Co-occurrence and associated factors of developmental delay, functional disability, and undernutrition in early childhood: evidence from 15 population-based surveys in sub-Saharan African countries.

Background: Early childhood developmental delay, functional disability, and undernutrition pose critical public health challenges in low-resource settings. However, the co-occurrence of these conditions remains poorly understood. This study examined co-occurrence patterns of these three major global health concerns and associated risk factors among children aged 36-59 months in 15 sub-Saharan Africa (SSA) countries using cross-sectional data. Methods: We analyzed data from 15 SSA countries, namely Benin, Central African Republic, Chad, Comoros, Democratic Republic of the Congo, Gambia, Ghana, Guinea-Bissau, Lesotho, Madagascar, Malawi, Sao Tome and Principe, Sierra Leone, Togo, and Zimbabwe, available from 2017 to 2022 from the Multiple Indicator Cluster Survey (MICS) online repository. Latent class analysis (LCA) was performed to identify the co-occurrence patterns of early childhood developmental delay, functional disability, and undernutrition. Multinomial logistic regression (MLR) was used to examine the risk factors associated with the co-occurrence patterns identified by LCA. Findings: Five distinct co-occurrence patterns were identified: Relatively Healthy (66.7%), Co-occurrence of Wasting and Underweight with Developmental Delay (CWU-DD) (5.2%), Co-occurrence of Underweight, Stunting, Developmental Delay, and Functional Disability (CUS-DD-FD) (1.0%), Co-occurrence of Underweight and Stunting with Developmental Delay (CUS-DD) (15.7%), and Co-occurrence of Developmental Delay and Stunting with Functional Disability (CDD-S-FD) (11.4%). MLR revealed that maternal functional disabilities were positively associated with CUS-DD-FD (odds ratio [OR] = 2.56, 95% CI: 1.60-4.12) and CDD-S-FD (OR = 1.46, 95% CI: 1.18-1.82). Non-aggressive discipline was associated with decreased risks of CWU-DD (OR = 0.72, 95% CI: 0.55-0.95), CUS-DD-FD (OR = 0.31, 95% CI: 0.20-0.49), CUS-DD (OR = 0.81, 95% CI: 0.70-0.94), and CDD-S-FD (OR = 0.77, 95% CI: 0.65-0.92), while physical-aggressive discipline was associated with an increased risk of CDD-S-FD (OR = 1.17, 95% CI: 1.01-1.36). Additionally, sex, diarrhea, maternal education, and some socio-environmental factors were also identified as significantly associated risk factors that had differentiated effect on membership of co-occurrence patterns. Interpretation: The identified co-occurrence patterns and their associated risk factors emphasize the need to address early childhood developmental delay, functional disability, and undernutrition as interconnected concerns. These findings support integrated approaches to early childhood interventions that account for the interconnected nature of developmental, functional, and nutritional vulnerabilities in young children. Funding: None.