DEVELOPMENTAL DELAY AND ASSOCIATED RISK FACTORS AMONG CHILDREN AT UNITED BULAWAYO HOSPITALS, ZIMBABWE

P. Madzimbe¹, J. Potterton¹

¹University of the Witwatersrand, Physiotherapy Department, Johannesburg, South Africa

Background: Early childhood development is a major challenge around the world. Globally, 8.4% of children below the age of five have developmental disorders, 95% of which reside in low-and-middle-income countries (LMICs). Sub-Saharan Africa has the highest prevalence of developmental delay, constituting 73% of the global burden of developmental delay.
Substantial evidence supports good outcomes when early identification and intervention of developmental delay are implemented. In Zimbabwe, the At Risk Surveillance System (ARSS) follows up babies with known developmental risk factors such as severe neonatal jaundice, and aims to identify children with neuro-developmental conditions in the first five months to twelve months of life. Children who are found to have developmental challenges are referred for early intervention. Standardised developmental assessment tools are not routinely used and little is known about the developmental status and risk factors for developmental delay among the infants in the system.

Purpose: To determine the prevalence and severity of developmental delay in children under the ARSS at United Bulawayo Hospitals.

Methods: A descriptive cross-sectional study systematically sampled 160 babies enrolled in the ARSS between 2019 and 2020 at United Bulawayo Hospitals (UBH). Infants were assessed at a routine clinic visit once informed consent from their caregiver had been obtained. The Bayley Scales of Infant and Toddler Development Third Edition (BSID-III) tool meticulously assessed cognitive, motor and language domains. A score of <85 on the BSID-III was considered a developmental delay. A self-developed data collection tool captured possible risk factors for developmental delay and demographic data from caregivers and patient files.

Results: Our sample presented a prevalence of 83.7% developmental delay, most of whom presented with mild developmental delay. The majority (60.0%) had delayed development in ≥2 domains.
The most important risk factors in the ARSS associated with developmental delay in all three domains assessed (cognitive, motor and language) were neonatal convulsions (aOR 5.6, p=0.03), Apgar scores of <5 (aOR 2.6, p=0.02) in the first five minutes and being a boy (aOR 7.1, p<0.001).

Conclusions: Most children in the ARSS presented with developmental delays in all three domains. Children exposed to risk factors had a higher chance of having developmental delay. Children with the most important risk factors (boys with low Apgar scores and/or neonatal convulsions) should be closely monitored in the ARSS as they have a high chance of having developmental delay in all three domains. It is recommended that future research should include all five central hospitals in Zimbabwe so that the results become a true reflection of the ARSS in Zimbabwe.

Implications: Developmental delay was high in this at risk group; hence there is a need to routinely assess children in the ARSS to allow early detection and intervention of developmental challenges.
Children with known risk factors should be closely monitored using the BSID-III, while the rest of the babies can be screened using a cheaper and faster tool such as the Ages and Stages Questionnaire (ASQ).

Funding acknowledgements: Not applicable.

Keywords:
Infant
At-risk
Neuro-development

Topics:
Paediatrics: cerebral palsy

Did this work require ethics approval? Yes

Institution: University of the Witwatersrand, Johannesburg

Committee: Human Research Ethics Committee (HREC) - Wits University

Ethics number: M200869