Factors associated with cognitive developmental delay among infants attending reproductive and child health clinics in Dar es salaam, Tanzania.

Abstract

Background Early child cognitive development is important throughout one’s life span. It is estimated that more than 200 million children under five years of age fail to achieve full cognitive development in the world and 80% of them are in South Asia and Sub-Saharan Africa. Genetic and environmental factors play a role in early child development (ECD). Most of the ECD occurs in the first 2 years of life, but largely during infancy. Malnutrition, poverty and poor health care to children have been found to have association with poor cognitive development and create a vicious cycle of poverty. This study gives the proportion and factors that are associated with infants’ cognitive developmental delay in our setting. Knowing these factors enhance early intervention to break the vicious cycle of poverty. Objectives To determine the proportion and factors associated with cognitive developmental delay among infants attending RCH clinics in Dar es Salaam. Methodology This was a health facility based descriptive cross-sectional study which was done in three health centers in Dar es Salaam from July to December 2012. A two- stage sampling technique was used. Lottery was used to get the health centers and all infants registered at RCH clinic with odd numbers on data collection day were assessed for cognitive development. A structured questionnaire was used to collect data and analysis was done using SPSS version 16 by Pearson’s chi-square, Fisher exact test and logistic regressions. Results A total of 350 infants were assessed for cognitive development and 50.6% were males. Participants were aged 1to 12 months with a mean (SD) of 7.26 (3.43) months and birth weight ranging from 1.3 to 4.6kg with mean (SD) of 3.11(0.50) kg. Proportion of infant who were found to have cognitive developmental delay was 12.3%. Young age of the child, caretakers other than the mother, and wasting were significantly associated with cognitive developmental delays even after adjusting for confounders. Infants aged less than 6months were 14 times more likely to have cognitive developmental delay compared to those aged six months and above (aOR=14; 95%CI 5.3-38.3, P<0.001). Absence of the mother, and therefore the use of assistant caretakers especially during day-time, was 12 times more likely for the infant to have cognitive developmental delay compared to infants who stayed with their mothers (aOR=12.1; 95%CI 3.0-53, P=0.001). Wasted infants were 4 times more likely to have cognitive developmental delay (aOR=3.9; 95%CI 1.1-13.3, P=0.032) compared to infants without wasting. Conclusion and recommendations The proportion of cognitive developmental delay among infant attending RCH clinics in Dar es Salaam was 12.3%. Young age of the child, use of other caretakers in absence of the mother, and wasting were associated with cognitive developmental delays. Parents whose infants’ are taken care by the assistant caretakers should try as much as possible to spend quality time with them. All infants should be assessed on cognitive development during their visits to the RCH clinics. A longitudinal study is needed to measure the magnitude of cognitive developmental delays and look at the causal relationship of the associated factors and for better interventions.