Journal of Education and Health Promotion

Assessment of risk factors for developmental delays among children in a rural community of North India: A cross‑sectional study

Document Type : Original Article

Authors

. Neha Sharma
. Jamal Masood 1
. S. N. Singh 2
. Naim Ahmad 3
. Prabhaker Mishra 4
. Shikhar Singh 5
. Sudip Bhattacharya

1 Department of Community Medicine and Public Health, King George’s Medical University

2 Department of Paediatrics, King George’s Medical University

3 Department of Community Medicine and Public Health, King Geo

4 Department of Biostatistics and Health Informatics, SGPGI

5 Department of Community Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India

Abstract
BACKGROUND: Initial formative years in every children’s life are critical for their optimal development,
as these frame the foundation of future well‑being. With a varied prevalence of developmental
delays (DDs) in the world and most of the studies representing the hospital‑based data. The present
study was aimed to find the prevalence and risk factors for DDs (domain wise) in children aged
2 months to 6 years in the rural area of North India.
METHODS: This was a cross‑sectional study in which a multistage random sampling technique was
used. From 30 Anganwadi centers, 450 children aged 2 months–6 years were taken in the study.
Rashtriya Bal Swasthya Karyakram screening tool developed by the Ministry of Health and Family
Welfare, India, was used for developmental screening. Binary logistic regression analysis was done
to identify the predictors for DDs (domain wise).
RESULTS: Seventy‑three (16.2%) children were found to have DDs and 60 (13.3%) children had
the global DDs. About 84/421 (20.0%) children had cognitive delay, followed by 43/450 (9.6%)
children who had delay in speech and language area. About 17/190 (8.9%) children had social
delay while 26/407 (6.4%) children had hearing and vision impairment. Gross motor delay was
seen in 24/450 (5.3%) children and 16/300 (5.3%) children had fine motor delay. Gestational
age (adjusted odds ratio [AOR] – 13.30), complications during delivery (AOR – 25.79), meconium
aspiration (AOR – 12.81), and child never breastfed (AOR – 8.34) were strong predictors for the
delay in different domains of developmental milestones.
CONCLUSION: Socio-economic, ante-natal, natal and post-natal factors should be considered for
prompt identification and initiation of intervention for DDs.
RECOMMENDATION: There is a need for increasing awareness and knowledge of parents regarding
the achievement of developmental milestones according to the age. A multipronged approach to the
holistic treatment of developmentally delayed children for early intervention is required.

Keywords

Developmental delays
developmental milestones
Rashtriya Bal Swasthya Karyakram
  1. David D, Toppo KJ, Saini K. Research article a study to assess
    the knowledge of mothers’ regarding developmental milestones
    of infants. Vol. 6, Issue, 07, pp. 7524‑7528, July, 2014Available
    from: http://www.gmferd.com/journalcra.com/sites/default/
    files/5791_1.pdf. .
    2. Eldred K, Darrah J. Using cluster analysis to interpret the
    variability of gross motor scores of children with typical
    development. Phys Ther 2010;90:1510‑8.
    3. Tervo RC. Identifying patterns of developmental delays can help
    diagnose neurodevelopmental disorders. Clin Pediatr (Phila)
    2006;45:509‑17.
    4. Walter F, Wrester F. Early childhood development. J Child Dev
    2009;23:23.
    5. Kerstjens JM, de Winter AF, Bocca‑Tjeertes IF, ten Vergert EMJ,
    Reijneveld SA, Bos AF: Developmental delay in moderately
    perterm‑born children at school entry. J Pediatr 2011;159:92‑8.
    6. Koch R. Institute: Results of the child and youth health survey.
    Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz
    2007;50:529‑908.
    7. Wohlfeil A. Developmental delays in children starting school
    with the resultant performance deficits. Öffentl Gesundhwes
    1991;53:175‑80.
    8. The Developmental Disabilities Services and Facilities
    Construction Act of 1970. p. 91‑517. Available from: http://
    www.mn.gov/mnddc/dd_act/documents/FEDREG/90DDALEGLISLATIVEHISTORY.pdf. [Last accessed on 2019 Jan
    02].
    9. Landgren M, Pettersson R, Kjellman B, Gillberg C. ADHD,
    DAMP and other neurodevelopmental/psychiatric disorders in
    6‑year‑old children: Epidemiology and co‑morbidity. Dev Med
    Child Neurol 1996;38:891‑906.
  2. 10. Tirosh E, Berger J, Cohen‑Ophir M, Davidovitch M, Cohen A.
    Learning disabilities with and without attention‑deficit
    hyperactivity disorder: Parents’ and teachers’ perspectives.
    J Child Neurol 1998;13:270‑6.
    11. Bishop DV. Handedness, clumsiness and developmental language
    disorders. Neuropsychologia 1990;28:681‑90.
    12. Nicolson RI, Fawcett AJ. Comparison of deficits in cognitive
    and motor skills among children with dyslexia. Ann Dyslexia
    1994;44:147‑64.
    13. Ministry of Health and Family Welfare Government of India.
    Rashtriya Bal Swasthya Karyakram (RBSK) Child Health
    Screening and Early Intervention Services under NRHM. Oper
    Guidelines; 2013.
    14. Mukherjee SB, Aneja S, Krishnamurthy V, Srinivasan R.
    Incorporating Developmental Screening and Surveillance of
    Young Children in Office Practice [Internet]. Vol. 627, INDIAN
    PEDIATRICS. 2014 [cited 2019 Feb 1]. Available from: https://
    www.indianpediatrics.net/aug2014/627.pdf.
    15. Cioni G, Inguaggiato E, Sgandurra G. Early intervention in
    neurodevelopmental disorders: Underlying neural mechanisms.
    Dev Med Child Neurol 2016;58 Suppl 4:61‑6.
    16. Campbell F, Conti G, Heckman JJ, Moon SH, Pinto R, Pungello E,
    et al. Early childhood investments substantially boost adult health.
    Science 2014;343:1478‑85.
    17. Rosenberg SA, Zhang D, Robinson CC. Prevalence of
    developmental delays and participation in early intervention
    services for young children. Pediatrics 2008;121:e1503‑9.
    18. Agarwal PK, Shi L, Daniel LM, Yang PH, Khoo PC, Quek BH,
    et al. Prospective evaluation of the ages and stages questionnaire
    3rd edition in very‑low‑birthweight infants. Dev Med Child Neurol
    2017;59:484‑9.
    19. Kerstjens JM, Bos AF, ten Vergert EM, de Meer G, Butcher PR,
    Reijneveld SA, et al. Support for the global feasibility of the ages
    and stages questionnaire as developmental screener. Early Hum
    Dev 2009;85:443‑7.
    20. Flamant C, Branger B, Nguyen The Tich S, de la Rochebrochard E,
    Savagner C, Berlie I, et al. Parent‑completed developmental
    screening in premature children: A valid tool for follow‑up
    programs. PLoS One 2011;6:e20004.
    21. Torabi F, Akbari SAA, Amiri S, Soleimani F, Majd HA. Correlation
    between high-risk pregnancy and developmental delay in
    children aged 4-60 months. Libyan J Med. 2012;7(1):0–6.
    22. Vora H, Shah P, Mansuri SH. A study on developmental
    delay among children less than 2 year attending well baby
    clinic – Prevalence and antecedents factors. Int J Med Sci Public
    Health 2013;462037:1084-7.
    23. Meenai Z, Longia S. A study on prevalence & antecedents of
    developmental delay among children less than 2 years attending
    well baby clinic: Peoples J Sci Res 2009;2:462037.
    24. Ali SS, Pa B, Dhaded SM, Goudar SS. Assessment of growth and
    global developmental delay: A study among young children
    in a rural community of India. International Multidisciplinary
    Research Journal 2011, 1(7):31-34.
    25. Séguin L, Xu Q, Gauvin L, Zunzunegui MV, Potvin L, Frohlich KL,
    et al. Understanding the dimensions of socioeconomic status
    that influence toddlers’ health: unique impact of lack of money
    for basic needs in Quebec’s birth cohort. Epidemiol Community
    Health 2005;59:42‑8. Available from: https://www.ncbi.nlm.
    nih.gov/pmc/articles/PMC1763364/pdf/v059p00042.pdf. [Last
    accessed on 2017 Sep 05].
    26. Binu A, Sunil R, Baburaj S, MohandasMK.Socio demographic
    profile of speech and language delay up to six years of age in
    Indian children. Int J Med Res Health Sci. 2014;3(1):98.
    27. Devi UL, Professor A, Resident S. Assessment of speech and
    language delay using language evaluation scale Trivandrum(LEST
    0‑3). Chettinad Health City Med J 2015;4:70‑4. Available from:
    http://www.chcmj.ac.in/journal/pdf/vol4_no2/Assessment.
    pdf. [Last accessed on 2017 Aug 27].
    28. Mondal N, Bhat BV, Plakkal N, Thulasingam M, Ajayan P,
    Poorna DR. Prevalence and risk factors of speech and language
    delay in children less than three years of age. J Compr Pediatr
    2016;7:e33173.
    29. Venketraman Kondekar S, Shree VS, Kondekar SV. Assessment
    of speech and language delay among 0-3 years old children
    attending well-baby clinics using Language Evaluation Scale
    Trivandrum. Indian J Child Health 2016;3:220-4. Available
    from: https://www.atharvapub.net/index.php/IJCH/article/
    viewFile/551/337. [Last accessed on 2017 Aug 25].
    30. Sidhu M, Malhi P, Jerath J. Early language development in Indian
    children: A population‑based pilot study. Ann Indian Acad
    Neurol 2013;16:371‑5.
    31. Dharmalingam A, Raghupathy NS, Belgin R, Kumar P. Cross
    sectional study on language assessment of speech delay in
    children 0 to 6 years. IOSR J Dent Med Sci 2015;14:2279‑861.
    Available from: http://www.iosrjournals.org. [Last accessed on
    2018, Oct 6].
    32. Gupta A, Kalaivani M, Gupta SK, Rai SK, Nongkynrih B. The
    study on achievement of motor milestones and associated factors
    among children in rural North India. J Family Med Prim Care
    2016;5:378‑82.
    33. Sajedi F, Vameghi R, Kraskian Mujembari A. Prevalence of
    undetected developmental delays in Iranian children. Child Care
    Health Dev 2014;40:379‑88.
    34. Bello AI, Quartey JN, Appiah LA. Screening for developmental
    delay among children attending a rural community welfare clinic
    in Ghana. BMC Pediatr 2013;13:119.
    35. DabarD, DasR, NageshS, YadavV, MangalA. Acommunity‑based
    study on growth and development of under‑five children in an
    urbanized village of South Delhi. J Trop Pediatr 2016;62:446‑56.
    36. Soleimani F, Vameghi R, Biglarian A, Rahgozar M. Prevalence of
    motor developmental disorders in children in Alborz province,
    Iran in 2010. Iran Red Crescent Med J 2014;16:e16711.
    37. Kerstjens JM, de Winter AF, Bocca‑Tjeertes IF, ten Vergert EM,
    Reijneveld SA, Bos AF, et al. Developmental delay in moderately
    preterm‑born children at school entry. J Pediatr 2011;159:92‑8.
    38. Bhattacharya T, Ray S, Das DK. Developmental delay among
    children below two years of age : A cross- sectional study in a
    community development block of Burdwan district, West Bengal.
    International Journal of Community Medicine and Public Health
    2017;4:1762-67.
    39. Sheelamma JK, Kumari KS. Developmental profile of children
    under two years in the coastal area of Kochi, Kerala. Int J Adv
    Res J 2013;1:870‑4. Available from: http://www.journalijar.
    com/uploads/2013‑12‑04_031544_778.pdf. [Last accessed on
    2017 Sep 05].
    40. Valla L, Wentzel‑Larsen T, Hofoss D, Slinning K. Prevalence of
    suspected developmental delays in early infancy: Results from
    a regional population‑based longitudinal study. BMC Pediatr
    2015;15:215.
    41. Hediger ML, Overpeck MD, Ruan WJ, Troendle JF. Birthweight
    and gestational age effects on motor and social development.
    Paediatr Perinat Epidemiol 2002;16:33‑46.
    42. Handal AJ, Lozoff B, Breilh J, Harlow SD. Sociodemographic and
    nutritional correlates of neurobehavioral development: A study
    of young children in a rural region of Ecuador. Rev Panam Salud
    Publica 2007;21:292‑300.
    43. Richter J, Janson H. A validation study of the Norwegian
    version of the ages and stages questionnaires. Acta Paediatr
    2007;96:748‑52.
    44. Potijk MR, Kerstjens JM, Bos AF, Reijneveld SA, de Winter AF.
    Developmental delay in moderately preterm‑born children
    with low socioeconomic status: Risks multiply. J Pediatr
    2013;163:1289‑95.
    45. Schady N. Parents’ education, mothers’ vocabulary, and cognitive development in early childhood: Longitudinal evidence from
    Ecuador. Am J Public Health 2011;101:2299‑307.
    46. Comuk‑Balci N, Bayoglu B, Tekindal A, Kerem‑Gunel M, Anlar B.
    Screening preschool children for fine motor skills: Environmental
    influence. J Phys Ther Sci 2016;28:1026‑31.
    47. Alvik A, Grøholt B. Examination of the cut-off scores determined
    by the Ages and Stages Questionnaire in a population-based
    sample of 6 month-old Norwegian infants [Internet]. 2011
    [cited 2019 Feb 1]. Available from: http://www.biomedcentral.
    com/1471-2431/11/117.
    48. Charan GS, Vagha J. Study of perinatal factors in children with
    developmental delay. International Journal of Contemporary
    Pediatrics 2017;4:182-90.
    49. Nguefack S, Kamga KK, Moifo B, Chiabi A, Mah E, Mbonda E.
    Causes of developmental delay in children of 5 to 72 months old
    at the child neurology unit of Yaounde Gynaeco‑obstetric and
    paediatric hospital (Cameroon). Open J Pediatr 2013;3:279‑85.
    Available from: http://www.dx.doi.org/10.4236/ojped.
    2013.33050. [Last accessed on 2017 Aug 27].
    50. Sachdeva S, Amir A, Alam S, Khan Z, Khalique N, Ansari MA,
    et al. Global developmental delay and its determinants among
    urban infants and toddlers: A cross sectional study. Indian J
    Pediatr 2010;77:975‑80.
    51. Tikaria A, Kabra M, Gupta N, Sapra S, Balakrishnan P, Gulati S,
    et al. Aetiology of global developmental delay in young children:
    Experience from a tertiary care centre in India. Natl Med J India
    2010;23:324‑9.
    52. El Marroun H, Zeegers M, Steegers EA, van der Ende J, Schenk JJ,
    Hofman A, et al. Post‑term birth and the risk of behavioural
    and emotional problems in early childhood. Int J Epidemiol
    2012;41:773‑81.
    53. Olesen AW, Olsen J, Zhu JL. Developmental milestones in children
    born post‑term in the Danish national birth cohort: A main
    research article. BJOG 2015;122:1331‑9.
    54. Beligere N, Rao R. Neurodevelopmental outcome of infants with
    meconium aspiration syndrome: Report of a study and literature
    review. J Perinatol 2008;28 Suppl 3:S93‑101.
    55. Wiswell TE, Bent RC. Meconium staining and the meconium
    aspiration syndrome. Unresolved issues. Pediatr Clin North Am
    1993;40:955‑81.
    56. Vidyasagar D, Harris V, Pildes RS. Assisted ventilation in infants
    with meconium aspiration syndrome. Pediatrics 1975;56:208‑13.
    57. Koul R, Al‑Yahmedy M, Al‑Futaisi A. Evaluation children with
    global developmental delay: A prospective study at Sultan
    Qaboos university hospital, Oman. Oman Med J 2012;27:310‑3.
    58. Thomaidis L, Zantopoulos GZ, Fouzas S, Mantagou L,
    Bakoula C, Konstantopoulos A, et al. Predictors of severity
    and outcome of global developmental delay without definitive
    etiologic yield: A prospective observational study. BMC Pediatr
    2014;14:40.
    59. Juneja M, Mohanty M, Jain R, Ramji S. Ages and stages
    questionnaire as a screening tool for developmental delay in
    Indian children. Indian Pediatr 2012;49:457‑61.
    60. de Kieviet JF, Piek JP, Aarnoudse‑Moens CS, Oosterlaan J. Motor
    development in very preterm and very low‑birth‑weight children
    from birth to adolescence: Ameta‑analysis. JAMA 2009;302:2235‑42.
    61. Ballot DE, Chirwa TF, Cooper PA. Determinants of survival in
    very low birth weight neonates in a public sector hospital in
    Johannesburg. BMC Pediatr 2010;10:30.
    62. Chattopadhyay N, Mitra K. Neurodevelopmental outcome of
    high risk newborns discharged from special care baby units in a
    rural district in India. J Public Health Res 2015;4:318.
    63. Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW,
    Matush L, et al. Breastfeeding and child cognitive development:
    New evidence from a large randomized trial. Arch Gen Psychiatry
    2008;65:578‑84.
    64. Jedrychowski W, Perera F, Jankowski J, Butscher M, Mroz E,
    Flak E, et al. Effect of exclusive breastfeeding on the development
    of children’s cognitive function in the Krakow prospective birth
    cohort study. Eur J Pediatr 2012;171:151‑8.
    65. Lundqvist‑Persson C, Lau G, Nordin P, Strandvik B, Sabel KG.
    Early behaviour and development in breast‑fed premature infants
    are influenced by omega‑6 and omega‑3 fatty acid status. Early
    Hum Dev 2010;86:407‑12.
    66. Pérez‑Escamilla R. Influence of Breastfeeding on Psychosocial
    Development; 2008 Available from: http://www.childencyclopedia.com/sites/default/files/textes‑experts/en/545/
    influence-of-breastfeeding‑on‑psychosocial‑development.
    pdf. [Last accessed on 2018 Aug 31].
    67. Walfisch A, Sermer C, Cressman A, Koren G. Breast milk and
    cognitive development – The role of confounders: A systematic
    review. BMJ Open 2013;3:e003259.
    68. Bernard JY, Armand M, Peyre H, Garcia C, Forhan A,
    De Agostini M, et al. Breastfeeding, polyunsaturated fatty acid
    levels in colostrum and child intelligence quotient at age 5‑6 years.
    J Pediatr 2017;183:43‑50.e3.
Journal of Education and Health Promotion
Volume 9, Issue 6
June 2019
Pages 1-12

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us