Magnitude of Developmental Delay and Its Associated Factors among Nine Month Infants in South Wollo Zone, Dessie City Public Health Facilities 2024

Magnitude of Developmental Delay and Its Associated Factors among Nine Month Infants in South Wollo Zone, Dessie City Public Health Facilities 2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Magnitude of Developmental Delay and Its Associated Factors among Nine Month Infants in South Wollo Zone, Dessie City Public Health Facilities 2024 Shiferaw Abeway Mamuye, Jemal Ali, Samuel Nebiyu, Muluken Amare This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7241180/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Developmental delay is a condition where a child fails to reach the five developmental domains at the expected age. Children who are developmentally delayed are less likely to be productive. Objective:- To assess the magnitude of developmental delay and associated factors among infants at the age of 9 month attending public health facilities of Dessie city, Ethiopia, in 2024. Methods:- An institutional-based cross-sectional study was conducted from March 30 to April 30, 2024. A systematic random sampling technique was used to select the study participants. Developmental delay was assessed using the Age and Stage Questionnaires, Version 3. Data were collected through a face-to-face interviewer-administered questionnaire. Data were entered into EPI-Data version 4.7software and exported to STATA version 17 for analysis. In the multivariable analysis, variables with a p-value less than 0.05 were considered significantly associated with developmental delay. Result: - In this study the magnitude of developmental delay was 102 (26.5%) with a 95% CI (22.2, 31.2). More delay was observed in gross motor 132 (34.3%), followed by communication (30.9%), problem solving 112 (29.1%), personal and social 110 (28.6%), and fine motor skill 78 (20.3%). Maternal education level no formal education [AOR = 4.16, 95% CI (1.29, 13.42)], primary education [AOR = 5.48, 95% CI (1.84, 16.27)], previous sibling history of developmental delay [AOR = 6.67, 95% CI (1.55, 29.43)], and didn’t iron intake during pregnancy [AOR = 3.56, 95% CI (1.24, 10.13)] were significantly associated with developmental delay with p-value <0.05. Conclusion and recommendation: - The prevalence of developmental delay among infants was 26.5%. Maternal education level, previous sibling history of developmental delay, and iron intake during pregnancy were significantly associated. Public health efforts focus on promoting awareness, access to iron-rich foods and supplementation, and routine monitoring to address iron deficiency and ensure optimal developmental outcomes for infants. Age and Stage Questionnaires Developmental delay Public health facilities Dessie Figures Figure 1 Figure 2 INTRODUCTION Child development is a maturation process that progresses sequentially through five key domains of development abound namely; gross motor skills, fine motor skills, communication skills, cognition skills and social/personal activities. Early childhood development assessment is an ongoing process of observing, collecting, documenting, and analysing data to measure a child's progress over time (Moodie et al., 2014 ). In the field of child health care, developmental delay is defined as the inability of a child to develop and/or acquire skills in line with a predetermined sequence of steps also this definition is widely accepted (Abo et al., 2017 ; Organization, 2012 ). Developmental delays can be caused by adverse environmental, social and psychological conditions or by birth complications (e.g. premature birth), encephalitis and brain damage; severe postpartum illness; congenital metabolic defects; Genetic or chromosomal abnormalities; Lack of stimulation, chronic diseases, iron deficiency anemia, malnutrition (Bélanger & Caron, 2018 ). Biological and psychosocial risk factors affecting child development are common in developing countries (Kapci et al., 2010 ; Sachdeva et al., 2010 ). Signs of developmental disabilities include intellectual disability, Down syndrome, fetal alcohol syndrome, cerebral palsy, autism spectrum disorder, and behavioral disorders (Sim et al., 2019 ; Warren et al., 2016 ). However, if diagnosed and intervened before the age of 5 year developmental delays can be identified using well-validated screening tools as important predictors of learning, motor and behavioral difficulties (Faruk et al., 2020 ). Management requires a comprehensive approach to appropriate care and support, including: Assessment and early intervention planning; service; Monitoring and evaluation and also timely evaluation also it permits for the timely application of interventions and management plans specific to the defect (WHO, 2012) METHODS Study Design and area Institution -based cross sectional study was conducted from March 30 to April 30 in South Wollo Zone, public health facilities of Dessie City, which is situated 401 kilometers northeast of Addis Ababa in the Amhara Regional State of Ethiopia. The city had 10 urban and 6 rural Kebele. There are 27 private clinics, 9 hospitals, 1 privet pediatric specialty clinic, 8 health centers, and 2 public health facilities. All of these health facilities provided pediatric and child health services Sample size determination The sample size was determined by using a prevalence of 50% because there is no comparable study conducted in the study area. Thus with 95% confidence level and 10% non-response rate making the final sample size 422. The study was conducted by using systematic random sampling method to recruit participants. Sampling procedure From the total 10 health facility of Dessie, City 4 health facility were selected by simple random a sample. The sampling unit was selected from each health facilities by allocating the total sample proportionately by considering the last three month report, number of nine month infants attending in each selected health facility. After sample size allocated in each selected facility study participants were select by using systematic random sampling technique among those infants with mother who comes in the selected health facility. The first participant was selected by using lottery method and the next participants selected by every K th interval. Operational definitions and term of definition Developmental Delay :-Delay in specific or global functioning of children involving domains communication, fine motor and gross motor, problem-solving, and personal-social areas. It was measured by using 30 items with the response format of Yes, Sometimes, and Not Yet and categorized as ‘Delayed if the respondents answered below the mean score (mean = 223.7), otherwise ‘Not delayed'. (Alamri et al., 2021). The participant’s response of "yes" means that the child was able to achieve the skills mentioned, "Sometimes" for occasionally demonstrating the skill, and "not yet" for not achieving the skill at all. To quantify the responses, a scoring system was employed. A response of "yes" was assigned 10 points. A response of "sometimes" was assigned 5 points. Lastly, a response of "not yet" was assigned 0 points. (Squires et al ., 2009). Practice of sun light exposure : Sunlight exposure Practice exposure of infants to sunlight for 15-20minutes per day in the morning (8am-10am) starting from two weeks of age after birth with uncovered body, without applying any ointment and the practices of sun light exposure of infants will be assessed by seven questions. Mothers who were respond practice related questions equal and above the mean value was considered as good practices and “coded as “1”and, mothers who were responded less than the mean was considered as poor practices coded as”0’ (Gedamu & Tafere, 2019; Teklehaimanot et al., 2021). Previous sibling history of developmental delay : - was assessed by yes or no question which is assessing by asking the question dose developmental delay in their sibling previously which is confirmed by medical diagnosis. Fasting during pregnancy : - was assessed by yes or no question which is assessing by asking the question dose the mother have fasting during pregnancy, refers to abstaining from food and drink for a certain period of time at least eight hours Data collecting tools and procedures The ASQ3 rd version a parent/caregiver and data collector completed developmental screening instrument at the age of 9 month was used for the data collection. Each ASQ version-3 questionnaire includes 30 questions that focus on five developmental domains and the sensitivity and specificity of the ASQ measured in different studies are 75% and 95%, respectively.(Elbers & Macnab, 2008).Data were collected at well baby clinic before getting the service and it takes 15 minutes for one respondents. To evaluate fine motor, personal, and social skills, an interviewer-based questionnaire was used in the study. However, for assessing gross motor and fine motor skills, both observational and interviewer-based questionnaires were employed. Various instruments, such as small toys, 4x4 box-like toys, and a string, were utilized to assess whether the child fulfilled the skills required for each item. When the mother expressed confidence that her child could master the skills specified in an item, that particular item was highlighted. In cases where there was uncertainty about the child's ability to master the skill or if the mother had not observed the skill, the assessment was concluded after the child attempted the skill. Data collection was carried out by three BSC nurses. To ensure consistency and quality, one supervisor was recruited, and training was given. Data Quality Assurance The quality of the data was assured before, during, and after data collection. To ensure data quality, a pre-test was conducted on a 5% sample (21 infants aged 9 months) at the public health center in the city of Kombolcha, Kebele 03 health center, before the actual data collection. Data collectors received one-day training on the purpose of the survey, the content of the survey, especially the confidentiality of responses, and the rights of respondents. Data cleaning was done. The English version of the questioner was translated to the local language (Amharic) and again translated back to English to check consistency. Data processing and Analysis The consistency and completeness of the completed questionnaires were examined. Following verification, the data was entered into Epi-data 4.7 and exported to STATA version 17 for analysis. Text, graphs, and tables were used to present descriptive and summary statistics. The frequency distribution of socio‐demographical variables, such as maternal age, sex of the child, marital status, and educational status, was expressed in percentages. Continuous variables were expressed as mean ± standard deviation values. Bivariable and multivariable logistic regression were used to assess the association between independent and dependent variables. Bivariate analysis was used to look for candidate variables for multivariate logistic regression. All variables that showed a P-value less than 0.2 were entered into the multivariate analysis. The odds ratio and their 95% confidence intervals, together with a p-value <0.05, were used to identify factors associated with developmental delay. Multicollinearity was checked by variance inflation factors (VIF), which was 1.3–7.2. For a finally fitted multivariable logistic regression model, model fitness was checked by Hosmer-Lemeshow goodness-of-fit, which was (p-value =.81). Ethical Consideration An ethical approval was first obtained from the CMHS (College of Medicine and Health Science) research ethical approval committee. Then a legal, official clearance letter was written to selected public health institutions. Prior to commencing the data collection process, the participant’s care givers were provided with comprehensive information concerning the study's objectives as well as the potential benefits and risks involved. Written consent was obtained from each participant/s care giver before the interview. Throughout the review and interview procedures, utmost care was taken to ensure the privacy and confidentiality of each participant. RESULTS Socio-demographic characteristics From the total of 422 mothers with their infants, 385 were enrolled with a response rate of 91.2%. 220 (57.1%) of the infants are female. The mean of the mothers was 29.6 years, with a standard deviation of ±4.9 years. Education level of mothers 174 (45.5%), mothers had attained a college-level education or higher. (Table 1) Table 1: Socio-demographic characteristics of mothers/caregivers of 9 month infants attending in Dessie , City public health facilities Ethiopia, 2024 (n=385). Variables Category Frequency Percent (%) Sex of infant Male 165 42.9 Female 220 57.1 Place of Residence Rural 13 3.4 Urban 372 96.6 Marital status of the mother Married 363 94.3 Unmarried 22 5.7 Educational status of the Mother No formal education 54 14.0 Primary education 41 10.6 Secondary education 116 30.1 College and above 174 45.5 Educational status of the Father No formal education 79 20.5 Grade 1-8 42 10.9 Grade 9-12 131 34.0 College and above 133 34.5 Occupational status of mother Employed 177 46.0 Unemployed 208 54.0 Primary caretaker of the child Mother 197 51.2 Father 2 .5 Grandparent 27 7.0 Brother/Sister 8 2.1 House help 151 39.2 Family number =3 375 97.4 Maternal age =35 45 11.7 Obstetric and Health related factor The majority, of infants 251(65.2%), were born through spontaneous vaginal delivery. 75.6% of the pregnancies were planned and 89.4%, of the infants were born at term. Among the respondents 339 (88.1%) were not Previous sibling history of developmental delay and 320(83.1%) of infants had no history of neonatal illness. (Table 2) Table 2: Obstetric and health related characteristics of mothers/caregivers of 9 months infants attending in Dessie , City public health facilities Ethiopia, 2024 (n=385) Variables Category Frequency Percent (%) Mode of delivery SVD 251 65.2 Instrumental assisted 72 18.7 C/D 62 16.1 Birth weight 2.5 kg-4 kg 296 76.9 4 kg 51 13.2 Type of pregnancy Unplanned 94 24.4 Planned 291 75.6 Term at the delivery Yes 344 89.4 No 41 10.6 Birth spacing =3years 162 42.1 History of birth asphyxia Yes 61 15.8 No 324 84.2 Order of birth 1 st 50 13.0 2nd and 4 th 283 73.5 5th and above 52 13.5 History of neonatal illness Yes 65 16.9 No 320 83.1 Infant sick in the past 2 weeks Yes 86 22.3 No 299 77.7 Previous sibling history of developmental delay Yes 46 11.9 No 339 88.1 Note: - C/D= Cesarean delivery, SVD= Spontaneous vaginal delivery. Nutritional related factors Study shows that 282 (73.2%) of infants, began complementary feeding at six months and above. Close to half of the mothers, 204 (48.3%), had exposure to sunlight, and among them, 160 (41.6%) had good sunlight exposure practice habits. (Table 3) Table 3: Nutritional related characteristics of mothers/caregivers of 9 months infants attending in Dessie , City public health facilities Ethiopia, 2024 (n=385). Variables Category Frequency Percent (%) Initiation of complementary feeding At 6 months and above 282 73.2 Before six month 103 26.8 Iron intake during pregnancy Yes 275 71.4 No 110 28.6 Sunlight exposure during postnatal period Yes 206 53.5 No 179 46.5 The main reason not exposed to sun light Fear 137 35.6 Have no time 47 10.9 Practice of sunlight exposure poor practice 40 10.4 good practice 160 41.6 Fast during pregnant Yes 292 75.8 No 93 24.2 Magnitude of Developmental Delay In this study, about 132 (34.3%) of the participants had a gross motor skills delay following a communication skills delay (30.9%) (Fig.1). Over all magnitude of developmental delay The magnitude of developmental delay was 102 (26.5%), (95% CI=22.2, 31.2%) (Fig. 2). Factors Associated with developmental delay In the bivariate analysis, factors such as marital status, father's educational status, mother's educational status, maternal occupation, maternal age at delivery, mode of delivery, birth weight, type of pregnancy, term at delivery, history of birth asphyxia, birth order, history of neonatal illness, family history of developmental delay, initiation of complementary feeding and iron intake during pregnancy, were significant with p-value < 0.2. However, in the multivariable analysis, only maternal educational status, previous sibling history of developmental delay, and iron intake during pregnancy were significantly associated with p-value < 0.05. Mothers who had no formal education were more than four times more likely [AOR = 4.16, 95% CI (1.29, 13.42)], to have infant developmental delay as compared to mothers who had educated college and above. Similarly, mothers who had primary education were more than five times more likely [AOR = 5.48, 95% CI (1.84, 16.27)] to have infant developmental delays as compared to mothers who had educated college and above. Those with previous sibling history of developmental delay were more than six times [AOR = 6.76, 95% CI (1.55, 29.43)] more likely to develop developmental delay as compared with their counterparts. Infants whose mother didn’t take iron during pregnancy were more than three times 3.56 [AOR = 2.58, 95% CI 1.30, 5.11) more likely to develop developmental delays as compared with their counterparts. (Table 4) Table 4: Bi-variable and multivariable regression of factors associated with developmental delay among mothers of 9-month-old infants attending Dessie, City public health facilities in Ethiopia, 2024 (n = 385) Variables Category Developmental delay COR (CI: 95%) AOR (CI: 95%) Delayed Not delayed Educational status of father No formal education 48 (60.8) 31(39.2) 11.32 (5.67, 22.58) 2.19 (.72, 6.70) Primary education 10(23.8) 32(76.2) 2.28 (.94, 5.51) .61 (.17, 2.13) Secondary education 28(21.4) 103(78.6) 1.98 (1.01, 3.88) .90 (.32, 2.48) College and above 16(12.0) 117(88.0) 1 1 Educational status of mother No formal education 34(63.0) 20(37.0) 11.16 (5.51, 22.59) 4.16 (1.29, 13.42)* Primary education 17(41.5) 24(58.5) 4.65(2.17, 9.95) 5.48 (1.84. 16.27)* Secondary education 28(24.1) 88(75.9) 2.08 (1.13, 3.84) 1.40 (.53, 3.72) College and above 23(13.2) 151(86.8) 1 1 Maternal occupation Employed 56(31.6) 121(68.4) .61 (.38, .96) .87 (.44, 1.72) Unemployed 46(22.1) 162(77.9) 1 1 Maternal age at time of delivery Less than 35 years 73(21.5) 267(78.5) 1 1 35 years and above 29(64.4) 16(35.6) 6.62 (3.41, 12.86) 1.74 (.61, 4.91) Mode of delivery SVD 56(22.3) 195(77.7) 1 1 Instrumental assisted 21(29.2) 51(70.8) 1.43 (.79, 2.58) .63 (.22, 1.79) C/S 25(40.3) 37(59.7) 2.35 (1.30, 4.23) 1.18 (.47, 2.94) Birth of infant weight (kg) 2.5-4 kg 56(18.9) 240(81.1) 1 1 Less than 2.5 kg 21(55.3) 17(44.7) 5.29 (2.62, 10.68) 2.65 (.88, 7.98) Above 4kg 25(49.0) 26(51.0) 4.12 (2.21, 7.67) 2.13 (.75, 6.06) Type of pregnancy Unplanned 47(50.0) 47(50.0) .23 (.14 , .38) .81 (.36, 1.82) Planned 55(18.9) 236(81.1) 1 1 Term at delivery Yes 79(23.0) 256(77.0) 1 1 No 23(56.1) 18(43.9) 4.28 (2.20, 8.34) .75 (.23, 2.41) History of birth asphyxia Yes 56(17.3) 268(82.7) 14.67 ( 7.66, 28.11) 2.10 (.72, 6.05) No 46(75.4) 15(24.6) 1 1 Birth order First 13(26.0) 37(74.0) 1 1 Second-fourth 62(21.9) 221(78.1) .79 (.40, 1.59) 1.08 (.40, 2.86) Fifth and above 27(51.9) 25(48.1) 3.07 (1.33, 7.07) .67 (.17, 2.71) History of neonatal illness Yes 50(76.9) 15(23.1) 17.17 (8.97, 32.87) 2.58 (.96, 6.91) No 52(16.3) 268(83.8) 1 1 Sibling history of developmental delay Yes 42(91.3) 4(8.7) 48.82 (16.86, 141.32) 6.76 (1.55, 29.43)* No 60(17.7) 279(82.3) 1 1 Initiation of complementary feeding At 6 month & above 47(16.7) 235(83.3) 5.72 (3.48, 9.42) 2.06 (.99, 4.30) Before six month 55(53.4) 48(46.6) 1 1 Iron intake during pregnancy Yes 52(18.9) 223(81.1) 1 1 No 50(45.5) 60(54.5) 3.57 (2.20, 5.78) 2.58 (1.30, 5.11)* Note: COR=crude odd ratio: AOR=Adjusted odds ratio; CI= confidence interval; *= significant at p-value ≤0.05; 1=Reference group DISCUSSION The findings of this study revealed that 26.5%, 95%CI (22.1–31.2) of infants who visited public health facilities in Dessie City had developmental delays. Maternal educational level (no formal education and primary school attended mothers), family history of developmental delay, and iron intake during pregnancy were significantly associated with developmental delay. The magnitude of DD found in this study was consistent with a study conducted in Addis Ababa, Ethiopia (28.13%). (Ayele, 2018 ). Kolkata, India (26%) (Manna et al., 2022 ).This similarity might be both area of study design was cross sectional which and equal sample size were taken. The result of this study was lower than the study done in rural Siliguri Subdivision, Darjeeling District, West Bengal, India(38.2%) (Chakraborty et al., 2019 ), Nigeria (35.4%) (Jimoh et al., 2017 )another rural and urban Kashmir, India (39.1%)(Dar, 2018 ),a low-income South African community (51.8%) (Abdoola et al., 2023 ), Nepal's urban slums (56.4%) (Bishwokarma et al., 2022 ). This discrepancy might be due to sample size, different in socio-demographic and cultural status. However the finding of this study was higher than that the study conducted in an urban slum of Agra City, India (12.2%)(Agarwal et al., 2018 ), Malawi (11.7%) (Murphy et al., 2020 ), Saudi Arabia (16.4%)(Shatla & Goweda, 2020 ), South Delhi an urbanized village in India (10.6%)(Dabar et al., 2016 ), Cairo, Egypt (9.3%) (Abdelbaky et al., 2022 ), Aligarh, India (7.1%) (Sachdeva et al., 2010 ), The possible explanation for this disparity might be due to variations in study setting, study population were quality different i.e all of them were there study population not at exact nine month rater including it, and socio-cultural variation; it also might be due to differences in method used, sample size variation, using different variables, and the tools used to measure developmental delay. The findings from the current study showed that infants of less educated mothers were at increased risk of developmental delay compared to infants of more educated mothers. Studies from other countries also support this findings, study conducted in Saudi Arabia (Shatla & Goweda, 2020 ), study conducted in an urban slum of Agra (Agarwal et al., 2018 ), Conducted in Nigerian (Jimoh et al., 2017 ), studies conducted in Kabale Hospital in Uganda (Komutambo et al., 2022 ). Since the fact that scientifically proven the lower the mother's educational level the higher the odds of having developmental delay (Carneiro et al., 2013 ; Tumwine et al .,2004).Moreover, prior studies show that highly educated mothers in developing countries are more likely to seek appropriate care for their children (Geldsetzer et al., 2014 ). Findings from studies examining the association between increases in maternal education and children’s school readiness show that expressive and receptive language ability, and cognitive test results were better among preschool children who had mothers with higher education (Magnuson et al., 2009 ). More over maternal education has its own impact on child development that means the educational level of mothers plays a significant role in child development (Currie, 2009 ). It implies that maternal education plays an important role in reducing the risk of child developmental delay, and educated mothers are more likely to make decisions concerning their children’s health condition independently, perceiving that their behavior is their own responsibility. By providing accessible and quality education for women, societies can promote positive outcomes for both mothers and their infants, ultimately leading to a more prosperous and equitable future. Addressing educational disparities and promoting access to quality education for women are vital public health strategies to ensure optimal developmental outcomes for children. This study found that explain mothers who didn’t take iron during pregnancy more likely to have their infants were developmental delay than those who take iron. This evidence is supported by study conducted in Bengaluru City, India (R & Lonimath, 2023 ) and study in Dessie city, Ethiopia (Mitiku et al., 2023 ). Because of that a comprehensive narrative review of the literature, study’s highlights that importance balance iron in shaping children's neurological functions and key findings that underscore the influence of maternal nutrition during pregnancy and the peri-gestational period on children's cognitive, motor, speech, and socio-emotional development and consequently, ensuring optimal nutrition is imperative for fostering appropriate brain development in children (de Matos Reis et al., 2024 ). Due to the fact that, sufficient iron intake by pregnant women is crucial for both maternal and infant health and it is particularly important in pregnancy and infancy to meet the high demands for hematopoiesis, growth and development (Brannon & Taylor, 2017 ). Iron deficiency during pregnancy can lead to adverse birth outcomes and increase the risk of developmental delays. It is noteworthy that supplementation with these micronutrients during pregnancy yields benefits for both the mother and the child (Ouyang et al., 2024 ). The major reasons to maintain an iron-sufficient state during pregnancy are to protect the health of the mother, improve pregnancy outcomes, and foster fetal development (Georgieff, 2020 ). It implies that adequate and proper iron intake during pregnancy can help mitigate these risks, support optimal long-term development in infants, and contribute to optimal developmental outcomes for infants. This study found that infants with previous sibling history of developmental delay were more likely to experience developmental delay as compared to infants without family history of developmental delay. Possible explanations include a genetic or hereditary component to developmental delays, where certain conditions or disorders can run in families. In addition to genetics, family members may also share environmental factors that can influence development. These can include socioeconomic status, access to healthcare, exposure to toxins or infections, and overall family dynamics. It implies that families with a history of developmental delay may experience unique challenges and concerns on infant’s developmental milestone outcome. Based on this working on early routine developmental screenings be implemented for infants, those with previous sibling history of developmental delay will decrease its presence. CONCLUSION The study shows that the magnitude of developmental delays was 102(26.5%) which is high as compared to the global prevalence. Several variables were found to be associated with developmental delay, including the mother's educational level, the lack of iron intake during pregnancy and previous sibling history of developmental delay. So based on this finding working more on the significant variable might be decrease the magnitude and early identification of developmental disorders is important due to their potential negative impact on intellectual and learning abilities. Abbreviations ASQ Age and Stage Questioners DD Developmental Delay LMIC Low and Middle Income Country STATA Statistical Software For Data Science Declarations Ethics Approval and Consent to Participate An ethical approval was first obtained from the CMHS (College of Medicine and Health Science) research ethical approval committee. Then a legal, official clearance letter was written to selected public health institutions. Prior to commencing the data collection process, the participants were provided with comprehensive information concerning the study's objectives as well as the potential benefits and risks involved. Written consent was obtained from each participant’s care giver before the interview. All participant’s care giver provided written informed consent, and this study was conducted in accordance with the Declaration of Helsinki as a statement of ethical principles for medical research involving human subjects. Consent for Publication Not applicable. Clinical trial number Not applicable Availability of Data and Materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' Contributions Shiferaw Abeway: Conceptualized and designed the study, supervised the research process, coordinated data analysis, and led the review and editing of the manuscript. Jemal Ali: Collected the data, performed data entry and preliminary analysis, and drafted the initial version of the manuscript. Samuel Nebiyu: Assisted in literature review, contributed to data interpretation, and supported manuscript editing. Muluken Amare: Provided critical revision of the manuscript for intellectual content and contributed to the final editing and formatting. All authors read and approved the final manuscript. Acknowledgment Above all, we would like to express our appreciation to Wollo University college of Medicine and Health Sciences for continuous support and funded for this work. Our thanks also go Desie town health bureau administrative Offices for the provision of the required information and their full courage and assistance. Finally, we would like to acknowledge our study participants for their cooperation. References Abdelbaky, O. A., Deifallah, S., Amin, G., & Marzouk, D. (2022). Screening for Developmental Delays in Children 2-36 Months of Age in a Primary Health Care Center in Cairo, Egypt. Journal of High Institute of Public Health, 52 (2), 53-58. Abdoola, S., Swanepoel, D. W., Graham, M. A., & van der Linde, J. (2023). Developmental characteristics of young children in a low-income South African community. Journal of Child Health Care , 13674935231173023. Abo El Elella, S. S., Tawfik, M. A., Abo El Fotoh, W. M. M., & Barseem, N. F. (2017). Screening for developmental delay in preschool-aged children using parent-completed Ages and Stages Questionnaires: additional insights into child development. Postgraduate Medical Journal, 93 (1104), 597-602. Agarwal, D., Chaudhary, S. S., Sachdeva, S., Misra, S. K., & Agarwal, P. (2018). Prevalence of developmental delay and factors affecting the development status among under 5 children in an urban slum of Agra city. National Journal of Community Medicine, 9 (07), 474-479. Alamri, A., Aljadhai, Y. I., Alrashed, A., Alfheed, B., Abdelmoaty, R., Alenazi, S., . . . Benini, R. (2021). Identifying clinical clues in children with global developmental delay/intellectual disability with abnormal brain magnetic resonance imaging (MRI). Journal of Child Neurology, 36 (6), 432-439. Ayele, M. (2018). The Prevalence of Developmental Delays among Infants and Young Children in Addis Ababa, Ethiopia. The Ethiopian Journal Of Behavioural Studies, 2 (1), 148-173. Bélanger, S. A., & Caron, J. (2018). Evaluation of the child with global developmental delay and intellectual disability. Paediatrics & child health, 23 (6), 403-410. Bellman, M., Byrne, O., & Sege, R. (2013). Developmental assessment of children. Bmj, 346 . Bello, A. I., Quartey, J. N., & Appiah, L. A. (2013). Screening for developmental delay among children attending a rural community welfare clinic in Ghana. BMC pediatrics, 13 , 1-7. Bhattacharya, T., Ray, S., & Das, D. K. (2017). Developmental delay among children below two years of age: a cross-sectional study in a community development block of Burdwan district, West Bengal. International Journal of Community Medicine and Public Health, 4 (5), 1762-1767. . Bishwokarma, A., Shrestha, D., Bhujel, K., Chand, N., Adhikari, L., Kaphle, M., . . . Karmacharya, I. (2022). Developmental delay and its associated factors among children under five years in urban slums of Nepal. Plos one, 17 (2), e0263105. . Black, M. M., Walker, S. P., Fernald, L. C., Andersen, C. T., DiGirolamo, A. M., Lu, C., . . . Shiffman, J. (2017). Early childhood development coming of age: science through the life course. The lancet, 389 (10064), 77-90. . Brannon, P. M., & Taylor, C. L. (2017). Iron supplementation during pregnancy and infancy: uncertainties and implications for research and policy. Nutrients, 9 (12), 1327. . Bushnell, E., McCoy, D., Black, M., Daelmans, B., & Dua, T. (2016). Existing approaches and challenges. Early Childhood Matters.Available at: https://bernardvanleer.org/app/uploads/2016/07/Early-Childhood-Matters-2016_6.pdf . . Carneiro, P., Meghir, C., & Parey, M. (2013). Maternal education, home environments, and the development of children and adolescents. Journal of the European Economic Association, 11 (S1), 123-160. doi:10.1111/j.1542-4774.2012.01096.x. Chakraborty, S., Bhattacherjee, S., Das, D. K., & Dasgupta, S. (2019). DEVELOPMENTAL DELAYS AND ITS PREDICTORS AMONG INFANTS-A CROSS SECTIONAL STUDY IN RURAL AREAS OF SILIGURI SUBDIVISION, DARJEELING DISTRICT, WEST BENGAL. International Journal of Medical and Biomedical Studies, 3 (4), 96-104. . Chakraborty, S., Bhattacherjee, S., Kumar Das, D., & Dasgupta, S. (2019). Developmental delays and its predictors among infants-a cross sectional study in rural areas of siliguri subdivision, darjeeling district, west bengal. International Journal of Medical and Biomedical Studies, 3 (4), 96-104. 0. Currie, J. (2009). Healthy, wealthy, and wise: Socioeconomic status, poor health in childhood, and human capital development. JoUrnal of economIc lIteratUre, 47 (1), 87-122. . Dabar, D., Das, R., Nagesh, S., Yadav, V., & Mangal, A. (2016). A community-based study on growth and development of under-five children in an Urbanized Village of South Delhi. Journal of tropical pediatrics , fmw026. . Dagvadorj, A., Ganbaatar, D., O. Balogun, O., Yonemoto, N., Bavuusuren, B., Takehara, K., . . . Akahira-Azuma, M. (2018). Maternal socio-demographic and psychological predictors for risk of developmental delays among young children in Mongolia. BMC pediatrics, 18 , 1-8. . Dar, J. A. (2018). Developmental Delay and Disability among 0-6 Year Children in Rural and Urban Kashmir India. Inter-national Journal of Indian Psychology, 6 (1). . de Matos Reis, Á. E., Teixeira, I. S., Maia, J. M., Luciano, L. A. A., Brandião, L. M., Silva, M. L. S., . . . Soriano, R. N. (2024). Maternal nutrition and its effects on fetal neurodevelopment. Nutrition , 112483. . Demirci, A., & Kartal, M. (2016). The prevalence of developmental delay among children aged 3–60 months in Izmir, Turkey. Child: Care, Health and Development, 42 (2), 213-219. . Dupont-Soares, M., Dos Santos, M., Garcia, E. M., Soares, M. C. F., Muccillo-Baisch, A. L., & da Silva Júnior, F. M. R. (2021). Maternal, neonatal and socio-economic factors associated with intellectual development among children from a coal mining region in Brazil. Environmental Geochemistry and Health, 43 , 3055-3066. . Eapen, V., Zoubeidi, T., Yunis, F., Gururaj, A. K., Sabri, S., & Ghubash, R. (2006). Prevalence and psychosocial correlates of global developmental delay in 3-year-old children in the United Arab Emirates. Journal of psychosomatic research, 61 (3), 321-326. . El Din, E., Rabah, T., Metwally, A., Nassar, M., Elabd, M., Shaalan, A., . . . Shaaban, S. (2019). Potential Risk Factors of Developmental Cognitive Delay in the First Two Years of Life. Open Access Maced J Med Sci.. Elbers, J., & Macnab, A. (2008). The Ages and Stages Questionnaires: feasibility of use as a screening tool for children in Canada. Canadian Journal of Rural Medicine, 13 (1), 9. . Engle, P. L., Black, M. M., Behrman, J. R., De Mello, M. C., Gertler, P. J., Kapiriri, L., . . . Young, M. E. (2007). Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. The lancet, 369 (9557), 229-242. . Farid, A., Maqbool, S., Ullah, E., Ali, A., & Farid, Z. (2020). Risk factors in children presenting with developmental delay. Pakistan Armed Forces Medical Journal, 70 (3), 812-817. . Faruk, T., King, C., Muhit, M., Islam, M. K., Jahan, I., ul Baset, K., . . . Khandaker, G. (2020). Screening tools for early identification of children with developmental delay in low-and middle-income countries: a systematic review. BMJ open, 10 (11), e038182. . FMOH. (2021). This revised Integrated Management of Newborn and Childhood Illness training material has incorporated the following changes over the 2015 version. . Ford, N. D., & Stein, A. D. (2016). Risk factors affecting child cognitive development: a summary of nutrition, environment, and maternal–child interaction indicators for sub-Saharan Africa. Journal of developmental origins of health and disease, 7 (2), 197-217. . Gedamu, H., & Tafere, Y. (2019). Assessment of knowledge, attitude, and practice of sunlight exposure of infants among mothers attending in governmental health facilities in Farta district, South Gondar zone, North West Ethiopia, 2018. International journal of reproductive medicine, 2019 . . Geldsetzer, P., Williams, T. C., Kirolos, A., Mitchell, S., Ratcliffe, L. A., Kohli-Lynch, M. K., . . . Campbell, H. (2014). The recognition of and care seeking behaviour for childhood illness in developing countries: a systematic review. Plos one, 9 (4), e93427. Georgieff, M. K. (2020). Iron deficiency in pregnancy. American journal of obstetrics and gynecology, 223 (4), 516-524. . Ghosh, R., & Saha, S. (2022). A Prospective Observational Cross-Sectional Study on Developmental Delay and Associated Socioeconomic, Demographic and Clinical Factors among Apparently Neurologically Normal Children Aged 2 Months to 36 Months in Eastern India. International Journal Of Medical Science And Clinical Research Studies, 2 (10), 1110-1115. . Glascoe, F. P. (2000). Early detection of developmental and behavioral problems. Pediatrics in review, 21 (8), 272-280. . Grantham-McGregor, S., Cheung, Y. B., Cueto, S., Glewwe, P., Richter, L., & Strupp, B. (2007). Developmental potential in the first 5 years for children in developing countries. The lancet, 369 (9555), 60-70. . Gupta, S., Shrivastava, P., Samsuzzaman, M., Banerjee, N., & Das, D. K. (2021). Developmental delay among children under two years of age in slums of Burdwan Municipality: A cross-sectional study. Journal of Family Medicine and Primary Care, 10 (5), 1945. . Hirai, A. H., Kogan, M. D., Kandasamy, V., Reuland, C., & Bethell, C. (2018). Prevalence and variation of developmental screening and surveillance in early childhood. JAMA pediatrics, 172 (9), 857-866. . Jimoh, A. O., Anyiam, J. O., & Yakubu, A. M. (2017). Prevalence and sociodemographic determinants of developmental delay: a cross-sectional study of under-five Nigerian children. Highland Medical Research Journal, 17 (1), 19-25. . Kapci, E. G., Kucuker, S., & Uslu, R. I. (2010). How applicable are Ages and Stages Questionnaires for use with Turkish children? Topics in Early Childhood Special Education, 30 (3), 176-188. . Komutambo, I.-M., Kimiywe, J., & Munga, J. (2022). Determinants of Developmental Milestones among Children 0-23 Months at Kabale Hospital, Uganda. African Journal of Health Sciences, 35 (2), 123-143. . Magnuson, K. A., Sexton, H. R., Davis-Kean, P. E., & Huston, A. C. (2009). Increases in maternal education and young children's language skills. Merrill-Palmer Quarterly (1982-) , 319-350. . Mandarwal, D., Ahluwalia, S., Gite, M. A. R., Datta, B., Datta, B. C., & Datta, B. (2023). A Cross-sectional study to compare the prevalence & causes of delayed milestones in children (0-3years) of rural & urban Jaipur. . Manna, N., Das, S., SK, S. R., & Das, D. (2022). Prevalence and factors affecting developmental delay among 0–6-year-old children attending immunization clinic. National Journal of Physiology, Pharmacy and Pharmacology, 12 (6), 834-834. . McCoy, D. C., Peet, E. D., Ezzati, M., Danaei, G., Black, M. M., Sudfeld, C. R., . . . Fink, G. (2016). Early childhood developmental status in low-and middle-income countries: national, regional, and global prevalence estimates using predictive modeling. PLoS medicine, 13 (6), e1002034. . Mitiku, K., Nega, T., Arefaynie, M., Tilahun, D., Kefale, B., Damtie, Y., . . . Yalew, M. (2023). Gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia. BMC pediatrics, 23 (1), 638. . Moodie, S., Daneri, P., Goldhagen, S., Halle, T., Green, K., & LaMonte, L. (2014). Early Childhood Developmental Screening: A Compendium of Measures for Children Ages Birth to Five. OPRE Report 2014-11. US Department of Health and Human Services . . Murphy, R., Jolley, E., Lynch, P., Mankhwazi, M., Mbukwa, J., Bechange, S., . . . Schmidt, E. (2020). Estimated prevalence of disability and developmental delay among preschool children in rural Malawi: Findings from “Tikule Limodzi,” a cross‐sectional survey. Child: Care, Health and Development, 46 (2), 187-194. . Ofek-Shlomai, N., & Berger, I. (2014). Inflammatory injury to the neonatal brain–what can we do? Frontiers in Pediatrics, 2 , 30. . Olusanya, B. O., Davis, A. C., Wertlieb, D., Boo, N.-Y., Nair, M., Halpern, R., . . . Gladstone, M. (2018). Developmental disabilities among children younger than 5 years in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Global Health, 6 (10), e1100-e1121. . Organization, W. H. (2008,Geneva: World Health Organization Press; 2008. Available at http://www. who.int/healthinfo/global_burden_disease/GBD_report_2004update_part3. pdf. Accessed on August 1, 2009). The global burden of disease: 2004 update : World Health Organization.. Organization, W. H. (2012). Early childhood development and disability: A discussion paper. . Organization, W. H. (2017). World Health Statistics, 2010. Developmental problems in children Available from: http://www.who.org. [Last Accessed on 2019 Sep 22].. Ouyang, J., Cai, W., Wu, P., Tong, J., Gao, G., Yan, S., . . . Huang, K. (2024). Association between Dietary Patterns during Pregnancy and Children’s Neurodevelopment: A Birth Cohort Study. Nutrients, 16 (10), 1530. . R, D., & Lonimath, A. (2023). Screening of Early Developmental Delay and Its Risk Factors Among Children Seeking Health Care in India-Exploring Missed Opportunities. Function and Disability Journal, 6 . doi:10.32598/fdj.6.260.1. R, D., Lonimath, A., & Santhosh, G. (2023). Screening of Early Developmental Delay and Its Risk Factors Among Children Seeking Health Care in India-exploring Missed Opportunities. Function and Disability Journal, 6 (1), 0-0. doi:10.32598/fdj.6.260.1. Sabri, N. A. I., Gan, W. Y., Law, L. S., Chin, Y. S., & Mohd Shariff, Z. (2022). Factors associated with cognitive and motor delays in Malaysian infants aged 6–12 months. Early Child Development and Care, 192 (5), 781-794. . Sachdeva, S., Amir, A., Alam, S., Khan, Z., Khalique, N., & Ansari, M. (2010). Global developmental delay and its determinants among urban infants and toddlers: a cross sectional study. The Indian Journal of Pediatrics, 77 , 975-980. . Sajedi, F., Vameghi, R., & Kraskian Mujembari, A. (2014). Prevalence of undetected developmental delays in I ranian children. Child: Care, Health and Development, 40 (3), 379-388. . Scherzer, A. L., Chhagan, M., Kauchali, S., & Susser, E. (2012). Global perspective on early diagnosis and intervention for children with developmental delays and disabilities. Developmental Medicine & Child Neurology, 54 (12), 1079-1084. . Sharma, N., Masood, J., Singh, S., Ahmad, N., Mishra, P., Singh, S., & Bhattacharya, S. (2019). Assessment of risk factors for developmental delays among children in a rural community of North India: A cross-sectional study. Journal of Education and Health Promotion, 8 . . Shatla, M. M., & Goweda, R. A. (2020). Prevalence and factors associated with developmental delays among preschool children in Saudi Arabia. Journal of High Institute of Public Health, 50 (1), 10-17. . Sheldrick, R. C., Merchant, S., & Perrin, E. C. (2011). Identification of developmental-behavioral problems in primary care: a systematic review. Pediatrics, 128 (2), 356-363. . Sices, L., & Fund, C. (2007). Developmental Screening in Primary Care: The Effectiveness of Current Practice and Recommendations for Improvement : Commonwealth Fund.. Sim, F., Thompson, L., Marryat, L., Ramparsad, N., & Wilson, P. (2019). Predictive validity of preschool screening tools for language and behavioural difficulties: A PRISMA systematic review. Plos one, 14 (2), e0211409. . Squires, J., Bricker, D. D., & Twombly, E. (2009). Ages & stages questionnaires : Paul H. Brookes Baltimore.. Teklehaimanot, W. Z., Kitawu, L. D., Tesfaye, T., Mihretie, A., Tizazu, M. A., Mekuriyaw, A. M., . . . Muluneh, M. A. (2021). Assessment of practice and factors associated with sunlight exposure of infants among mothers in Debre Berhan Town, North Shewa Zone, Amhara Region, Ethiopia. Pediatric Health, Medicine and Therapeutics , 507-517. . TUYISENGE, V. (2020). Screening for developmental delay in children aged 9 and 16 months, Kigali-Rwanda: using Ages and Stages questionnaire 3. University of Rwanda, CMHS. . UNICEF. (2012). Inequities in Early Childhood Development What the data say Evidence from the multiple cluster surveys. New York: United Nations Childrens Fund , 2-16. . Vipulaguna, D., Jahan, I., Girish, M., Chinnappa, G. D., Gopalaswamy, S., Shahidullah, M., & Sumanasena, S. P. (2022). Early interventions for infants at risk for developmental impairment: The South Asian perspective. Indian Journal of Pediatrics, 89 (3), 254-261. . Walker, S. P., Wachs, T. D., Grantham-McGregor, S., Black, M. M., Nelson, C. A., Huffman, S. L., . . . Lozoff, B. (2011). Inequality in early childhood: risk and protective factors for early child development. The lancet, 378 (9799), 1325-1338. . Wamani, H., Tylleskär, T., Astrøm, A. N., Tumwine, J. K., & Peterson, S. (2004). Mothers' education but not fathers' education, household assets or land ownership is the best predictor of child health inequalities in rural Uganda. International journal for equity in health, 3 (1), 9-9. doi:10.1186/1475-9276-3-9. Warren, R., Kenny, M., Bennett, T., Fitzpatrick-Lewis, D., Ali, M. U., Sherifali, D., & Raina, P. (2016). Screening for developmental delay among children aged 1-4 years: a systematic review. Canadian Medical Association Open Access Journal, 4 (1), E20-E27. . Zhang, J., Guo, S., Li, Y., Wei, Q., Zhang, C., Wang, X., . . . Scherpbier, R. W. (2018). Factors influencing developmental delay among young children in poor rural China: a latent variable approach. BMJ open, 8 (8). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7241180","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504803654,"identity":"26cef53f-d1ad-429a-812e-e2273ff10baf","order_by":0,"name":"Shiferaw Abeway Mamuye","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYDACCcaGD4wNDHIg9oEHRGppnAHUYgzWkkCcFgZGkJbEBhCHKC3ys5sbGz7uOJw+P+zwQ6AtdnK6DQS0GNw52Ng488zh3I230wyAWpKNzQ4Q0iKR2P6Ytw2oZXYCSMuBxG2EtMjPSGxs/tt2ON1wdvoH4rQw3ABqYWw7nCAvnUOkLQZALY29Z9INN0jnFBxIMCDCL/Iz0h82/NxhLS8/O33zhw8VdnIEtUBBM4MBWKUBccpBoI5BvoF41aNgFIyCUTDCAADa9U9uZo3lUwAAAABJRU5ErkJggg==","orcid":"","institution":"Wollo University","correspondingAuthor":true,"prefix":"","firstName":"Shiferaw","middleName":"Abeway","lastName":"Mamuye","suffix":""},{"id":504803655,"identity":"b79c3aa1-2511-4cc8-b15a-63ae29495da7","order_by":1,"name":"Jemal Ali","email":"","orcid":"","institution":"Wollo University","correspondingAuthor":false,"prefix":"","firstName":"Jemal","middleName":"","lastName":"Ali","suffix":""},{"id":504803656,"identity":"0570d9d9-849a-45f7-a906-7743b2ae306d","order_by":2,"name":"Samuel Nebiyu","email":"","orcid":"","institution":"Wollo University","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Nebiyu","suffix":""},{"id":504803657,"identity":"f4ae0968-c650-4695-992f-6279271dfcda","order_by":3,"name":"Muluken Amare","email":"","orcid":"","institution":"Wollo University","correspondingAuthor":false,"prefix":"","firstName":"Muluken","middleName":"","lastName":"Amare","suffix":""}],"badges":[],"createdAt":"2025-07-29 08:53:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7241180/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7241180/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90125008,"identity":"fcba563a-4603-4c5d-8789-435bb967d19a","added_by":"auto","created_at":"2025-08-28 18:50:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":16965,"visible":true,"origin":"","legend":"\u003cp\u003eMagnitude of developmental delay in each domain of developmental milestone at the age of 9 month infants in selected health facilities Dessie, City Ethiopia, 2024\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7241180/v1/b57d8ab569a7141ab01d9450.png"},{"id":90125496,"identity":"8180f05f-0f56-478a-8664-e6123105f579","added_by":"auto","created_at":"2025-08-28 18:58:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":34409,"visible":true,"origin":"","legend":"\u003cp\u003eMagnitude developmental delay at the age of 9 month infants in selected health facilities Dessie, City Ethiopia, 2024\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7241180/v1/dbfa3e6ce568ecdab740b471.png"},{"id":90820684,"identity":"756ab302-45e0-40b0-96f9-cff1fbf9cd5b","added_by":"auto","created_at":"2025-09-08 14:09:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1119221,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7241180/v1/c58e33c6-faca-4daa-a8b9-79a8209d0f3a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Magnitude of Developmental Delay and Its Associated Factors among Nine Month Infants in South Wollo Zone, Dessie City Public Health Facilities 2024","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eChild development is a maturation process that progresses sequentially through five key domains of development abound namely; gross motor skills, fine motor skills, communication skills, cognition skills and social/personal activities. Early childhood development assessment is an ongoing process of observing, collecting, documenting, and analysing data to measure a child's progress over time (Moodie et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the field of child health care, developmental delay is defined as the inability of a child to develop and/or acquire skills in line with a predetermined sequence of steps also this definition is widely accepted (Abo et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Organization, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Developmental delays can be caused by adverse environmental, social and psychological conditions or by birth complications (e.g. premature birth), encephalitis and brain damage; severe postpartum illness; congenital metabolic defects; Genetic or chromosomal abnormalities; Lack of stimulation, chronic diseases, iron deficiency anemia, malnutrition (B\u0026eacute;langer \u0026amp; Caron, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Biological and psychosocial risk factors affecting child development are common in developing countries (Kapci et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Sachdeva et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSigns of developmental disabilities include intellectual disability, Down syndrome, fetal alcohol syndrome, cerebral palsy, autism spectrum disorder, and behavioral disorders (Sim et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Warren et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, if diagnosed and intervened before the age of 5 year developmental delays can be identified using well-validated screening tools as important predictors of learning, motor and behavioral difficulties (Faruk et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Management requires a comprehensive approach to appropriate care and support, including: Assessment and early intervention planning; service; Monitoring and evaluation and also timely evaluation also it permits for the timely application of interventions and management plans specific to the defect (WHO, 2012)\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and area\u003c/strong\u003e \u003c/p\u003e\n\u003cp\u003eInstitution -based cross sectional study was conducted from March 30 to April 30 in South Wollo Zone, public health facilities of Dessie City, which is situated 401 kilometers northeast of Addis Ababa in the Amhara Regional State of Ethiopia. The city had 10 urban and 6 rural Kebele. There are 27 private clinics, 9 hospitals, 1 privet pediatric specialty clinic, 8 health centers, and 2 public health facilities. All of these health facilities provided pediatric and child health services\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was determined by using a prevalence of 50% because there is no comparable study conducted in the study area. Thus with 95% confidence level and 10% non-response rate making the final sample size 422. The study was conducted by using systematic random sampling method to recruit participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e Sampling procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom the total 10 health facility of Dessie, City 4 health facility were selected by simple random a sample. The sampling unit was selected from each health facilities by allocating the total sample proportionately by considering the last three month report, number of nine month infants attending in each selected health facility. After sample size allocated in each selected facility study participants were select by using systematic random sampling technique among those infants with mother who comes in the selected health facility. The first participant was selected by using lottery method and the next participants selected by every K\u003csup\u003eth\u003c/sup\u003e interval. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definitions and term of definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDevelopmental Delay\u003c/strong\u003e:-Delay in specific or global functioning of children involving domains communication, fine motor and gross motor, problem-solving, and personal-social areas. It was measured by using 30 items with the response format of Yes, Sometimes, and Not Yet and categorized as \u0026lsquo;Delayed if the respondents answered below the mean score (mean = 223.7), otherwise \u0026lsquo;Not delayed\u0026apos;. (Alamri \u003cem\u003eet al., \u003c/em\u003e2021). The participant\u0026rsquo;s response of \u0026quot;yes\u0026quot; means that the child was able to achieve the skills mentioned, \u0026quot;Sometimes\u0026quot; for occasionally demonstrating the skill, and \u0026quot;not yet\u0026quot; for not achieving the skill at all. To quantify the responses, a scoring system was employed. A response of \u0026quot;yes\u0026quot; was assigned 10 points. A response of \u0026quot;sometimes\u0026quot; was assigned 5 points. Lastly, a response of \u0026quot;not yet\u0026quot; was assigned 0 points. (Squires \u003cem\u003eet al\u003c/em\u003e., 2009).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePractice of sun light exposure\u003c/strong\u003e: Sunlight exposure Practice exposure of infants to sunlight for 15-20minutes per day in the morning (8am-10am) starting from two weeks of age after birth with uncovered body, without applying any ointment and the practices of sun light exposure of infants will be assessed by seven questions. Mothers who were respond practice related questions equal and above the mean value was considered as good practices and \u0026ldquo;coded as \u0026ldquo;1\u0026rdquo;and, mothers who were responded less than the mean was considered as poor practices coded as\u0026rdquo;0\u0026rsquo; (Gedamu \u0026amp; Tafere, 2019; Teklehaimanot \u003cem\u003eet al.,\u003c/em\u003e 2021).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevious sibling history of developmental delay\u003c/strong\u003e: - was assessed by yes or no question which is assessing by asking the question dose developmental delay in their sibling previously which is confirmed by medical diagnosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFasting during pregnancy\u003c/strong\u003e: - was assessed by yes or no question which is assessing by asking the question dose the mother have fasting during pregnancy, refers to abstaining from food and drink for a certain period of time at least eight hours\u003c/p\u003e\n\u003ch2\u003eData collecting tools and procedures\u003c/h2\u003e\n\u003cp\u003eThe ASQ3\u003csup\u003erd\u003c/sup\u003e version a parent/caregiver and data collector completed developmental screening instrument at the age of 9 month was used for the data collection. Each ASQ version-3 questionnaire includes 30 questions that focus on five developmental domains and the sensitivity and specificity of the ASQ measured in different studies are 75% and 95%, respectively.(Elbers \u0026amp; Macnab, 2008).Data were collected at well baby clinic before getting the service and it takes 15 minutes for one respondents. To evaluate fine motor, personal, and social skills, an interviewer-based questionnaire was used in the study. However, for assessing gross motor and fine motor skills, both observational and interviewer-based questionnaires were employed. Various instruments, such as small toys, 4x4 box-like toys, and a string, were utilized to assess whether the child fulfilled the skills required for each item. When the mother expressed confidence that her child could master the skills specified in an item, that particular item was highlighted. In cases where there was uncertainty about the child\u0026apos;s ability to master the skill or if the mother had not observed the skill, the assessment was concluded after the child attempted the skill. Data collection was carried out by three BSC nurses. To ensure consistency and quality, one supervisor was recruited, and training was given.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Quality Assurance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe quality of the data was assured before, during, and after data collection. To ensure data quality, a pre-test was conducted on a 5% sample (21 infants aged 9 months) at the public health center in the city of Kombolcha, Kebele 03 health center, before the actual data collection. Data collectors received one-day training on the purpose of the survey, the content of the survey, especially the confidentiality of responses, and the rights of respondents. Data cleaning was done. The English version of the questioner was translated to the local language (Amharic) and again translated back to English to check consistency.\u003c/p\u003e\n\u003ch2 id=\"_Toc172107091\"\u003eData processing and Analysis\u003c/h2\u003e\n\u003cp\u003eThe consistency and completeness of the completed questionnaires were examined. Following verification, the data was entered into Epi-data 4.7 and exported to STATA version 17 for analysis. Text, graphs, and tables were used to present descriptive and summary statistics. The frequency distribution of socio‐demographical variables, such as maternal age, sex of the child, marital status, and educational status, was expressed in percentages. Continuous variables were expressed as mean \u0026plusmn; standard deviation values. Bivariable and multivariable logistic regression were used to assess the association between independent and dependent variables. Bivariate analysis was used to look for candidate variables for multivariate logistic regression. All variables that showed a P-value less than 0.2 were entered into the multivariate analysis. The odds ratio and their 95% confidence intervals, together with a p-value \u0026lt;0.05, were used to identify factors associated with developmental delay. Multicollinearity was checked by variance inflation factors (VIF), which was 1.3\u0026ndash;7.2. For a finally fitted multivariable logistic regression model, model fitness was checked by Hosmer-Lemeshow goodness-of-fit, which was (p-value =.81).\u003c/p\u003e\n\u003ch2 id=\"_Toc172107092\"\u003eEthical Consideration\u003c/h2\u003e\n\u003cp\u003eAn ethical approval was first obtained from the CMHS (College of Medicine and Health Science) research ethical approval committee. Then a legal, official clearance letter was written to selected public health institutions. Prior to commencing the data collection process, the participant\u0026rsquo;s care givers were provided with comprehensive information concerning the study\u0026apos;s objectives as well as the potential benefits and risks involved. Written consent was obtained from each participant/s care giver before the interview. Throughout the review and interview procedures, utmost care was taken to ensure the privacy and confidentiality of each participant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003ch2\u003eSocio-demographic characteristics\u003c/h2\u003e\n\u003cp\u003eFrom the total of 422 mothers with their infants, 385 were enrolled with a response rate of 91.2%. 220 (57.1%) of the infants are female. The mean of the mothers was 29.6 years, with a standard deviation of \u0026plusmn;4.9 years. Education level of mothers 174 (45.5%), mothers had attained a college-level education or higher. (Table 1)\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1: Socio-demographic characteristics of mothers/caregivers of 9 month infants attending in Dessie , City public health facilities Ethiopia, 2024 (n=385).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"643\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCategory\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eFrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePercent (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eSex of infant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e42.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003ePlace of Residence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eUrban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e96.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eMarital status of the mother\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e94.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eEducational status of the Mother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePrimary education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCollege and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e45.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eEducational status of the Father\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGrade 1-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGrade 9-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e34.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCollege and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e34.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eOccupational status of mother\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e46.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003ePrimary caretaker of the child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e51.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGrandparent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eBrother/Sister\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHouse help\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e39.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eFamily number\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026lt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026gt;=3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e97.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eMaternal age\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026lt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e88.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026gt;=35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eObstetric and Health related factor\u003c/h2\u003e\n\u003cp\u003eThe majority, of infants 251(65.2%), were born through spontaneous vaginal delivery. 75.6% of the pregnancies were planned and 89.4%, of the infants were born at term. Among the respondents 339 (88.1%) were not Previous sibling history of developmental delay and 320(83.1%) of infants had no history of neonatal illness. (Table 2)\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2: Obstetric and health related characteristics of mothers/caregivers of 9 months infants attending in Dessie , City public health facilities Ethiopia, 2024 (n=385)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of delivery\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eInstrumental assisted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eC/D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eBirth weight\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2.5 kg-4 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e76.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026lt;2.5 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026gt;4 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eType of pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eUnplanned\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e24.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePlanned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e75.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eTerm at the delivery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e89.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eBirth spacing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026lt;3\u0026nbsp;years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e57.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026gt;=3years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eHistory of birth asphyxia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e84.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eOrder of birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e1\u003csup\u003est\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e2nd and 4\u003csup\u003eth\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e73.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e5th \u0026nbsp;and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eHistory of neonatal illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e83.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eInfant sick in the past 2 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e77.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003ePrevious sibling history of developmental delay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e88.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: - C/D= Cesarean delivery, SVD= Spontaneous vaginal delivery.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u0026nbsp;Nutritional related factors\u003c/h2\u003e\n\u003cp\u003eStudy shows that 282 (73.2%) of infants, began complementary feeding at six months and above. Close to half of the mothers, 204 (48.3%), had exposure to sunlight, and among them, 160 (41.6%) had good sunlight exposure practice habits. (Table 3)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table\u0026nbsp;3: Nutritional related characteristics of mothers/caregivers of 9 months infants attending in Dessie , City public health facilities Ethiopia, 2024 (n=385).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"671\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eCategory\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eFrequency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eInitiation of complementary feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eAt 6 months and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e73.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eBefore six month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eIron intake during pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eSunlight exposure during postnatal period\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e53.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e46.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eThe main reason not exposed to sun light\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eFear\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eHave no time\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003ePractice of sunlight exposure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003epoor practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003egood practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eFast during pregnant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e75.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 185px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eMagnitude of Developmental Delay\u003c/h2\u003e\n\u003cp\u003eIn this study, about 132 (34.3%) of the participants had a gross motor skills delay following a communication skills delay (30.9%) (Fig.1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOver all magnitude of developmental delay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe magnitude of developmental delay was 102 (26.5%), (95% CI=22.2, 31.2%) (Fig. 2).\u003c/p\u003e\n\u003ch2\u003eFactors Associated with developmental delay\u003c/h2\u003e\n\u003cp\u003eIn the bivariate analysis, factors such as marital status, father\u0026apos;s educational status, mother\u0026apos;s educational status, maternal occupation, maternal age at delivery, mode of delivery, birth weight, type of pregnancy, term at delivery, history of birth asphyxia, birth order, history of neonatal illness, family history of developmental delay, initiation of complementary feeding and iron intake during pregnancy, were significant with p-value \u0026lt; 0.2. However, in the multivariable analysis, only maternal educational status, previous sibling history of developmental delay, and iron intake during pregnancy were significantly associated with p-value \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003eMothers who had no formal education were more than four times more likely [AOR = 4.16, 95% CI (1.29, 13.42)], to have infant developmental delay as compared to mothers who had educated college and above. Similarly, mothers who had primary education were more than five times more likely [AOR = 5.48, 95% CI (1.84, 16.27)] to have infant developmental delays as compared to mothers who had educated college and above.\u003c/p\u003e\n\u003cp\u003eThose with previous sibling history of developmental delay were more than six times [AOR = 6.76, 95% CI (1.55, 29.43)] more likely to develop developmental delay as compared with their counterparts. \u0026nbsp;Infants whose mother didn\u0026rsquo;t take iron during pregnancy were more than three times 3.56 [AOR = 2.58, 95% CI 1.30, 5.11) more likely to develop developmental delays as compared with their counterparts. (Table 4)\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eTable 4: Bi-variable and multivariable regression of factors associated with developmental delay among mothers of 9-month-old infants attending Dessie, City public health facilities in Ethiopia, 2024 (n = 385)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"747\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDevelopmental delay\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eCOR (CI: 95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eAOR (CI: 95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eDelayed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNot delayed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eEducational status of father\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNo formal education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e48 (60.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e31(39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e11.32 (5.67, 22.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.19 (.72, 6.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003ePrimary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e10(23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e32(76.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e2.28 (.94, 5.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.61 (.17, 2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e28(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e103(78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1.98 (1.01, 3.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.90 (.32, \u0026nbsp;2.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eCollege and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e16(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e117(88.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eEducational status of mother\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNo formal education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e34(63.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e20(37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e11.16 (5.51, 22.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e4.16 (1.29, 13.42)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003ePrimary education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e17(41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e24(58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e4.65(2.17, \u0026nbsp;9.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e5.48 (1.84. 16.27)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e28(24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e88(75.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e2.08 (1.13, 3.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.40 (.53, 3.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eCollege and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e23(13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e151(86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMaternal occupation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e56(31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e121(68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e.61 (.38, .96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.87 (.44, 1.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e46(22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e162(77.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMaternal age at time of delivery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eLess than 35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e73(21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e267(78.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e35 years and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e29(64.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16(35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e6.62 (3.41, 12.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.74 (.61, 4.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMode of delivery\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eSVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e56(22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e195(77.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eInstrumental assisted\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e21(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e51(70.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1.43 (.79, 2.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.63 (.22, 1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e25(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e37(59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e2.35 (1.30, 4.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.18 (.47, 2.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eBirth of infant weight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.5-4 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e56(18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e240(81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eLess than 2.5 kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e21(55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e17(44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e5.29 (2.62, 10.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.65 (.88, 7.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eAbove 4kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e25(49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e26(51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e4.12 (2.21, 7.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.13 (.75, 6.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eType of pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eUnplanned\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e47(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e47(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e.23 (.14 , .38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.81 (.36, 1.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003ePlanned\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e55(18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e236(81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eTerm at delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e79(23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e256(77.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e23(56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e18(43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e4.28 (2.20, 8.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.75 (.23, 2.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHistory of birth asphyxia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e56(17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e268(82.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e14.67 (\u0026nbsp;7.66, 28.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.10 (.72, 6.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e46(75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e15(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eBirth order\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eFirst\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e13(26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e37(74.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eSecond-fourth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e62(21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e221(78.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e.79 (.40, 1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.08 (.40, \u0026nbsp;2.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eFifth and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e27(51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e25(48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e3.07 (1.33, 7.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e.67 (.17, 2.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHistory of neonatal illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e50(76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e15(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e17.17 (8.97, 32.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.58 (.96, 6.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e52(16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e268(83.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSibling history of developmental delay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e42(91.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e4(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e48.82 (16.86, 141.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e6.76 (1.55, 29.43)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e60(17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e279(82.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eInitiation of complementary feeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eAt 6 month \u0026amp; above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e47(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e235(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e5.72 (3.48, 9.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.06 (.99, 4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eBefore six month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e55(53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e48(46.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eIron intake during pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e52(18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e223(81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e50(45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e60(54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e3.57 (2.20, 5.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e2.58 \u0026nbsp;(1.30, 5.11)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 747px;\"\u003e\n \u003cp\u003e\u0026nbsp;Note: COR=crude odd ratio: AOR=Adjusted odds ratio; CI= confidence interval; *= significant at p-value \u0026le;0.05; 1=Reference group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe findings of this study revealed that 26.5%, 95%CI (22.1\u0026ndash;31.2) of infants who visited public health facilities in Dessie City had developmental delays. Maternal educational level (no formal education and primary school attended mothers), family history of developmental delay, and iron intake during pregnancy were significantly associated with developmental delay.\u003c/p\u003e\u003cp\u003eThe magnitude of DD found in this study was consistent with a study conducted in Addis Ababa, Ethiopia (28.13%). (Ayele, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Kolkata, India (26%) (Manna et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).This similarity might be both area of study design was cross sectional which and equal sample size were taken.\u003c/p\u003e\u003cp\u003eThe result of this study was lower than the study done in rural Siliguri Subdivision, Darjeeling District, West Bengal, India(38.2%) (Chakraborty et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), Nigeria (35.4%) (Jimoh et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)another rural and urban Kashmir, India (39.1%)(Dar, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2018\u003c/span\u003e),a low-income South African community (51.8%) (Abdoola et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), Nepal's urban slums (56.4%) (Bishwokarma et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This discrepancy might be due to sample size, different in socio-demographic and cultural status.\u003c/p\u003e\u003cp\u003eHowever the finding of this study was higher than that the study conducted in an urban slum of Agra City, India (12.2%)(Agarwal et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), Malawi (11.7%) (Murphy et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), Saudi Arabia (16.4%)(Shatla \u0026amp; Goweda, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), South Delhi an urbanized village in India (10.6%)(Dabar et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), Cairo, Egypt (9.3%) (Abdelbaky et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), Aligarh, India (7.1%) (Sachdeva et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2010\u003c/span\u003e), The possible explanation for this disparity might be due to variations in study setting, study population were quality different i.e all of them were there study population not at exact nine month rater including it, and socio-cultural variation; it also might be due to differences in method used, sample size variation, using different variables, and the tools used to measure developmental delay.\u003c/p\u003e\u003cp\u003eThe findings from the current study showed that infants of less educated mothers were at increased risk of developmental delay compared to infants of more educated mothers. Studies from other countries also support this findings, study conducted in Saudi Arabia (Shatla \u0026amp; Goweda, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), study conducted in an urban slum of Agra (Agarwal et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), Conducted in Nigerian (Jimoh et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), studies conducted in Kabale Hospital in Uganda (Komutambo et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Since the fact that scientifically proven the lower the mother's educational level the higher the odds of having developmental delay (Carneiro et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Tumwine \u003cem\u003eet al\u003c/em\u003e.,2004).Moreover, prior studies show that highly educated mothers in developing countries are more likely to seek appropriate care for their children (Geldsetzer et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Findings from studies examining the association between increases in maternal education and children\u0026rsquo;s school readiness show that expressive and receptive language ability, and cognitive test results were better among preschool children who had mothers with higher education (Magnuson et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). More over maternal education has its own impact on child development that means the educational level of mothers plays a significant role in child development (Currie, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt implies that maternal education plays an important role in reducing the risk of child developmental delay, and educated mothers are more likely to make decisions concerning their children\u0026rsquo;s health condition independently, perceiving that their behavior is their own responsibility. By providing accessible and quality education for women, societies can promote positive outcomes for both mothers and their infants, ultimately leading to a more prosperous and equitable future. Addressing educational disparities and promoting access to quality education for women are vital public health strategies to ensure optimal developmental outcomes for children.\u003c/p\u003e\u003cp\u003eThis study found that explain mothers who didn\u0026rsquo;t take iron during pregnancy more likely to have their infants were developmental delay than those who take iron. This evidence is supported by study conducted in Bengaluru City, India (R \u0026amp; Lonimath, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and study in Dessie city, Ethiopia (Mitiku et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Because of that a comprehensive narrative review of the literature, study\u0026rsquo;s highlights that importance balance iron in shaping children's neurological functions and key findings that underscore the influence of maternal nutrition during pregnancy and the peri-gestational period on children's cognitive, motor, speech, and socio-emotional development and consequently, ensuring optimal nutrition is imperative for fostering appropriate brain development in children (de Matos Reis et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Due to the fact that, sufficient iron intake by pregnant women is crucial for both maternal and infant health and it is particularly important in pregnancy and infancy to meet the high demands for hematopoiesis, growth and development (Brannon \u0026amp; Taylor, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Iron deficiency during pregnancy can lead to adverse birth outcomes and increase the risk of developmental delays. It is noteworthy that supplementation with these micronutrients during pregnancy yields benefits for both the mother and the child (Ouyang et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The major reasons to maintain an iron-sufficient state during pregnancy are to protect the health of the mother, improve pregnancy outcomes, and foster fetal development (Georgieff, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt implies that adequate and proper iron intake during pregnancy can help mitigate these risks, support optimal long-term development in infants, and contribute to optimal developmental outcomes for infants.\u003c/p\u003e\u003cp\u003eThis study found that infants with previous sibling history of developmental delay were more likely to experience developmental delay as compared to infants without family history of developmental delay. Possible explanations include a genetic or hereditary component to developmental delays, where certain conditions or disorders can run in families. In addition to genetics, family members may also share environmental factors that can influence development. These can include socioeconomic status, access to healthcare, exposure to toxins or infections, and overall family dynamics. It implies that families with a history of developmental delay may experience unique challenges and concerns on infant\u0026rsquo;s developmental milestone outcome. Based on this working on early routine developmental screenings be implemented for infants, those with previous sibling history of developmental delay will decrease its presence.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe study shows that the magnitude of developmental delays was 102(26.5%) which is high as compared to the global prevalence. Several variables were found to be associated with developmental delay, including the mother's educational level, the lack of iron intake during pregnancy and previous sibling history of developmental delay. So based on this finding working more on the significant variable might be decrease the magnitude and early identification of developmental disorders is important due to their potential negative impact on intellectual and learning abilities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eASQ\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eAge and Stage Questioners\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eDD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eDevelopmental Delay\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eLMIC\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eLow and Middle Income Country\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 169px;\"\u003e\n \u003cp\u003eSTATA\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 421px;\"\u003e\n \u003cp\u003eStatistical Software For Data Science\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn ethical approval was first obtained from the CMHS (College of Medicine and Health Science) research ethical approval committee. Then a legal, official clearance letter was written to selected public health institutions. Prior to commencing the data collection process, the participants were provided with comprehensive information concerning the study\u0026apos;s objectives as well as the potential benefits and risks involved. Written consent was obtained from each participant\u0026rsquo;s care giver before the interview. All participant\u0026rsquo;s care giver provided written informed consent, and this study was conducted in accordance with the Declaration of Helsinki as a statement of ethical principles for medical research involving human subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShiferaw Abeway: Conceptualized and designed the study, supervised the research process, coordinated data analysis, and led the review and editing of the manuscript.\u003c/p\u003e\n\u003cp\u003eJemal Ali:\u0026nbsp;Collected the data, performed data entry and preliminary analysis, and drafted the initial version of the manuscript.\u003c/p\u003e\n\u003cp\u003eSamuel Nebiyu:\u0026nbsp;Assisted in literature review, contributed to data interpretation, and supported manuscript editing.\u003c/p\u003e\n\u003cp\u003eMuluken Amare:\u0026nbsp;Provided critical revision of the manuscript for intellectual content and contributed to the final editing and formatting.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp id=\"_Toc172107058\"\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbove all, we would like to express our appreciation to Wollo University college of Medicine and Health Sciences for continuous support and funded for this work. Our thanks also go Desie town health bureau administrative Offices for the provision of the required information and their full courage and assistance. Finally, we would like to acknowledge our study participants for their cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdelbaky, O. A., Deifallah, S., Amin, G., \u0026amp; Marzouk, D. (2022). Screening for Developmental Delays in Children 2-36 Months of Age in a Primary Health Care Center in Cairo, Egypt. \u003cem\u003eJournal of High Institute of Public Health, 52\u003c/em\u003e(2), 53-58. \u003c/li\u003e\n\u003cli\u003eAbdoola, S., Swanepoel, D. W., Graham, M. A., \u0026amp; van der Linde, J. (2023). Developmental characteristics of young children in a low-income South African community. \u003cem\u003eJournal of Child Health Care\u003c/em\u003e, 13674935231173023. \u003c/li\u003e\n\u003cli\u003eAbo El Elella, S. S., Tawfik, M. A., Abo El Fotoh, W. M. M., \u0026amp; Barseem, N. F. (2017). Screening for developmental delay in preschool-aged children using parent-completed Ages and Stages Questionnaires: additional insights into child development. \u003cem\u003ePostgraduate Medical Journal, 93\u003c/em\u003e(1104), 597-602. \u003c/li\u003e\n\u003cli\u003eAgarwal, D., Chaudhary, S. S., Sachdeva, S., Misra, S. K., \u0026amp; Agarwal, P. (2018). Prevalence of developmental delay and factors affecting the development status among under 5 children in an urban slum of Agra city. \u003cem\u003eNational Journal of Community Medicine, 9\u003c/em\u003e(07), 474-479. \u003c/li\u003e\n\u003cli\u003eAlamri, A., Aljadhai, Y. I., Alrashed, A., Alfheed, B., Abdelmoaty, R., Alenazi, S., . . . Benini, R. (2021). Identifying clinical clues in children with global developmental delay/intellectual disability with abnormal brain magnetic resonance imaging (MRI). \u003cem\u003eJournal of Child Neurology, 36\u003c/em\u003e(6), 432-439. \u003c/li\u003e\n\u003cli\u003eAyele, M. (2018). The Prevalence of Developmental Delays among Infants and Young Children in Addis Ababa, Ethiopia. \u003cem\u003eThe Ethiopian Journal Of Behavioural Studies, 2\u003c/em\u003e(1), 148-173. \u003c/li\u003e\n\u003cli\u003eB\u0026eacute;langer, S. A., \u0026amp; Caron, J. (2018). Evaluation of the child with global developmental delay and intellectual disability. \u003cem\u003ePaediatrics \u0026amp; child health, 23\u003c/em\u003e(6), 403-410. \u003c/li\u003e\n\u003cli\u003eBellman, M., Byrne, O., \u0026amp; Sege, R. (2013). Developmental assessment of children. \u003cem\u003eBmj, 346\u003c/em\u003e. \u003c/li\u003e\n\u003cli\u003eBello, A. I., Quartey, J. N., \u0026amp; Appiah, L. A. (2013). Screening for developmental delay among children attending a rural community welfare clinic in Ghana. \u003cem\u003eBMC pediatrics, 13\u003c/em\u003e, 1-7. \u003c/li\u003e\n\u003cli\u003eBhattacharya, T., Ray, S., \u0026amp; Das, D. K. (2017). Developmental delay among children below two years of age: a cross-sectional study in a community development block of Burdwan district, West Bengal. \u003cem\u003eInternational Journal of Community Medicine and Public Health, 4\u003c/em\u003e(5), 1762-1767. . \u003c/li\u003e\n\u003cli\u003eBishwokarma, A., Shrestha, D., Bhujel, K., Chand, N., Adhikari, L., Kaphle, M., . . . Karmacharya, I. (2022). Developmental delay and its associated factors among children under five years in urban slums of Nepal. \u003cem\u003ePlos one, 17\u003c/em\u003e(2), e0263105. .\u003c/li\u003e\n\u003cli\u003eBlack, M. M., Walker, S. P., Fernald, L. C., Andersen, C. T., DiGirolamo, A. M., Lu, C., . . . Shiffman, J. (2017). Early childhood development coming of age: science through the life course. \u003cem\u003eThe lancet, 389\u003c/em\u003e(10064), 77-90. .\u003c/li\u003e\n\u003cli\u003eBrannon, P. M., \u0026amp; Taylor, C. L. (2017). Iron supplementation during pregnancy and infancy: uncertainties and implications for research and policy. \u003cem\u003eNutrients, 9\u003c/em\u003e(12), 1327. .\u003c/li\u003e\n\u003cli\u003eBushnell, E., McCoy, D., Black, M., Daelmans, B., \u0026amp; Dua, T. (2016). Existing approaches and challenges. \u003cem\u003eEarly Childhood Matters.Available at:\u003c/em\u003e\u003cem\u003ehttps://bernardvanleer.org/app/uploads/2016/07/Early-Childhood-Matters-2016_6.pdf\u003c/em\u003e. .\u003c/li\u003e\n\u003cli\u003eCarneiro, P., Meghir, C., \u0026amp; Parey, M. (2013). Maternal education, home environments, and the development of children and adolescents. \u003cem\u003eJournal of the European Economic Association, 11\u003c/em\u003e(S1), 123-160. doi:10.1111/j.1542-4774.2012.01096.x.\u003c/li\u003e\n\u003cli\u003eChakraborty, S., Bhattacherjee, S., Das, D. K., \u0026amp; Dasgupta, S. (2019). DEVELOPMENTAL DELAYS AND ITS PREDICTORS AMONG INFANTS-A CROSS SECTIONAL STUDY IN RURAL AREAS OF SILIGURI SUBDIVISION, DARJEELING DISTRICT, WEST BENGAL. \u003cem\u003eInternational Journal of Medical and Biomedical Studies, 3\u003c/em\u003e(4), 96-104. .\u003c/li\u003e\n\u003cli\u003eChakraborty, S., Bhattacherjee, S., Kumar Das, D., \u0026amp; Dasgupta, S. (2019). Developmental delays and its predictors among infants-a cross sectional study in rural areas of siliguri subdivision, darjeeling district, west bengal. \u003cem\u003eInternational Journal of Medical and Biomedical Studies, 3\u003c/em\u003e(4), 96-104. 0.\u003c/li\u003e\n\u003cli\u003eCurrie, J. (2009). Healthy, wealthy, and wise: Socioeconomic status, poor health in childhood, and human capital development. \u003cem\u003eJoUrnal of economIc lIteratUre, 47\u003c/em\u003e(1), 87-122. .\u003c/li\u003e\n\u003cli\u003eDabar, D., Das, R., Nagesh, S., Yadav, V., \u0026amp; Mangal, A. (2016). A community-based study on growth and development of under-five children in an Urbanized Village of South Delhi. \u003cem\u003eJournal of tropical pediatrics\u003c/em\u003e, fmw026. .\u003c/li\u003e\n\u003cli\u003eDagvadorj, A., Ganbaatar, D., O. Balogun, O., Yonemoto, N., Bavuusuren, B., Takehara, K., . . . Akahira-Azuma, M. (2018). Maternal socio-demographic and psychological predictors for risk of developmental delays among young children in Mongolia. \u003cem\u003eBMC pediatrics, 18\u003c/em\u003e, 1-8. .\u003c/li\u003e\n\u003cli\u003eDar, J. A. (2018). Developmental Delay and Disability among 0-6 Year Children in Rural and Urban Kashmir India. \u003cem\u003eInter-national Journal of Indian Psychology, 6\u003c/em\u003e(1). .\u003c/li\u003e\n\u003cli\u003ede Matos Reis, \u0026Aacute;. E., Teixeira, I. S., Maia, J. M., Luciano, L. A. A., Brandi\u0026atilde;o, L. M., Silva, M. L. S., . . . Soriano, R. N. (2024). Maternal nutrition and its effects on fetal neurodevelopment. \u003cem\u003eNutrition\u003c/em\u003e, 112483. .\u003c/li\u003e\n\u003cli\u003eDemirci, A., \u0026amp; Kartal, M. (2016). The prevalence of developmental delay among children aged 3\u0026ndash;60 months in Izmir, Turkey. \u003cem\u003eChild: Care, Health and Development, 42\u003c/em\u003e(2), 213-219. .\u003c/li\u003e\n\u003cli\u003eDupont-Soares, M., Dos Santos, M., Garcia, E. M., Soares, M. C. F., Muccillo-Baisch, A. L., \u0026amp; da Silva J\u0026uacute;nior, F. M. R. (2021). Maternal, neonatal and socio-economic factors associated with intellectual development among children from a coal mining region in Brazil. \u003cem\u003eEnvironmental Geochemistry and Health, 43\u003c/em\u003e, 3055-3066. .\u003c/li\u003e\n\u003cli\u003eEapen, V., Zoubeidi, T., Yunis, F., Gururaj, A. K., Sabri, S., \u0026amp; Ghubash, R. (2006). Prevalence and psychosocial correlates of global developmental delay in 3-year-old children in the United Arab Emirates. \u003cem\u003eJournal of psychosomatic research, 61\u003c/em\u003e(3), 321-326. .\u003c/li\u003e\n\u003cli\u003eEl Din, E., Rabah, T., Metwally, A., Nassar, M., Elabd, M., Shaalan, A., . . . Shaaban, S. (2019). Potential Risk Factors of Developmental Cognitive Delay in the First Two Years of Life. Open Access Maced J Med Sci..\u003c/li\u003e\n\u003cli\u003eElbers, J., \u0026amp; Macnab, A. (2008). The Ages and Stages Questionnaires: feasibility of use as a screening tool for children in Canada. \u003cem\u003eCanadian Journal of Rural Medicine, 13\u003c/em\u003e(1), 9. .\u003c/li\u003e\n\u003cli\u003eEngle, P. L., Black, M. M., Behrman, J. R., De Mello, M. C., Gertler, P. J., Kapiriri, L., . . . Young, M. E. (2007). Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. \u003cem\u003eThe lancet, 369\u003c/em\u003e(9557), 229-242. .\u003c/li\u003e\n\u003cli\u003eFarid, A., Maqbool, S., Ullah, E., Ali, A., \u0026amp; Farid, Z. (2020). Risk factors in children presenting with developmental delay. \u003cem\u003ePakistan Armed Forces Medical Journal, 70\u003c/em\u003e(3), 812-817. .\u003c/li\u003e\n\u003cli\u003eFaruk, T., King, C., Muhit, M., Islam, M. K., Jahan, I., ul Baset, K., . . . Khandaker, G. (2020). Screening tools for early identification of children with developmental delay in low-and middle-income countries: a systematic review. \u003cem\u003eBMJ open, 10\u003c/em\u003e(11), e038182. .\u003c/li\u003e\n\u003cli\u003eFMOH. (2021). This revised Integrated Management of Newborn and Childhood Illness training material has incorporated the following changes over the 2015 version. .\u003c/li\u003e\n\u003cli\u003eFord, N. D., \u0026amp; Stein, A. D. (2016). Risk factors affecting child cognitive development: a summary of nutrition, environment, and maternal\u0026ndash;child interaction indicators for sub-Saharan Africa. \u003cem\u003eJournal of developmental origins of health and disease, 7\u003c/em\u003e(2), 197-217. .\u003c/li\u003e\n\u003cli\u003eGedamu, H., \u0026amp; Tafere, Y. (2019). Assessment of knowledge, attitude, and practice of sunlight exposure of infants among mothers attending in governmental health facilities in Farta district, South Gondar zone, North West Ethiopia, 2018. \u003cem\u003eInternational journal of reproductive medicine, 2019\u003c/em\u003e. .\u003c/li\u003e\n\u003cli\u003eGeldsetzer, P., Williams, T. C., Kirolos, A., Mitchell, S., Ratcliffe, L. A., Kohli-Lynch, M. K., . . . Campbell, H. (2014). The recognition of and care seeking behaviour for childhood illness in developing countries: a systematic review. \u003cem\u003ePlos one, 9\u003c/em\u003e(4), e93427.\u003c/li\u003e\n\u003cli\u003eGeorgieff, M. K. (2020). Iron deficiency in pregnancy. \u003cem\u003eAmerican journal of obstetrics and gynecology, 223\u003c/em\u003e(4), 516-524. .\u003c/li\u003e\n\u003cli\u003eGhosh, R., \u0026amp; Saha, S. (2022). A Prospective Observational Cross-Sectional Study on Developmental Delay and Associated Socioeconomic, Demographic and Clinical Factors among Apparently Neurologically Normal Children Aged 2 Months to 36 Months in Eastern India. \u003cem\u003eInternational Journal Of Medical Science And Clinical Research Studies, 2\u003c/em\u003e(10), 1110-1115. .\u003c/li\u003e\n\u003cli\u003eGlascoe, F. P. (2000). Early detection of developmental and behavioral problems. \u003cem\u003ePediatrics in review, 21\u003c/em\u003e(8), 272-280. .\u003c/li\u003e\n\u003cli\u003eGrantham-McGregor, S., Cheung, Y. B., Cueto, S., Glewwe, P., Richter, L., \u0026amp; Strupp, B. (2007). Developmental potential in the first 5 years for children in developing countries. \u003cem\u003eThe lancet, 369\u003c/em\u003e(9555), 60-70. .\u003c/li\u003e\n\u003cli\u003eGupta, S., Shrivastava, P., Samsuzzaman, M., Banerjee, N., \u0026amp; Das, D. K. (2021). Developmental delay among children under two years of age in slums of Burdwan Municipality: A cross-sectional study. \u003cem\u003eJournal of Family Medicine and Primary Care, 10\u003c/em\u003e(5), 1945. .\u003c/li\u003e\n\u003cli\u003eHirai, A. H., Kogan, M. D., Kandasamy, V., Reuland, C., \u0026amp; Bethell, C. (2018). Prevalence and variation of developmental screening and surveillance in early childhood. \u003cem\u003eJAMA pediatrics, 172\u003c/em\u003e(9), 857-866. .\u003c/li\u003e\n\u003cli\u003eJimoh, A. O., Anyiam, J. O., \u0026amp; Yakubu, A. M. (2017). Prevalence and sociodemographic determinants of developmental delay: a cross-sectional study of under-five Nigerian children. \u003cem\u003eHighland Medical Research Journal, 17\u003c/em\u003e(1), 19-25. .\u003c/li\u003e\n\u003cli\u003eKapci, E. G., Kucuker, S., \u0026amp; Uslu, R. I. (2010). How applicable are Ages and Stages Questionnaires for use with Turkish children? \u003cem\u003eTopics in Early Childhood Special Education, 30\u003c/em\u003e(3), 176-188. .\u003c/li\u003e\n\u003cli\u003eKomutambo, I.-M., Kimiywe, J., \u0026amp; Munga, J. (2022). Determinants of Developmental Milestones among Children 0-23 Months at Kabale Hospital, Uganda. \u003cem\u003eAfrican Journal of Health Sciences, 35\u003c/em\u003e(2), 123-143. .\u003c/li\u003e\n\u003cli\u003eMagnuson, K. A., Sexton, H. R., Davis-Kean, P. E., \u0026amp; Huston, A. C. (2009). Increases in maternal education and young children\u0026apos;s language skills. \u003cem\u003eMerrill-Palmer Quarterly (1982-)\u003c/em\u003e, 319-350. .\u003c/li\u003e\n\u003cli\u003eMandarwal, D., Ahluwalia, S., Gite, M. A. R., Datta, B., Datta, B. C., \u0026amp; Datta, B. (2023). A Cross-sectional study to compare the prevalence \u0026amp; causes of delayed milestones in children (0-3years) of rural \u0026amp; urban Jaipur. .\u003c/li\u003e\n\u003cli\u003eManna, N., Das, S., SK, S. R., \u0026amp; Das, D. (2022). Prevalence and factors affecting developmental delay among 0\u0026ndash;6-year-old children attending immunization clinic. \u003cem\u003eNational Journal of Physiology, Pharmacy and Pharmacology, 12\u003c/em\u003e(6), 834-834. .\u003c/li\u003e\n\u003cli\u003eMcCoy, D. C., Peet, E. D., Ezzati, M., Danaei, G., Black, M. M., Sudfeld, C. R., . . . Fink, G. (2016). Early childhood developmental status in low-and middle-income countries: national, regional, and global prevalence estimates using predictive modeling. \u003cem\u003ePLoS medicine, 13\u003c/em\u003e(6), e1002034. .\u003c/li\u003e\n\u003cli\u003eMitiku, K., Nega, T., Arefaynie, M., Tilahun, D., Kefale, B., Damtie, Y., . . . Yalew, M. (2023). Gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia. \u003cem\u003eBMC pediatrics, 23\u003c/em\u003e(1), 638. .\u003c/li\u003e\n\u003cli\u003eMoodie, S., Daneri, P., Goldhagen, S., Halle, T., Green, K., \u0026amp; LaMonte, L. (2014). Early Childhood Developmental Screening: A Compendium of Measures for Children Ages Birth to Five. OPRE Report 2014-11. \u003cem\u003eUS Department of Health and Human Services\u003c/em\u003e. .\u003c/li\u003e\n\u003cli\u003eMurphy, R., Jolley, E., Lynch, P., Mankhwazi, M., Mbukwa, J., Bechange, S., . . . Schmidt, E. (2020). Estimated prevalence of disability and developmental delay among preschool children in rural Malawi: Findings from \u0026ldquo;Tikule Limodzi,\u0026rdquo; a cross‐sectional survey. \u003cem\u003eChild: Care, Health and Development, 46\u003c/em\u003e(2), 187-194. .\u003c/li\u003e\n\u003cli\u003eOfek-Shlomai, N., \u0026amp; Berger, I. (2014). Inflammatory injury to the neonatal brain\u0026ndash;what can we do? \u003cem\u003eFrontiers in Pediatrics, 2\u003c/em\u003e, 30. .\u003c/li\u003e\n\u003cli\u003eOlusanya, B. O., Davis, A. C., Wertlieb, D., Boo, N.-Y., Nair, M., Halpern, R., . . . Gladstone, M. (2018). Developmental disabilities among children younger than 5 years in 195 countries and territories, 1990\u0026ndash;2016: a systematic analysis for the Global Burden of Disease Study 2016. \u003cem\u003eThe Lancet Global Health, 6\u003c/em\u003e(10), e1100-e1121. .\u003c/li\u003e\n\u003cli\u003eOrganization, W. H. (2008,Geneva: World Health Organization Press; 2008. Available at http://www. who.int/healthinfo/global_burden_disease/GBD_report_2004update_part3. pdf. Accessed on August 1, 2009). \u003cem\u003eThe global burden of disease: 2004 update\u003c/em\u003e: World Health Organization..\u003c/li\u003e\n\u003cli\u003eOrganization, W. H. (2012). Early childhood development and disability: A discussion paper. .\u003c/li\u003e\n\u003cli\u003eOrganization, W. H. (2017). World Health Statistics, 2010. Developmental problems in children Available from: http://www.who.org. [Last Accessed on 2019 Sep 22]..\u003c/li\u003e\n\u003cli\u003eOuyang, J., Cai, W., Wu, P., Tong, J., Gao, G., Yan, S., . . . Huang, K. (2024). Association between Dietary Patterns during Pregnancy and Children\u0026rsquo;s Neurodevelopment: A Birth Cohort Study. \u003cem\u003eNutrients, 16\u003c/em\u003e(10), 1530. .\u003c/li\u003e\n\u003cli\u003eR, D., \u0026amp; Lonimath, A. (2023). Screening of Early Developmental Delay and Its Risk Factors Among Children Seeking Health Care in India-Exploring Missed Opportunities. \u003cem\u003eFunction and Disability Journal, 6\u003c/em\u003e. doi:10.32598/fdj.6.260.1.\u003c/li\u003e\n\u003cli\u003eR, D., Lonimath, A., \u0026amp; Santhosh, G. (2023). Screening of Early Developmental Delay and Its Risk Factors Among Children Seeking Health Care in India-exploring Missed Opportunities. \u003cem\u003eFunction and Disability Journal, 6\u003c/em\u003e(1), 0-0. doi:10.32598/fdj.6.260.1.\u003c/li\u003e\n\u003cli\u003eSabri, N. A. I., Gan, W. Y., Law, L. S., Chin, Y. S., \u0026amp; Mohd Shariff, Z. (2022). Factors associated with cognitive and motor delays in Malaysian infants aged 6\u0026ndash;12 months. \u003cem\u003eEarly Child Development and Care, 192\u003c/em\u003e(5), 781-794. .\u003c/li\u003e\n\u003cli\u003eSachdeva, S., Amir, A., Alam, S., Khan, Z., Khalique, N., \u0026amp; Ansari, M. (2010). Global developmental delay and its determinants among urban infants and toddlers: a cross sectional study. \u003cem\u003eThe Indian Journal of Pediatrics, 77\u003c/em\u003e, 975-980. .\u003c/li\u003e\n\u003cli\u003eSajedi, F., Vameghi, R., \u0026amp; Kraskian Mujembari, A. (2014). Prevalence of undetected developmental delays in I ranian children. \u003cem\u003eChild: Care, Health and Development, 40\u003c/em\u003e(3), 379-388. .\u003c/li\u003e\n\u003cli\u003eScherzer, A. L., Chhagan, M., Kauchali, S., \u0026amp; Susser, E. (2012). Global perspective on early diagnosis and intervention for children with developmental delays and disabilities. \u003cem\u003eDevelopmental Medicine \u0026amp; Child Neurology, 54\u003c/em\u003e(12), 1079-1084. .\u003c/li\u003e\n\u003cli\u003eSharma, N., Masood, J., Singh, S., Ahmad, N., Mishra, P., Singh, S., \u0026amp; Bhattacharya, S. (2019). Assessment of risk factors for developmental delays among children in a rural community of North India: A cross-sectional study. \u003cem\u003eJournal of Education and Health Promotion, 8\u003c/em\u003e. .\u003c/li\u003e\n\u003cli\u003eShatla, M. M., \u0026amp; Goweda, R. A. (2020). Prevalence and factors associated with developmental delays among preschool children in Saudi Arabia. \u003cem\u003eJournal of High Institute of Public Health, 50\u003c/em\u003e(1), 10-17. .\u003c/li\u003e\n\u003cli\u003eSheldrick, R. C., Merchant, S., \u0026amp; Perrin, E. C. (2011). Identification of developmental-behavioral problems in primary care: a systematic review. \u003cem\u003ePediatrics, 128\u003c/em\u003e(2), 356-363. .\u003c/li\u003e\n\u003cli\u003eSices, L., \u0026amp; Fund, C. (2007). \u003cem\u003eDevelopmental Screening in Primary Care: The Effectiveness of Current Practice and Recommendations for Improvement\u003c/em\u003e: Commonwealth Fund..\u003c/li\u003e\n\u003cli\u003eSim, F., Thompson, L., Marryat, L., Ramparsad, N., \u0026amp; Wilson, P. (2019). Predictive validity of preschool screening tools for language and behavioural difficulties: A PRISMA systematic review. \u003cem\u003ePlos one, 14\u003c/em\u003e(2), e0211409. .\u003c/li\u003e\n\u003cli\u003eSquires, J., Bricker, D. D., \u0026amp; Twombly, E. (2009). \u003cem\u003eAges \u0026amp; stages questionnaires\u003c/em\u003e: Paul H. Brookes Baltimore..\u003c/li\u003e\n\u003cli\u003eTeklehaimanot, W. Z., Kitawu, L. D., Tesfaye, T., Mihretie, A., Tizazu, M. A., Mekuriyaw, A. M., . . . Muluneh, M. A. (2021). Assessment of practice and factors associated with sunlight exposure of infants among mothers in Debre Berhan Town, North Shewa Zone, Amhara Region, Ethiopia. \u003cem\u003ePediatric Health, Medicine and Therapeutics\u003c/em\u003e, 507-517. .\u003c/li\u003e\n\u003cli\u003eTUYISENGE, V. (2020). \u003cem\u003eScreening for developmental delay in children aged 9 and 16 months, Kigali-Rwanda: using Ages and Stages questionnaire 3.\u003c/em\u003e University of Rwanda, CMHS. .\u003c/li\u003e\n\u003cli\u003eUNICEF. (2012). Inequities in Early Childhood Development What the data say Evidence from the multiple cluster surveys. \u003cem\u003eNew York: United Nations Childrens Fund\u003c/em\u003e, 2-16. .\u003c/li\u003e\n\u003cli\u003eVipulaguna, D., Jahan, I., Girish, M., Chinnappa, G. D., Gopalaswamy, S., Shahidullah, M., \u0026amp; Sumanasena, S. P. (2022). Early interventions for infants at risk for developmental impairment: The South Asian perspective. \u003cem\u003eIndian Journal of Pediatrics, 89\u003c/em\u003e(3), 254-261. .\u003c/li\u003e\n\u003cli\u003eWalker, S. P., Wachs, T. D., Grantham-McGregor, S., Black, M. M., Nelson, C. A., Huffman, S. L., . . . Lozoff, B. (2011). Inequality in early childhood: risk and protective factors for early child development. \u003cem\u003eThe lancet, 378\u003c/em\u003e(9799), 1325-1338. .\u003c/li\u003e\n\u003cli\u003eWamani, H., Tyllesk\u0026auml;r, T., Astr\u0026oslash;m, A. N., Tumwine, J. K., \u0026amp; Peterson, S. (2004). Mothers\u0026apos; education but not fathers\u0026apos; education, household assets or land ownership is the best predictor of child health inequalities in rural Uganda. \u003cem\u003eInternational journal for equity in health, 3\u003c/em\u003e(1), 9-9. doi:10.1186/1475-9276-3-9.\u003c/li\u003e\n\u003cli\u003eWarren, R., Kenny, M., Bennett, T., Fitzpatrick-Lewis, D., Ali, M. U., Sherifali, D., \u0026amp; Raina, P. (2016). Screening for developmental delay among children aged 1-4 years: a systematic review. \u003cem\u003eCanadian Medical Association Open Access Journal, 4\u003c/em\u003e(1), E20-E27. .\u003c/li\u003e\n\u003cli\u003eZhang, J., Guo, S., Li, Y., Wei, Q., Zhang, C., Wang, X., . . . Scherpbier, R. W. (2018). Factors influencing developmental delay among young children in poor rural China: a latent variable approach. \u003cem\u003eBMJ open, 8\u003c/em\u003e(8). \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Age and Stage Questionnaires, Developmental delay, Public health facilities, Dessie","lastPublishedDoi":"10.21203/rs.3.rs-7241180/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7241180/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eDevelopmental delay is a condition where a child fails to reach the five developmental domains at the expected age. Children who are developmentally delayed are less likely to be productive.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:-\u003c/strong\u003eTo assess the magnitude of developmental delay and associated factors among infants at the age of 9 month attending public health facilities of Dessie city, Ethiopia, in 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:-\u003c/strong\u003eAn institutional-based cross-sectional study was conducted from March 30 to April 30, 2024. A systematic random sampling technique was used to select the study participants. Developmental delay was assessed using the Age and Stage Questionnaires, Version 3. Data were collected through a face-to-face interviewer-administered questionnaire. Data were entered into EPI-Data version 4.7software and exported to STATA version 17 for analysis. In the multivariable analysis, variables with a p-value less than 0.05 were considered significantly associated with developmental delay.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: -\u003c/strong\u003eIn this study the magnitude of developmental delay was 102 (26.5%) with a 95% CI (22.2, 31.2). More delay was observed in gross motor 132 (34.3%), followed by communication (30.9%), problem solving 112 (29.1%), personal and social 110 (28.6%), and fine motor skill 78 (20.3%). Maternal education level no formal education [AOR = 4.16, 95% CI (1.29, 13.42)], primary education [AOR = 5.48, 95% CI (1.84, 16.27)], previous sibling history of developmental delay [AOR = 6.67, 95% CI (1.55, 29.43)], and didn’t iron intake during pregnancy [AOR = 3.56, 95% CI (1.24, 10.13)] were significantly associated with developmental delay with p-value \u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and recommendation: -\u003c/strong\u003e The prevalence of developmental delay among infants was 26.5%. Maternal education level, previous sibling history of developmental delay, and iron intake during pregnancy were significantly associated. Public health efforts focus on promoting awareness, access to iron-rich foods and supplementation, and routine monitoring to address iron deficiency and ensure optimal developmental outcomes for infants.\u003c/p\u003e","manuscriptTitle":"Magnitude of Developmental Delay and Its Associated Factors among Nine Month Infants in South Wollo Zone, Dessie City Public Health Facilities 2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-28 18:50:53","doi":"10.21203/rs.3.rs-7241180/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a206f9b5-e19a-4b26-8c3b-b6865e43fbbd","owner":[],"postedDate":"August 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T14:08:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-28 18:50:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7241180","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7241180","identity":"rs-7241180","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}