Global developmental delay and its determinants among urban infants and toddlers: a cross sectional study

Prevalence and determinants of developmental delay among children in low- and middle-income countries: a systematic review and meta-analysis

Background

Developmental delay is a public health problem in low- and middle-income countries. However, there is no summarized evidence in low- and middle-income countries on developmental delay, and primary studies on this issue show varied and inconclusive results. This systematic review and meta-analysis aimed to assess the pooled magnitude of confirmed developmental delay and its determinants among children in low- and middle-income countries.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to write this systematic review and meta-analysis. Primary studies were searched from PubMed, PsycINFO, Hinari, Science Direct, African Journal of Online, Web of Science, and Google Scholar databases. The Newcastle-Ottawa Scale, adapted for the cross-sectional studies, was used to assess the quality of the included studies. Heterogeneity and publication bias were assessed by the I2 and Eggers tests, respectively. Due to the high heterogeneity, the random effects model was used for analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to show the association between developmental delay and its determinants.

Results

The pooled prevalence of confirmed developmental delay was 18.83, 95% CI (15.53-22.12). In the subgroup analysis, a high prevalence of developmental delay [26.69% (95% CI, 15.78-37.60)] was observed in studies performed in Africa. Maternal education [3.04; 95% CI (2.05, 4.52)] and low birth weight [3.61; 95% CI (1.72, 7.57)] were significant determinants of developmental delay.

Conclusion

The pooled prevalence of developmental delay in low- and middle-income countries was high as compared to that in high-income countries. Maternal education level and weight at birth were significantly associated with developmental delays. Therefore, strategies should be designed to decrease the rate of low birth weight and the number of illiterate mothers living in low- and middle-income countries.

Systematic review registration

PROSPERO, CRD42024513060.

Alopecia areata-like pattern of baldness: the most recent update and the expansion of novel phenotype and genotype in the CTNNB1 gene

Neurodevelopmental disorder with spastic diplegia and visual defects (NEDSDV) is a rare autosomal dominant genetic disorder caused by genetic alterations in the CTNNB1 gene. CTNNB1 is a gene that encodes β-catenin, an effector protein in the canonical Wnt pathway involved in stem cell differentiation and proliferation, synaptogenesis, and a wide range of essential cellular mechanisms. Mutations in this gene are also found in specific malignancies as well as exudative vitreoretinopathy. To date, only a limited number of cases of this disease have been reported, and though they share some phenotypic manifestations such as intellectual disability, developmental delay, microcephaly, behavioral abnormalities, and dystonia, the variety of phenotypic traits of these patients shows extreme heterogeneity. In this study, two cases of NEDSDV with de novo CTNNB1 mutations: c.1420C>T(p.R474X) and c.1377_1378Del(p.Ala460Serfs*29), found with whole exome sequencing (WES) have been reported and the clinical and paraclinical characteristics of these patients have been described. Due to such a wide range of clinical characteristics, the identification of new patients and novel variants is of great importance in order to establish a more complete phenotypic spectrum, as well as to conclude the genotype-phenotype correlations in these cases.

National screening for developmental delays and their determinants among Egyptian school age children: A step towards implementing life skills programs

AIM

This study aimed to estimate the national prevalence of developmental delays (DDs) and their determinants among Egyptian children aged 6 to 12 years. Such estimation is a prerequisite step toward the application of Life Skill Education (LSE) programs that will potentiate children's future capabilities.

METHODS

Vineland Adaptive Behavior Scales" was used as a reliable and diagnostic test for DDs screening during this national cross sectional study. Gross motor (GM), fine motor (FM), daily living skills, communication, and socialization skills were assessed. The multivariate logistic regression analysis was used to identify factors associated with DDs. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval was estimated to indicate the strength of association. A p-value of <0.05 was used to declare statistical significance.

RESULTS

Out of the 20324 surveyed school-aged children, 7.4% were found to have at least one delay. Communication deficits were the most common (6.4%) followed by delay in daily living skills (2.0%). The final model of logistic regression had a good fit for seven variables out of the sociodemographic, epidemiological characteristics, maternal and perinatal problems that were associated with a higher likelihood of at least one DD: Children suffering from any convulsions (AOR = 4.32; 95% CI: 3.18-5.88), male gender (AOR = 1.86; 95% CI: 1.65-2.09), birth weight less than 2.5 kg (AOR = 1.77; 95% CI: 1.40-2.24), history of maternal health problem during pregnancy (AOR = 1.64; 95% CI:1.34-2.01), children staying in an incubator for more than two days (AOR = 1.57, 95% CI: 1.29-1.91), having less educated fathers (AOR = 1.55, 95% CI: 1.24-1.95) and belonging to the middle social class (AOR = 1.40, 95% CI: 1.24-1.58).

CONCLUSION

The identified types and determinants for each DD are allowing for the implementation of tailored programs for school children's life skills promotion for achieving the most sustainable effects on children's biological and psychological health and well-being.

National screening for developmental delays and their determinants among Egyptian school age children: A step towards implementing life skills programs

Aim

This study aimed to estimate the national prevalence of developmental delays (DDs) and their determinants among Egyptian children aged 6 to 12 years. Such estimation is a prerequisite step toward the application of Life Skill Education (LSE) programs that will potentiate children’s future capabilities.

Methods

Vineland Adaptive Behavior Scales” was used as a reliable and diagnostic test for DDs screening during this national cross sectional study. Gross motor (GM), fine motor (FM), daily living skills, communication, and socialization skills were assessed. The multivariate logistic regression analysis was used to identify factors associated with DDs. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval was estimated to indicate the strength of association. A p-value of <0.05 was used to declare statistical significance.

Results

Out of the 20324 surveyed school-aged children, 7.4% were found to have at least one delay. Communication deficits were the most common (6.4%) followed by delay in daily living skills (2.0%). The final model of logistic regression had a good fit for seven variables out of the sociodemographic, epidemiological characteristics, maternal and perinatal problems that were associated with a higher likelihood of at least one DD: Children suffering from any convulsions (AOR = 4.32; 95% CI: 3.18–5.88), male gender (AOR = 1.86; 95% CI: 1.65–2.09), birth weight less than 2.5 kg (AOR = 1.77; 95% CI: 1.40–2.24), history of maternal health problem during pregnancy (AOR = 1.64; 95% CI:1.34–2.01), children staying in an incubator for more than two days (AOR = 1.57, 95% CI: 1.29–1.91), having less educated fathers (AOR = 1.55, 95% CI: 1.24–1.95) and belonging to the middle social class (AOR = 1.40, 95% CI: 1.24–1.58).

Conclusion

The identified types and determinants for each DD are allowing for the implementation of tailored programs for school children’s life skills promotion for achieving the most sustainable effects on children’s biological and psychological health and well-being.

Capacity Building of Frontline Workers for Detection of Children (0-6 Years) with Developmental Delays in a Rural Setting: A Cluster-Randomized Trial

INTRODUCTION

Development during the early stage of life i.e. in the first 1000 d is crucial in determining the psychosocial productivity of a child in the future. Frontline workers (FLWs) are not trained to detect of developmental delays (DDs) in children under the national programme of Rashtriya Bal Swasthya Karyakram (RBSK) in India.

OBJECTIVE

To train the FLWs and assess the effectiveness of a training strategy in detection of DDs in children less than 6 y of age using a cluster-randomized trial approach.

METHODS

A community-based interventional study was conducted in Khurdha district of Odisha. Training was imparted to FLWs in intervention arm using a training module developed in regional language. Knowledge level of FLWs was assessed before and after the training in both study arms using a structured questionnaire, and data were analyzed in IBM SPSS 22. Outcomes were compared using chi square, Student t (both paired and unpaired) and Man-Whitney U test. After 3 mo of intervention, the investigator examined a sample of children (intervention arm: 870, control arm: 847) for DDs using the Denver Developmental Screening Test II.

RESULTS

The mean difference in knowledge scores of FLWs was found to be 7.26 (8.8 to 5.7) and 1.11 (1.38 to 0.84) in intervention and control arm, respectively. Case detection rate by FLWs in intervention and control arm was 61.5% and 9.09%, respectively.

CONCLUSION

Capacity building of the FLWs should be considered by the government for integrating them in the Rashtriya Bal Swasthya Karyakram (RBSK) programme for screening children.

Early-onset developmental impairments among infants attending the routine immunization clinic at the University College Hospital, Ibadan, Nigeria

Developmental disorders are frequently overlooked in the developing countries, particularly in sub-Saharan Africa. Early identification of developmental delays (DDs) is critical to optimal outcomes. This study set out to determine the proportion of children who are at risk of DDs among infants attending immunization clinics at the University College Hospital, Ibadan, Nigeria. Infants 6 weeks to 12 months of age (median age 6 months) who presented for routine immunization were screened for DDs using the Ages and Stages Questionnaire. A total of 587 infants [312 (53.2%) males] were enrolled. A total of 198 (33.7%) children showed signs of DDs. For the domains of communication skills, fine motor skills, gross motor skills, problem solving/cognition skills and personal/social skills, the prevalences of DDs were 7.5%, 15.0%, 10.7%, 14.1% and 14.8%, respectively, and 14.3% had global DDs. Factors that significantly predicted DDs included prematurity (odds ratio [OR] 2.64 [95% confidence interval {CI} 1.45 to 2.05]) and a history of perinatal asphyxia (OR 1.74 [95% CI 1.77 to 2.49]). There is a need to incorporate routine developmental screening into the Nigerian healthcare system for timely recognition of DDs and prompt interventions.

Vitamin B12 status and neurodevelopmental delay in Indian infants: a hospital-based cross-sectional study

Background: Vitamin B₁₂ deficiency owing to a vegetarian diet is common in India and is associated with neurodevelopmental disorders.Objective: To investigate the prevalence of vitamin B₁₂ deficiency in infants aged 1-12 months and to correlate the results with neurodevelopment.Methods: A cross-sectional study of 200 infants aged 1-12 months presenting to the emergency department or ward and requiring blood sampling or intravenous cannulation was undertaken in a tertiary-care centre of Northern India. Patients' serum vitamin B₁₂ levels were correlated with Denver development screening test II (DDST II).Results: Of 200 infants recruited, 43 (22%) were vitamin B₁₂-deficient (<211 pg/ml). After excluding 16 (8%) infants who were unsuitable for DDST screening, 21/39 (54%) and 22/145 (15%) were DDST-suspect in the vitamin B₁₂-deficient and sufficient groups, respectively (p = 0.0001). There was a statistically significant correlation between B₁₂ deficiency and an abnormal DDST (p < 0.0001).Conclusion: In India, vitamin B₁₂ deficiency is prevalent in infancy and is associated with neurodevelopmental delay.

The Impact of Autism Spectrum Disorder in Comparison with Other Neuro-Developmental Disorders in Children on the Family: Single Centre Experience

BACKGROUND

Neurodevelopmental disorders (NDD), especially autism spectrum disorder (ASD), have a substantial impact on the family, with a consequent decrease in the quality of life. The current study was undertaken to understand if having ASD contributed to a higher impact on families compared to other NDD and to understand additional factors impacting families of children with either disorder in a low-middle income country (LMIC) setting.

METHODS

Impact of ASD and other NDD along with sociodemographic factors was examined, by a retrospective analysis, among 540 children in a tertiary care center in South India.

RESULTS

Both ASD and NDD had high, but comparable, impact on the family. Being a girl child, having seizures, and having sleep problems predicted a higher impact.

CONCLUSIONS

In children with NDD, managing co-morbidities such as achieving better seizure control and addressing sleep-related problems may improve the impact of NDD on the family. Gender disparity in disability needs to be studied within the local cultural context.

Prevalence and Incidence of Developmental Disorders in Korea: A Nationwide Population-Based Study

Prevalence of developmental disorders (DDs) has been increasing worldwide. This study identifies a trend in their prevalence and incidence, using nationwide population-based data to analyze the characteristics of children with DDs in Korea. The prevalence of DDs steadily increased by more than four times (from 0.6 to 2.5) from 2003 to 2017. Boys had higher incidence than girls throughout the period, during which the gap increased from 19.1 to 31.4%. The incidence also increased by the size of city and medical insurance quartile. The ratio of autism spectrum disorder, developmental delay and language disorders among the total incident cases of DDs increased by 13.7%, 817.6%, and 30.7%, respectively, indicating their contribution to the trend of increasing prevalence.

Child Development and Nutritional Status in Ecuador

We assessed the development, nutritional status, and complementary feeding of 12- to 23-month-old children from Cuenca, Ecuador in 2013. Ecuador, an upper-middle-income country, developed a child policy in accordance with World Health Organization (WHO) guidelines. We collected cross-sectional survey data. Child development was assessed using the Integrated Management of Childhood Illness Guide–2011. The nutritional status was defined with WHO Child Growth Standards−2006. We investigated nutrient density, WHO Infant and Young Child Feeding Indicators, and nutrient supplementation intake of the complementary feeding. In all, 11.7% of children had “possible developmental delay,” stunting was identified in 29.4% of the children, and 25.3% faced overnutrition (overweight risk/overweight/obesity). The complementary feeding composition can be summarized as having adequate fat, high energy (MJ/day) and protein, and low iron and zinc. Children with “possible developmental delay” received less iron (P < .05) than children with normal development. Overall, 30.4% of children had minimum dietary diversity. A total of 47.7% of children received nutrient supplementation. This epidemiological profile of infants remains a challenge for Ecuador’s health programs.

The association between malnutrition and childhood disability in low- and middle- income countries: systematic review and meta-analysis of observational studies

OBJECTIVE

The aim of this study was to evaluate the association between childhood disability and malnutrition in low- and middle- income countries (LMICs).

METHODS

Articles were identified from 1990 to August 2017 by searching nine electronic databases. Epidemiological studies, undertaken in LMICs that compared the prevalence of malnutrition in children with disabilities to children without disabilities were eligible for inclusion. Titles, abstracts, and full texts were screened by two reviewers, and data were extracted using a structured table for eligible papers. Meta-analyses for the association between childhood disability and undernutrition were performed.

RESULTS

The search generated 4678 results, from which 17 articles were eligible. Fifty-three per cent of these studies showed a positive association between childhood disability and undernutrition. Results varied when disaggregated by type of disability, with positive associations identified for 44% of studies focussed on neurodevelopmental disability, 60% of general disability studies and 67% of studies on hearing impairment. Only four studies were identified that considered overnutrition outcomes, and these showed variable results. Eighteen per cent of eligible studies were considered at low risk of bias, 53% had a medium risk, and 29% had a high risk of bias. Pooled ORs showed that children with disabilities were almost three times more likely to be underweight (OR 2.97, 95% CI 2.33, 3.79), and nearly twice as likely to experience stunting and wasting (Stunting: 1.82, 1.40, 2.36; Wasting: 1.90, 1.32-2.75), compared to controls.

CONCLUSIONS

Children with disabilities may be a vulnerable group for undernutrition in LMICs, which should be reflected in disability and nutritional programming and policy-making.

A Community-based Study on Growth and Development of Under-Five Children in an Urbanized Village of South Delhi

BACKGROUND

Optimal development of children in their early months and years has a bearing on their achievement levels later in life.

OBJECTIVES

To assess the socio-emotional and cognitive development in children 0-5 years and to find out the proportion of children having developmental delay and its associated factors.

METHODS

A community-based cross-sectional study was carried out in 520 children in Delhi. Development was assessed using the Indian Council for Medical Research Development Screening Test.

RESULTS

In all, 10.6% of children <5 years old were found to be developmentally delayed. Maximum number of children (10.1%) were found to have a delay in the do main of 'hearing language, concept development'. Of all the factors, the strongest association was found with stunting, paternal education, alcohol abuse, attendance in anganwadi/playschool.

CONCLUSIONS

The study concludes that developmental delay is present in a sizable proportion of children <5 years of age and may be a significant factor in the overall achievement of life's potential in them.

Time trends and determinants of multiple development delays in Bavarian preschool children: a retrospective analysis from 1997 to 2010

OBJECTIVES

The aim of this study was to identify the time trends of multiple developmental delays and to determine the strength of selected factors influencing preschool child's development.

METHODS

We reviewed the records of 13,876 preschoolers in a district of Lower Bavaria to determine prevalence and time trends of combined developmental delays from 1997 to 2010. The effect of age, sex and nationality on development was estimated by using regression models.

RESULTS

The largest increase was in the area of psychosocial development (1997:3.8 % versus 2010:13.8 %), followed by twofold combined delays in motor (2.6 versus 14.4 % in 2009) and twofold delays (1.3 versus 6.2 %) in cognition. Youngest children (4.26-5.49 years) had the highest risk for twofold delays in motor (4.78; 95 % CI 3.30-6.92), whereas strongest protection was observed for girls (0.28; 95 % CI 0.22-0.36) for threefold delays in motor and for a German nationality (0.30; 95 % CI 0.20-0.43) for fourfold delays in cognition.

CONCLUSIONS

According to this study, multiple disabilities in development were increasing in preschool children. These children can be considered as a risk group who therefore require measures in Public Health.

Iron deficiency in children with global developmental delay and autism spectrum disorder

AIM

To investigate the prevalence of and risk factors for iron deficiency in children with global developmental delay and/or autism spectrum disorder (ASD).

METHOD

A retrospective review was conducted of the files of children referred to community paediatric clinics in South West Sydney from May 2009 to July 2011 who were diagnosed with global developmental delay and/or ASD. Data were extracted on iron studies and potential risk factors. Data were analysed using Pearson's ÷(2) -test and Fisher's exact test.

RESULTS

Subjects included 122 children. The prevalence of iron depletion was 2.5% (95% CI 0.5-7.0%); that of iron deficiency was 6.6% (95% CI 2.9-12.5%), and that of iron deficiency anaemia was 4.1% (95% CI 1.3-9.3%). In children with global developmental delay without ASD, the prevalence of iron depletion was 1.8% (95% CI 0-9.7%), that of iron deficiency 5.5% (95% CI 1.1-15.1%) and that of iron deficiency anaemia 5.5% (95% CI 1.1-15.1%). In children with ASD with or without global developmental delay, the prevalence of iron depletion was 3.0% (95% CI 0.4-10.4%), that of iron deficiency 7.5% (95% CI 2.5-16.6%) and that of iron deficiency anaemia 3.0% (95% CI 0.4-10.4%). Univariate analysis demonstrated three significant potential risk factors for iron depletion, iron deficiency and iron deficiency anaemia: problems sucking, swallowing or chewing (P = 0.002); poor eating behaviour (P = 0.008); and inadequate amounts of meat, chicken, eggs or fish (P = 0.002).

CONCLUSION

Iron deficiency and iron deficiency anaemia were more common in this clinical sample of children with global developmental delay and/or ASD than in the general population.

Predictors of severity and outcome of global developmental delay without definitive etiologic yield: a prospective observational study

BACKGROUND

Although several determinants of global developmental delay (GDD) have been recognized, a significant number of children remain without definitive etiologic diagnosis. The objective of this study was to assess the effect of various prenatal and perinatal factors on the severity and outcome of developmental delay without definitive etiologic yield.

METHODS

From March 2008 to February 2010, 142 children with developmental quotient (DQ) <70 and without definitive etiologic diagnosis, were included. Prenatal and perinatal risk factors known to be associated with disordered neonatal brain function were identified. Participants underwent a thorough investigation, an individualized habilitation plan was recommended, and the children were followed-up regularly for a period of 2 < years. The effect of prenatal and perinatal risk factors on the severity and outcome of GDD was assessed by regression analysis.

RESULTS

The mean age at enrolment was 31 ± 12 < months, and the mean DQ 52.2 ± 11.4. Prematurity and intrauterine growth restriction (IUGR) were found to be independently associated with lower DQ values. The mean DQ after the 2-year follow-up was 62.5 ± 12.7, and the DQ difference from the enrollment 10.4 ± 8.9 (median 10; range-10 to 42). DQ improvement (defined as a DQ difference?≥?median) was noted in 52.8% of the children. IUGR, low socio-economic status, and poor compliance to habilitation plan were found to be independently associated with poorer developmental outcomes.

CONCLUSIONS

Prematurity and IUGR were found to be significantly and independently related to the severity of GDD in cases without definitive etiologic yield. Poorer 2-year developmental outcome was associated with IUGR, low socioeconomic status and non compliance to habilitation plan. Prematurity was a significant determinant of the outcome only in association with the above mentioned factors.