The association of preterm birth and small birthweight for gestational age on childhood disability screening using the Ten Questions Plus tool in rural Sarlahi district, southern Nepal

Child Care Health Dev. 2012 May;38(3):332-40. doi: 10.1111/j.1365-2214.2011.01221.x. Epub 2011 Mar 6.


Context: The Ten Questions tool was developed in 1984 as a low-cost, simple screen for childhood disability and referral for diagnosis in low-resource settings, and its use in Nepal has not been previously evaluated. Preterm birth and intrauterine growth restriction are potential risk factors for child disability and loss of developmental potential, but there are few studies examining this relationship from developing settings.

Objective: To examine the associations of small for gestational age and preterm birth as predictors of Ten Questions Plus positivity.

Design, setting and participants: The Ten Questions Plus questionnaire was administered to caregivers of 680 children between 2 and 5 years of age from August 2007 to March 2008 in rural Sarlahi, southern Nepal. Participants had previously been enrolled in a randomized trial of chlorhexidine cleansing at birth. At 1 month of age, children were then enrolled into a randomized 2 × 2 factorial trial of daily iron and zinc supplementation between October 2001 and January 2006.

Intervention: None.

Main outcome measure: Positive screen on the Ten Questions Plus tool defined as a positive response to one or more questions.

Results: Of preterm children, 37 (33.6%) had a positive response to at least one question on the Ten Questions Plus and were considered at risk for disability. One hundred and seventy term children (29.8%) were at risk for disability.

Conclusions: The Ten Questions Plus tool can be used in this rural Nepali setting to identify children at increased risk for mental and physical disability to be targeted for further examination. The prevalence of parent-reported disabilities is high in this population (almost one-third of children); children who are both preterm and small-for-gestational age are at increased risk for motor milestone delay, reported learning difficulty, speech and behavioural problems. Intrauterine growth restriction may affect child development and result in disabilities later in childhood.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Birth Weight*
  • Child
  • Child, Preschool
  • Disabled Children / statistics & numerical data*
  • Female
  • Fetal Growth Retardation*
  • Gestational Age*
  • Humans
  • Male
  • Mass Screening / methods*
  • Nepal / epidemiology
  • Premature Birth*
  • Surveys and Questionnaires