Behavioural and emotional comorbidities in school-aged children with neurological conditions in Kilifi, Kenya, and their long-term consequences

Figures & data

Table 1. Association of neurological conditions with total behavioural and emotional problems

Neurological conditions	Adjusted OR (95% CI)	P-value	Adjusted β coefficient (95% CI)	P-value
Cognitive impairment	2.39 (1.59–3.59)	<0.001	1.28 (0.19, 2.37)	0.021
Visual impairment	1.13 (0.24–5.27)	0.877	−0.05 (−3.51, 3.42)	0.980
Hearing impairment	2.07 (1.12–3.83)	0.020	0.39 (−1.22, 2.02)	0.631
Motor impairment	3.17 (1.72–5.82)	<0.001	2.11 (0.31, 3.91)	0.022
Epilepsy	4.18 (2.69–6.48)	<0.001	1.62 (0.33, 2.92)	0.014
Any neurological condition	2.20 (1.59–3.04)	<0.001	0.85 (0.06, 1.64)	0.030

Table 2. Association of neurological conditions with internalizing and externalizing problems

Neurological conditions	Internalizing problems		Externalizing problems
	Adjusted OR (95% CI)	Adjusted β coefficient (95% CI)	Adjusted OR (95% CI)	Adjusted β coefficient (95% CI)
Cognitive impairment	1.58* (1.05–2.38)	0.45** (0.26, 0.65)	2.16** (1.48–3.14)	0.25 (−0.78, 1.28)
Visual impairment	0.89 (0.19–4.00)	−0.26 (−0.85, 0.33)	1.32 (0.36–4.85)	−0.19 (−3.52, 3.13)
Hearing impairment	2.14** (1.23–3.73)	0.28* (−0.01, 0.56)	1.35 (0.74–2.46)	−0.13 (−1.67, 1.41)
Motor impairment	2.87** (1.59–5.15)	0.68** (0.35, 1.01)	2.23** (1.23–4.03)	0.66 (−1.04, 2.37)
Epilepsy	2.75** (1.78–4.24)	0.72** (0.48, 0.95)	3.43** (2.26–5.20)	0.42 (−0.81, 1.65)
Any neurological condition	1.68** (1.23–2.30)	0.39** (0.24, 0.55)	1.79** (1.33–2.42)	0.07 (−0.67, 0.81)

*p-value<0.05; **p-value<0.01

Table 3. Risk factors for total behavioural and emotional problems and scores

Risk factors	Binary total behavioural and emotional problems		Continuous total behavioural and emotional scores
	OR (95% CI)	P-value	β coefficient (95% CI)	P-value
Sociodemographic factors
Younger age (6–7 years)	1.79 (1.34–2.39)	<0.001	0.49 (−0.09, 1.08)	0.101
Older age (8–9 years)	0.56 (0.42–0.74)	<0.001	−0.49 (−1.08, 0.09)	0.101
Male	1.69 (1.28–2.24)	<0.001	0.14 (−0.45, 0.73)	0.641
Number of children in the family	0.99 (0.94–1.05)	0.912	0.13 (0.01, 0.25)	0.043
Poor nutritional status	0.76 (0.41–1.42)	0.393	−0.01 (−1.23, 1.22)	0.996
Child not schooling	1.37 (1.05–1.80)	0.02	0.93 (0.34, 1.52)	0.002
Father’s lack of economic activity	1.16 (0.84–1.59)	0.375	−0.01 (−0.79, 0.79)	0.991
Mother’s lack of economic activity	1.15 (0.85–1.55)	0.360	0.18 (−0.48, 0.84)	0.599
Single maternal marital status	0.79 (0.55–1.14)	0.210	−0.45 (−1.22, 0.31)	0.246
No maternal education	0.67 (0.50–0.89)	0.005	0.04 (−0.59, 0.68)	0.898
Perinatal factors
Home delivery	0.75 (0.53–1.07)	0.112	−0.28 (−1.07, 0.52)	0.497
Birth difficulty	1.54 (0.97–2.45)	0.068	0.52 (−0.60, 1.65)	0.361
Post-natal factors
Neonatal insults	0.87 (0.29–2.54)	0.799	0.36 (−1.12, 1.85)	0.631
Child not immunized	0.86 (0.45–1.64)	0.645	−0.44 (−2.25, 1.36)	0.630
Neonatal jaundice	2.52 (1.66–3.81)	<0.001	2.01 (0.91, 3.10)	<0.001
Neurological deficit	3.38 (2.13–5.36)	<0.001	2.12 (1.38, 2.87)	<0.001
Developmental problems	1.98 (1.40–2.78)	<0.001	0.76 (−0.09, 1.61)	0.079
Neurological conditions
Cognitive impairments	2.42 (1.64–3.57)	<0.001	1.29 (0.27, 2.33)	0.013
Hearing impairments	1.66 (0.92–3.00)	0.092	0.23 (−1.27, 1.73)	0.768
Visual impairments	0.89 (0.20–4.01)	0.889	−0.24 (−3.39, 2.91)	0.881
Motor impairments	3.11 (1.73–5.58)	<0.001	2.09 (0.42, 3.78)	0.014
Epilepsy	3.88 (2.55–5.90)	<0.001	1.58 (0.38, 2.78)	0.010

Table 4. Risk factors for total internalizing and externalizing problems and scores

Risk factors	Internalizing problems and scores		Externalizing problems and scores
	Univariable OR (95% CI)	Univariable β coefficient (95% CI)	Univariable OR (95% CI)	Univariable β coefficient (95% CI)
Sociodemographic factors
Younger age (6–7 years)	1.51** (1.15–1.97)	0.17** (0.05, 0.29)	1.43** (1.12–1.84)	−0.09 (−0.64, 0.46)
Older age (8–9 years)	0.66**(0.51–0.87)	−0.17** (−0.29, -0.05)	0.69** 0.54–0.89	0.09 (−0.46, 0.64)
Male	1.14 (0.88–1.49)	0.04 (−0.08, 0.16)	1.53** (1.19–1.95)	−0.06 (−0.60, 0.48)
Number of children born to the family	1.03 (0.98–1.09)	0.02 (−0.01, 0.05)	1.01 (0.96–1.06)	0.09 (−0.02, 0.21)
Poor nutritional status	0.88 (0.49–1.55)	0.09 (−0.16, 0.34)	0.84 (0.49–1.43)	−0.22 (−1.35, 0.91)
Father’s lack of economic activity	1.06 (0.78–1.45)	0.12 (−0.04, 0.27)	1.11 (0.83–1.48)	−0.26 (−1.01, 0.48)
Mother’s lack of economic activity	1.19 (0.89–1.59)	0.08 (−0.05, 0.21)	1.18 (0.90–1.54)	0.08 (−0.54, 0.69)
Single maternal marital status	0.98 (0.70–1.36)	−0.07 (−0.22, 0.09)	0.75 (0.54–1.03)	−0.33 (−1.04, 0.38)
No maternal education	0.73* (0.56–0.95)	−0.07 (−0.20, 0.05)	0.64** (0.49–0.82)	−0.07 (−0.67, 0.51)
Perinatal factors
Home delivery	0.85 (0.60–1.19)	−0.07 (−0.23, 0.10)	0.79 (0.57–1.08)	−0.29 (−1.03, 0.45)
Birth difficulty	1.74** (1.13–2.69)	0.43** (0.19, 0.66)	1.25 (0.81–1.94)	−0.13 (−1.17, 0.92)
Post-natal factors
Neonatal insults	0.78 (0.27–2.28)	−0.23 (−0.89, 0.44)	1.21 (0.45–3.21)	0.37 (−0.18, 0.92)
Child not immunized	1.09 (0.62–1.92)	0.01 (−0.25, 0.27)	0.64 (0.35–1.15)	−0.64 (−2.39, 1.11)
Neonatal jaundice	1.65* (1.07–2.55)	0.41** (0.18, 0.63)	2.67** (1.82–3.92)	1.09* (0.07, 2.11)
Neurological deficit	2.76** (1.74–4.38)	0.79** (0.52, 1.05)	2.47** (1.57–3.87)	0.78** (0.22, 1.33)
Developmental problems	1.53** (1.09–2.14)	0.32** (0.15, 0.49)	1.87** (1.36–2.56)	0.10 (−0.69, 0.89)
Neurological conditions
Cognitive impairment	1.58* (1.06–2.36)	0.45** (0.26, 0.65)	2.19** (1.52–3.15)	0.23 (−0.74, 1.19)
Hearing impairment	1.92* (1.11–3.32)	0.20 (−0.09, 0.49)	1.17 (0.65–2.09)	−0.15 (−1.55, 1.24)
Visual impairment	0.77 (0.17–3.42)	−0.35 (−0.97, 0.28)	1.06 (0.29–3.79)	−0.22 (−3.17, 2.2)
Motor impairment	2.86** (1.61–5.09)	0.68** (0.35, 1.01)	2.21** (1.24–3.95)	0.65 (−0.92, 2.22)
Epilepsy	2.68** (1.75–4.09)	0.69** (0.46, 0.93)	3.32** (2.21–4.97)	0.42 (−0.71, 1.54)

*p-value<0.05; **p-value<0.01

Table 5. Age and sex adjusted analysis of long-term impact of neurological conditions and mental health problems

Predictors of outcome	Occupation Adjusted OR (95% CI)	Schooling Adjusted OR (95% CI)	Access to modern source of lighting Adjusted OR (95% CI)	Assets; working mobile phone or radio Adjusted OR (95% CI)
Neurological conditions
Cognitive impairment	1.20 (0.40–3.58)	1.25** (0.14–1.46)	0.39* (0.17–0.92)	1.63 (0.79–3.36)
Epilepsy	1.78 (1.59–5.36)	1.40 (0.53–3.69)	1.71 (0.89–3.31)	2.78* (0.99–7.85)
Hearing impairment	1.46 (0.33–6.53)	1.42* (0.18–1.99)	0.53 (0.16–1.77)	0.79 (0.34–1.86)
Visual impairment	-	0.22 (0.03–1.49)	-	1.03 (0.12–8.88)
Motor impairment	0.71 (0.09–5.59)	0.45 (0.16–1.23)	0.70 (0.21–2.38)	1.61 (0.48–5.44)
Mental health problems
Total behaviour and emotional problems	2.44* (1.09–5.44)	1.56* (1.32–1.98)	1.26 (0.77–2.07)	1.29 (0.76–2.22)
Internalizing problems	0.99 (0.41–2.45)	0.83 (0.48–1.43)	1.27 (0.80–2.02)	1.71* (1.00–2.95)
Externalizing problems	1.85 (0.91–3.76)	1.57* (1.35–1.90)	1.73** (1.15–2.62)	1.11 (0.71–1.72)

*p-value<0.05; **p-value<0.01