GLOBAL HEALTLH PRIORITIES AND THE PREVENTION OF NEURODEVELOPMENTAL DISABILITIES

Objective: Epidemiologic studies indicate severe neurodevelopmental disabilities are more prevalent in low income countries than in higher income countries, and may be increasing in prevalence with recent improvements in infant and child survival. Studies also suggest many of the risk factors for neurodevelopmental disabilities in low income countries are preventable, and proven interventions for the prevention and treatment of neurological disorders in children are not accessible to the majority of the world's children living in developing countries. The objectives of this study are to identify cost-effective interventions for neurodevelopmental disorders in low income countries and to identify specific gaps in information and research priorities.

Methods: A review of international epidemiologic data on the prevalence of and risk factors for developmental disabilities and cost-effectiveness and sensitivity analyses of selected interventions are presented.

Results: Evidence of cost effectiveness is ample for selected interventions, including folic acid fortification of food, prenatal screening and intervention for chromosomal anomalies, and newborn screening and intervention for congenital hypothyroidism in low income countries. We estimate, for example, that newborn screening and treatment for hypothyroidism in selected low income countries would result in cost savings of US$14 million per 100,000 live births. Information is currently insufficient for evaluating the cost effectiveness of other selected interventions, including prevention of premature birth and low birth weight, and rehabilitation services for children with developmental disabilities.

Conclusion: Expansion of interventions for the prevention and treatment of neurodevelopmental disabilities should be considered a global public health priority.

Keywords: Neurodevelopmental disabilities, global health, epidemiology, prevention, cost-effectiveness.