Behavioural and emotional comorbidities in school-aged children with neurological conditions in Kilifi, Kenya, and their long-term consequences.

BACKGROUND: Neurological conditions and mental health problems are common in children in low- and middle-income countries, but the risk factors and downstream impact of these problems on children with neurological conditions are not reported. OBJECTIVE: To determine the association of neurological conditions with behavioural and emotional problems in children, the prevalence and risk factors of behavioural and emotional problems, and long-term impact of these conditions. METHODS: Data on multiple neurological conditions and mental health problems were available for 1,616 children (aged 6-9 years) from Kilifi, Kenya. Neurological conditions were diagnosed using standardised tools and clinical examination. Behavioural and emotional problems assessed using Child Behaviour Questionnaire for Parents. Long-term outcomes were obtained from census data of the Kilifi Health and Demographic Surveillance System. Logistic and linear regression were used to measure associations. RESULTS: Mental health problems were higher in those with any neurological condition compared to those without (24% vs. 12%, p < 0.001). Cognitive (odds ratio (OR) = 2.39; 95% CI: 1.59-3.59), motor (OR = 3.17; 95% CI: 1.72-5.82), hearing (OR = 2.07; 95% CI:1.12-3.83) impairments, and epilepsy (OR = 4.18; 95% CI: 2.69-6.48), were associated with mental health problems. Prevalence of any mental health problem was 15%, with externalizing problems more common than internalizing problems (21% vs. 17%, p = 0.004). Longitudinal follow-up indicated that the disorders affected an individual's future schooling (e.g. OR = 1.25; 95% CI: 0.14-1.46 following cognitive impairments), occupation (OR = 2.44; 95% CI: 1.09-5.44 following mental health problems), and access to household assets (OR = 2.78; 95% CI: 0.99-7.85 following epilepsy). CONCLUSIONS: Neurological conditions in school-aged children in Kilifi are associated with mental health problems, and both disorders have long-term consequences. Preventive and therapeutic measures for these conditions are needed to improve outcomes of these children.