Counting Children With Disability in Low-Income Countries: Enhancing Prevention, Promoting Child Development, and Investing in Economic Well-being

There has been increased recognition that strategies to address women's and children's health require comprehensive approaches of reproductive, prenatal, neonatal, and both early- and middle-childhood public health and educational interventions.1–3 Several preventive themes have been highlighted, including prenatal nutrition, attendants at delivery, antiviral treatment for those with HIV, tetanus prophylaxis, breastfeeding during the first year, aggressive immunization campaigns, prevention of malnutrition and vitamin and trace-element deficiencies (folate, vitamin A, vitamin D, iron, zinc, iodine), oral rehydration, and community safety.4 The scope of this problem is daunting: 4 million of the 130 million infants born each year around the world die during the first 4 weeks of life.5 In addition, there are ∼6 million preventable child (<5 years old) deaths each year in developing countries.6 Major associations with these neonatal deaths include preterm birth, severe infections, and asphyxia, which in aggregate contribute to 80% of these deaths.5,7 The historic assumption has been that if one sequentially applies advances in preventive health, then the presence of child disability will be substantially reduced. In the preschool years, this has happened with reductions of motor disability from polio and cerebral palsy from iodine deficiency; deafness from rubella, measles, mumps, and bacterial meningitis; blindness from gonococcus and vitamin A deficiency; and mental retardation from vaccine-preventable encephalitis and meningitis.8,9 In the United States, medical, community, and public health advances have resulted in 98% of children entering kindergarten without neurodevelopmental disability.10 However, in developing countries in south Asia and sub-Saharan Africa, 200 million children under 5 years of age fail to reach their cognitive potential because of poverty, poor health and nutrition, and suboptimal home environments.11 These disadvantaged children are likely to do poorly in school and subsequently have low … Address correspondence to Michael E. Msall, MD, University of Chicago Pritzker School of Medicine, 5841 S Maryland Ave, MC0900, Chicago, IL 60637. E-mail: mmsall{at}peds.bsd.uchicago.edu