{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T20:37:16Z","timestamp":1770842236683,"version":"3.50.1"},"reference-count":33,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2017,6,17]]},"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Improving newborn health remains a global health priority. Little however is known about the neurodevelopmental consequences for survivors of complications in pregnancy, labour and the neonatal period in in low-income countries outside of small selective and typically urban facility studies. We ask which antenatal, birth and neonatal factors are associated with disability in childhood in a large community birth cohort from rural Nepal.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>6436 infants were recruited during a cluster randomised control trial (RCT) of participatory women's groups (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"31137309\">ISRCTN31137309<\/jats:ext-link>), of whom 6075 survived beyond 28 days. At mean age of 11\u22195 years (range 9.5\u201313.1), 4219 children (27% lost to follow-up) were available for disability screening which was conducted by face-to-face interview using the Module on Child Functioning and Disability produced by the Washington Group\/UNICEF. Hypothesised risk factors for disability underwent multivariable regression modelling.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>Overall prevalence of disability was 7.4%. Maternal underweight (OR 1.44 (95% CI 1.01\u20132.08)), maternal cohabitation under 16 years of age (OR 1.50 (1.13\u20132.00)), standardised infant weight at 1\u2009month (OR 0.82 (0.71\u20130.95)) and reported infant diarrhoea and vomiting in the first month (OR 2.48 (1.58\u20133.89)) were significantly associated with disability adjusted for trial allocation. The majority of hypothesised risk factors, including prematurity, were not significant.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>Proxies for early marriage and low birth weight and a measure of maternal undernutrition were associated with increased odds of disability. The lack of association of most other recognised risk factors for adverse outcome and disability may be due to survival bias.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2017-000312","type":"journal-article","created":{"date-parts":[[2017,8,29]],"date-time":"2017-08-29T15:36:02Z","timestamp":1504020962000},"page":"e000312","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Prenatal and perinatal risk factors for disability in a rural Nepali birth cohort"],"prefix":"10.1136","volume":"2","clinical-trial-number":[{"clinical-trial-number":"isrctn31137309","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2191-8166","authenticated-orcid":false,"given":"Edward J N","family":"Haworth","sequence":"first","affiliation":[{"name":"Great Ormond Street UCL Institute for Child Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirti M","family":"Tumbahangphe","sequence":"additional","affiliation":[{"name":"Mother and Infant Research Activities, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Costello","sequence":"additional","affiliation":[{"name":"Department of Maternal, Newborn, Child and Adolescent Health (MCA), World Health Organization, Geneva, Switzerland"},{"name":"UCL Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dharma","family":"Manandhar","sequence":"additional","affiliation":[{"name":"Mother and Infant Research Activities, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dhruba","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Mother and Infant Research Activities, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bharat","family":"Budhathoki","sequence":"additional","affiliation":[{"name":"Mother and Infant Research Activities, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dej Krishna","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Mother and Infant Research Activities, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khadka","family":"Sagar","sequence":"additional","affiliation":[{"name":"Mother and Infant Research Activities, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Heys","sequence":"additional","affiliation":[{"name":"Great Ormond Street UCL Institute for Child Health, University College London, London, UK"},{"name":"UCL Institute for Global Health, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,8,6]]},"reference":[{"key":"2025073014371098000_2.3.e000312.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60496-7"},{"key":"2025073014371098000_2.3.e000312.2","unstructured":"United Nations Division for Social Policy and Development. Disability Inclusive Sustainable Development Goals. 2015 http:\/\/www.un.org\/disabilities\/documents\/sdgs\/disability_inclusive_sdgs.pdf (accessed 01\/08\/2016)."},{"key":"2025073014371098000_2.3.e000312.3","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.3109\/09638288.2014.972589","article-title":"Disability and the post-2015 development agenda","volume":"37","author":"Tardi","year":"2015","journal-title":"Disabil Rehabil"},{"key":"2025073014371098000_2.3.e000312.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61689-4"},{"key":"2025073014371098000_2.3.e000312.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17021-9"},{"key":"2025073014371098000_2.3.e000312.6","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2013.203"},{"issue":"Suppl 1","key":"2025073014371098000_2.3.e000312.7","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1038\/pr.2013.206","article-title":"Intrapartum-related neonatal encephalopathy incidence and impairment at regional and global levels for 2010 with trends from 1990","volume":"74 Suppl 1","author":"Lee","year":"2013","journal-title":"Pediatr Res"},{"key":"2025073014371098000_2.3.e000312.8","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2013.207"},{"key":"2025073014371098000_2.3.e000312.9","unstructured":"Bank W , Nepal D . South Asia. http:\/\/data.worldbank.org\/?locations=NP-8S (Accessed 01\/08\/2016)."},{"key":"2025073014371098000_2.3.e000312.10","unstructured":"Washington Group on Disability Statistics & UNICEF. Module on Child Functioning and Disability 2014 https:\/\/www.cdc.gov\/nchs\/data\/washington_group\/meeting13\/wg13_unicef_child_disability_background.pdf (Accessed 01\/08\/2016)."},{"key":"2025073014371098000_2.3.e000312.11","unstructured":"Washington Group on Disability Statistics. Overview of Implementation Protocols for Testing the Washington Group Short Set of Questions on Disability Rationale for and development of the WG questions. 2006 https:\/\/www.cdc.gov\/nchs\/data\/washington_group\/meeting6\/main_implementation_protocol.pdf (Accessed 01\/08\/2016)."},{"key":"2025073014371098000_2.3.e000312.12","unstructured":"Bank W . Data for low income, lower middle income. http:\/\/data.worldbank.org\/?locations=XM-XN (Accessed 01\/05\/2017)."},{"key":"2025073014371098000_2.3.e000312.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61577-8"},{"key":"2025073014371098000_2.3.e000312.14","unstructured":"UNICEF. What Works for Children in South Asia. Newborn Care: An Overview 2004 https:\/\/www.unicef.org\/rosa\/Newborn.pdf (Accessed 01\/08\/2016)."},{"key":"2025073014371098000_2.3.e000312.15","unstructured":"World Health Organisation. Making pregnancy safer: the critical role of the skilled attendant (. 2004 http:\/\/www.who.int\/maternal_child_adolescent\/documents\/9241591692\/en\/ (Accessed 01\/08\/2016)."},{"key":"2025073014371098000_2.3.e000312.16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1093\/bmb\/ldm001","article-title":"Measuring socioeconomic position in health research","volume":"81-82","author":"Galobardes","year":"2007","journal-title":"Br Med Bull"},{"key":"2025073014371098000_2.3.e000312.17","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dys037"},{"key":"2025073014371098000_2.3.e000312.18","unstructured":"StataCorp. Stata Statistical Software: release 13. College Station, TX: StataCorp, 2013."},{"key":"2025073014371098000_2.3.e000312.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0306-5456(00)00021-8"},{"key":"2025073014371098000_2.3.e000312.20","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.nutr.17.1.19"},{"key":"2025073014371098000_2.3.e000312.21","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1093\/jn\/131.2.565S","article-title":"Iron-deficiency Anemia: reexamining the nature and magnitude of the public health problem","volume":"131","author":"Stoltzfus","year":"2001","journal-title":"J. Nutr"},{"key":"2025073014371098000_2.3.e000312.22","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.112.052332"},{"key":"2025073014371098000_2.3.e000312.23","doi-asserted-by":"crossref","first-page":"291S-297S","DOI":"10.1093\/ajcn\/72.1.291S","article-title":"Nutrition and obstructed labor","volume":"72","author":"Konje","year":"2000","journal-title":"Am J Clin Nutr"},{"key":"2025073014371098000_2.3.e000312.24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.worlddev.2012.05.024","article-title":"Disability and poverty in developing countries: a multidimensional study","volume":"41","author":"Mitra","year":"2013","journal-title":"World Dev"},{"key":"2025073014371098000_2.3.e000312.25","first-page":"97","article-title":"Can skilled attendance at delivery reduce maternal mortality in developing countries? Safe Mother","volume":"17","author":"Graham","year":"2001","journal-title":"Strateg. a Rev. Evid"},{"key":"2025073014371098000_2.3.e000312.26","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/1471-2431-14-58","article-title":"Associations between preterm birth, small-for-gestational age, and neonatal morbidity and cognitive function among school-age children in Nepal","volume":"14","author":"Christian","year":"2014","journal-title":"BMC Pediatr"},{"key":"2025073014371098000_2.3.e000312.27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2214.2011.01221.x"},{"key":"2025073014371098000_2.3.e000312.28","doi-asserted-by":"crossref","unstructured":"MacTaggart I , Cappa C , Kuper H . Field testing a draft version of the UNICEF\/Washington Group Module on child functioning and disability. Background, methodology and preliminary findings from Cameroon and India. Alter-European Journal of Disability Research 2016;0672.","DOI":"10.1016\/j.alter.2016.09.003"},{"key":"2025073014371098000_2.3.e000312.29","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1542\/peds.2007-0043B","article-title":"Childhood disability in low- and middle-income countries: overview of screening, prevention, services, legislation, and epidemiology","volume":"120 Suppl 1","author":"Maulik","year":"2007","journal-title":"Pediatrics"},{"key":"2025073014371098000_2.3.e000312.30","unstructured":"UNICEF. Cost of Inaction, Child and Adolescent Marriage in Nepal, 2012. http:\/\/unicef.org.np\/uploads\/files\/614784587893950542-final-working-paper-001.pdf. (Accessed 01\/08\/2016)."},{"key":"2025073014371098000_2.3.e000312.31","doi-asserted-by":"publisher","DOI":"10.1179\/2046905514Y.0000000158"},{"key":"2025073014371098000_2.3.e000312.32","doi-asserted-by":"crossref","unstructured":"Qar Z , et al . Maternal and Child Undernutrition 3 what works? interventions for maternal and child undernutrition and survival. 371: The Lancet, 2008.","DOI":"10.1016\/S0140-6736(07)61869-8"},{"key":"2025073014371098000_2.3.e000312.33","unstructured":"UNICEF. Child Mortality estimates Nepal. http:\/\/www.childmortality.org\/index.php?r=site\/graph#ID=NPL_Nepal (Accessed 01\/08\/2016)."}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2017-000312","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T21:37:19Z","timestamp":1753911439000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2017-000312"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2017,8,6]]},"published-print":{"date-parts":[[2017,8]]}},"alternative-id":["10.1136\/bmjgh-2017-000312"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2017-000312","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8]]}}}