Abstract:
Background: In 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.
Methods: A 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.
Results: Out 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).
Conclusion: About 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.
