{"paper_id":"2ad8023f-50f9-4c09-90d3-2f83d73e2fbf","body_text":"Abstract\nBackground Neurodevelopmental disorders (NDDs) are a group of conditions with their onset during the early developmental period and include conditions such as autism, intellectual disability and attention deficit hyperactivity disorder (ADHD). Occurrence of NDDs is thought to be determined by both genetic and environmental factors, but data on the role of environmental risk factors for NDD in Africa is limited. This study investigates environmental influences on NDDs in children from Kenya. This case-control study compared children with NDDs and typically developing children from two studies on the Kenyan coast that did not overlap.\nMethods and Findings We included 172 of the study participants from the Kilifi Autism Study and 151 from the NeuroDev Study who had a diagnosis of at least one NDD and 112 and 73 with no NDD diagnosis from each study, respectively. Potential risk factors were identified using unadjusted univariable analysis and adjusted multivariable logistic regression analysis. Univariable analysis in the Kilifi Autism Study sample revealed hypoxic-ischaemic encephalopathy conferred the largest odds ratio (OR) 10.52 (95%CI 4.04 – 27.41) for NDDs, followed by medical complications during pregnancy (gestational hypertension & diabetes, eclampsia, and maternal bleeding) OR: 3.17 (95%CI 1.61 – 6.23). In the NeuroDev study sample, labour and birth complications (OR: 7.30 (2.17 – 24.61)), neonatal jaundice (OR: 5.49 (95%CI 1.61 – 18.72)) and infection during pregnancy (OR: 5.31 (1.56 – 18.11)) conferred the largest risk associated with NDDs. In the adjusted analysis, seizures before age 3 years in the Kilifi Autism study and labour and birth complications in the NeuroDev study conferred the largest increased risk. Higher parity, the child being older and delivery at home were associated with a reduced risk for NDDs.\nConclusion Recognition of important risk factors such as labour and birth complications could guide preventative interventions, developmental screening of at-risk children and monitoring progress. Further studies examining the aetiology of NDDs in population-based samples, including investigating the interaction between genetic and environmental factors, are needed.\nCompeting Interest Statement\nThe authors have declared no competing interest.\nFunding Statement\nThe Kilifi Autism study was funded through the Cheryl & Reece Scott Professorship Award to Prof. Charles Newton. NeuroDev is supported by the Stanley Center for Psychiatric Research at the Broad Institute, a grant from SFARI (704413), and by the National Institute of Mental Health of the National Institutes of Health under Award Number U01MH119689. Research reported in this publication was also supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD102975.\nAuthor Declarations\nI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.\nYes\nThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:\nThe Kilifi Autism study was approved in August 2012 by the Kenya Medical Research Institute National Ethics and Review Committee (reference number: KEMRI/RES/7/3/1). Written informed consent was obtained from the participants. For the NeuroDev study, ethical approval was sought in Kilifi, Kenya, and approval was granted by the Kenya Medical Research Institute Scientific Ethics and Review Unit (KEMRI/SERU/CGMR-C/104/3629) in April 2018 and the Harvard T.H. Chan School of Public Health IRB17-0600 in June 2018.\nI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.\nYes\nI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).\nYes\nI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.\nYes\nData Availability\nCoded individual-level data that do not allow researchers to identify participants will be made available by the authors, without undue reservation. Curated data for this manuscript, will be deposited to the Harvard Dataverse.","source_license":"CC-BY-4.0","license_restricted":false}