Association of Possible Developmental Delays with Emotional and Behavioral Disorders, and Risk Factors in Children Under Six in Karachi, Pakistan: A Cross-sectional Study: Association of Developmental Delays with Emotional and Behavioral Disorders

Shumaila Shabbir; Kauser Mahmood; Neelum Jamal; Gati Ara; Bina Fawad; Shabina Salahuddin

doi:10.54393/pjhs.v6i2.2738

Authors

Shumaila Shabbir Department of Community Health Sciences, Fazaia Ruth Pfau Medical College, Ziauddin Medical College, Karachi, Pakistan
Kauser Mahmood Department of Neurology, Fazaia Ruth Pfau Medical College, Karachi, Pakistan
Neelum Jamal Department of Community Health Sciences, Fazaia Ruth Pfau Medical College, Karachi, Pakistan
Gati Ara Department of Community Health Sciences, Dow University of Health Sciences, Karachi, Pakistan
Bina Fawad Department of Community Health Sciences, Ziauddin Medical College, Karachi, Pakistan
Shabina Salahuddin Department of Community Health Sciences, Fazaia Ruth Pfau Medical College, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i2.2738

Keywords:

Developmental Delays, Primary Health Care, Determinants, Behavioural Disorders

Abstract

Developmental delays refer to a child not reaching expected milestones. They are linked to various factors and, if unaddressed in early childhood, can lead to long-term consequences in adulthood. Objectives: To determine the association of developmental delays with emotional and behavioural disorders and other risk factors in children less than six years of age. Methods: This cross-sectional study was conducted at a primary healthcare center in a Karachi slum from October 2020 to July 2021. Using non-probability consecutive sampling, 425 participants (parents of children aged 1-5½ years) were selected. Data were collected using the validated Survey of Well-being of Young Children tool and analyzed in SPSS version 23.0. Logistic regression assessed associations between outcomes and risk factors. Results: Of 425 participants, 161 (37.9%) had possible developmental delays. No association was found with emotional/behavioural disorders (p=0.30). Binary logistic regression linked delays to male gender, uneducated parents, unemployed mothers, low income, domestic violence, and tobacco/drug exposure at home (p<0.05). After adjustment, significant associations remained with the mother’s education (aOR=1.785, CI: 1.040-3.065, p=0.036), income (aOR=3.361, CI: 1.197-9.434, p=0.021), and domestic violence (aOR=2.603, CI: 1.055-6.423, p=0.027). Conclusions: It was concluded that the prevalence of developmental delays in slum-dwelling children is high. No association was found with emotional/behavioural disorders. Socioeconomic factors, such as the mother’s education.

References

Demirci A and Kartal ME. The Prevalence of Developmental Delay Among Children Aged 3–60 Months in Izmir, Turkey. Child: Care, Health and Development. 2016 Mar; 42(2): 213-9. doi: 10.1111/cch.12289.

Simeonsson RJ, Lollar D, Hollowell J, Adams M. Revision of the International Classification of Impairments, Disabilities, and Handicaps: Developmental Issues. Journal of Clinical Epidemiology. 2000 Feb; 53(2): 113-24. doi: 10.1016/S0895-4356(99)00133-X.

Samuels A, Slemming W, Balton S. Early Childhood Intervention in South Africa in Relation to the Developmental Systems Model. Infants and Young Children. 2012 Oct; 25(4): 334-45. doi: 10.1097/IYC.0b013e3182673e12.

Gil JD, Ewerling F, Ferreira LZ, Barros AJ. Early Childhood Suspected Developmental Delay in 63 Low-and Middle-Income Countries: Large Within-and Between-Country Inequalities Documented Using National Health Surveys. Journal of Global Health. 2020 Jun; 10(1): 010427. doi: 10.7189/jogh.10.010427.

Abdoola S, Swanepoel DW, Van Der Linde J, Glascoe FP. Detecting Developmental Delays in Infants from A Low-Income South African Community: Comparing the BSID-III and PEDS tools. Early Child Development and Care. 2021 Mar; 191(4): 545-554. doi: 10.1080/03004430.2019.1628027.

Saleem J, Zakar R, Bukhari GM, Fatima A, Fischer F. Developmental Delay and Its Predictors Among Children Under Five Years of Age with Uncomplicated Severe Acute Malnutrition: A Cross-Sectional Study in Rural Pakistan. BioMed Central Public Health. 2021 Dec; 21: 1-0. doi: 10.1186/s12889-021-11445-w.

Zaib R, Yaqoob M, Iftikhar N, Qureshi EM, aur Rehman A. Delayed Speech in Children of Working and Non-Working Mothers in Lahore, Pakistan: Prevalence and Associated Factors. Journal of Fatima Jinnah Medical University. 2022; 16(3): 124-9. doi: 10.37018/GRMX3731.

Kumar R, Ali M, Pasha MS, Ansari HW, Durrani N. Knowledge, Attitude, and Practices of Parents Regarding the Red Flags of Developmental Milestones in Children Aged 0–5 Years in Karachi, Pakistan: A Cross-Sectional Study. BioMed Central Pediatrics. 2024 Feb; 24(1): 120. doi: 10.1186/s12887-024-04574-9.

Lipkin PH, Macias MM, Norwood KW, Brei TJ, Davidson LF, Davis BE et al. Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics. 2020 Jan; 145(1). doi: 10.1542/peds.2019-3449.

Parts of the SWYC | Tufts Medicine [Internet]. [cited 2025 Feb 11]. Available from: https://www.tuftsmedicine.org/medical-professionals-trainees/academic-departments/department-pediatrics /survey-well-being-young-children/parts-swyc.

Buckley N, Glasson EJ, Chen W, Epstein A, Leonard H, Skoss R et al. Prevalence Estimates of Mental Health Problems in Children and Adolescents with Intellectual Disability: A Systematic Review and Meta-Analysis. Australian and New Zealand Journal of Psychiatry. 2020 Oct; 54(10): 970-84. doi: 10.1177/0004867420924101.

Bishwokarma A, Shrestha D, Bhujel K, Chand N, Adhikari L, Kaphle M et al. Developmental Delay and Its Associated Factors among Children Under Five Years in Urban Slums of Nepal. PloS One. 2022 Feb; 17(2): e0263105. doi: 10.1371/journal.pone.0263105.

Farid A, Maqbool S, Ullah E, Ali A, Farid Z. Risk Factors in Children Presenting with Developmental Delay. Pakistan Armed Forces Medical Journal. 2020 Jun; 70(3): 812.

Rakesh D, Whittle S, Sheridan MA, McLaughlin KA. Childhood Socioeconomic Status and the Pace of Structural Neurodevelopment: Accelerated, Delayed, Or Simply Different? Trends in Cognitive Sciences. 2023 Sep; 27(9): 833-51. doi: 10.1016/j.tics.2023.03.011.

Lankinen V, Lähteenmäki M, Kaljonen A, Korpilahti P. Father–Child Activities and Paternal Attitudes in Early Child Language Development: The STEPS Study. Early Child Development and Care. 2020 Oct; 190(13): 2078-92. doi: 10.1080/03004430.2018.1557160.

Cuartas J. The Effect of Maternal Education On Parenting and Early Childhood Development: An Instrumental Variables Approach. Journal of Family Psychology. 2022 Mar; 36(2): 280. doi: 10.1037/fam0000886.

Badshah N, Mattison KA, Ahmad S, Chopra P, Johnston HR, Ahmad S et al. Novel Missense CNTNAP2 Variant Identified in Two Consanguineous Pakistani Families with Developmental Delay, Epilepsy, Intellectual Disability, and Aggressive Behavior. Frontiers in Neurology. 2022 Jul; 13: 918022. doi: 10.3389/fneur.2022.918022.

Masri A, Hamamy H, Khreisat A. Profile of Developmental Delay in Children Under Five Years of Age in A Highly Consanguineous Community: A Hospital-Based Study–Jordan. Brain and Development. 2011 Nov; 33(10): 810-5. doi: 10.1016/j.braindev.2010.12.002.

Mahabee-Gittens EM, Yolton K, Merianos AL. Prevalence of Mental Health and Neurodevelopmental Conditions in US Children with Tobacco Smoke Exposure. Journal of Pediatric Health Care. 2021 Jan; 35(1): 32-41. doi: 10.1016/j.pedhc.2020.07.006.

Wei CF, Lin CC, Tsai MS, Guo YL, Lin SJ, Liao HF et al. Associations Between Infant Developmental Delays and Secondhand Smoke Exposure Modified by Maternal Pre-Pregnancy Overweight and Obesity Status. Nicotine and Tobacco Research. 2021 Sep; 23(9): 1475-83. doi: 10.1093/ntr/ntab024.

Urizar Jr GG and Muñoz RF. Role of Maternal Depression On Child Development: A Prospective Analysis from Pregnancy to Early Childhood. Child Psychiatry and Human Development. 2022 Jun; 53(3): 502-14. doi: 10.1007/s10578-021-01138-1.

Schiavo RD and Perosa GB. Child Development, Maternal Depression and Associated Factors: A Longitudinal Study. Paidéia (Ribeirão Preto). 2020 Jun; 30: e3012. doi: 10.1590/1982-4327e3012.

Yosep I, Hikmat R, Mardhiyah A. The impact of Domestic Violence On Cognitive and Psychological Development of Children: A Scoping Review. Jurnal Keperawatan Padjadjaran. 2022 Dec; 10(3): 196-203. doi: 10.24198/jkp.v10i3.2076.

Toso K, De Cock P, Leavey G. Maternal Exposure to Violence and Offspring Neurodevelopment: A Systematic Review. Pediatric and Perinatal Epidemiology. 2020 Mar; 34(2): 190-203. doi: 10.1111/ppe.12651.

Nonweiler J, Rattray F, Baulcomb J, Happé F, Absoud M. Prevalence and Associated Factors of Emotional and Behavioural Difficulties During COVID-19 Pandemic in Children with Neurodevelopmental Disorders. Children. 2020 Sep; 7(9): 128. doi: 10.3390/children7090128.