 2% of the controls, none of whom had vision or hearing deficits. Conclusions In addition to risk of death, Hib meningitis in children causes severe disabilities in survivors. These data facilitated a comprehensive understanding of the burden of Hib meningitis, specifically in developing countries where disabled children remain incapacitated because of lack of resources and facilities. The evidence generated from this study is expected to provide a compelling argument in favor of introduction and continuation of Hib conjugate vaccine in the national immunization program for children.

To identify predictors of seizure control in newly presenting children with epilepsy in countries with limited resources.Three hundred and ninety children (273 males, 117 females) aged 2 months to 15 years with newly diagnosed epilepsy were enrolled prospectively at first visit to the multidisciplinary clinic at the children's hospital in Dhaka, Bangladesh. Data about seizures, motor disability, psychomotor development, and electroencephalography were obtained. Regular monitoring of antiepileptic drug treatment was continued at least for one year. Associations between seizure control and potential predictors were determined by multivariate analysis.Three hundred and ninety children were enrolled in 6 months, of whom over 60% were from low-income families, 60% had onset at under 1 year, 74% had more than one seizure per week, 69% a single-seizure type, and 38% a history of delayed onset of breathing at birth. Cognitive deficits (IQ70; 58%) and/or motor (significant limitation of daily living activities; 47%) deficits were common. After 1 year of regular treatment, seizure control was good (seizure freedom) in 53%, and poor (at least one seizure in the last 3mo of follow-up) in 47%. The predictors of poor seizure control were an IQ70, associated motor disability, multiple seizure types, and a history of cognitive regression (1.9 times more likely to have poor seizure control).Seizure control can be predicted using three clinical factors (motor disability, cognitive impairment, and multiple seizure types) at the first clinic visit. Such predictors assist the development of referral plans and management guidelines for childhood epilepsies in resource-poor countries.

An international study to validate the Ten Questions screen for serious childhood disability was undertaken in communities in Bangladesh, Jamaica, and Pakistan, where community workers screened more than 22,000 children ages 2-9 years. All children who screened positive, as well as random samples of those who screened negative, were referred for clinical evaluations. Applying comparable diagnostic criteria, the sensitivity of the screen for serious cognitive, motor, and seizure disabilities is acceptable (80-100%) in all three populations, whereas the positive predictive values range from 3 to 15%. These results confirm the usefulness of the Ten Questions as a low-cost and rapid screen for these disabilities, although not for vision and hearing disabilities, in populations where few affected children have previously been identified and treated. They also show that the value of the Ten Questions for identifying disability in underserved populations is limited to that of a screen; more thorough evaluations of children screened positive are necessary to distinguish true- from false-positive results and to identify the nature of the disability if present.

Summary. Although numerous estimates of the prevalence of seizure disorders in populations in the less developed world have now been published, these estimates are difficult to interpret due to lack of comparability of study methods and criteria for case definition. The results reported in this paper are from a large, collaborative study of disabilities in 2- to 9-year-old children in which standard research procedures and case definitions were used in three diverse populations (located in Bangladesh, Jamaica and Pakistan). A two-phase study design (screening followed by professional evaluations) was used in this study allowing for the professional evaluation to serve as the criterion in the estimation of prevalence, even for rare disorders. As a result, the prevalence estimates reported here have a high degree of comparability across populations and exhibit unusually strong validity for population surveys. Febrile seizures were the most common type of seizure history in all three populations, with point estimates of lifetime prevalence ranging from 10.9 to 62.8 per 1000. The lifetime prevalence rates of epilepsy (recurrent unprovoked seizures) ranged from 5.8 to 15.5 per 1000. Lifetime prevalence rates of neonatal, all provoked and all unprovoked seizures, as well as estimates of the prevalence of active epilepsy, are also reported.

Objective: To determine the prevalence of child behaviour problems reported by parents in rural Bangladesh. Methods: A total of 4003 children aged 2-9 years were identified during a population-based survey of 2231 households. A predetermined sample of 499 was selected, of which health professionals saw 453 (90.8%) for structured physical and neurological examination, standardized testing of cognition and adaptive behaviour and parent report of developmental history and behaviour problems. Results: The prevalence of behaviour impairments was 14.6% (95% CI 11.4, 17.9). The majority involved somatic complaints, including nocturnal enuresis and pica. Problems such as aggression or restlessness were infrequently reported. Behaviour impairments were significantly associated with malnutrition (prevalence ratio 2.1, 95% CI 1.2, 3.6, p < 0.01) and cognitive, motor or seizure disabilities (prevalence ratio 1.8, 95% CI 1.1, 2.9, p < 0.05). Conclusions: The prevalence and nature of reported behaviour impairments in rural Bangladesh have implications for public health planning and delivery of health services.

Background The aim of this paper was to ascertain stress experienced by mothers of prospectively followed up preterm infants, and associations with family, child and maternal factors and children's neuro-development. Methods Within a follow-up study of preterm infants

OBJECTIVES. The purpose of this work was to determine neurodevelopmental outcomes of preterm infants followed by a multidisciplinary team in a tertiary hospital in Bangladesh. METHODS. Infants RESULTS. Of the 159 enrolled children, 65% survived, 16% died, and 19% were lost to follow-up. Family income was lowest among those who died, and maternal and paternal literacy was highest among the survivors. At a mean age of 31 months, developmental status of the 85 children followed-up for ≥12 months was normal in 32%; 45% had mild and 23% had serious neurodevelopmental impairments. Cognitive impairment was the most common deficit (60%). Final outcome was significantly better than estimated initially. Most serious (85%) but fewer mild (37%) problems were identified independently by both child health physicians and psychologists. CONCLUSIONS. Parental education and family income had significant influence on postdischarge mortality. Two thirds of infants demonstrated neurodevelopmental impairments. Most mild cognitive impairments would have been missed had either physicians or psychologists alone done the assessments. Preterm infants in this low-resource setting are at high risk for neurodevelopmental impairments, which need to be identified early, preferably by a multidisciplinary team of professionals.

Very little is known about childhood epilepsies in Bangladesh. This study was conducted within a national children's hospital in Dhaka city to provide baseline information on diagnosis and clinical outcomes of 151 children (98 males, 53 females, age range between 2 months to 15 years, median age of 3 years). Participants who presented with recurrent unprovoked seizures were followed up in an epilepsy clinic for at least 1 year. Of presenting families, 68.3% were from middle-income and lower-income groups. A history of perinatal asphyxia and neonatal seizures was present in 46.4% and 41.1% of participants respectively. Generalized, partial, and unclassifiable epilepsy were found in 63.6%, 25.2%, and 11.2% respectively. Severe outcome (malignant) epilepsy syndromes were diagnosed in 14.6%. Symptomatic epilepsy was found in 61%. Poor cognitive development was present in 72.8% and poor adaptive behaviour in 57%. Poor seizure remission occurred in 50.3%. Factors most predictive of poor seizure remission were: multiple types of seizures, poor cognition at presentation, high rates of seizures, associated motor disability, and EEG abnormalities. The study suggests that most children presenting at tertiary hospitals for seizure disorders come late and with associated neurodevelopmental morbidities. Specialized services are needed closer to their homes. The process for establishing early referral and comprehensive management of childhood epilepsies in Bangladesh requires further study.

To validate a rapid neurodevelopmental assessment tool for use by child care professionals to determine neurodevelopmental impairments (NDIs) in children ages 5-9 years (61-108 months) in Bangladesh.In a convenience sample of community children (n = 18), interrater reliability was determined between 6 testers. Validity was determined in 121 children by simultaneous administration of a test of adaptive behavior (AB) (ie, the Independent Behavior Assessment Scale, or Gold Standard I) and IQ tests (Wechsler Preschool and Primary Scales of Intelligence or the Wechsler Intelligence Scales for Children, or Gold Standard II) by child psychologists.Interrater reliability was excellent (kappa = 1.00). Significantly lower scores were obtained on AB and IQ tests in those identified with "any (≥1) NDI" and most specific NDIs. Sensitivity and specificity for "any NDI" with (a) "significant difficulties" (defined as AB z-scores-2 SD and/or IQ70) or (b) "mild difficulties included" (AB z scores-1 SD and/or IQ85) were 84% and 57%; and 83% and 70%, respectively.The rapid neurodevelopmental assessment tool shows promise as a tool for use by a range of professionals for identifying NDIs in children of primary school age. Further refinement for identifying specific impairments is needed.