Impact of iron and zinc supplementation on child disability screening using the Ten Questions Plus tool in rural Sarlahi District, southern Nepal

摘要

Introduction: The Ten Questions tool was developed in 1984 as a low-cost tool to screenfor child disability prior to referral for definitive diagnosis. Iron and zinc contribute to childgrowth and development, but few studies examine the relationship between supplementationand longer-term neuro-developmental outcomes.Methods: The Ten Questions Plus tool was administered to caregivers of 1410 childrenbetween 1-9 years of age from August 2007 to March 2008 in rural Sarlahi, southern Nepal.Participants had been previously enrolled in a randomized 2x2 factorial trial of daily iron andzinc supplementation between October 2001 and January 2006.Results: Nearly 30% of the sample screened positive for disability. The most commonproblems were learning disability (12.3%) and motor milestone delay (11.3%). Childrensupplemented with zinc were less likely to screen positive overall, and for motor and learningproblems. Children supplemented with smaller doses of iron were more likely to screenpositive overall, and for physical, and cognitive problems, but these differences were notstatistically significant. There were no differences in children dually supplemented with ironand zinc compared with placebo.Conclusions: The Ten Questions Plus tool can be used in this rural Nepali setting to identifychildren at increased risk for physical and cognitive disability who should be referred forclinical examination, diagnosis and enrollment in intervention services. We found evidencefor a beneficial effect of zinc supplementation in reducing the likelihood of screening positivefor disability.