Factors associated with risk of developmental delay in preschool children in a setting with high rates of malnutrition: a cross-sectional analysis of data from the IHOPE study, Madagascar

Background Nearly two hundred eighty million children in low and middle income countries are at risk for not achieving their full developmental potential(1). Poor development can lead to reduced scholastic ability(2) or opportunity (promoting and entrenching inequity), and has been associated with lower adult earning potential(3), and poorer health(4), thus potentially contributing to intergenerational poverty traps. While the entire period of childhood is important for development, the first 1000 days (conception to age 2) are critically important for brain development; with the most rapid and prolific development of neural pathways, first in sensory development, then language skills and then higher cognitive functioning(5). Experiences during this period – positive or negative – can substantially impact the architecture of the developing brain. Adverse events such as exposure to familial or societal violence, toxins such as lead or arsenic, illness (anemia, diarrhea, HIV, chronic malnutrition, maternal depression), or lack of a developmentally stimulating and nurturing environment can all act as toxic stressors on young children that negatively impact cognitive development throughout the life-course(6). Infants and young children in settings of poverty are often faced with many of these stressors(7).