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      Burden of neurodevelopmental disorders in low and middle-income countries: A systematic review and meta-analysis

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          Abstract

          Background: Childhood mortality from infectious diseases has declined steadily in many low and middle-income (LAMIC) countries, with increased recognition of non-communicable diseases such as neurodevelopmental disorders (NDD). There is lack of data on the burden of NDD in LAMIC. Current global burden of these disorders are largely extrapolated from high-income countries. The main objective of the study was therefore to estimate the burden of NDD in LAMIC using meta-analytic techniques.

          Methods: We systematically searched online databases including Medline/PubMed, PsychoInfo, and Embase for studies that reported prevalence or incidence of NDD. Pooled prevalence, heterogeneity and risk factors for prevalence were determined using meta-analytic techniques.

            Results: We identified 4,802 records, but only 51 studies met the eligibility criteria. Most studies were from Asia-Pacific (52.2%) and most were on neurological disorders (63.1%). The median pooled prevalence per 1,000 for any NDD was 7.6 (95%CI 7.5-7.7), being 11.3 (11.7-12.0) for neurological disorders and 3.2 (95%CI 3.1-3.3) for mental conditions such as attention-deficit hyperactivity disorder (ADHD). The type of NDD was significantly associated with the greatest prevalence ratio in the multivariable model (PR=2.6(95%CI 0.6-11.6) (P>0.05). Incidence was only reported for epilepsy (mean of 447.7 (95%CI 415.3-481.9) per 100,000). Perinatal complications were the commonest risk factor for NDD.

          Conclusion: The burden of NDD in LAMIC is considerable. Epidemiological surveys on NDD should screen all types of NDD to provide reliable estimates.

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          Measuring inconsistency in meta-analyses.

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            Quantifying heterogeneity in a meta-analysis.

            The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity. Copyright 2002 John Wiley & Sons, Ltd.
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              Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

              Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal AnalysisRole: MethodologyRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: ConceptualizationRole: MethodologyRole: ResourcesRole: Writing – Review & Editing
                Role: MethodologyRole: Writing – Review & Editing
                Role: ConceptualizationRole: ResourcesRole: SupervisionRole: Writing – Review & Editing
                Journal
                Wellcome Open Res
                Wellcome Open Res
                Wellcome Open Res
                Wellcome Open Research
                F1000 Research Limited (London, UK )
                2398-502X
                14 March 2018
                2017
                : 2
                Affiliations
                [1 ]KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research , (Coast), Kilifi, Kenya
                [2 ]Department of Public Health, Pwani University, Kilifi, Kenya
                [3 ]Department of Psychiatry, University of Oxford, Oxford, UK
                [1 ]SickKids Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
                [1 ]Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
                [1 ]Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
                KEMRI-Wellcome Trust Research Program, Kenya
                [1 ]Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
                [1 ]Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
                [2 ]School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
                KEMRI-Wellcome Trust Research Program, Kenya
                Author notes

                No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: I declare no competing interests

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Article
                10.12688/wellcomeopenres.13540.3
                5964629
                Copyright: © 2018 Bitta M et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Funding
                Funded by: Wellcome Trust
                Award ID: 083744
                Funded by: Wellcome Trust
                Award ID: 099782
                SK and CRJCN are supported by the Wellcome Trust [099782] and [083744], respectively.
                The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Systematic Review
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