ArticleBMC primary care2026
Exploring factors associated with autism spectrum disorder diagnosis among children in primary care clinics in Kelantan, Malaysia.
Article in BMC primary care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundAutism spectrum disorder (ASD) is a neurodevelopmental condition characterised by impairments in social communication and restricted or repetitive behaviors. In Malaysia, timely identification within routine primary care services remains challenging, particularly outside major urban centres. This study examined factors associated with ASD diagnosis among children attending government primary care clinics in Kelantan to inform strategies for strengthening primary care developmental surveillance.
methodsA clinic-based cross-sectional study was conducted from March to September 2025 in five districts. Using purposive sampling, 207 children aged 18 months to 12 years were recruited during routine clinic visits, developmental presentations and primary care visits. Sociodemographic and clinical data were captured via a structured proforma. All enrolled children underwent Sensory-Behavior Profile screening followed by clinical assessment utilizing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria regardless of screening result. Simple and multiple logistic regression were applied to examine associations between child and parental characteristics and ASD diagnosis.
resultsOf the 207 children analysed, 29 were newly diagnosed with ASD during the study assessment and 178 were classified as non-ASD. In the multivariable analysis, two factors remained independently associated with ASD diagnosis. Older age at assessment was associated with higher odds of ASD diagnosis (aOR 1.30, 95% CI 1.10,1.55; p = 0.003), a finding that likely reflects later recognition, presentation, referral, or diagnostic confirmation within primary care pathways rather than an etiologic risk factor. First-born children were more likely to have an ASD diagnosis than second- or later-born children (aOR 2.48, 95% CI 1.08,5.71; p = 0.033).
conclusionsThese findings support the strengthening of primary care developmental surveillance through consistent routine screening, improved clinician competency in developmental surveillance, increased parent awareness, and clear, time-bound referral pathways linked to timely assessment capacity within routine child health services.
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