Open AccessThe burden of neurological impairments and disability in older children measured in disability-adjusted life-years in rural Kenya
Author(s) -
Jonathan A. Abuga,
Symon M. Kariuki,
Amina Abubakar,
Samson Kinyanjui,
Michaël Boele van Hensbroek,
Charles R. Newton
Publication year - 2022
Publication title -
plos global public health
Language(s) - English
Resource type - Journals
ISSN - 2767-3375
DOI - 10.1371/journal.pgph.0000151
Subject(s) - medicine , years of potential life lost , quality adjusted life year , life expectancy , disability adjusted life year , burden of disease , visual impairment , demography , disease burden , gerontology , quality of life (healthcare) , pediatrics , cost effectiveness , population , environmental health , psychiatry , risk analysis (engineering) , nursing , sociology
Neurological impairment (NI) and disability are common in sub-Saharan Africa (SSA), but the overall burden in terms of morbidity and mortality in older children remains unknown. We estimated the burden of NI in disability-adjusted life years (DALYs), years of life lost to premature mortality (YLLs), and years lived with disability (YLDs) for older children in a defined rural setting in Kenya. We used empirical and literature estimates to model the overall burden for children aged 5–14 years in five domains: epilepsy (lifetime and active) and moderate/severe cognitive, hearing, motor, and visual impairments. We obtained internally consistent estimates of prevalence, mortality, and transitional hazards using DisMod II software. Disability weights and life expectancy estimates were based on the global burden of disease (GBD) studies. We used the most plausible parameters to calculate YLLs, YLDs, and DALYs and their bootstrapped 95% uncertainty intervals (95%UI) for the defined area. NI in the five domains resulted in a total of 4587 (95%UI 4459–4715) absolute DALYs or 53 (95%UI 39–67) DALYs per 1000 children aged 5–14 years, of which 83% were YLLs and 17% YLDs. Girls had significantly more YLLs and DALYs than boys (p-values <0.001, respectively). Besides being the leading cause of fatal and non-fatal outcomes, epilepsy accounted for the greatest proportion of the total burden for a single domain (20 DALYs per 1000, 95%UI 11–26, or 38.5% of the total DALYs). Visual impairment accounted for the least proportion of the total burden (6 per 1000, 95%UI 1–17, or 12.1%). Children with NI and disability bear a significantly high burden of fatal and non-fatal outcomes. The burden is highest among girls and those with childhood-onset epilepsy. We recommend active identification, treatment, and rehabilitative support for the affected children to prevent premature mortality and improve their quality of life.