Preventing significant cognitive delay in young children in low and middle income countries by ensuring that every child receives adequate stimulation at home: estimating effects in six Asian countries

15 Feb 2017

250 million children under the age of 5 years who live in low-income or middle-income countries are at risk of not reaching their developmental potential. Significant cognitive delay in early childhood is associated with low ‘school readiness’, poor educational attainment, unemployment, social exclusion, poor health (including mental health) and reduced life expectancy.

Loss of developmental potential arises from the exposure of young children to a range of nutritional, environmental and social risks associated with growing up in poverty. Parental stimulation and material quality of home learning environment are two key components of nurturing care that are amenable to intervention.

This report answers the question: what would be the impact on the prevalence of significant cognitive delay in children growing up in low and middle income Asian countries if we could ensure that every young child received adequate parental stimulation and lived in a home with adequate learning materials?

To answer this question we used data collected through UNICEF’s Multiple Cluster Indicator Surveys programme in six Asian countries; Bangladesh, Bhutan, Laos, Nepal, Pakistan and Vietnam. For each country, we estimated the population attributable fraction (PAF) of significant cognitive delay that could be attributed to low levels of child stimulation. PAFs are useful for providing estimates of the potential impact of an intervention in reducing the prevalence of a given health condition or impairment.

Our analyses suggest that the prevalence of significant cognitive delay could be reduced by 19-24% across these six countries if all children under five were to receive adequate levels of home-based child stimulation. If achieved, this would reduce by up to 500,000 the number of 3-4 year old children with significant cognitive delay in these six countries.



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