topic selection: Mental Retardation and the article is on file 2-3 pages 1) Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions. a. Select

topic selection: Mental Retardation  and the article is on file

2-3 pages

1) Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions. a. Select a scholarly nursing or research article, published within the last five years, related to mental health

nursing. The content of the article must relate to evidence-based practice.

• You may need to evaluate several articles to find one that is appropriate.

b. Ensure that no other member of your clinical group chooses the same article, then submit your choice for

faculty approval.

c. The submitted assignment should be 2-3 pages in length, excluding the title and reference pages.

2) Include the following sections (detailed criteria listed below and in the Grading Rubric must match exactly).

Introduction (10 points/10%)

• Establishes purpose of the paper

• Captures attention of the reader Article Summary (30 points/30%)

• Statistics to support significance of the topic to mental health care

• Key points of the article

• Key evidence presented

• Examples of how the evidence can be incorporated into your nursing practice Article Critique (30 points/30%)

• Present strengths of the article

• Present weaknesses of the article

• Discuss if you would/would not recommend this article to a colleague

Conclusion (15 points/15%)

• Provides analysis or synthesis of information within the body of the text

• Supported by ides presented in the body of the paper

• Is clearly written

Article Selection and Approval (5 points/5%)

• Current (published in last 5 years)

• Relevant to mental health care

• Not used by another student within the clinical group

• Submitted and approved as directed by instructor

APA format and Writing Mechanics (10 points/10%)

topic selection: Mental Retardation and the article is on file 2-3 pages 1) Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions. a. Select
Research Article Risk Factors Associated with Severity of Nongenetic Intellectual Disability (Mental Retardation) among Children Aged 2–18 Years Attending Kenyatta National Hospital Mathieu Nemerimana ,1,2 Margaret Njambi Chege, 1and Eunice Ajode Odhiambo 1 1School of Nursing Sciences, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya2Department of Nursing and Midwifery, Kibogora Polytechnic, P.O. Box b1, Rusizi, Rwanda Correspondence should be addressed to Mathieu Nemerimana; [email protected] Received 23 October 2017; Revised 24 February 2018; Accepted 12 March 2018; Published 18 April 2018 A c ademic Editor: Mamede de Carvalho Copyright © 201b Mathieu Nemerimana et al. 9is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background . Many of the nongenetic causal risk factors of intellectual d isability (ID) can be prevented if they are identi5ed early. 9ere is paucity on information regarding potential risk factors associated with this condition in Kenya. 9is study aimed to establish risk factors associated with severity of nongenetic intellectual disability (ID) among children presenting with this condition at Kenyatta National Hospital (KNH). Methods. A hospital-based cross-sectional study was conducted over the period between March and June 2017 in pediatric and child/youth mental health departments of Kenyatta National Hospital (KNH), Kenya. It included children aged 2–1b years diagnosed with ID without underlying known genetic cause. Results. Of 67 patients with nongenetic ID, 24% had mild ID, 40% moderate, 23% severe-profound, and 10% unspeci5ed ID. 9e mean age of children was f.b ( ±3.b) years. Male children were predominant (b2%). 9ree independent factors including “labor complications” [AOR = 6.4f, 6f% CI = 1.23–113.26, = = 0.036], “admission to neonatal intensive care unit” [AOR = b.06, 6f% CI = 2.11–31.07, = = 0.002], and “cerebral palsy” [AOR = 21.1b, CI = 4.1b–107.40, = = 0.001] were signi5cantly associated with increased risk of severe/profound nongenetic ID. Conclusion . 9e present study 5ndings suggest that perinatal compli cationsaswellaspostnatalinsultsareassociatedwith increased risk of developing severe-profound intellectual disability, implying that this occurrence may be reduced with appropriate antenatal, perinatal, and neonatal healthcare interventions. 1. Introduction Intellectual disability (ID), formerly known as “mental retar- dation,” is a condition characterized by signi5cant below average intellectual functioning and impairment in adaptive behaviors, manifested before age 1b years. 9e degrees of intellectual disability include mild, moderate, and severe and profound intellectual disability [1, 2]. Intellectual disability is a public concern due to the number of people alected by this condition with consideration of the increased demand of specialized medical, psychosocial, and educational services required to improve their quality of life [3]. According to recent reviews and meta-analysis, globally, about 1% of general population is alected by intellectual disability [4, f]. Child/adolescent population has higher prevalence (1b.30/1000) than the adult population (4.64/1000) [f]. Fur- thermore, it is estimated that about 1% of children between the ages 3 and 10 years are alected by intellectual disability worldwide [b]. Intellectual disability is associated with multicausal risk factors including genetic and nongenetic or acquired causes. But in some cases, the aetiology is unknown [7]. Genetic factors such as chromosomal abnormalities, inherited genetic traits, and single gene disorders are the major causes accounting for 30% to f0% of all intellectual disability cases. Nongenetic causes comprise prenatal, perinatal, postnatal, and environmental factors [b]. Most prevalent reported nongenetic prenatal risk factors include maternal conditions such as asthma, diabetes, hypertension, renal conditions, and epilepsy [b, 6]. Other factors are tobacco or alcohol use, Hindawi Neurology Research International Volume 2018, Article ID 6956703, 11 pages https://doi.org/10.1155/2018/6956703 2Neurology Research International parental advanced age, low maternal education, multiparity, and maternal black race [b]. Main perinatal factors are low birth weight, preterm birth, birth complications, and perinatal infections [b, 10]. Postnatal infections, exposure to toxicants like lead or mercury, developmental disorders, central nervous system malignancies, and chronic severe malnutrition have been reported as postnatal factors [7, b]. 9ese associated factors of intellectual disability are in inter- active complexity with environmental factors and sociode- mographic and socioeconomic characteristics of population [6, 11]. It is that many of the factors and causes of nongenetic intellectual disability are preventable, if early detection is done and timely interventions are taken [b, 12]. Most of the studies regarding risk factors of intellectual disability have been conducted in developed countries, with limited information from developing countries [3]. In Kenya, information on incidence, prevalence, and associated factors of intellectual disability is scarce. Studies are needed to establish more information on the burden of this condition in Kenya. Furthermore, little is known on the magnitude of potential nongenetic risk factors contributing to development of intellectual disability among children alected with this condition in Kenya. Given the paucity of epidemiological information on the causal risk factors associated with intel- lectual disability in Kenya, the aim of this study was to explore potential risk factors associated with development of severe/profound nongenetic intellectual disability among children presenting with this condition at Kenyatta National Hospital (KNH). 2. Methods 2.1. Study Setting and Design. 9is study was a hospital- based, descriptive cross-sectional study conducted over period from March, 2017, to June, 2017, in the pediatric and mental health departments of Kenyatta National Hospital (KNH). KNH is the biggest national referral hospitals in Kenya located in Nairobi, capital city of Kenya. 9is hospital is located in Upper-Hill area along hospital road, ol-Ngong’ road, Nairobi. Its total bed capacity is 2000. KNH has f0 inpatient wards and dilerent outpatient and specialized clinics, among them are pediatric department and mental health department. 9e mental health department provides dilerent services, among them are child psychiatric clinic and youthmentalhealthclinic,bothworkingonoutpatientbasis. Patients with mental health problems requiring inpatient care were being admitted to the general pediatric-medical wards. At KNH, children with intellectual disability with age of up to 12 years are followed up at the child psychiatric clinic and at pediatric neurologic outpatient clinic while the adolescents aged from 13 years are followed up at the youth mental health clinic. 2.2. Study Participants. Children/adolescents between the ages of 2 and 1b years and diagnosed with intellectual disabil- ity without underlying known genetic cause were recruited consecutively from pediatric wards, pediatric outpatient clin- ics, and mental health department of KNH, over a period of 4 months. 9e age group (2 to 1b years) of children was chosen based on the fact that DSM-f (Diagnostic and Statistical Manual of Mental Disorders, Fieh Edition) criteria specify that diagnosis of intellectual disability is made during devel- opment period, before age of 1b years [1]. Participants were selected aeer the con5rmation of the diagnosis of intellectual disability by a pediatrician and clinical psychologist. Children who were identi5ed with genetic conditions known to lead to intellectual disability were excluded from the study. 9ose who were critically ill were also excluded from the study. Using purposive sampling method, a total of 67 patients with nongenetic intellectual disability were consecutively recruited as study participants over the 4-month period of data collection. 2.b. Data Collection and Analysis. Data was collected from consenting parents and through desk reviews of patient 5les. 9e details on degree of intellectual disability were obtained from the patient’s medical records. Using semistructured questionnaire, data on child and parental sociodemographic characteristics, pregnancy, birth history, postnatal history, medical and nutritional histories, and environmental expo- sure were collected from the child’s parents. 9is was sup- plemented by data from desk reviews. Information on the comorbid conditions was also checked from the medical records. Data was analyzed using Statistical Package for Social Sciences (SPSS) 23.0 version (IBM SPSS Statistics v23). 9e relationships between the individual factors and severity of intellectual disability were evaluated using crude odds ratio for bivariate and adjusted odds ratio for multivariate logistic regression models. Signi5cance of statistical association was tested using con5dence interval (CI) of 6f% and =value < 0.0f. 2.4. Ethical Consideration. 9e ethical approval and per- missiontoconductthestudywasgrantedbytheKeny- atta National Hospital-University of Nairobi Ethics and Research Committee (KNH/UON-ERC) (Approval number: P6b1/12/201b). 9e permission to collect data was provided by the Kenyatta National Hospital (KNH) administration. Written parental permission/informed consent was obtained from the parents of children with intellectual disability attending KNH. Assent was also obtained from adolescent without profound intellectual disability. 3. Results b.1. Sociodemographic Characteristics of the Children and Parents. Of 67 children/adolescents included in the study, themeanagewasf.byears(SD± 3.b years), majority were males(b1.6%),andmost(74.2%)werelivingwithbothoftheir parents. Table 1 provides details on the sociodemographic characteristics of the children. Table 2 shows the distribution of selected sociodemo- graphic and socioeconomic characteristics among the par- ents. Majority of children’s parents (mothers (b2.f%) and fathers (fb.7%)) were in middle ages between 21 and 3f years. 9e highest percentage (47.4%) of mothers were casual workers and only 31% were regularly employed, while about Neurology Research International3 T 1: Distribution sociodemographic characteristics among the children. Va r i a b l e =97% Age in years 2to3 3132 4tof 3132 bandabove 3f3b Mean ( ±SD) = f.b ( ±3.b) Gender Male b0b2 Female 373b Family setup Both parents 7274 Single mother 2324 Orphan/adopted 11 Abandoned 11 Number of children in the family 1child fff7 2 children 2f2b 3 children 1414 4 children 33 Siblings’ history of intellectual disability Ye s ff No 626f Degree of intellectual disability (ID) Mild ID 2324 Moderate ID 3640 Severe/profound ID 2223 Unspeci5ed ID 1313 21.b% were unemployed. More than half of the fathers were having regular employment. Majority of the mothers (f7.7%) and fathers (fb.7%) had attained secondary school education. 26.3% of fathers were smokers. Majority f3.b% of parents reported earning between 21,000 and f0.000 Kenyan Shillings as their monthly family income. b.2. Bivariate Analysis of Factors Associated with Severity of Nongenetic Intellectual Disability among Children. 9ere was more proportion of severe/profound intellectual disability among children of single mothers (3b.6%) compared to those children raised by both parents (23.4%). However, this was not statistically signi5cant [OR = 2.0b; 6f% CI = 0.b6–b.31; = = 0.196].9estudyshowednosigni5cantassociation between the other sociodemographic characteristics of chil- dren and severity of intellectual disability (Table 3). Table 4 shows the relationship between sociodemo- graphic and economic characteristics of parents and severity of nongenetic intellectual disability. Even though mothers aged above 3f years had increased proportion of children with severe/profound nongenetic intellectual disability (4b.7%) compared to those aged between 21 and 3f years (21.7%), this was not statistically signi5cant [OR = 3.1f; 6f% CI = 0.6b–10.06; = = 0.053]. Children of unemployed mothers T 2: Selected sociodemographic and economic characteristics of mothers. Va r i a b l e =97% Age of the mother 21–3f years b0 b2.f 3b years 17 17.f Age of the mother at the time of child’s birth Below 20 years b b.2 21–3f years b4 bb.b 3b years 7 7.2 Age of the father 21–3f years f4 fb.7 3b years 3b 41.3 Missing f Age of the father at the time of birth of the child 21–3f years bb 73.6 3b years 24 2b.1 Missing f Highest level of education of the mother Primary level 31 32 Secondary level fb f7.7 College/university Level 10 10.3 Highest level of education of the father No formal education 2 2.2 Primary level b b.7 Secondary level f4 fb.7 College/university Level 2b 30.4 Missing f Occupation of the mother Regular employment 30 30.6 Casual employment 4b 47.4 Unemployed 21 21.b Occupation of the father Regular employment 4b f2.2 Casual employment 42 4f.7 Unemployed 2 2.2 Missing f Whether the father smokes Ye s 2 7 2 6 . 3 No bf 70.7 Missing f Average monthly income in the family in Kenyan Shillings More than f0,000 4 4.1 21,000 to f0,000 f2 f3.b 11,000 to 20,000 3b 36.2 Less than 10,000 3 3.1 4Neurology Research International T 3: Relationship between sociodemographic characteristics of children and severity of intellectual disability. Va r i a b l e sSevere/profound Mild/moderate OR6f% CI 2test % %L ow er Upp er =value Age in years 2 to 3 b 42.1% 11 f7.6% 2.10 0.b4 b.b7 0.216 4 to f f 1b.7% 2f b3.3% 0.fb 0.17 1.6b 0.376 b and above 6 2f.7% 2b 74.3% 1.00 Gender Male 12 23.f% 36 7b.f% 0.71 0.2b 1.60 0.460 Female 10 30.3% 23 b6.7% 1.00 Family setup Both parents 1f 23.4% 46 7b.b% 1.00 Single mother 7 3b.6% 11 b1.1% 2.0b 0.b6 b.31 0.16b Number of children in the family 1 child 6 16.1% 3b b0.6% 1.00 2 children b 2b.b% 1f 71.4% 1.b6 0.f1 f.f7 0.3b6 3-4 children 7 43.b% 6 fb.3% 3.2b 0.6b 11.16 0.0f7 Siblings’ history of intellectual disability Yes 1 2f.0% 3 7f.0% 0.64 0.06 6.f0 0.6fb No 21 2b.3% f6 73.b% 1.00 OR = odds ratio; CI = con5dence interval; 2=Chi-square. and those of fathers with regular employment were hav- ing increased odds of severe/profound intellectual disability compared to others; however, this was not statistically sig- ni5cant [OR = 2; 6f% CI = 0.fb–7.06;= = 0.283and OR = 2.b0; 6f% CI = 0.b2–b.20; = = 0.096, resp.]. Similarly, there was no signi5cant association between severity of nongenetic intellectual disability and other parental sociodemographic characteristics. 9e relationship between pregnancy-related factors and severity of intellectual disability was analyzed. On the variable “took any drugs during pregnancy,” there is a signi5cant increase in the number of children with mild/moderate intellectual disability in mothers who denied having taken drugs during pregnancy. In the case of the severe/profound intellectual disability, the number of cases was the same to the mothers who did not take drugs. 9ere were more children with intellectual disability, born of mothers who had indicated “living in environment where people smoke” than those who reported otherwise, and this was signi5cant [OR = 0.1b;6f%CI:0.0b–0.ff; P=0.001](Tablef). Table b shows the relationship between birth history of the children and severity of intellectual disability. Children born through labor complications had signi5cantly more proportion of severe/profound intellectual disability (36.1%) [OR = f.4b; 6f% CI = 1.bb–1b.02; = = 0.003]comparedto those children without labor complications (10.f%). 9ere was signi5cantly higher proportion of severe/profound intel- lectual disability among children delivered by caesarean section (f0.0%) [OR = 4.b4; 6f% CI = 1.b1–13.3b; == 0.005] than those children delivered through spontaneous vaginal delivery (17.7%) and this was statistically signi5cant. Apgar score at birth was also signi5cantly associated with severity of intellectual disability among children. Children withApgarscorelowerthan7outoftensigni5cantlysulered severe/profound intellectual disability (3b.b%) [OR = 4.41; 6f% CI = 1.44–13.4b; = = 0.007]morethanchildrenwho scored above 7 out of ten (12.f%). Similarly children who were resuscitated at birth had signi5cantly higher proportion of severe/profound intellectual disability (40.0%) [OR = 4.22; 6f% CI = 1.4f–12.26; = = 0.006]thanthosewhowerenot (13.b%). 9ere was signi5cantly increased proportion of severe/profound intellectual disability among children who had any neonatal di culties (3b.f%) [OR = f.f7; 6f% CI = 1.46–20.7f; = = 0.006] than those children without (6.4%). Children who were admitted to NICU during neonatal period had signi5cantly more proportion of severe/profound intellectual disability (41.6%) [OR = b.bb; 6f% CI = 2.01–22.03; = = 0.001] compared to those children that have never been admitted in NICU during neonatal period (6.b%). Similarly, those children with neonatal breathing di culties (37.b%) had higher proposition of severe/profound intellectual disability than others without neonatal breathing di culties (17.0%) and this was signi5cant [OR = 2.67; 6f% CI = 1.0b–b.1f; = = 0.031]. 9ere was also signi5cant association between neonatal feeding di culties and severe/profound intellectual disability where children with neonatal feeding di culties had signi5cantly more severe/profound intellectual disability (f0.0%) [OR = 3.bb; 6f% CI = 1.23–12.06; = = 0.016] compared to those children without (20.b%). No statistical signi5cant relationship was found in the factors such as neonatal seizures, neonatal infection, and neonatal jaundice (Table 7). 9ere was no statistically signi5cant association observed between infant and childhood medical and severity of intellectual disability among the children (Table b). Neurology Research Internationalf T 4: Association between sociodemographic and economic characteristics of mothers and severity of intellectual disability. Va r i a b l e sSevere/profound Mild/moderate OR6f% CI 2test % %L ow er Upp er =value Age of the mother 21–3f years 1f 21.7% f4 7b.3% 1.00 3b years 7 4b.7% b f3.3% 3.1f 0.6b 10.06 0.0f3 Age of the mother at the time of birth of the child Below 20 years 2 33.3% 4 bb.7% 1.2f 0.12 13.24 0.bf3 21–3f years 1b 2f.4% f3 74.b% 0.bf 0.1f 4.7b 0.bf2 >3b years 2 2b.b% f 71.4% Age of the father 21–3f years b 17.4% 3b b2.b% 0.44 0.1f 1.2b 0.120 >3b years 11 32.4% 23 b7.b% 1.00 Age of the father at the time of birth of the child 21–3f years 12 20.7% 4b 76.3% 0.fb 0.16 1.bb 0.26b >3b years 7 31.b% 1f bb.2% 1.00 Highest level of education of the mother Primary level b 30.b% 1b b6.2% 0.74 0.14 3.bb 0.722 Secondary level 11 22.0% 36 7b.0% 0.47 0.10 2.2b 0.346 College/university Level 3 37.f% f b2.f% 1.00 Highest level of education of the father Primary level 2 2b.b% f 71.4% 0.60 0.14 f.bb 0.611 Secondary level 6 20.0% 3b b0.0% 0.fb 0.16 1.70 0.306 College/university Level b 30.b% 1b b6.2% 1.00 Occupation of the mother Regular employment b 30.b% 1b b6.2% 1.00 Casual employment b 14.b% 3f bf.4% 0.36 0.12 1.2b 0.120 Unemployed b 47.1% 6 f2.6% 2.00 0.fb 7.06 0.2b3 Occupation of the father Regular employment 13 30.2% 30 b6.b% 2.b0 0.b2 b.20 0.06b Casual employment f 14.3% 30 bf.7% 1.00 Unemployed Whether the father smokes Yes 3 12.0% 22 bb.0% 0.33 0.06 1.27 0.06b No 1b 26.1% 36 70.6% 1.00 Average monthly income in the family (in KES) <21,000 b 23.f% 2b 7b.f% 0.76 0.26 2.1b 0.b47 21,000 and more 14 2b.0% 3b 72.0% 1.00 OR = odds ratio; CI = con5dence interval; 2=chi-square. Table 6 shows the bivariate analysis of relationship between preexisting/comorbid and severity of intellectual disability. Children with cerebral palsy were signi5cantly more likely to suler severe/profound intellectual disability [OR = 1b.1b; 6f% CI = 3.bb–bf.14; = = 0.001]comparedto those children without. 9ere was no statistically signi5cant associationobservedinothervariables. b.b. Multivariate Analysis of Factors Associated with Severity of Nongenetic Intellectual Disability among Children. Binary logistic regression analysis was applied to identify the vari- ables independently associated with severity of intellectual disability among children aged 2 to 1b years. Eleven (11) factors were considered in the analysis including labor com- plications, mode of delivery, APGAR score at birth, whether the baby was resuscitated at birth, any neonatal di culties, whether the baby was admitted in NICU, neonatal breath- ing di culty, neonatal feeding di culties, cerebral palsy, using drugs during pregnancy, and living in environment where people smoke. Upon 5tting these factors using binary logistic regression and by specifying “backward LR”method with removal at = < 0.05, three (3) factors remained in the 5nal analysis (Table 10). Severe/profound intellectual disability was about 10 times more among children with labor complications during birth [AOR = 6.4f; 6f% CI = 1.23–113.26; = = 0.036] compared to those children without bNeurology Research International T f: Relationship between pregnancy-related factors and severity of intellectual disability. Va r i a b l e sSevere/profound Mild/moderate OR6f% CI 2test % %L ow er Upp er =value Attending ANC during pregnancy of the child Yes 22 27.2% f6 72.b% 1.00 No 0 0.0% 3 100.0% UD UD UD 0.263 Frequency of attending ANC 1-2 times 3 1b.7% 1f b3.3% 0.4b 0.12 1.76 0.2fb 3-4 times 16 30.2% 44 b6.b% 1.00 Took any drugs during pregnancy Yes 11 47.b% 12 f2.2% 4.17 1.4b 11.b7 0.006 No 11 1b.0% f0 b2.0% 1.00 Smoking during pregnancy Yes 1 10.0% 6 60.0% 0.2b 0.03 2.3f 0.21f No 21 2b.4% f3 71.b% 1.00 Living in environment where people smoke Yes 12 1b.2% f4 b1.b% 0.1b 0.0b 0.ff 0.001 No 10 ff.b% b 44.4% 1.00 Using alcohol during this pregnancy Yes f 3f.7% 6 b4.3% 1.73 0.f1 f.bb 0.37f No 17 24.3% f3 7f.7% 1.00 OR = odds ratio; CI = con5dence interval; 2=chi-square;UD=unde5ned. labor complications. Children who were admitted to nursery during neonatal period had b times more likely to have severe/profound intellectual disability [AOR = b.06; 6f% CI = 2.11–31.07;= = 0.002] compared to those children that have been never admitted in nursery during neonate. Children with cerebral palsy were 21-fold more likely to have severe/profoundintellectualdisability[AOR=21.1b;6f%CI =4.1b–107.40; = = 0.001] compared to those children without cerebral palsy. 4. Discussion 9e study 5ndings indicate that mean age of study population was f.b years with a standard deviation of 3.b years. Male children were more alected than females; this 5nding is in agreement with the results from other studies which reported male predominance [4, f, 13]. Current 5ndings show that high proportion (40%) of children were sulering moderate intellectual disability. 9is result agrees with a similar study conducted in India [14] where 40% of children had moderate intellectual disability. 9is high proportion of moderate intellectual disability could be attributed to referrals as KNH serves as a referral hospital. Children with moderate intellec- tual disability tend to have remarkable limitations in meeting expected standards of personal independence and social responsibility in dilerent aspects of daily life, especially when they start school. 9erefore, when child starts to show slow academic achievements, he/she is referred for psychological evaluation. Logistic regressions analysis did not reveal any signi5cant association of child sociodemographic variables (including age, gender, family set-up, and number of children in family) and severity of intellectual disability. 9is result is similar to the 5ndings of a study done in India [14] which examined correlation of sociodemographic variables of patients with intellectual disability and types of intellectual disability. In the present study, mothers aged 3f years and above were having increased proportion of children with severe- profound intellectual disability compared to those aged 21–3f years. However, there was no statistically signi5cant relationship between parental age and severity of intellec- tual disability. An early study done by Drews et al. [1f] and a recent systemic review and meta-analysis done by Huang et al. [b] reported a positive association between advanced parental age and intellectual disability though these studies were combining both genetic and nongenetic cases. 9e present study included only children with intellectual disability that is considered nongenetic, with exclusion of thosewhowerehavinggeneticdisordersknowntoleadto intellectual disability. 9is fact may explain the predominance ofparentswithmiddleagesinthisstudy.Norelationshipwas revealed between parental level of education and severity of intellectual disability. However, a review and meta-analysis by Huang et al. reported positive association of lack of maternal education with intellectual disability [b]. Moreover, one of the 5ndings from a study carried out in Utah, America, indicated asigni5cantassociationbetweenintellectualdisability(with exclusion of genetic cases) and maternal education though that was not signi5cant on paternal education [10]. Even though socioeconomic status of the parents did not show any statistically signi5cant relationship with the severity of intellectual disability, great proportion of children with severe-profound intellectual disability were found among mothers who were unemployed compared to those with Neurology Research International7 T b: Association between birth history of the children and severity of intellectual disability. Va r i a b l e sSevere/profound Mild/moderate OR6f% CI 2test % %L ow er Upp er =value Place of deliver for the baby Health facility 22 2b.b% ff 71.4% 1.00 Home 0 0.0% 7 100.0% UD UD UD 0.100 Gestational age when the child born From 33–37 weeks 7 31.b% 1f bb.2% 1.43 0.46 4.17 0.f10 Over 37 weeks 1f 24.b% 4b 7f.4% 1.00 Labor complications Yes 1b 36.1% 2b b0.6% f.4b 1.bb 1b.02 0.003 No 4 10.f% 34 b6.f% 1.00 Mode of delivery Spontaneous vaginal delivery 11 17.7% f1 b2.3% 1.00 Cesarean section 11 f0.0% 11 f0.0% 4.b4 1.b1 13.3b 0.005 Birth weight <2.f kg f 27.b% 13 72.2% 1.11 0.34 3.f7 0.bb3 2.f Kg and above 17 2f.b% 46 74.2% 1.00 Apgar score at birth <7/10 (did not cry) 17 3b.b% 27 b1.4% 4.41 1.44 13.4b 0.007 >7/10 (cried immediately) f 12.f% 3f b7.f% 1.00 Whether the baby was resuscitated at birth Yes 1b 40.0% 24 b0.0% 4.22 1.4f 12.26 0.006 No b 13.b% 3b bb.4% 1.00 OR = odds ratio; CI = con5dence interval; 2=chi-square;UD=unde5ned. T 7: Association between neonatal medical history o f the children and severity of intellectual disability. Va r i a b l e sSevere/profound Mild/moderate OR6f% CI 2test % %L ow er Upp er =value Any neonatal di culties Yes 16 3b.f% 33 b3.f% f.f7 1.46 20.7f 0.006 No 3 6.4% 26 60.b% 1.00 Whether the baby was admitted in NICU Yes 1b 41.6% 2f fb.1% b.bb 2.01 22.03 0.001 No 4 6.b% 37 60.2% 1.00 Neonatal breathing di culty Yes 14 37.b% 23 b2.2% 2.67 1.0b b.1f 0.031 No b 17.0% 36 b3.0% 1.00 Neonatal seizures Yes b 30.0% 14 70.0% 1.26 0.42 3.61 0.bf7 No 1b 2f.0% 4b 7f.0% 1.00 Neonatal infection Yes 4 20.0% 1b b0.0% 0.b4 0.16 2.17 0.471 No 1b 2b.1% 4b 71.6% 1.00 Neonatal jaundice Yes 3 27.3% b 72.7% 1.07 0.2b 4.44 0.630 No 16 2b.0% f4 74.0% 1.00 Neonatal feeding di culties Yes b f0.0% b f0.0% 3.bb 1.23 12.06 0.016 No 14 20.b% f4 76.4% 1.00 OR = odds ratio; CI = con5dence interval; 2=chi-square;UD=unde5ned. bNeurology Research International T b: Association of infant and childhood medical history with severity of intellectual disability. Va r i a b l e sSevere/profound Mild/moderate OR6f% CI 2test % %L ow er Upp er =value Immunization history Fully immunized 20 2f.0% b0 7f.0% 1.00 Not fully immunized 2 f0.0% 2 f0.0% 3.00 0.40 22.71 0.2b7 Su er from any disease Yes 10 22.7% 34 77.3% 0.b6 0.2b 1.b2 0.446 No 12 30.0% 2b 70.0% Histor y of meningitis Yes b 20.0% 24 b0.0% 0.f6 0.20 1.73 0.33b No 1b 26.b% 3b 70.4% Histor y of encephalitis Yes 0 0.0% b 100.0% UD UD UD 0.130 No 22 2b.2% fb 71.b% 1.00 Histor y of cerebral malaria Yes 2 bb.7% 1 33.3% b.10 0.f3 70.60 0.104 No 20 24.7% b1 7f.3% 1.00 Histor y of head injur y Yes 2 1b.2% 6 b1.b% 0.f6 0.12 2.6b 0.f71 No 20 27.4% f3 72.b% 1.00 Histor y of severe malnutrition Yes 3 23.1% 10 7b.6% 0.b2 0.20 3.31 0.7b1 No 16 2b.b% f2 73.2% 1.00 Breastfeeding history Breastfeed <1 month 1 33.3% 2 bb.7% 1.14 0.06 14.7b 0.616 Breastfeed 1–24 months 13 22.b% 44 77.2% 0.bb 0.23 1.66 0.477 Breastfeed >24 months 7 30.4% 1b b6.b% 1.00 OR = odds ratio; CI = con5dence interval; 2=chi-square. employment. Comparable 5ndings were reported in Indian study in which no signi5cant association of intellectual disability severity and socioeconomic status was found [14]. A cohortstudydoneinBrazilreportedalsolackofassociation between socioeconomic status and groups with intellectual disability[1b].Onthecontrary,astudydoneinAustralia found positive relationship of socioeconomic disadvantage and increased risk of intellectual disability [17]. Probably, this dilerence may be due to the fact that the latter studies used dilerent methods and large population compared to the present study. Tobacco smoking and use of alcohol during pregnancy was found to be a major risk factor for developing intellectual disability in the olspring [4, b]. In this study, no association was found between alcohol use or tobacco smoking during pregnancy and severity of intellectual disability. O’Leary et al., in their population based study to examine the association of maternal alcohol use disorder and intellectual disability, found that children of mothers with an alcohol-related diag- nosis recorded during pregnancy had three times increased risk of intellectual di

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