This study aimed to identify the prevalence and associations of childhood psychiatric disorder in Calicut District, South India. Among 1403 children aged 8 to 12 years selected by random cluster sampling, a projected prevalence of 9.4% (95% CI 7.9-10.8%) was found. Associations of disorder with male sex, the Muslim religion, lower social class, less parental education, school failure, and impaired reading and vocabulary were found, but not with malnutrition or perinatal problems. The similarity to associations of disorder in Western studies was noted. The discussion focuses on the validity of comparisons of prevalence across cultures.
Background A pattern of major and minor congenital anomalies, facial dysmorphic features, and neurodevelopmental difficulties, including cognitive and social impairments has been reported in some children exposed to sodium valproate (VPA) during pregnancy. Recognition of the increased risks of in utero exposure to VPA for congenital malformations, and for the neurodevelopmental effects in particular, has taken many years but these are now acknowledged following the publication of the outcomes of several prospective studies and registries. As with other teratogens, exposure to VPA can have variable effects, ranging from a characteristic pattern of major malformations and significant intellectual disability to the other end of the continuum, characterised by facial dysmorphism which is often difficult to discern and a more moderate effect on neurodevelopment and general health. It has become clear that some individuals with FVSD have complex needs requiring multidisciplinary care but information regarding management is currently lacking in the medical literature. Methods An expert group was convened by ERN-ITHACA, the European Reference Network for Congenital Malformations and Intellectual Disability comprised of professionals involved in the care of individuals with FVSD and with patient representation. Review of published and unpublished literature concerning management of FVSD was undertaken and the level of evidence from these sources graded. Management recommendations were made based on strength of evidence and consensus expert opinion, in the setting of an expert consensus meeting. These were then refined using an iterative process and wider consultation. Results Whilst there was strong evidence regarding the increase in risk for major congenital malformations and neurodevelopmental difficulties there was a lack of high level evidence in other areas and in particular in terms of optimal clinical management.. The expert consensus approach facilitated the formulation of management recommendations, based on literature evidence and best practice. The outcome of the review and group discussions leads us to propose the term Fetal Valproate Spectrum Disorder (FVSD) as we feel this better encompasses the broad range of effects seen following VPA exposure in utero. Conclusion The expert consensus approach can be used to define the best available clinical guidance for the diagnosis and management of rare disorders such as FVSD. FVSD can have medical, developmental and neuropsychological impacts with life-long consequences and affected individuals benefit from the input of a number of different health professionals. Electronic supplementary material The online version of this article (10.1186/s13023-019-1064-y) contains supplementary material, which is available to authorized users.
The mental health of children in developing countries is important but underexplored. Methodological problems of prevalence studies in this ® eld include the use of case de® nitions and disability criteria developed in theWest and the assumption that dimensions of disorder and thresholds for reporting problems are similar to European and North American populations. School, clinic and population-based prevalence studies conducted in developing countries report a diversity of prevalence rates but the absence of methodological uniformity prevents useful comparisons. In addition to social, demographic and academic associations of child psychiatric disorder in developing countries, the relevance of malnutrition, tropical infections and adverse perinatal factors is reviewed.The implications of research ® ndings for service provision are discussed.
To determine the prevalence of epilepsy and its association with indices of malnutrition, infection and perinatal complications in children in Calicut District, Kerala, India, a door-to-door two-stage survey was conducted in two local government districts. Among the random sample of 1172 children aged 8-12 y, 26 conformed to the definition of epilepsy giving a 5-y period prevalence of 22.2/1000. A history of perinatal complications, low BMI and recent physical symptoms were independently associated with active epilepsy. The results suggest epilepsy is highly prevalent in this population of children and that further research is needed into its cause.
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