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Early Childhood Developmental Delay in 63 Low- and Middle-Income Countries: Prevalence and Inequalities Estimated From National Health Surveys

21 Pages Posted: 14 May 2019

See all articles by Jesus Gil

Jesus Gil

Federal University of Pelotas (UFPel) - International Center for Equity in Health (ICEH); Federal University of Pelotas (UFPel) - Postgraduate Program in Epidemiology

Fernanda Ewerling

Federal University of Pelotas (UFPel) - International Center for Equity in Health (ICEH); Federal University of Pelotas (UFPel) - Postgraduate Program in Epidemiology

Leonardo Ferreira

Federal University of Pelotas (UFPel) - International Center for Equity in Health (ICEH)

Aluisio Barros

Federal University of Pelotas (UFPel) - International Center for Equity in Health (ICEH)

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Abstract

Introduction: The 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, but previous studies have shown that a large number of children are at risk of poor development. We studied the prevalence and inequalities of delay in child development in 63 low- and middle-income countries.

Methods: We used data on the early child development module that was introduced in national health surveys. This instrument covers four developmental domains (physical, social-emotional, learning, literacy-numeracy) and provides a combined indicator (early child development indicator, 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.

Findings: We 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 42% in West & Central Africa to 10% in Europe & Central Asia. The literacy-numeracy domain was by far the most challenging, with the highest proportions of delay. We observed very large within country inequalities for the ECDI, and most markedly for the literacy-numeracy domain.

Interpretation: To date, our study presents the most comprehensive analysis of child development using a direct measure of development. We found an overall prevalence of developmental delay that was lower than previous studies. Nonetheless, a quarter of the children were suspected of not being on track. This represents an immense challenge for countries and multilateral agencies given the large number of children in need of help, the multifactorial aspect of early child development and the large between- and within country gaps we found.

Funding Statement: This work was funded by the Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative, OPP1148933).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: DHS and MICS are public sources of information and ethical approval has already been obtained by the institutions responsible for the implementation in each country.

Keywords: Equity health, Child development, Global health

Suggested Citation

Gil, Jesus and Ewerling, Fernanda and Ferreira, Leonardo and Barros, Aluisio, Early Childhood Developmental Delay in 63 Low- and Middle-Income Countries: Prevalence and Inequalities Estimated From National Health Surveys (May 10, 2019). Available at SSRN: https://ssrn.com/abstract=3386281 or http://dx.doi.org/10.2139/ssrn.3386281

Jesus Gil

Federal University of Pelotas (UFPel) - International Center for Equity in Health (ICEH) ( email )

Brazil

Federal University of Pelotas (UFPel) - Postgraduate Program in Epidemiology ( email )

Brazil

Fernanda Ewerling

Federal University of Pelotas (UFPel) - International Center for Equity in Health (ICEH) ( email )

Brazil

Federal University of Pelotas (UFPel) - Postgraduate Program in Epidemiology ( email )

Brazil

Leonardo Ferreira

Federal University of Pelotas (UFPel) - International Center for Equity in Health (ICEH) ( email )

Brazil

Aluisio Barros (Contact Author)

Federal University of Pelotas (UFPel) - International Center for Equity in Health (ICEH) ( email )

Brazil

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