49. Learning and Developmental Disabilities


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Richard Lord, www.rlordphoto.com

Learning and developmental disabilities (LDDs) include functional limitations that manifest in infancy or childhood as a result of disorders or injuries to the developing nervous system. These limitations, which range from mild to severe, may be caused by genetic or nutritional factors, infections, toxic exposures, trauma, perinatal factors, and multifactorial conditions.

Information on the prevalence and impact of disabilities in low– and middle–income countries (LMIC) is scarce, but some factors suggest that LDDs are, or should be, a public health priority in LMIC. These include data on specific causes and types of LDDs in LMIC, the lifelong adverse impact of these conditions, the health and social costs, and the cost–effectiveness of proven interventions.

Folic acid fortification of the food supply is one of three cost–effective interventions for LDDs. Prenatal screening and selective pregnancy termination can be highly cost–effective under some conditions, but these methods raise ethical, social, and cultural concerns that may preclude their use. Neonatal screening and treatment for congenital hypothyroidism are highly cost–effective in developed countries, but effectiveness may be reduced in places where only a part of the newborn population can be reached by screening.

The costs and benefits of community–based rehabilitation have not been sufficiently quantified to allow cost–benefit analysis. An intervention that is not recommended is electronic fetal monitoring in labor, because it has been associated with a higher risk of cerebral palsy and is unsuccessful in preventing neurological disability from premature birth.