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A Nation-Wide Prevalence Study of Very Young Children with ASD in Bangladesh
The Bangladesh ASD Survey in Young Children 2017 was funded by the IPNA, a project under the Ministry of Health and Family Welfare of the Government of the People’s Republic of Bangladesh. The survey was designed to assess the prevalence of this condition in young children from 16 to 30 months of age.
Objectives:
The main objective of this survey was to determine the prevalence of autistic spectrum disorder (ASD) on young children in Bangladesh. Another objectives of the survey were to detect the prevalence at urban-rural distribution in Bangladesh.
Methods:
A sample size estimate of 38,250 young children. Survey was done in 85 Primary Sampling Units/Enumeration Areas (PSU/EAs) – each PSU containing about 100 households – distributed among each of 30 randomly selected districts across eight divisions of the country. Rural and urban areas were selected proportionately.
Preparatory activities including training of survey personnel (Health Assistants, Heath Inspectors and Medical Officers) took place between January and April 2017 and actual data collection was in two phases – the first in May and June and the second in October and November 2017.
In the first step of the survey, Interviewers collected information as well as carried out household level screening of ASD among survey children using ‘Red Flag’. Second step screening of ASD was done among all children referred as positive following Red Flag by trained Medical Officers using M-CHAT at Upazila Health Complex or Sadar (district) Hospitals. At the third and final stage, Expert Teams from Dhaka HQ ( Paediatric Neurologists, Clinical and Educational Psychologists) diagnosed ASD with DSM-5 among all children referred after ‘Red Flag’ at the respective Civil Surgeon offices of sample districts.
Field monitoring was done by spot checks by Quality Control Officers (MO), Master Trainers from IPNA, HQ coordinators and local health administrators such as UHFPOs.
Data from the field was manually edited and entered. Data capturing, editing, cleaning, identifying missing data, duplication detection, analysis and tabulation processes were carried out using CSPro 7.1 and SPSS 21. All results presented in this report are calculated from weighted data
Results:
The survey was undertaken in 37,982 households (71% rural, 29% urban) distributed across eight divisions and containing 38,440 children (52% boys, 48% girls) aged 16-30 months. The prevalence of DSM-5 positive ASD in16-30-month-old children was 17/10,000 young children (boys 24/10,000, girls 9.8/10,000) – in other words 1 in 589 young children (1 in 423boys; 1 in 1,026girls). Rural prevalence was 14/10,000 and urban 25/10,000.
Conclusions:
This was one of the largest surveys of ASD in young children undertaken anywhere in the world. There were many challenges in its implementation. Despite the overall low prevalence of autism, prevention programmes need to start right away because of the higher prevalence of ASD detected in high income families with higher education and Bangladesh’s rapid economic development. Further studies need to elucidate the reasons for the higher prevalence in the upper socioeconomic class. Detection and early intervention programmes need to be planned carefully to target those more in need.