Abstract
BackgroundIn developing countries, malnutrition in children and developmental delays are two major challenges for public health. To achieve the vision of the Sustainable Development Goals from the broader perspective of child health, early identification of developmental delays and timely intervention are crucial. The aim of this study is to assess the prevalence of suspected developmental delay and their predictors in children under the age of 5 years with uncomplicated severe acute malnutrition in rural areas of Pakistan.MethodsA multicentre cross-sectional study was conducted among 185 children with uncomplicated severe acute malnutrition. We screened children aged 6–59 months for their nutritional status and clinical complications. Children fulfilling the inclusion criteria underwent the Denver Development Screening Tool II (DDST-II). The children’s global developmental profile was calculated according to the established protocols of DDST-II, which are based on four important domains of development: personal and social behaviour, language, gross motor adaptive skills and fine motor adaptive skills. A pretested questionnaire was used to collect data on socio-demographic and nutritional factors for assessing predictors of developmental delay, which were analysed using a multivariate logistic regression model.ResultsOut of 177 children with severe acute malnutrition, 69 (38.9%) had normal global development and 108 (61.1%) had delayed global development. Significant associations were found between global developmental delay and younger children (6–24 months vs. 25–59 months; AOR = 4.53, 95% CI: 1.56–13.10, p < 0.01), children who were not exclusively breastfed (AOR = 3.07, 95% CI: 1.24–7.56, p = 0.01), and a history of contact with a tuberculosis smear-positive adult (AOR = 2.67, 95% CI: 1.30–5.49, p < 0.01).ConclusionAbout two thirds of the study participants showed delayed or unstable global development. Thus, according to DDST-II-established protocols, there is a high prevalence of suspected developmental delay among children under the age of five years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Children in their first 2 years of life were at particularly high risk due to insufficient breastfeeding. This emphasizes the need to provide adequate infrastructure and information to parents for the prevention of developmental delay in remote areas.
Highlights
In developing countries, malnutrition in children and developmental delays are two major challenges for public health
According to Denver Development Screening Tool II (DDST-II)-established protocols, there is a high prevalence of suspected developmental delay among children under the age of five years with uncomplicated severe acute malnutrition in rural areas of Pakistan
A multivariate logistic regression was run to measure the dynamics among the potential predictors for delayed development among the children and to present the results in terms of Adjusted Odds Ratios (AOR) with 95% confidence intervals and level of significance (p < 0.05)
Summary
Malnutrition in children and developmental delays are two major challenges for public health. Grantham et al estimated that, globally, just over 200 million children under five are unable to attain their developmental potential due to poverty, malnutrition, inappropriate childcare and/or child abuse. Most of these were from South Asia and sub-Saharan Africa [3]. SAM is responsible for a large proportion of the global disease burden among children and has a high lethality (10–30%). Those children who survive have compromised physical and cognitive development, which leads to reduced productivity in adulthood [6,7,8]
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