G290(P) A systematic review of household and family alcohol misuse and childhood developmental outcomes in low- and middle-income countries

Abstract

Aims This systematic review seeks to collate studies from low- and middle-income countries (LMICs) to identify links between consumption of alcohol by household members and children’s neurodevelopmental health outcomes. Methods Five databases (Medline, EMBASE, OVID Global Health, Cochrane Library and PsycInfo) were searched from 1990–2018 including terms ‘alcohol use’, ‘household’, ‘child’ and ‘neurodevelopmental/behavioural outcome(s)’ and derivatives. A Cochrane LMIC filter was utilised to screen abstracts and World Bank definitions to define LMICs. Studies were eligible if they explicitly investigated alcohol misuse (or synonyms e.g. abuse, dependency), with misuse being defined as a pattern of alcohol consumption putting the individual or dependents at risk of physical and mental health problems. Studies of fetal alcohol syndrome were excluded. Eligibility was also assessed for participants, neurodevelopmental outcomes, and language. Quality appraisal utilised the National Institute of Heart, Lung and Blood (NIHLB) Quality Assessment Tools. Since the range of outcomes differed by age group, we split into studies of children and studies of adolescents. This study reports developmental outcomes for children, aged 18 months to 16 years. Results From 24 844 results, 25 studies were included. Across these studies, there were 43 007 participants from 12 different LMICs. Most studies reported paternal drinking (n=10), followed by parental/caregiver (n=9), maternal (n=3) and household members (n=3). The most commonly investigated outcome related to household alcohol exposure was children’s behavioural problems/disorders (16 studies). Overall all the studies reported a positive association between household alcohol misuse and childhood behavioural problems/disorder. Other outcomes included cognitive delay/disorder related to intelligence and academic performance (4 studies) and risky behaviour in children such as suicide attempts, self-harm, substance abuse/misuse and risky behaviour (5 studies). Conclusion This is the first study to document household alcohol misuse as an adverse childhood experience and its impact on neurodevelopmental outcomes in LMICs. Despite varying settings and designs, this review found that alcohol misuse by household members in LMICs is associated with adverse child neurodevelopmental outcomes, although it cannot be established whether this is an independent risk factor. Future studies should consider clearly defined neurodevelopmental outcomes, careful standardized quantification of alcohol and adjustment for confounders.