Earthquake exposure in utero and after birth and early child development and growth in disadvantaged Nepalese children
BACKGROUND: In 2015, Nepal was struck by major earthquakes causing great damage to the society. Previous studies have demonstrated high rates of long-term psychological consequences from major earthquakes in vulnerable adults. Studies demonstrate that maternal stress in pregnancy is associated with premature delivery, lower birth weight and suboptimal brain development, and postnatally, maternal distress is associated with impaired growth and suboptimal neurodevelopment.
GAP: Not enough is known on how major disasters contribute to impaired development and growth in children from populations in low-income countries with multiple risks of compromised development.
HYPOTHESIS: Maternal earthquake exposure influence development and growth at 6-11 months and 18-23 months in disadvantaged Nepalese children.
METHODS: In an ongoing clinical trial in 600 children from the densely populated city of Bhaktapur, Nepal, in which the 2015 earthquakes caused great damage to the society, we have included an earthquake exposure inventory (practical impact) and the Impact of Event Scale-Revised (subjective distress) to the caregivers. At enrollment (6 to 11 months) and after 12 months we assess neurodevelopment by the Bayley Scales of Infant and Toddlers Development 3rd ed., growth is measured at enrollment and every month subsequently for 12 months.
RESULTS: More than 60% of the caregivers respond that the earthquakes had a great deal of negative effects on their family`s life. In 30% of the families, their house had totally collapsed or was not usable as a result of the earthquakes, and 17% of the families had lived more than 4 places since the earthquakes. Of the caregivers, 4.7% report that close family members died and 10.5% that family members were injured. On the IES-R, 17.1% had scores indicating that PTSD is a clinical concern, while 7.1% had scores indicating a probable PTSD diagnosis. In regression models, living in families were the caregivers and husbands report to be illiterate or have educational level up to grade 5 is associated with higher scores on the total IES-R, compared to families with higher levels of education. Compared to caregivers that reported that no close family members or relatives were killed, caregivers that had close family that were killed had 9.9 [95% CI (5.00, 13.88), P=0.000] points higher IES-R scores while caregivers that had relatives that were injured had 4 [95%CI (2.08, 5.98), P=0.000] points higher IES-R score. Caregivers that reported that the earthquakes had “a great deal” of negative effect on the family`s daily life had a 9.8 [95% CI (5.9, 13.6), P=0.000] points increase in the total IES-R score compared to caregivers that reported that the earthquakes had no negative effects. The negative impact is seen in aspects such as economy, food security, employment and health related issues. 76% of the caregivers, reported that they had assisted in rescue efforts after the earthquakes. Assisting in such efforts gave a decrease of 2.7 [95% CI (0.71, 4.71), P=0.008] points compared to caregivers that report that they did not participate in rescue work.
IMPACT: Our findings demonstrate the magnitude of the impact of the 2015 earthquakes on the daily life of Nepalese families, and that the impact is related to PTSD-symptoms in the caregivers. The result lend support to the need for mental health care policies for survivors after major traumatic events in low-income countries. The impact of the earthquake exposures through maternal PTSD symptoms on early child development and growth will be explored further.
Kvestad, I., Ranjitkar, S., Ulak, M., Chandyo, R. K., Shrestha, M., Shrestha, L., Strand, T.A. & Hysing, M. (2019). Earthquake exposure and post-traumatic stress among Nepalese mothers after the 2015 earthquakes. Frontiers in psychology, 10.