Determinants of Developmental Delay Among Under-Three Years Children in Addis Ababa, Ethiopia 2025.

Abstract

ABSTRACT Background: Developmental delays among children under three years of age are a significant public health issue, particularly in low- and middle-income countries like Ethiopia. The prevalence of these delays is alarmingly high, with estimates suggesting that over 30% of children in Ethiopia exhibits delay due to factors such as malnutrition, inadequate healthcare access, and socioeconomic disparities. Objectives: This study aims to assess determinants of developmental delay among under three years children in Addis Ababa, Ethiopia, 2025. Methods and Materials: A community-based unmatched case-control study was conducted in Addis Ababa, targeting children under three years of age, with a sample size of 589, with 295 cases and 294 controls, determined through clustered random sampling to ensure diverse socio-demographic representation. Caregivers were provided informed consent, and data was collected via structured questionnaires and home visits conducted by trained enumerators. Quality control measures were included training, pre-testing of instruments, and supervision, along with ethical approval to protect confidentiality. The data were entered into EpiData 4.6.0 and exported to SPSS 25 for analysis. The analysis began with descriptive statistics for categorical and continuous variables. A bivariate binary logistic regression were identified associations between independent and dependent variables, retaining those with p < 0.25 for multivariable binary logistic regression analysis. The final model was quantified using Adjusted Odds Ratios (AOR) with 95% confidence intervals (CI) and a significance threshold of p < 0.05.Multi-collinearity was checked among predictors and the Hosmer–Lemeshow test was performed to assess model fit.. Results: Multiple factors were independently associated with developmental delay. Key risk factors included maternal illiteracy (AOR = 6.45, 95% CI: 3.44–12.07), late initiation of complementary feeding (AOR = 2.03, 95% CI: 1.12–3.68), maternal infections during pregnancy (AOR = 2.22, 95% CI: 1.30–3.79), low birth weight (AOR = 2.35, 95% CI: 1.44–3.83), and nutritional deficiencies (AOR = 2.00, 95% CI: 1.27–3.15). Protective factors included larger family size (AOR = 0.51, 95% CI: 0.28–0.92), availability of local early childhood resources (AOR = 0.60, 95% CI: 0.40–0.89), and access to trained healthcare professionals (AOR = 0.57, 95% CI: 0.34–0.95). Conclusion: Developmental delay among under-three children in Addis Ababa is determined by a complex interplay of factors. Interventions should be multi-sectorial, focusing on improving maternal education, enhancing prenatal and postnatal care, promoting optimal infant feeding practices, and strengthening community-based early childhood development programs and healthcare services. Key Words: Developmental delays, early childhood development, socio-demographic factors, maternal health