Global Health
Child’s functional difficulties and early childhood development in 22 low- and middle-income countries Hyejun Chi* Hyejun Chi Rockli Kim
Backgrounds: Disability is one of the health components that can compromise the developmental potential of children. However, only few studies have explored how a child’s disabilities can affect their early childhood development (ECD) in low- and middle-income countries (LMICs); the existing literature was limited in terms of considering the types and severity of disabilities and their potential moderators.
Methods: Using Multiple Indicator Cluster Surveys from 22 LMICs (2017-2020), we performed three-level random effects linear regressions to assess the association with a child’s functional difficulties and the standardized ECD z-score. Difficulties were further categorized into sensory, physical, and cognitive functions and according to their severity. Statistical interaction with functional difficulties and learning-related variables were additionally estimated.
Results: Overall, 6.0% of children reported any functional difficulties (sensory 1.0%; physical 0.9%; cognitive 5.1%). After adjusting for sociodemographic covariates, having any functional difficulties was associated with 0.47 lower ECD z-score (b=-0.47, 95% CI=-0.50, -0.45). Difficulty in sensory, physical, and cognitive functions were also associated with lower ECD z-score (b=-0.42, 95% CI=-0.47, -0.36 for sensory; b=-0.62, 95% CI=-0.67, -0.56 for physical; b=-0.51, 95% CI=-0.53, -0.49 for cognitive). Severe functional difficulties were associated with lower ECD z-score across the categories. We found little statistical interaction between functional difficulties and learning-related variables (interaction p-value>0.05).
Conclusions: Children with functional difficulties showed less optimal developmental status compared to their peers without difficulties. Efforts to improve the ECD of these children should focus on inclusive education and family support programs so that they can be successfully integrated into societies.
