One Third of 3 and 4 Year Olds 
in Low- and Middle-Income Countries 
Fail to Reach Developmental Milestones  
With data on almost 100,000 children, new research reveals extent 
of developmental setbacks among 3 and 4 year olds in
 low- and middle-income countries

In some countries, as many as 2 in 3 children fail to reach 
expected cognitive and/or socio-emotional development
Toronto ON, Boston MA -- In developing countries, one third of children 3 and 4 years old don't reach basic milestones in cognitive and/or socio-emotional growth, according to a new study from the Harvard T.H. Chan School of Public Health, funded by the Government of Canada through Grand Challenges Canada.

The study authors estimate that 80.8 million of the roughly 240 million preschool-aged children in the world's 132 low- and middle-income countries fail to develop a core set of age-appropriate skills that allow them to maintain attention, understand and follow simple directions, communicate and get along with others, control aggression, and solve progressively complex problems.  

These early abilities are associated with subsequent development, mental and physical health, and ultimately, better learning in school and more productive lives as adults.

Published today by PLoS Medicine (http://bit.ly/1RxF3nb), the study draws on data provided by the caregivers of almost 100,000 children living in 35 low- and middle-income countries between 2005 and 2015. The data were collected as part of UNICEF's Multiple Indicator Cluster Survey (MICS) program, Demographic and Health Surveys (DHS), and global data from the Nutrition Impact Model Study.  

This is the first study to directly estimate the global extent of cognitive and/or socio-emotional development deficits; earlier estimates of this unmet potential globally were based on proxy measures of development including poor physical growth and exposure to poverty.

The researchers found that among 3 and 4 year olds in low- and middle-income countries, the problem is most acute in sub-Saharan Africa (29.4 million children not reaching developmental milestones; 44% of all 3 or 4 year olds), followed by South Asia (27.7 million; 38%) and the East Asia and Pacific region (15.1 million; 26%). A significant burden is also notable in Latin America/Caribbean (4.1 million, 19%) and North Africa, Middle East and Central Asia (4.5 million, 18%).

Low development scores were associated with stunting, poverty, male gender, rural residence, and lack of cognitive stimulation.

Says lead author Dana McCoy, Assistant Professor of Education at the Harvard Graduate School of Education: "In addition to the 33% of children overall who did not meet the selected cognitive and socio-emotional milestones, we estimate that 17% were physically stunted, meaning that approximately half of the children in these countries are developing poorly in one way or another."

The importance of children thriving, not just surviving, is emphasized in the United Nations Sustainable Development Goals and is central to the Every Woman Every Child Global Strategy for Women's, Children's and Adolescents' Health. 

"Achieving optimal early child health and development is critical for attaining success in school, and has significant life-long implications for the health and economic wellbeing of individuals, families and communities," says the project's principal investigator, Wafaie Fawzi, Professor and Chair of the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health. 

He added that quantifying the burden of failing to reach developmental milestones at national and global levels is important to monitoring progress towards the Sustainable Development Goals. 

An estimate of the global economic cost of this unrealized human potential is the focus of a companion study conducted at Harvard, also funded by Grand Challenges Canada, with publication planned for later this year. 

These studies are part of a larger project to estimate the epidemiologic and economic impacts of risk factors for child development, including a multi-disciplinary team of clinicians, economists, psychologists, epidemiologists, nutritional scientists, disease and risk factor modellers, and statisticians at the Harvard T. H. Chan School of Public Health, Imperial College London, Aga Khan University (Pakistan) and Ifakara Health Institute, Tanzania.

"When one in three children is failing to reach their full potential, we are looking at one of the world's grandest challenges. This research helps shine an ever brighter light on the value of investing in a child's earliest years - for the benefit of our children, our world and our future," said Dr.
Person Place Thing - Peter Singer

Person Place Thing - Peter Singer

Image by Princeton Public Library

, Chief Executive Officer of Grand Challenges Canada.

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Table: Estimated prevalence of children with low Early Childhood Development Index (ECDI) scores in 135 developing countries 

Notes: Population numbers are based on the World Population Prospects 2015. The estimated prevalence of low ECDI scores is based on Multiple Indicator Cluster Survey, and Demographic and Health Survey (MICS/DHS) data where available, and on predictive model otherwise. Countries from Eastern Europe were not included in the global LMIC model due to the lack of anthropometric data.

Country Estimated percentage of 3 and 4 year olds with low ECDI scores Type of estimate Estimated number of 3 and 4 year olds with low ECDI scores
Afghanistan 46.9% Model prediction 1,024,00
Algeria 17.4% Model prediction 304,100
Angola 40.4% Model prediction 817,300
Antigua and Barbuda 11.3% Model prediction 300
Argentina 8.3% Model prediction 124,100
Armenia 17.8% Model prediction 14,700
Azerbaijan 15.8% Model prediction 60,800
Bahamas 12.2% Model prediction 1,400
Bahrain 7.4% Model prediction 2,800
Bangladesh 38.3% MICS/DHS 2,490,200
Barbados 18.2% MICS/DHS 1,300
Belize 21.6% MICS/DHS 3,300
Benin 44.8% Model prediction 322,400
Bhutan 34.1% MICS/DHS 9,800
Bolivia 26.3% Model prediction 133,500
Botswana 4.4% MICS/DHS 4,600
Brazil 16.1% Model prediction 1,006,200
Burkina Faso 54.3% Model prediction 718,500
Burundi 53.1% Model prediction 446,500
Cambodia 37.5% Model prediction 274,200
Cameroon 53.1% MICS/DHS 844,600
Cape Verde 27.6% Model prediction 6,100
Central African Republic 54.1% MICS/DHS 168,600
Chad 67.0% MICS/DHS 755,500
Chile 8.0% Model prediction 38,000
China 20.2% Model prediction 6,667,900
Colombia 19.5% Model prediction 305,100
Comoros 42.6% Model prediction 21,000
Congo 49.0% MICS/DHS 151,000
Costa Rica 14.8% Model prediction 21,200
Cuba 11.8% Model prediction 29,100
Cote d'Ivoire 47.2% Model prediction 725,800
Democratic Republic of the Congo 47.9% MICS/DHS 2,770,300
Djibouti 46.4% Model prediction 20,500
Dominican Republic 20.0% Model prediction 87,600
Ecuador 18.3% Model prediction 119,500
Egypt 22.1% Model prediction 985,100
El Salvador 25.1% Model prediction 55,700
Equatorial Guinea 31.7% Model prediction 16,800
Eritrea 54.0% Model prediction 184,500
Ethiopia 50.7% Model prediction 3,091,200
Fiji 18.3% Model prediction 6,800
Gabon 24.0% Model prediction 23,100
Gambia 47.6% Model prediction 70,100
Georgia 16.4% Model prediction 19,200
Ghana 32.6% MICS/DHS 532,100
Grenada 16.1% Model prediction 700
Guatemala 29.5% Model prediction 249,600
Guinea 53.3% Model prediction 455,600
Guinea-Bissau 50.6% Model prediction 63,800
Guyana 28.2% Model prediction 8,200
Haiti 44.5% Model prediction 236,700
Honduras 17.0% MICS/DHS 59,700
India 32.2% Model prediction 17,147,500
Indonesia 23.8% Model prediction 2,409,000
Iran (Islamic Republic of) 15.5% Model prediction 417,600
Iraq 28.3% MICS/DHS 625,200
Jamaica 17.2% Model prediction 17,100
Jordan 37.8% MICS/DHS 138,800
Kazakhstan 13.6% MICS/DHS 99,100
Kenya 38.3% Model prediction 1,134,500
Kiribati 32.0% Model prediction 1,900
Kuwait 8.5% Model prediction 11,400
Kyrgyzstan 19.1% MICS/DHS 53,700
Lao People's Democratic Republic 17.7% MICS/DHS 62,400
Lebanon 22.9% MICS/DHS 29,600
Lesotho 44.4% Model prediction 51,400
Liberia 51.5% Model prediction 149,700
Libyan Arab Jamahiriya 14.1% Model prediction 38,700
Madagascar 40.9% Model prediction 615,100
Malawi 40.0% MICS/DHS 486,700
Malaysia 12.7% Model prediction 121,000
Maldives 21.9% Model prediction 3,100
Mali 51.0% Model prediction 707,900
Mauritania 42.7% Model prediction 107,300
Mauritius 14.2% Model prediction 4,300
Mexico 15.2% Model prediction 723,800
Micronesia (Federated States of) 26.7% Model prediction 1,300
Mongolia 20.6% Model prediction 26,300
Morocco 29.6% Model prediction 401,000
Mozambique 51.9% Model prediction 1,037,300
Myanmar 39.2% Model prediction 799,800
Namibia 29.6% Model prediction 39,200
Nepal 42.0% MICS/DHS 522,800
Nicaragua 28.7% Model prediction 72,900
Niger 59.9% Model prediction 992,500
Nigeria 45.7% MICS/DHS 5,999,500
Occupied Palestinian Territory 23.3% Model prediction 64,000
Oman 10.0% Model prediction 13,600
Pakistan 48.1% MICS/DHS 4,928,800
Panama 13.6% Model prediction 20,100
Papua New Guinea 42.1% Model prediction 174,000
Paraguay 23.5% Model prediction 65,500
Peru 18.2% Model prediction 223,600
Philippines 24.9% Model prediction 1,150,500
Qatar 4.8% Model prediction 2,000
Rwanda 46.3% Model prediction 335,100
Saint Lucia 11.0% MICS/DHS 600
Saint Vincent and the Grenadines 18.9% Model prediction 700
Samoa 20.5% Model prediction 2,100
Sao Tome and Principe 36.7% Model prediction 4,500
Saudi Arabia 9.0% Model prediction 109,100
Senegal 46.0% Model prediction 468,700
Seychelles 15.5% Model prediction 500
Sierra Leone 54.3% MICS/DHS 244,300
Solomon Islands 42.0% Model prediction 14,300
South Africa 26.1% Model prediction 579,900
Sri Lanka 16.0% Model prediction 112,300
Sudan 45.0% Model prediction 1,133,300
Suriname 32.0% MICS/DHS 6,400
Swaziland 42.5% MICS/DHS 31,300
Syrian Arab Republic 26.6% Model prediction 261,400
Tajikistan 29.9% Model prediction 137,900
Thailand 18.4% Model prediction 288,000
Timor-Leste 30.7% Model prediction 26,000
Togo 47.3% MICS/DHS 226,900
Tonga 18.7% Model prediction 1,000
Trinidad and Tobago 12.5% Model prediction 5,000
Tunisia 27.9% MICS/DHS 105,500
Turkey 16.1% Model prediction 420,100
Turkmenistan 23.7% Model prediction 52,100
Uganda 44.2% Model prediction 1,321,100
United Arab Emirates 6.4% Model prediction 11,500
United Republic of Tanzania 41.4% Model prediction 1,549,400
Uruguay 11.6% Model prediction 11,500
Uzbekistan 24.9% Model prediction 317,900
Vanuatu 31.8% Model prediction 4,200
Venezuela (Bolivarian Republic of) 14.0% Model prediction 168,100
Viet Nam 16.8% MICS/DHS 516,800
Yemen 41.7% Model prediction 678,600
Zambia 35.5% Model prediction 416,100
Zimbabwe 37.5% MICS/DHS 380,200


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