Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modeling

Background The development of cognitive and socioemotional skills early in life influences later health and well-being. Existing estimates of unmet developmental potential in low- and middle-income countries (LMICs) are based on either measures of physical growth or proxy measures such as poverty. In this paper we aim to directly estimate the number of children in LMICs who would be reported by their caregivers to show low cognitive and/or socioemotional development. Methods and Findings The present paper uses Early Childhood Development Index (ECDI) data collected between 2005 and 2015 from 99,222 3- and 4-y-old children living in 35 LMICs as part of the Multiple Indicator Cluster Survey (MICS) and Demographic and Health Surveys (DHS) programs. First, we estimate the prevalence of low cognitive and/or socioemotional ECDI scores within our MICS/DHS sample. Next, we test a series of ordinary least squares regression models predicting low ECDI scores across our MICS/DHS sample countries based on country-level data from the Human Development Index (HDI) and the Nutrition Impact Model Study. We use cross-validation to select the model with the best predictive validity. We then apply this model to all LMICs to generate country-level estimates of the prevalence of low ECDI scores globally, as well as confidence intervals around these estimates. In the pooled MICS and DHS sample, 14.6% of children had low ECDI scores in the cognitive domain, 26.2% had low socioemotional scores, and 36.8% performed poorly in either or both domains. Country-level prevalence of low cognitive and/or socioemotional scores on the ECDI was best represented by a model using the HDI as a predictor. Applying this model to all LMICs, we estimate that 80.8 million children ages 3 and 4 y (95% CI 48.1 million, 113.6 million) in LMICs experienced low cognitive and/or socioemotional development in 2010, with the largest number of affected children in sub-Saharan Africa (29.4.1 million; 43.8% of children ages 3 and 4 y), followed by South Asia (27.7 million; 37.7%) and the East Asia and Pacific region (15.1 million; 25.9%). Positive associations were found between low development scores and stunting, poverty, male sex, rural residence, and lack of cognitive stimulation. Additional research using more detailed developmental assessments across a larger number of LMICs is needed to address the limitations of the present study. Conclusions The number of children globally failing to reach their developmental potential remains large. Additional research is needed to identify the specific causes of poor developmental outcomes in diverse settings, as well as potential context-specific interventions that might promote children’s early cognitive and socioemotional well-being.
Using survey data from 35 low- and middle-income countries, Dana McCoy and colleagues estimate the prevalence of children who are reported by their caregivers to show low cognitive and/or socioemotional development.
Author Summary Why Was This Study Done? Previous research suggests that more than 200 million children under age five living in low- and middle-income countries (LMICs) experience malnutrition and poverty. Despite this known risk, little is known about the status of young children’s cognitive and socioemotional development. Estimates of the number of children facing developmental setbacks are important for policy and resource allocation, as well as for tracking progress toward meeting global development goals (for example, the Sustainable Development Goals). What Did the Researchers Do and Find? This study extrapolates data from nearly 100,000 three- and four-year-old children living in 35 LMICs sampled as part of the Multiple Indicator Cluster Survey and the Demographic Health Surveys. The results suggest that one in every three preschool-aged children living in LMICs is failing to meet basic milestones in either their cognitive or socioemotional development, with an additional 16% facing setbacks in their physical growth. What Do These Findings Mean? The results highlight the ongoing challenges faced by young children living in developing countries in meeting basic developmental milestones. Additional intervention is needed to improve children’s cognitive and socioemotional well-being worldwide. Future research should consider additional dimensions of children’s development across a broader age range.