Introduction:
Childhood, being the foundation of life, is associated with numerous changes in birth and attainment of maturity. Remarkable changes are noticed particularly in the first year of life. A full term child is considered physically and mentally normal only when it attains developmental milestones corresponding to expected age. General mental capacity is referred through intelligence, which involves reasoning ability, planning, thinking abstractly, problem solving, understanding complex ideas, quick learning, and learning ability from experiences. Intelligent Quotient (IQ) score represents intelligence. This score is obtained by standardized tests performed by trained professionals. An individual is considered as intellectually disabled if IQ test score is approximately 70 or below. (1)
Intellectual Disability (ID) is a neurodevelopmental condition that is characterized by significant limitations of both intellectual functioning and adaptive behaviour (conceptual, social & practical skills). These limitations manifest themselves before 22 years of age. (2) ID is considered as a main public health condition that develops in pregnancy and leads to permanent disability. It involves multiple etiologies, which prevents a person from operating properly. (3) A case-control study conducted in Iran to determine the risk factors associated with borderline intelligence during the prenatal, intranatal, and postnatal periods found that both prenatal and postnatal factors influence school children's IQ levels. (4)
A retrospective case-file study, performed at the National Institute for Mentally Handicapped (NIMH) Regional Centre in Kolkata, India, found that particular biological factors can predict developmental delay in people with ID. (5) As per the National Mental Health Survey of India 2015-16, implemented by National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bengaluru with the support from Ministry of Health and Family Welfare, 0.6% of the population was affected with this condition. (6) The Indian Ministry of Social Justice and Empowerment conducted a survey to examine the age-adjusted prevalence of ID in urban and rural populations, as well as its relationship with age in children and adults. The survey revealed that, in ID, India has a prevalence rate of 10.5/1000. Compared to rural population (10.08/1000; P = 0.044), the population in urban were somewhat in higher rate (11/1000). The prevalence of ID was shown to be highly linked with age in urban children (ϱ = 0.954, P = 0.000) and adults (ϱ = 0.957, P = 0.000), as well as in rural children (ϱ=0.981, P = 0.019) and the rural population. (7)’ In India, the prevalence of ID is around 2% for mild and 0.5% for severe levels of ID (defined as IQ < 50). In comparison to mild levels of ID, 60-70% of cases revealed severe levels of ID, while 35-55% remained idiopathic. In Kerala, the prevalence is 1%. ID is a serious public health issue because of its prevalence and the need for extensive support services. It can be managed with early detection and management, as well as access to health care and appropriate supports. Identification of a cause can aid in the targeting of interventions, therapies, surveillance, and appropriate counselling in advance of any medical or behavioural consequences, as well as providing a more precise prognosis. (8)
A descriptive study was conducted by using the data from Inclusive Education Resource Centre (IERC) of Mangalore in 2011, described the prevalence of MR among school children by age, religion, sex & location by stratified multi stage sampling. The relationship between age and severity of MR was also reported. Though there was sex difference between rural and urban areas, the prevalence was considerably high among males (p<0.001). The figures showed, Hindus, ranging between 9-12 years of age, most of who were mildly retarded (48.15%). But the diagnosis of mild and moderate types was found to be delayed in severe and profound MR’s. The study calls for finding causes, intervention & proper classification in future studies. (9)
To cut down the incidence of disabilities and impairments in children, women must attempt to take suitable and effective protective measures during their pregnancy and immediate postnatal period as well as for their children particularly during the early childhood period. Many studies have indicated that the parent of a disabled child suffer from enormous amount of stress. These families suffer from difficulties and pressures related to financial standing, emotional relationship among family, depression, limited social life and constraints in time due to higher demand for child care. These depends on whether the disability is mental or physical and its severity.
From the literature review it is evident that, there are multiple causes for ID. The greater the number of risk factors, the more likely a child may experience significant developmental delay. However, It’s worth noting that the majority of these risk factors can be avoided. To vastly analyse the risk factors in depth, causing ID, this study has been carried out on biological factors such as prenatal, during delivery and postnatal periods and psychological as well as social factors. Early identification of such risk factors and their control may provide strategies for maternal and child health care.
Materials and Methods:
The study used a quantitative approach with a case-control method. Administrative and Institutional Ethical Committee permission (IEC 721/2017) was obtained, CTRI registration was done (CTRI/2018/01/016870). Data was collected by interviewing the mothers of children aged 6-15 years old (ID children and children without ID). The mothers who dropped their children to special school/regular school were interviewed at the school itself after obtaining their consent. For those mothers who did not drop their children to school, an informed consent form (consisting of contact details to be filled in) and Participant Information Sheet was sent through the children. After obtaining their consent and contact details, the respective mothers were contacted and meetings arranged at their convenience for an interview. During the course of the interview, some mothers tended to become emotional and further questioning was subject to the mother being able to, or willing to continue.
The period of study was from November 2017 to January 2018. The study enrolled a total of 160 mothers, using convenient sampling technique. The sample size was determined based on estimation of odds ratio from the previous study; where in odds ratio for consanguineous marriage (2.9) and exposure among controls (0.24) was taken into consideration. (10) Sample size was calculated with alpha level of 5% and at 80% power. Adjusting for 20% nonresponse rate, we would need a minimum of 80 cases and 80 controls. Participants whose children are going to different special schools/regular schools of Udupi District, Karnataka were shortlisted. Special schools/regular schools were selected through convenient sampling.
The inclusion criteria considered while selecting samples for the study were – mothers who are willing to respond to the questionnaire, mothers who know to read and write Kannada and English. Mothers of children with ID aged 6-15‘years were included in the cases, while mothers with children without ID aged 6-15 years were included in the controls.
The exclusion criteria considered were child with psychiatric illness, mothers who-are not available during the data-collection period, mothers who are not-willing to answer the questionnaire, caregivers of children other than mothers, mothers who are chronically ill and mothers who are illiterate.
Data Collection Tools: To find out the biopsychosocial risk factors that may contribute to ID, the data collection method included a demographic proforma and a semi-structured questionnaire. The semi-structured questionnaire was developed by the investigator and comprised 38 questions, in the area of biological, i.e. prenatal (14 items), factors during labour (7 items), post-natal (7 items), psychological (5 items) and social (5 items) risk factors. The semi-structured questionnaire was given to the subject experts to assess its validity and they were asked to evaluate the item on its appropriateness, relevance and accuracy. The calculated Scale Content Validity Index (SCVI) was 0.9684. Inter rater reliability method was used and by using Percent Agreement Formula, reliability of the semi-structured questionnaire was computed (r=0.9960).
Confidentiality was assured to the participants and they were offered the option of withdrawing from the study at any point of time during the study period. Clear information regarding purpose of the interview and study was conveyed to the participants who met the inclusion criteria. On their understanding of the same, the interview was proceeded with. Average time taken by the researcher to complete the interview was 20-30 minutes.
Statistical Analysis: Based on the study's objective and hypothesis, the data were analysed using descriptive and inferential statistics with SPSS (Statistical Package of Social Sciences) version 16 software. Continuous variables are presented by mean and standard deviation, while categorical variables are reported by frequency and percentage. Probabilities with a probability of 0.05 or less were considered significant. The odds ratio and 95% confidence intervals were used to calculate risk.
Results:
The study was conducted among the mothers of children aged 6-15 years old (ID children and children without ID).
Sample characteristics of mothers: Most of the cases 60 (74.9%) and controls 57 (71.2%) belonged to 34-45 years. The mean age of the cases and controls were 40.35 and 35.36 respectively. Most of the cases 44 (55%) and controls 42 (52.5%) were within the age group of 18 -24 years at the time of marriage. Mean age of the mothers at marriage for cases was 24.19 years and controls, 24.49 years. Age of 4 (5%) of the cases at marriage was above 35 years. Majority of the cases 73 (91.2%) and controls 74 (92.5%) had institutional delivery. Most of the cases 65 (81.2%) and controls 71 (88.8%) belong to the Hindu religion. Majority of the cases 49 (61.2%) and controls 68 (85%) belonged to rural areas. 23 (28.8%) of cases completed higher secondary level of education, whereas 42 (52.5%) of the controls completed high school education. There was only one mother (1.2%) in control group who completed her Graduation. 54 (67.5%) cases and 68 (85%) controls were employed as housewives. The monthly income of 44 (55%) of the cases and 46 (57.5%) controls, was less than 15,000. There were 10 (12.5%) cases and 2 (2.5%) of controls having income above 25,000. 65 (81.2%) of the cases and 55 (68.8%) controls belong to a nuclear family. 50 (62.5%) of the cases and 57 (71.2%) controls had only two children.
Sample characteristics of children: Majority 38 (47.6%) of the children with ID belong to the age group of 13-15 years, whereas 49 (61.3%) belong to the control group of ages within 6-9 years. Mean age of the ID children was 11.98 years and children without ID was 8.89 years. Cases of children diagnosed with ID before and after 6 months of delivery were 40 (50%). Learning disability was the major comorbidity 65 (81.2%) in the intellectually disabled children.
Biological factors that might lead to ID: The data presented in Table 1 shows that, odds of having child with ID among mothers who had taken drugs during pregnancy is 5 times greater (OR=4.529, 95% CI, 1.226-16.728, p=0.015) than the mothers who did not take drugs during pregnancy. Hence the study findings revealed that the prenatal factors did not play a significant role as a factor contributing to ID.
Table 1: Prenatal Risk Factor Analysis for ID (n=160) |
Variables |
Cases n=80 |
Controls n=80 |
Odds ratio |
95% CI |
P
value |
f |
% |
f |
% |
Lower limit |
Upper limit |
Age at conception |
18 |
1 |
1.2 |
4 |
50 |
0.241 |
0.026 |
2.201 |
0.367 |
18 and above |
79 |
98.8 |
76 |
95 |
Birth order of the child |
First born |
41 |
51.25 |
53 |
66.25 |
- |
Second |
32 |
40 |
26 |
32.5 |
0.629 |
0.325 |
1.215 |
0.167 |
>3 |
7 |
8.75 |
1 |
1.25 |
0.111 |
0.013 |
0.934 |
0.04 |
History of abortion |
Yes |
9 |
11.2 |
4 |
5 |
2.408 |
0.710 |
8.169 |
0.148 |
No |
71 |
88.8 |
76 |
95 |
Treatment before pregnancy |
Yes |
1 |
1.2 |
1 |
1.2 |
1.000 |
0.061 |
16.270 |
1.000 |
No |
79 |
98.8 |
79 |
98.8 |
Nutrition during pregnancy |
Yes |
70 |
87.5 |
65 |
81.2 |
1.615 |
0.678 |
3.850 |
0.276 |
No |
10 |
12.5 |
15 |
18.8 |
Infections during pregnancy |
Yes |
3 |
3.8 |
1 |
1.2 |
3.078 |
0.313 |
30.238 |
0.620 |
No |
77 |
96.2 |
79 |
98.8 |
Drugs during pregnancy |
Yes |
12 |
15 |
3 |
3.8 |
4.529 |
1.226 |
16.728 |
0.015* |
No |
68 |
85 |
77 |
96.2 |
X-ray exposure during pregnancy |
Yes |
9 |
11.2 |
0 |
0 |
- |
No |
71 |
88.8 |
80 |
100 |
Gestational age |
After 9 months |
61 |
76.3 |
70 |
87.5 |
0.459 |
0.198 |
1.061 |
0.065 |
Before 9 months |
19 |
23.75 |
10 |
12.5 |
History of falls or abdominal trauma |
Yes |
2 |
2.5 |
0 |
0 |
- |
No |
78 |
97.5 |
80 |
100 |
Illness during pregnancy |
No disease |
68 |
85 |
71 |
88.75 |
0.718 |
0.285 |
1.813 |
0.482 |
Had disease |
12 |
15 |
9 |
11.25 |
Alcohol consumption during pregnancy |
No |
80 |
100 |
80 |
100 |
- |
Family history of ID |
Yes |
8 |
10 |
5 |
6.2 |
1.667 |
0.521 |
5.334 |
0.385 |
No |
72 |
90 |
75 |
93.8 |
Habit of smoking cigarettes, tobacco use, chewing betel leaves |
No |
80 |
100 |
80 |
100 |
- |
| *significant at 0.05 level |
The data presented in Table 2 revealed that, odds of having ID in children with delayed cry soon after delivery is 3 times greater (OR=3.203, 95% CI, 1.323-7.755, p=0.008) than the children who cried soon after delivery and among the cases, neonates who had delayed cry, 11 (13.75%) of them cried after 5 minutes of delivery. Odds of developing ID in children is 5 times greater in mothers who faced problems during pregnancy (OR=4.944, 95% CI, 1.033-23.657, p=0.056) as compared to mothers who did not face any such problems during their delivery. Odds of developing ID in children is 3 times greater in low birth weight babies (OR=3.000, 95% CI, 1.234-7.295, p=0.013) as compared to babies with normal weight.
| Table 2: During Delivery Risk Factor Analysis for ID (n=160) |
Variables |
Cases n=80 |
Controls n=80 |
Odds ratio |
95% CI |
P value |
f |
% |
f |
% |
Lower limit |
Upper limit |
Type of delivery |
Normal vaginal |
46 |
57.5 |
50 |
62.5 |
0.812 |
0.431 |
1.530 |
0.519 |
Instrumental/ Caesarean section |
34 |
42.5 |
30 |
37.5 |
Cry of the baby |
Delayed |
21 |
26.2 |
8 |
10 |
3.203 |
1.323 |
7.755 |
0.008* |
Not delayed |
59 |
73.8 |
72 |
90 |
Colour of the baby |
Cyanosed |
6 |
7.5 |
2 |
2.5 |
3.162 |
0.619 |
16.165 |
0.276 |
Not cyanosed |
74 |
92.5 |
78 |
97.5 |
Problems during delivery |
Yes |
9 |
11.2 |
2 |
2.5 |
4.944 |
1.033 |
23.657 |
0.056* |
No |
71 |
88.8 |
78 |
97.5 |
Prolapsed cord |
Yes |
3 |
3.8 |
6 |
7.5 |
0.481 |
0.116 |
1.992 |
0.495 |
No |
77 |
96.2 |
74 |
92.5 |
Low birth weight (2.5kg) |
Yes |
20 |
25 |
8 |
10 |
3.000 |
1.234 |
7.295 |
0.013* |
No |
60 |
75 |
72 |
90 |
Baby born after due date |
Yes |
5 |
6.2 |
4 |
5 |
1.267 |
0.327 |
4.900 |
1.000 |
No |
75 |
93.8 |
76 |
95 |
| *significant at 0.05 level |
The data depicted in Table 3 shows that, odds of developing ID in children is 7 times greater in children who had head trauma (OR=6.882, 95% CI, 1.488-31.843, p=0.009) as compared to children who did not have any head trauma. Odds of developing ID in children is 5 times greater in complications leading to NICU admission (OR=4.672, 95% CI, 1.649-13.238, p=0.002) as compared to babies who did not have complications soon after delivery leading to NICU admissions. Among the neonates who were admitted to the NICU soon after delivery, 9 (11.25%) cases had low birth weight.
Table 3: Post-Natal Risk Factor Analysis for Intellectual Disability (n=160) |
Variables |
Cases n=80 |
Controls n=80 |
Odds ratio |
95% CI |
P Value |
f |
% |
f |
% |
Lower limit |
Upper limit |
Convulsion in the first month of life |
Yes |
5 |
6.2 |
0 |
0 |
- |
No |
75 |
93.8 |
80 |
100 |
Exclusive breast feeding continued up to |
Not breast fed |
3 |
3.8 |
0 |
0 |
- |
=6 months |
11 |
13.8 |
10 |
12.5 |
>6 months |
66 |
82.5 |
70 |
87.5 |
Head trauma during or after birth |
Yes |
12 |
15 |
2 |
2.5 |
6.882 |
1.488 |
31.843 |
0.009* |
no |
68 |
85 |
78 |
97.5 |
Childhood illness |
No disease |
54 |
67.5 |
73 |
91.2 |
0.199 |
0.081 |
0.493 |
0.000 |
Had disease |
26 |
32.5 |
7 |
8.75 |
Immunization |
Yes |
71 |
88.8 |
73 |
91.2 |
0.756 |
0.267 |
2.141 |
0.598 |
No |
9 |
11.2 |
7 |
8.8 |
NICU Admission (soon after delivery) |
Yes |
20 |
25 |
5 |
6.2 |
4.672 |
1.649 |
13.238 |
0.002* |
No |
60 |
75 |
75 |
93.8 |
Milestone achievement |
Yes |
1 |
1.2 |
77 |
96.2 |
0.0004 |
0.00005 |
0.005 |
<0.001 |
No |
79 |
98.8 |
3 |
3.8 |
| *significant at 0.05 level |
Psychological factors that might lead to ID: Most of the 78 (97.5%) cases and 77 (96.2%) controls accepted their pregnancy. There was no fear related to pregnancy in both cases 74 (92.5%) and 65 (81.2%) controls. 78 (97.5%) cases and 74 (92.5%) controls were compliant to the treatment. There was no stress observed in both 76 (95%) cases and controls. Suicidal ideation was not present in both 79 (98.8%) cases and 80 (100%) controls. However, only one mother (1.2%) among cases had suicidal ideation. Odds ratio computed for acceptance of pregnancy (OR=1.519, 95% CI, 0.247-9.347, p=1.000), fear related pregnancy (OR=0.351, 95% CI, 0.129-0.959, p=0.035), compliance to treatment (OR=3.162, 95% CI, 0.619-16.165, p=0.276), Stress during pregnancy (OR=1.000, 95% CI, 0.241-4.145, p=1.000), does not show significant difference between ID and psychological factors. Hence psychological factors were not responsible for developing ID in the present study.
Social factors that might lead to ID: Data presented in table 4 shows that, Odds of developing ID in children is 3 times greater in family facing financial problems during delivery (OR=2.825, 95% CI, 1.243-6.417, p=0.011) as compared to families not facing any financial problems.
| Table 4: Social Risk Factor Analysis for ID (n =160) |
Variables |
Cases n=80 |
Controls n=80 |
Odds ratio |
95% CI |
P value |
f |
% |
f |
% |
Lower limit |
Upper limit |
Education of husband |
High school & below |
44 |
55 |
54 |
67.5 |
0.588 |
0.310 |
1.119 |
0.105 |
Higher secondary & above |
36 |
45 |
26 |
32.5 |
Consanguineous marriage |
Yes |
6 |
7.5 |
8 |
10 |
0.730 |
0.241 |
2.208 |
0.576 |
No |
74 |
92.5 |
72 |
90 |
Financial problems during pregnancy |
Yes |
23 |
28.8 |
10 |
12.5 |
2.825 |
1.243 |
6.417 |
0.011* |
No |
57 |
71.2 |
70 |
87.5 |
Family support during delivery |
Yes |
62 |
77.5 |
73 |
91.25 |
0.330 |
0.129 |
0.842 |
0.017 |
No |
18 |
22.5 |
7 |
8.75 |
Occupation of husband |
Husband is no more |
4 |
5 |
0 |
0 |
- |
Employed |
75 |
93.8 |
76 |
95 |
unemployed |
1 |
1.2 |
4 |
5 |
Education of mother |
Primary |
16 |
20 |
13 |
16.2 |
- |
High school |
21 |
26.2 |
42 |
52.5 |
2.350 |
0.960 |
5.752 |
0.06 |
Higher secondary |
23 |
28.8 |
24 |
24 |
1.284 |
0.507 |
3.251 |
0.598 |
Graduate and above |
20 |
25 |
1 |
1 |
0.065 |
0.008 |
0.551 |
0.012 |
| *significant at 0.05 level |
Discussion:
ID disrupts performance of self-care activities and socialization. Many biopsychosocial factors prevent a child from developing competency at par with a normal child. It hinders learning and is considered a major global health issue. Present study data revealed that, with respect to the education of the mother, 23 (28.8%) of the mothers with ID children completed higher secondary level of education, whereas 42 (52.5%) of the controls completed high school education. There was only one mother (1.2%) in control group who completed her Graduation. These findings are contradicted by a study done to compare the perinatal risk factors among children, where the researcher found that, 29% of the mothers had the qualifications lower than high school. (11)
The present study shows that most 65 (81.2%) of the mothers of ID children belong to the Hindu religion, 49 (61.2%) belong to the rural areas and 65 (81.2%) belong to nuclear families. Odds of developing ID in children is 3 times greater in a family facing financial problems during delivery (OR=2.825, 95% CI, 1.243-6.417, p=0.011) as compared to families not facing any financial problems. These findings are in agreement with the study done in Silchar Medical College and Hospital, Silchar, Assam. The study reveals that majority of the ID children belong to the Hindu 50 (50%) religion, 52 (52%) belong to the rural areas and 49 (49%) belong to nuclear families. Most of the mothers of ID children were illiterate 30 (30%) and the findings disclosed that late presentation in health-care facilities, low-paying high labouring job of the parents, and burden of belonging to lower socio-economic strata of the society significantly contributes in development of ID. (12)
The present study revealed that, cases of children diagnosed with ID before and after 6 months of delivery were 40 (50%) and majority of the ID children 79 (98.8%) did not achieve developmental mile stones at the appropriate age whereas in the controls 77 (96.2%) achieved it. A study was conducted at a Paediatric Hospital in Egypt to determine the possible causes for autism among children. 100 autistic participants and 200 normal children comprised the control group by taking detailed history from the mothers. The results were supported in 46 % of autistic children aged one and a half years and 32 % of autistic children aged two years, and the research showed that all of the studied developmental milestones were delayed in autistic children relative to the control group (P=0.000). (13)
The present study showed that, 38 (47.6%) of the children with ID belonged to the age group of 13-15 years, whereas 49 (61.3%) belonged to the control group of ages within 6-9 years and majority of the cases 49 (61.2%) and controls 68 (85%) belonged to rural areas. The findings are in line with a case-control research in Visakhapatnam, Andhra Pradesh's North Coast, that looked at the results of genetic demography and blood group markers in mentally retarded school children. The most number of cases were observed in both the study and control groups among persons aged 10 - 25, however a larger number of cases were discovered in urban areas in both the study (81%) and control (67%) groups. (14)
The present study revealed that odds of having a child with ID among mothers who had taken drugs during pregnancy is 5 times greater (OR=4.529, 95% CI, 1.226-16.728, p=0.015) as compared to mothers who were not taking drugs during pregnancy. These findings are in harmony with the case-control study done among 200 school children aged 6 years to estimate the risk factors that are associated with borderline intelligence during prenatal, intra natal and post-natal period in Iran. According to the study, maternal drug consumption during pregnancy was one of the risk factors for ID in children (AOR=1.7, 95% CI, 1.1-2.5, P=0.003). (4)
The prenatal factors reported in the present study where maternal age at conception (OR=0.241, 95% CI, 0.026-2.201, p=0.367) was not substantially connected to the risk of developing ID and there were no mothers, who had the history of alcohol consumption, using tobacco during pregnancy. The study found that odds of developing ID in children is 3 times greater in low birth weight babies (OR=3.000, 95% CI, 1.234-7.295, p=0.013) as compared to babies with normal weight. These findings are contradictory to the systematic review and meta-analysis, where the study revealed that advanced maternal age (OR=1.53, 95% CI, 1.35-1.72, p=<0.001), maternal alcohol use (OR=1.63, 95% CI, 1.49-1.78, p=<0.001), maternal tobacco use (OR=1.10, 95% CI, 1.06-1.15, p=<0.001) and preterm birth (OR=2.03, 95% CI, 1.79-2.31, p=<0.001) were the significant factors during pregnancy that might contribute to the development of ID. The findings related to the low birth weight babies is supported by this study where the authors concluded that there was a significant positive association between ID risk and low birth weight (OR=3.43, 95% CI, 2.25-5.32, P=<0.001). (15) The findings of this study are, again, in agreement with the case-control study in Utah to pinpoint antenatal and perinatal risk factors associated with ID among the 8-year-old children. Low birth weight, delayed cry were identified as risk factors leading to ID in this study. (16)
In the current study, odds of developing ID in children is 7 times greater in children who had head trauma (OR=6.882, 95% CI, 1.488-31.843, p=0.009) as compared to children who did not have any head trauma. The findings of the study are supported by a study done in Saudi Arabia among cases and controls, to recognize the risk factors of mild MR in children by interviewing 69 parents. The study revealed that head trauma was found as one of risk factor leading to ID in children (P=0.004). (17)
In the current study, odds ratio computed for the psychological factors like, acceptance of pregnancy, fear related pregnancy, compliance to the treatment, stress during pregnancy and suicidal ideation does not show significant difference between ID and psychological factors. Hence psychological factors were not responsible for developing ID in the present study. These findings are supported by a retrospective study done at NIMH in Kolkata, India, which gathered data from 438 case-files with the aim of identifying the biological and psychosocial factors associated with developmental delay and ID in children, and showed that psychological trauma during pregnancy is not associated with the development of ID in children (p=1.270) and the results of this research contradict those of the current study in terms of economic status, where it did not play a significant role on development (P=0.679). (5)
In the present study, the data collected was mostly the past history from the mothers of ID children and children without any ID about the biopsychosocial risk factors. So it was limited to the data which was provided by the mothers. The study was also limited to the mothers of children in the age group of 6-15 years of selected special and regular schools. Therefore, generalization of the study can be done only to the similar population.
The following recommendations are put forward by the researcher as per the findings of the study. A similar study can be replicated using a large sample size in other areas, a prospective longitudinal cohort study to explore the prenatal factors contributing to ID, a retrospective study to explore prenatal and intra natal factors that might lead to ID, a qualitative study can be carried out to identify the risk factors leading to ID, a biomarker study can be conducted to find out the risk factors that might lead to ID.
Knowledge concerning the biopsychosocial risk factors helps in screening out the mothers in their early antenatal period thus helping them to prepare for their offspring. When the need arises, Health Care Professionals (HCP’s) can counsel the pregnant women and also explain to them the benefits as well as choices available to them if required to undergo genetic screening.
HCP’s play a major role in educating patients. They can educate the mothers who come for their antenatal visits including drug intake during pregnancy. The HCP’s can also motivate the mothers and explain the need for regular antenatal visits as per the schedule. The nurses can educate the mothers on the importance of immediate reporting of any injury or complications and can take initiative in demonstrating post-natal care to the primi mothers so as to reduce risk of injuries to the baby during early childhood. This knowledge could be passed on to families by grassroots experts such as health workers in a community setting when health services are not readily available.
Conclusion:
Present study results provide the baseline data for the health care professional to be aware of about the risk factors in order to prepare and plan education for future expectant mothers to take appropriate care during pregnancy and thus reduce the risk of ID in the child. The study concludes that; Biopsychosocial factors play a major role in the development of ID. Controlling these factors will be crucial in global maternal and child health prevention strategies.
Declarations of Interest: There are no conflicts of interest declared by the authors.
Acknowledgement: The authors acknowledge all the institution heads for the permission to conduct the study and also thank all the study subjects who participated in the study for their cooperation.
Funding: This study did not receive any specific support from public, private, or non-profit funding bodies.
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