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

Abstract

Introduction: The Ten Questions tool was developed in 1984 as a low-cost tool to screen for child disability prior to referral for definitive diagnosis. Iron and zinc contribute to child growth and development, but few studies examine the relationship between supplementation and longer-term neuro-developmental outcomes.

Methods: The Ten Questions Plus tool was administered to caregivers of 1410 children between 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 and zinc supplementation between October 2001 and January 2006.

Results: Nearly 30% of the sample screened positive for disability. The most common problems were learning disability (12.3%) and motor milestone delay (11.3%). Children supplemented with zinc were less likely to screen positive overall, and for motor and learning problems. Children supplemented with smaller doses of iron were more likely to screen positive overall, and for physical, and cognitive problems, but these differences were not statistically significant. There were no differences in children dually supplemented with iron and zinc compared with placebo.

Conclusions: The Ten Questions Plus tool can be used in this rural Nepali setting to identify children at increased risk for physical and cognitive disability who should be referred for clinical examination, diagnosis and enrollment in intervention services. We found evidence for a beneficial effect of zinc supplementation in reducing the likelihood of screening positive for disability.