{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:07:13Z","timestamp":1792094833642,"version":"4.4.0"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention-deficit\/hyperactivity disorder (ADHD), and intellectual disability contribute to one-tenth of the global burden of mental and neurologic disorders. The burden of NDDs is not well documented in Africa.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the prevalence, risk factors, and comorbidities of NDDs in young Kenyan children.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study was conducted among children aged 6 to 9 years residing in the Kilifi Health and Demographic Surveillance System in Kenya. In stage I of the study, children were screened for NDDs from March 16, 2015, to September 14, 2016; those with a positive screening result and a randomly selected proportion of those with a negative screening result were invited to undergo clinical evaluation to confirm the diagnosis (stage II).<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Adverse perinatal events, medical and family history, and socioeconomic status.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Prevalence of NDDs was estimated, and risk factors and medical comorbidities associated with NDDs were assessed using generalized linear models and link functions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 11\u202f223 children screened in stage I, 5646 (50.3%) were males, and mean (SD) age was 7.6 (0.96) years. A total of 522 children had an NDD confirmed in stage II, with an overall adjusted prevalence of 9.1% (90.8 [95% CI, 83.4-98.6] cases per 1000 children), which differed by sex (237 of 5577 females [4.2%] vs 285 of 5646 males [5.0%];\n P<\/jats:italic>\n \u2009=\u2009.045). The NDDs with the highest prevalence were ADHD (50.8 [95% CI, 45.2-57.1] cases per 1000 children) and cognitive impairment (27.1 [95% CI, 22.9-31.9] cases per 1000 children); ASD was also common (15.6 [95% CI, 12.6-19.1] cases per 1000 children). Co-occurrence of NDDs was reported in 118 children (22.6%; 95% CI, 19.2%-26.5%). Key factors associated with occurrence or onset of NDDs included adverse perinatal events (adjusted risk ratio [ARR], 1.64; 95% CI, 1.29-2.09), febrile infections (ARR, 1.28; 95% CI, 1.05-1.56), eating soil (ARR, 1.45; 95% CI, 1.13-1.85), snoring (ARR, 1.50; 95% CI, 1.27-1.76), and being landless (ARR, 1.32; 95% CI, 1.12-1.56). Head injuries were unique to developmental conditions and febrile infections to neurologic conditions, with many risk factors shared. Common medical comorbidities for NDDs after adjusting for attrition and screening specificity included motor neuron dysfunction (ARR, 2.79; 95% CI, 2.18-3.56) and malnutrition (ARR, 1.80; 95% CI, 1.37-2.39).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n NDDs were common in school-aged children in this rural area of Kenya, and the findings suggest their occurrence was associated with preventable environmental risk factors. These disorders and associated comorbidities should be identified and addressed in children in Africa.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.48853","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T16:30:28Z","timestamp":1765557028000},"page":"e2548853","source":"Crossref","is-referenced-by-count":2,"title":["Burden of Neurodevelopmental Disorders in Kenyan Children"],"prefix":"10.1001","volume":"8","author":[{"given":"Symon M.","family":"Kariuki","sequence":"first","affiliation":[{"name":"Neuroscience Unit, Kenya Medical Research Institute (KEMRI)\u2013Wellcome Trust Research Programme, Kilifi, Kenya"},{"name":"Department of Public Health, Pwani University, Kilifi, Kenya"},{"name":"African Population and Health Research Center, Nairobi, Kenya"},{"name":"Department of Psychiatry, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Kipkemoi","sequence":"additional","affiliation":[{"name":"Neuroscience Unit, Kenya Medical Research Institute (KEMRI)\u2013Wellcome Trust Research Programme, Kilifi, Kenya"},{"name":"Institute for Human Development, Aga Khan University, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha Z.","family":"Kombe","sequence":"additional","affiliation":[{"name":"Neuroscience Unit, Kenya Medical Research Institute (KEMRI)\u2013Wellcome Trust Research Programme, Kilifi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary A.","family":"Bitta","sequence":"additional","affiliation":[{"name":"Neuroscience Unit, Kenya Medical Research Institute (KEMRI)\u2013Wellcome Trust Research Programme, Kilifi, Kenya"},{"name":"Department of Psychiatry, University of Oxford, Oxford, United Kingdom"},{"name":"Brain and Mind Institute, Aga Khan University, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline Phillips","family":"Owen","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, United Kingdom"},{"name":"South London and the Maudsley NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amina","family":"Abubakar","sequence":"additional","affiliation":[{"name":"Neuroscience Unit, Kenya Medical Research Institute (KEMRI)\u2013Wellcome Trust Research Programme, Kilifi, Kenya"},{"name":"Department of Public Health, Pwani University, Kilifi, Kenya"},{"name":"Department of Psychiatry, University of Oxford, Oxford, United Kingdom"},{"name":"Institute for Human Development, Aga Khan University, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles R. J. C.","family":"Newton","sequence":"additional","affiliation":[{"name":"Neuroscience Unit, Kenya Medical Research Institute (KEMRI)\u2013Wellcome Trust Research Programme, Kilifi, Kenya"},{"name":"Department of Public Health, Pwani University, Kilifi, Kenya"},{"name":"African Population and Health Research Center, Nairobi, Kenya"},{"name":"Department of Psychiatry, University of Oxford, Oxford, United Kingdom"},{"name":"Institute for Human Development, Aga Khan University, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"issue":"9859","key":"zoi251311r1","doi-asserted-by":"publisher","first-page":"2197","DOI":"10.1016\/S0140-6736(12)61689-4","article-title":"Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.","volume":"380","author":"Murray","year":"2012","journal-title":"Lancet"},{"key":"zoi251311r2","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/1743-0003-6-4","article-title":"Plasticity in neurological disorders and challenges for noninvasive brain stimulation (NBS).","volume":"6","author":"Thickbroom","year":"2009","journal-title":"J Neuroeng Rehabil"},{"issue":"7354","key":"zoi251311r3","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1038\/475027a","article-title":"Grand challenges in global mental health.","volume":"475","author":"Collins","year":"2011","journal-title":"Nature"},{"issue":"12","key":"zoi251311r4","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1111\/j.1469-8749.2012.04384.x","article-title":"Neurodevelopmental disorders in low- and middle-income countries.","volume":"54","author":"Newton","year":"2012","journal-title":"Dev Med Child Neurol"},{"issue":"3","key":"zoi251311r5","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1111\/j.1365-2214.2011.01347.x","article-title":"Parenting children with neurodevelopmental disorders and\/or behaviour problems.","volume":"39","author":"Garner","year":"2013","journal-title":"Child Care Health Dev"},{"key":"zoi251311r6","doi-asserted-by":"publisher","first-page":"121","DOI":"10.12688\/wellcomeopenres.13540.1","article-title":"Burden of neurodevelopmental disorders in low and middle-income countries: a systematic review and meta-analysis.","volume":"2","author":"Bitta","year":"2017","journal-title":"Wellcome Open Res"},{"issue":"7","key":"zoi251311r7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002615","article-title":"Neurodevelopmental disorders in children aged 2-9 years: population-based burden estimates across five regions in India.","volume":"15","author":"Arora","year":"2018","journal-title":"PLoS Med"},{"issue":"10","key":"zoi251311r8","doi-asserted-by":"publisher","first-page":"e1100","DOI":"10.1016\/S2214-109X(18)30309-7","article-title":"Developmental disabilities among children younger than 5 years in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.","volume":"6","author":"Olusanya","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"2","key":"zoi251311r9","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/S2215-0366(16)30403-5","article-title":"Burden, risk factors, and comorbidities of behavioural and emotional problems in Kenyan children: a population-based study.","volume":"4","author":"Kariuki","year":"2017","journal-title":"Lancet Psychiatry"},{"key":"zoi251311r10","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2022.110642","article-title":"Investigating the \u201ctwo-hit hypothesis\u201d: effects of prenatal maternal immune activation and adolescent cannabis use on neurodevelopment in mice.","volume":"120","author":"Guma","year":"2023","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"issue":"1","key":"zoi251311r12","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12916-018-1021-y","article-title":"Prevalence, risk factors and behavioural and emotional comorbidity of acute seizures in young Kenyan children: a population-based study.","volume":"16","author":"Kariuki","year":"2018","journal-title":"BMC Med"},{"issue":"3","key":"zoi251311r13","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1093\/ije\/dyl023","article-title":"Prevalence and risk factors of neurological disability and impairment in children living in rural Kenya.","volume":"35","author":"Mung\u2019ala-Odera","year":"2006","journal-title":"Int J Epidemiol"},{"issue":"3","key":"zoi251311r14","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/S1474-4422(13)70003-6","article-title":"Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies.","volume":"12","author":"Ngugi","year":"2013","journal-title":"Lancet Neurol"},{"issue":"6","key":"zoi251311r15","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1177\/1073191112457408","article-title":"Neuropsychological testing in a rural African school-age population: evaluating contributions to variability in test performance.","volume":"20","author":"Kitsao-Wekulo","year":"2013","journal-title":"Assessment"},{"issue":"14","key":"zoi251311r16","doi-asserted-by":"publisher","first-page":"2064","DOI":"10.1177\/1087054717753064","article-title":"Evaluation of psychometric properties and factorial structure of ADHD module of K-SADS-PL in children from rural Kenya.","volume":"24","author":"Kariuki","year":"2020","journal-title":"J Atten Disord"},{"issue":"5","key":"zoi251311r17","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1016\/j.seizure.2007.11.028","article-title":"Prevalence, incidence and risk factors of epilepsy in older children in rural Kenya.","volume":"17","author":"Mung\u2019ala-Odera","year":"2008","journal-title":"Seizure"},{"issue":"5","key":"zoi251311r18","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1111\/j.1365-2214.2012.01393.x","article-title":"Validation of a home-based neurodevelopmental screening tool for under 2-year-old children in Bangladesh.","volume":"39","author":"Khan","year":"2013","journal-title":"Child Care Health Dev"},{"key":"zoi251311r19","doi-asserted-by":"publisher","first-page":"137","DOI":"10.12688\/wellcomeopenres.16765.1","article-title":"Validity and reliability of the Neurodevelopmental Screening Tool (NDST) in screening for neurodevelopmental disorders in children living in rural Kenyan coast.","volume":"6","author":"Bitta","year":"2021","journal-title":"Wellcome Open Res"},{"key":"zoi251311r20","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1234929","article-title":"Utility of the 3Di short version in the identification and diagnosis of autism in children at the Kenyan coast.","volume":"15","author":"Kipkemoi","year":"2024","journal-title":"Front Psychiatry"},{"key":"zoi251311r21","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2015.07.033","article-title":"Electroencephalographic features of convulsive epilepsy in Africa: a multicentre study of prevalence, pattern and associated factors.","author":"Kariuki","journal-title":"Clin Neurophysiol"},{"issue":"4-5","key":"zoi251311r22","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1080\/09297040500473714","article-title":"Use of the Mullen Scales of Early Learning for the assessment of young children with autism spectrum disorders.","volume":"12","author":"Akshoomoff","year":"2006","journal-title":"Child Neuropsychol"},{"key":"zoi251311r23","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1111\/j.1528-1167.2011.03121.x","article-title":"Standards for epidemiologic studies and surveillance of epilepsy.","volume":"52","author":"Thurman","year":"2011","journal-title":"Epilepsia"},{"issue":"4","key":"zoi251311r24","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1002\/epi4.12069","article-title":"Prevalence, risk factors, and neurobehavioral comorbidities of epilepsy in Kenyan children.","volume":"2","author":"Kind","year":"2017","journal-title":"Epilepsia Open"},{"issue":"3","key":"zoi251311r25","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/dmcn.15059","article-title":"Neurological impairment and disability in children in rural Kenya.","volume":"64","author":"Abuga","year":"2022","journal-title":"Dev Med Child Neurol"},{"key":"zoi251311r26","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1007\/s00787-008-1006-z","article-title":"How often are German children and adolescents diagnosed with ADHD? prevalence based on the judgment of health care professionals: results of the German Health and Examination Survey (KiGGS).","volume":"17","author":"Huss","year":"2008","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"6","key":"zoi251311r27","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1176\/ajp.2007.164.6.942","article-title":"The worldwide prevalence of ADHD: a systematic review and metaregression analysis.","volume":"164","author":"Polanczyk","year":"2007","journal-title":"Am J Psychiatry"},{"key":"zoi251311r28","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/1753580","article-title":"Attention deficit hyperactivity disorder (ADHD) among children aged 6 to 17 years old living in Girja District, rural Ethiopia.","volume":"2019","author":"Lola","year":"2019","journal-title":"Behav Neurol"},{"issue":"2","key":"zoi251311r29","first-page":"1","article-title":"Prevalence of autism spectrum disorder among children aged 8 years\u2014Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010.","volume":"63","author":"Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators","year":"2014","journal-title":"MMWR Surveill Summ"},{"issue":"1","key":"zoi251311r30","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s13073-015-0216-5","article-title":"An assessment of sex bias in neurodevelopmental disorders.","volume":"7","author":"Polyak","year":"2015","journal-title":"Genome Med"},{"issue":"2","key":"zoi251311r31","doi-asserted-by":"publisher","first-page":"64","DOI":"10.4269\/ajtmh.2004.71.64","article-title":"The burden of the neurocognitive impairment associated with Plasmodium falciparum malaria in sub-Saharan Africa.","volume":"71","author":"Mung\u2019Ala-Odera","year":"2004","journal-title":"Am J Trop Med Hyg"},{"issue":"10111","key":"zoi251311r32","doi-asserted-by":"publisher","first-page":"2503","DOI":"10.1016\/S0140-6736(17)31073-5","article-title":"Global hearing health care: new findings and perspectives.","volume":"390","author":"Wilson","year":"2017","journal-title":"Lancet"},{"issue":"12","key":"zoi251311r33","doi-asserted-by":"publisher","first-page":"e1221","DOI":"10.1016\/S2214-109X(17)30393-5","article-title":"Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis.","volume":"5","author":"Flaxman","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"6","key":"zoi251311r34","doi-asserted-by":"publisher","first-page":"e1586","DOI":"10.1542\/peds.2013-3787","article-title":"Neurobehavioral comorbidities in children with active epilepsy: a population-based study.","volume":"133","author":"Reilly","year":"2014","journal-title":"Pediatrics"},{"issue":"1","key":"zoi251311r35","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1002\/epi4.12035","article-title":"Prevalence, causes, and behavioral and emotional comorbidities of acute symptomatic seizures in Africa: a critical review.","volume":"2","author":"Kariuki","year":"2017","journal-title":"Epilepsia Open"},{"issue":"3","key":"zoi251311r36","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1177\/1088357613475810","article-title":"Auditory hypersensitivity in children with autism spectrum disorders.","volume":"28","author":"Lucker","year":"2013","journal-title":"Focus Autism Other Dev Disabl"},{"issue":"20","key":"zoi251311r37","doi-asserted-by":"publisher","first-page":"2232","DOI":"10.1001\/jama.297.20.2232","article-title":"Burden, features, and outcome of neurological involvement in acute falciparum malaria in Kenyan children.","volume":"297","author":"Idro","year":"2007","journal-title":"JAMA"},{"issue":"4","key":"zoi251311r38","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1136\/jnnp.2004.043893","article-title":"Persistent neurocognitive impairments associated with severe falciparum malaria in Kenyan children.","volume":"76","author":"Carter","year":"2005","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"4","key":"zoi251311r39","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/0041-0101(94)90298-4","article-title":"From soil to brain: zinc deficiency increases the neurotoxicity of Lathyrus sativus and may affect the susceptibility for the motorneurone disease neurolathyrism.","volume":"32","author":"Lambein","year":"1994","journal-title":"Toxicon"},{"key":"zoi251311r40","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102170","article-title":"Parental substance use disorder and risk of intellectual disability in offspring in Sweden: a national register study.","volume":"63","author":"Khemiri","year":"2023","journal-title":"EClinicalMedicine"},{"issue":"5","key":"zoi251311r41","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1038\/mp.2015.70","article-title":"Autism risk associated with parental age and with increasing difference in age between the parents.","volume":"21","author":"Sandin","year":"2016","journal-title":"Mol Psychiatry"},{"issue":"10","key":"zoi251311r42","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1177\/0009922817705187","article-title":"Typical skin injuries in children with autism spectrum disorder.","volume":"56","author":"Slingsby","year":"2017","journal-title":"Clin Pediatr (Phila)"},{"issue":"6","key":"zoi251311r43","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1111\/j.1469-7610.2005.01546.x","article-title":"Sensory Experiences Questionnaire: discriminating sensory features in young children with autism, developmental delays, and typical development.","volume":"47","author":"Baranek","year":"2006","journal-title":"J Child Psychol Psychiatry"},{"issue":"1","key":"zoi251311r44","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s13229-023-00563-4","article-title":"Examining the latent structure and correlates of sensory reactivity in autism: a multi-site integrative data analysis by the autism sensory research consortium.","volume":"14","author":"Williams","year":"2023","journal-title":"Mol Autism"},{"issue":"1","key":"zoi251311r45","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1111\/epi.12392","article-title":"Clinical features, proximate causes, and consequences of active convulsive epilepsy in Africa.","volume":"55","author":"Kariuki","year":"2014","journal-title":"Epilepsia"},{"issue":"1","key":"zoi251311r46","doi-asserted-by":"publisher","DOI":"10.1088\/1748-9326\/aa94fe","article-title":"Urbanization in Africa: challenges and opportunities for conservation.","volume":"13","author":"G\u00fcneralp","year":"2017","journal-title":"Environ Res Lett"},{"key":"zoi251311r11","unstructured":"UNICEF. Committing to child survival: a promise renewed. September 8, 2015. Accessed November 4, 2025. https:\/\/data.unicef.org\/resources\/committing-to-child-survival-a-promise-renewed-2015\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2842686\/kariuki_2025_oi_251311_1764969745.23141.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T16:30:29Z","timestamp":1765557029000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2842686"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,12]]},"references-count":46,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.48853","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,12]]}}}