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

Summary

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.

Key Points

• 1Fourteen point six percent of children had low cognitive development scores
• 2Twenty-six point two percent showed low socioemotional scores
• 3Eighty point eight million children in low- and middle-income countries suffered low development in 2010
• 4The study utilized extensive data from UNICEF's ECDI and Health Surveys
• 5Findings indicate a strong link between low development scores and factors like poverty and stunting

Related articles

• Evaluating large language models for clinical note processing: local fine-tuning and internal-external validation using electronic health records from South Asia

  This research paper evaluates the effectiveness of large language models for processing clinical notes from electronic health records in South Asia, focusing on local fine-tuning and validation. It discusses the potential application of LLMs in clinical settings, particularly in resource-limited environments.

• Cardiac Cycle & Physiology: Understanding Cardiac Function

  This document provides a detailed overview of cardiac physiology, including the cardiac cycle, blood flow processes, and the cardiac conduction system. It aims to inform readers about the mechanics of the heart and its role in circulation.

• Cardiac Cycle & Physiology

  This document provides a comprehensive overview of cardiac cycle phases, blood flow through the heart, and the electrophysiology of cardiac conduction. It details the processes of deoxygenation and oxygenation of blood and the physiological aspects of cardiac output and common cardiovascular assessment findings.

• The Dual Pillars of Clinical and Community Care

  This document provides an in-depth examination of nutritional assessment and surveillance in clinical and community settings, offering guidelines on measuring malnutrition indicators and the importance of dietary interventions.

• Cather Simpson Lecture Research Brief Inaugural David Breen

  Cather Simpson Lecture Research Brief Inaugural David Breen Lecture | 14 October 2026 | 12 pm to 1 pm | AM103 The "Nespresso" of Diagnostics: Centrifugal Microfluidics for Point-of-Care Diagnostics; “Can we