1Makerere University-Mulago National Referral Hospital, Uganda.
Autism. 2014 May;18(4):447-57. doi: 10.1177/1362361313475848. Epub 2013 Mar 27.
Neurodevelopmental disorders are recognized to be relatively common in developing countries but little data exist for planning effective prevention and intervention strategies. In particular, data on autism spectrum disorders are lacking. For application in Uganda, we developed a 23-question screener (23Q) that includes the Ten Questions screener and additional questions on autism spectrum disorder behaviors. We then conducted household screening of 1169 children, 2-9 years of age, followed by clinical assessment of children who screened positive and a sample of those who screened negative to evaluate the validity of the screener. We found that 320 children (27% of the total) screened positive and 68 children received a clinical diagnosis of one or more moderate to severe neurodevelopmental disorders (autism spectrum disorder; cerebral palsy; epilepsy; cognitive, speech and language, hearing, or vision impairment), including 8 children with autism spectrum disorders. Prevalence and validity of the screener were evaluated under different statistical assumptions. Sensitivity of the 23Q ranged from 0.55 to 0.80 and prevalence for ≥1 neurodevelopmental disorders from 7.7/100 children to 12.8/100 children depending on which assumptions were used. The combination of screening positive on both autism spectrum disorders and Ten Questions items was modestly successful in identifying a subgroup of children at especially high risk of autism spectrum disorders. We recommend that autism spectrum disorders and related behavioral disorders be included in studies of neurodevelopmental disorders in low-resource settings to obtain essential data for planning local and global public health responses.
神经发育障碍在发展中国家被认为是相对常见的，但几乎没有数据可用于规划有效的预防和干预策略。特别是缺乏自闭症谱系障碍的数据。为了在乌干达应用，我们开发了一个 23 题筛查器（23Q），其中包括 10 个问题筛查器和自闭症谱系障碍行为的其他问题。然后，我们对 1169 名 2-9 岁的儿童进行了家庭筛查，对筛查阳性的儿童进行了临床评估，并对筛查阴性的儿童进行了抽样评估，以评估筛查器的有效性。我们发现 320 名儿童（占总数的 27%）筛查阳性，68 名儿童被临床诊断为一种或多种中度至重度神经发育障碍（自闭症谱系障碍；脑瘫；癫痫；认知、言语和语言、听力或视力障碍），包括 8 名自闭症谱系障碍儿童。在不同的统计假设下评估了筛查器的患病率和有效性。23Q 的敏感性范围为 0.55 至 0.80，根据使用的假设，≥1 种神经发育障碍的患病率为每 100 名儿童 7.7/100 至 12.8/100。自闭症谱系障碍和 10 个问题项目筛查阳性的组合在识别自闭症谱系障碍风险特别高的儿童亚组方面取得了一定的成功。我们建议在资源匮乏的环境中对神经发育障碍研究包括自闭症谱系障碍和相关行为障碍，以获得规划当地和全球公共卫生应对措施的必要数据。
