Prevalence and risk factors, premature mortality, and healthcare access by school-aged children with neurological impairments and disability in rural Kenya

The prevalence of neurological impairments (NI) and disability may have been changing over the past three decades, but the overall burden and rehabilitation for older children are unknown in resource-scarce countries. Using data from epidemiolocal studies conducted between 2000 and 2020, I investigated changes over time in the prevalence and risk factors, premature mortality, and healthcare for older children with NI in a defined rural area along the Kenyan coast. I used empirical and literature estimates to model disability-adjusted life-years (DALYs) for the ages 5-14 years. The overall prevalence decreased from 61 per 1000 (95% confidence interval [CI] 48.0-74.0 in 2001 to 44.7 per 1000 (95%CI 40.9-48.6) in 2015 (p<0.001). Associations between NI and some risk factors changed significantly over time. The rate of premature mortality was higher among NI cases (standardised mortality ratio 3.15, 95%CI 1.66-5.49). While developmental delay and malnutrition increased the risk of mortality, infections and accidents were common among decedents. Health education, rehabilitative exercises and assistive technology were the most common interventions in three rehabilitation clinics. NI in the five domains resulted in 53 (95%UI 39-67) DALYs per 1000 children, of which 83% were years of life lost prematurely. Girls had significantly more YLLs (p<0.001) and DALYs (p<0.001) than boys. Children with NI bear a significantly high burden of fatal and non-fatal outcomes. There is a need for active identification, treatment, and tailored comprehensive rehabilitative support for the affected children to prevent premature mortality and improve the quality of life and other outcomes.