Early childhood suspected developmental delay in 63 low- and middle-income countries: Large within- and between-country inequalities documented using national health surveys

Jesus DC Gil; Fernanda Ewerling; Leonardo Z Ferreira; Aluisio JD Barros

摘要

2Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, BrazilBackgroundThe Sustainable Development Goals call for inclusive, equitable and quality learning opportunities for all. This is especially important for children, to ensure they all develop to their full potential. We studied the prevalence and inequalities of suspected delay in child development in 63 low- and middle-income countries.MethodsWe used the early child development module from national health surveys, which covers four developmental domains (physical, social-emotional, learning, literacy-numeracy) and provides a combined indicator (early child development index, ECDI) of whether children are on track. We calculated the age-adjusted prevalence of suspected delay at the country level and stratifying by wealth, urban/rural residence, sex of the child and maternal education. We also calculated measures of absolute and relative inequality.ResultsWe studied 330?613 children from 63 countries. Prevalence of suspected delay for the ECDI ranged from 3% in Barbados to 67% in Chad. For all countries together, 25% of the children were suspected of developmental delay. At regional level, prevalence of delay ranged from 10% in Europe and Central Asia to 42% in West and Central Africa. The literacy-numeracy domain was by far the most challenging, with the highest proportions of delay. We observed very large inequalities, and most markedly for the literacy-numeracy domain.ConclusionsTo date, our study presents the most comprehensive analysis of child development using an instrument especially developed for national health surveys. With a quarter of the children globally suspected of developmental delay, we face an immense challenge. The multifactorial aspect of early child development and the large gaps we found only add to the challenge of not leaving these children behind.Early childhood development (ECD) is a process of maturation involving the development of motor, cognitive, language and socio-emotional skills during the first years of life [1]. A delay exists when a child does not reach developmental milestones at the expected age in any dimensions of functioning [2]. Several factors increase the risk of developmental delay, among them poverty, poor parental practices, lack of child stimulation and poor nutrition, which can, in the long run, affect human capital and productivity in adulthood [3,4].In 2016, a study updated the estimate of the number of children at risk of poor development. It concluded that approximately 43% of children under 5 years of age living in low- and middle-income countries (LMIC), nearly 250 million children, were at risk of not achieving their full potential [5]. That meant a modest reduction from a previous study published in 2007 [6]. However, because of the lack of specific data on child development in most of these countries, both studies used prevalence of stunting and extreme poverty as proxies to estimate the number of children at risk [5,6].In 2009, the Early Childhood Development Index (ECDI) was introduced in the Multiple Indicator Cluster Surveys (MICS), and more recently in Demographic Health Surveys (DHS). The ECDI is based on a 10-item instrument covering four domains of development: physical, social-emotional, learning and literacy-numeracy. Using the ECDI, a study estimated that 33% of children from 35 LMIC were not reaching their full cognitive or social-emotional developmental potential [7]. Other studies have also used the ECDI, evidencing the importance of availability of children’s books [8], economic status [9], parents education and interaction with the child [9-11] to improve their chances to develop properly. Besides that, it has been shown that less than half the fathers engage in stimulation activities in LMIC, [10] with the poorest children having the lowest engagement of both mothers and fathers in these activities [9].Child development is part of the transformative agenda to 2030, making it an international priority. Sustainable Development Goal 4 states that all children should have the opportunity to reach their full developmental potential [12]. The increasing number of surveys that include the ECDI, in both MICS and DHS surveys will allow for the monitoring of progress made in the area. This is made more relevant since we have evidence-based strategies and interventions to improve child development, such as cognitive stimulation and use of books, among others [7,9,11-14].The construction of the ECDI, however, has not been free of criticism. Some items have been considered too difficult, some too easy, some difficult to interpret [7]. In an attempt to improve its validity, some publications tried alternative scoring approaches, either by dropping items or using a different classification algorithm [7,9,11].Despite its shortcomings, the availability of the ECDI for LMIC allows a comparable analysis not only of national proportions of children with a suspected delay

机译：2流行病学，联邦Pelotas大学流行病学课程，巴西巴拉斯省，巴西地图可持续发展目标呼吁所有人的包容性，公平和质量学习机会。这对儿童来说尤为重要，以确保他们全部发展到他们的全部潜力。我们研究了63个低收入和中等收入国家的疑似儿童发展延迟的患病率和不等式。近期使用了来自国家健康调查的早期儿童开发模块，涵盖了四个发展域（物理，社会情感，学习，识字术 - 数值）并提供儿童是否在轨道上的组合指标（早期儿童开发指数，ECDI）。我们计算了国家一级疑似延迟的年龄调整后的普遍存在，财富，城市/农村住宅，儿童和孕产妇教育的分层。我们还计算了绝对和相对不平等的措施。研究了330名来自63个国家的630名儿童。涉嫌延迟的普遍率为委员会的3％从巴巴多斯的3％到乍得67％。对于所有国家共同，25％的儿童被怀疑发育延误。在区域一级，欧洲和中亚的延迟普及范围从西非和中非的42％到42％。识字率域名是迄今为止最具挑战性的，延迟比例最高。我们观察到非常大的不平等，最明显的识字域。我们的研究日期，使用专门为国家健康调查特别开发的仪器提供了对儿童开发的最全面的分析。随着四分之一的儿童涉嫌发展延误，我们面临着巨大的挑战。早期儿童发展的多因素方面以及我们发现的大缺口只会增加对不会离开这些儿童背后的挑战。童年开发（ECD）是涉及开发电机，认知，语言和社会情感技能的过程的过程在生命的第一年[1]。当儿童在任何功能的任何维度下，孩子在预期的年龄达到发展里程碑时，存在延迟[2]。有几个因素增加了发展延误的风险，其中贫困，贫困父母做法，缺乏儿童刺激和营养差，从长远来看，可以影响成年人的人力资本和生产力[3,4]。在2016年，a学习更新了有缺乏发展风险的儿童人数的估计。得出结论，约有43％的5岁以下居住在低收入和中等收入国家（LMIC）的儿童，近2.5亿个儿童，有可能没有实现其全部潜力[5]。这意味着从2007年开始发表的前一项研究的谦逊减少[6]。但是，由于大多数这些国家的儿童发展数据缺乏特定数据，这两个研究都使用了令人生畏和极端贫困的普遍存在的代理，以估计风险风险的儿童人数[5,6]。2009年，幼儿发展在多个指标群集调查（MICS）中介绍了索引（ecdi），最近在人口统计学健康调查（DHS）中。 ECDI基于一个10件仪器，涵盖了四个发展域名：物理，社会情感，学习和识字性。使用ECDI，一项研究估计，33％的35磅的儿童没有达到完全认知或社会情绪发展潜力[7]。其他研究也使用了ECDI，证明了儿童图书的可用性的重要性[8]，经济地位[9]，父母教育和与孩子的互动[9-11]改善他们妥善发展的机会。除此之外，已经表明，不到一半的父亲从事LMIC的刺激活动，[10]与母亲和父亲在这些活动中最低接合的最贫穷的儿童[9] .Child开发是转型性的一部分议程到2030年，使其成为国际优先事项。可持续发展目标4表示所有儿童都应该有机会达到其全面发展潜力[12]。在MIC和DHS调查中，包括ECDI的越来越多的调查将允许监测该地区的进展。由于我们具有以循证策略和干预措施来改善儿童发展的策略和干预措施，这是更相关的，例如认知刺激和书籍的使用，等等[7,9,11-14]。然而，ECDI的建设并没有没有批评。有些物品被认为太难了，有些太容易，一些难以解释[7]。在尝试改善其有效性，一些出版物尝试了替代评分方法，通过丢弃项目或使用不同的分类算法[7,9,11]。分析其缺点，对于LMIC的ECDI的可用性允许相当的分析不仅可以进行了可比的分析涉嫌延迟的国家比例

Early childhood suspected developmental delay in 63 low- and middle-income countries: Large within- and between-country inequalities documented using national health surveys

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