EPIDEMIOLOGICAL STUDY OF INTELLECTUAL DISABILITY IN DISTRICT LOWER DIR, KHYBER PAKHTUNKHWA, PAKISTAN

• Muhammad Younas

  Author

• Muhammad Ansar

  Author

• Javeed Farooqi

  Author

• Khalid Nawaz Khan

  Author

• Asad Ullah Jan

  Author

• Rehman Mehmood Khattak

  Author

Background: Intellectual disability (ID) is a significant population health issue in Pakistan, particularly in rural communities where the healthcare system has few infrastructures, and the rate of consanguinity is high. This research had the objective of determining the prevalence in epidemiological terms, risk factors and etiological determinants of ID in District Lower Dir, Khyber Pakhtunkhwa.

Procedures: A cross-sectional study was conducted using population based on multistage stratified random sampling of all the seven tehsils of District Lower Dir. The response rate was 67 percent and 4,099 participants aged 5-90 years were enrolled (out of 390 households). The full-scale tests were made, such as demographic profiling, clinical testing, anthropometric testing, and cognitive testing with standardized tools (Universal Nonverbal Intelligence Test, Stanford-Binet Intelligence Scales and Vineland Adaptive Behavior Scales). The diagnosis was according to DSM-5. The univariate results were compared by means of statistical tests comprising of chi-square tests and penalized Firth logistic regression in order to establish the multivariate results of the sociodemographic predictors, and the etiological history was evaluated descriptively.

Findings: The total prevalence of ID was 2.8% (115/4,099) with mild ID taking 2.1% of the total population. Males had more univariate prevalence compared to females (3.5% vs. 2.0%; p=0.003). The prevalence of ID was almost twice in consanguinity parentage than in non-consanguinity unions (4.6% vs. 2.3; p=0.001). Etiological disaggregation showed that genetic causes were the most common (68.7, 79/115), then postnatal factors (13.9, 16/115), perinatal factors (12.2, 14/115) and prenatal factors (3.5, 4/115). Congenital onset was an independent predictor of ID in multivariate Firth penalized logistic regression that controlled on sociodemographic factors (B=8.05, SE=3.53, p=0.023) and gender (p=0.241), consanguinity (p=0.922) and family structure (nuclear: p=0.236; extended: p=0.371) lost their statistically significant values after adjustment.

Conclusions: This is a first systematic epidemiological study in Lower Dir that presents an ID prevalence of 2.8% of which genetic factors describe 68.7% of the occurrences. The findings indicate the urgency of genetic counseling services in communities, premarital screening programs, and better perinatal care in high consanguinity communities. The research contains the necessary baseline information in the development of evidence-based health policy in rural Pakistan

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