title: Impact of caste on the neurodevelopment of young children from birth to 36 months of age: a birth cohort study in Chitwan Valley, Nepal.
abstract: BACKGROUND
  Caste, a proxy of socioeconomic position, can influence the neurodevelopment of children through several pathways, including exposure to toxic elements. Studies from developing countries where caste is represented by prevailing caste groups and people are highly exposed to toxic elements can provide useful insights into the mechanisms of neurodevelopmental inequities among children. This study aims to investigate the impact of caste on the neurodevelopment of children from birth to 36 months of age in Chitwan Valley, Nepal, where people are exposed to high levels of arsenic (As) and lead (Pb).
  
  
  METHODS
  Participants (N = 94) were mother-infant pairs from the Chitwan district in Nepal. The neurodevelopment of the infants was assessed using the Brazelton Neonatal Behavioral Assessment Scale, Third Edition, (NBAS III) at birth and the Bayley Scales of Infant Development, Second Edition, (BSID II) at ages 6, 24, and 36 months. Caste was categorized based on surname, which, in Nepal generally refers to one of four caste groups. We also measured the concentrations of As and Pb in cord blood.
  
  
  RESULTS
  Caste was positively associated with the state regulation cluster score of the NBAS III at birth after adjustment for covariates (p for trend < 0.01). Adding cord blood As levels attenuated the association (p for trend = 0.12). With regard to neurodevelopment at six months of age, the third-ranked caste group scored higher than the first-ranked caste group on the Mental Development Index (MDI) of the BSID II (coefficient = 3.7; 95% confidence interval (CI) = 1.3 to 6.0). This difference remained significant after adjustment for cord blood As levels and other covariates was made (coefficient = 3.9; 95% CI = 1.2 to 6.7). The remaining clusters of the NBAS III and BSID II at 6, 24, and 36 months were not significantly associated with caste group.
  
  
  CONCLUSIONS
  Caste was positively associated with the state regulation cluster score of NBAS III at birth. This association was partially mediated by cord blood As levels. However, the negative impact of caste on neurodevelopment disappeared as the children grew. Furthermore, an inverse association between caste and MDI at six months of age was observed. Additional studies are needed to elucidate the mechanism of how caste affects neurodevelopment.
authors.forename: Rajendra Prasad
authors.initials: RP
authors.lastname: Parajuli
authors.affiliation: Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, 157-8535 Tokyo, Japan. fujiwara-tk@ncchd.go.jp.
authors.forename: Takeo
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Masahiro
authors.initials: M
authors.lastname: Umezaki
authors.forename: Chiho
authors.initials: C
authors.lastname: Watanabe
mesh_terms: D001151:Arsenic / Q000097:blood; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005312:Fetal Blood; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007854:Lead / Q000097:blood; D008297:Male; D009390:Nepal; D009420:Nervous System / Q000254:growth & development*; D012923:Social Class
chemical_list: D007854:Lead; D001151:Arsenic