Developmental disabilities (DDs) are a global childhood problem whose prevalence is rising, with a disproportionate impact on individuals in low-and middle-income countries. However, data on the prevalence of DDs in the Arab world are limited. This review highlights what is currently known about the prevalence and risk factors of DDs in preschool children in the Arab world.
PubMed, Cochrane Library, Scopus, CINAHL, Science Direct, and Google Scholar were searched for publications on DDs among preschool children in the Arab world. Only 14 studies were identified in the literature, from 12 Arab countries.
The overall estimated prevalence of DDs among preschool children in the Arab world is 27.5%. An analysis of risk factors for DDs showed that child-related, maternal, and family-related factors account for a significant cumulative risk of developing DDs in preschool children. Maternal factors, such as antenatal and perinatal complications, were the most common risk factors.
The prevalence of DDs among preschoolers is significantly high in the Arab world, which emphasizes the importance of the early detection and diagnosis of DD, as well as its associated risk factors.
Children grow and develop rapidly and continuously in the first years of life [
Experiencing undesirable environmental conditions can result in developmental disabilities (DDs) in children. Children who do not meet developmental milestones compared to other children their age are deemed to have DDs [
Globally, the number of children who have ever been diagnosed with DDs or developmental delays has increased significantly [
Early child development is a critical determinant of one's potential throughout one's life, particularly in terms of health, education, and economic standing [
According to the Regional Office for the Eastern Mediterranean of the World Health Organization, in 2021 there were around 679 million people living in the Arab world, which includes 22 countries and territories, including Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the UAE, Yemen, and Palestine (the Gaza Strip and West Bank). Although the countries in the Arab world vary considerably in terms of their economic situations, they are all united by a shared language, culture, and religion [
There are few published studies that address the prevalence and risk factors of DDs in preschool-aged children in the Arab world, and there are less data on their prevalence. In light of this, the goal of this investigation was to assess the prevalence and risk factors of DDs among preschool children in the Arab world. Through this narrative review of DDs among preschool children in the Arab world, the researchers aimed to develop a regional protocol and early screening and intervention programs for all preschool children for any DD and to create a follow-up care program to optimize preschool children health and limit the burden of DD-related problems in adulthood.
This narrative literature review was designed to review the estimated prevalence, risk factors, and assessment methods for DDs among preschool children in the Arab world. This study followed the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist [
Between January 2001 and December 2021, a search was carried out in six major worldwide databases, including PubMed, Scopus, Cochrane Library, CINAHL, Science Direct, and Google Scholar, for all published articles on DDs among preschool children in the Arab world. On December 25, 2021, the first search was started, and on January 25, 2022, the last search was completed. Medical Subject Headings (MeSH) terms were used to identify research articles; the search keywords included "development disabilities" and "child, preschool". To find related publications, the Boolean operator "AND" was used to search these terms together. The reference lists of eligible studies were also searched. The population, exposure, and outcomes (PEOP) search approach was employed in this study. "Preschoolers", "developmental disabilities", "prevalence", and "risk factors", combined with the "Arab world" OR (Middle East, Arabian Gulf, and specific country names) were all included in the keyword search. The search items were combined using the Boolean operators "OR" and "AND". After reviewing 25 publications that explored the prevalence of DDs and risk factors for their occurrence in preschool children, 14 articles that met the specified inclusion criteria were selected.
This review included any study design reporting the prevalence of DDs or GDD among preschool children in the Arab world, written in English, and with full-text papers published within the last 20 years. This review did not include abstracts, conference papers, editorials, case reports, or articles for which the full text could not be obtained (even after emailing the corresponding author).
The outcome of this review was the estimated prevalence of DDs, which was determined by the percentage of preschool children who performed below the age-appropriate cut-off point for each developmental domain evaluated in the study. The prevalence of individual developmental domains and global delay was estimated [
To avoid bias in the literature review and research, two reviewers independently searched and evaluated the literature. Disagreements were then resolved through discussions. To ensure consistency, two reviewers retrieved data from eligible studies. When accessible in the reports, the development assessment tool was also extracted, along with risk factors that were reported to be significantly associated with DDs (
The literature search procedure was laid out in a PRISMA flowchart [
The main objectives of the 14 included studies were to identify the prevalence and risk factors of DD among preschool children, and the studies used self-reported questionnaires in addition to developmental screening measurements. In this review, Four studies used the Denver Developmental Screening Test [
The overall crude prevalence of DD reported in nine studies was 27.5% (n=11,791/42,890). Five of the reviewed studies were excluded from the crude prevalence calculation because the prevalence of DDs was not reported [
Child-related risk factors for DD were sex, prematurity, and child exposure to physical discipline and deprivation.
All studies included male and female participants, and a substantial relationship was identified between the prevalence of DD and sex. Five studies reported that boys were more likely than girls to have DD [
Prematurity [
History of pregnancy, birth, and perinatal complications were identified as substantial risk factors for DDs in preschool children, according to five of the studies analyzed; Asphyxia, jaundice, and congenital disorders were significantly associated with DDs in preschool children [
The family history was identified by four reviewed studies [
In 2016, approximately 52.9 million children worldwide were reported to be experiencing DDs. Because the majority of the world's population lives in LMICs, DDs and abnormalities are more common in those countries [
Our results showed that the DD prevalence varied both within and between countries. For instance, most studies that reported a high prevalence were carried out in LMICs, including Mauritania, Algeria, Iraq, Palestine, Jordan, and Lebanon, where low socio-economic status (SES) is common. The technique of performing developmental assessments varies among practitioners. In several studies, qualified professionals (i.e., nurses or physicians) measured development scores, but others stated that information on children's developmental status was obtained from their mothers or caregivers. Moreover, the heterogeneity of the findings may be explained by variations in lifestyles and SES among Arab countries, as well as between different geographic areas within countries. Geographic differences in DD prevalence have been previously reported [
Regarding maternal factors, research by Muller et al. [
Finally, family-related factors are relevant, such as the family's SES, which is reflected by a combination of indices including family income, parents' education and work status, family size, and residency. Researchers studying child development have paid special attention to family SES because it produces disparities among households in terms of home circumstances that promote children's well-being and development [
It is important to recognize a few limitations of our study. Even though we identified adequate research for this review, the distribution of studies across the Arab world was uneven, and the sample characteristics (such as sample size and age group) differed from one another. As a result, the overall findings may either over- or under-represent the DD burden in this area. Furthermore, some Arab countries were noticeably underrepresented, indicating the lack of high-quality prevalence data outside of the countries under study. Another notable limitation is the variation in case definitions and diag-nostic procedures used by researchers. Although the vast majority of research employed definitions based on the American Academy of Pediatrics Neurology guidelines, this study could not take into account all potential variations in the case description and diagnosis of DDs.
In the Arab world, DDs are prevalent among preschool children, although the rate varies among countries. Governments, legislators, and international organizations should think about bolstering global cooperation in DD screening and developing initiatives to assist in reducing the risks related to DDs. Local governments and policymakers ought to consider tightening rules to address social and environmental risk factors related to DDs in this population, as well as increasing public awareness about the early detection of children with delays, which would allow parents and caregivers to implement strategies to address problems before school entry. A combination of nurse- and patient-targeted educational interventions may also help to lessen the burden of DDs. The methods and standards used to assess and diagnose DDs in this population should be standardized.
In light of this review, additional studies are required to determine the prevalence of DD and its risk factors among Arab preschool children. This type of research is required to develop and implement primary preventive programs aimed at detecting and diagnosing DD children as early as possible. Research on this topic is also essential for the development of screening programs, which would entail low-cost preventive measures and public education campaigns to reduce the burden of disease in adulthood.
The prevalence of DDs in preschool children is substantially high in the Arab world (27.5%), which has implications for both national and international health. This analysis revealed that factors related to the child, the mother, and the family all contribute significantly to the risk of preschool children developing DD, with maternal factors such as prenatal and perinatal problems being the most common. In order to reduce the disease burden in adults, it is essential to identify and diagnose DDs and their associated risk factors as early as possible through screening programs.
Conceptualization: all authors; Data collection, Formal analysis: all authors; Writing-original draft: all authors; Writing-review and editing: all authors; Final approval of published version: all authors.
No existing or potential conflict of interest relevant to this article was reported.
None.
Please contact the corresponding author for data availability.
None.
Flow diagram illustrating the research selection process for studies on the prevalence and risk factors of developmental disabilities among preschool children in the Arab world.
Summary of the Reviewed Research on the Prevalence and Risk Factors of Developmental Disabilities among Preschool Children in the Arab World (
Author (year) | Study design | Setting | Age group | Country | Prevalence (%) | Population | Instrument | Risk factors |
---|---|---|---|---|---|---|---|---|
Masri et al. (2011) [ |
Retrospective study | Child Neurology Clinic of Jordan University Hospital | Under 5 years | Jordan | NA | 229 (GDD) | ․ Brain MRI | ․ History of perinatal complications |
․ Ophthalmological and auditory evaluation | ||||||||
․ Assessment of thyroid function | ․ Consanguinity | |||||||
Charafeddine et al. (2014) [ |
Cross-sectional study | Home, follow up | 3-7 years | Lebanon | 37.0 | 100 (premature children born at less than 37 weeks of gestation) | ․ DDST | ․ Prematurity |
․ PDMS | ||||||||
․ WPPSI | ||||||||
Salhi et al. (2021) [ |
Survey | UNICEF multiple Indicator cluster survey | 36-59 months | Iraq | Iraq: 28.8 | Iraq: 4,999 | ․ ECDI | ․ Exposure to physical discipline and deprivation (distinct associations with risk of socio-emotional and cognitive delay cross-nationally) |
Lebanon | Lebanon: 20.3 | Lebanon: 300 | ||||||
Palestine | Palestine: 31.6 | Palestine: 1,488 | ||||||
Habibullah et al. (2019) [ |
Retrospective | King Fahad Specialist Hospital Dammam (KFSHD) | 1-9 years | Saudi Arabia | NA | 134 (GDD) | ․ GMDS | ․ Birth weight below 2.5 kg |
․ Family history of consanguinity, epilepsy in close relatives, learning disability, relatives who went to special school, mental health problems and hearing difficulties in the family | ||||||||
Shatla and Goweda (2020) [ |
Cross-sectional study | Family medicine and well-baby clinics | 36, 48, and 60 months | Makkah, Saudi Arabia | 16.4 | 948 (children at the ages 36, 48, and 60 months) | ․ ASQ-3 | ․ Artificial/complementary feeding before 6 months of age |
․ Narrow spacing between children | ||||||||
․ Lower level of maternal education | ||||||||
Abolfotouh et al. (2018) [ |
Prospective study | King Abdulaziz Medical City, Riyadh, Saudi Arabia | 3-6 years after premat ure birth. | Saudi Arabia | 39.2 | 117 (ELBW infants admitted to the neonatal unit of King Abdulaziz Medical City, Riyadh, Saudi Arabia) | ․ Modified DDST for Arab Children | ․ Prematurity |
Eapen et al. (2006) [ |
Two-stage epidemiological study | Households | 3 years | UAE | 8.4 | 694 (UAE national children aged 3) | ․ DDST | ․ Pregnancy, birth complications |
․ Poor maternal education | ||||||||
․ Family history of developmental problems | ||||||||
․ Major traumatic life events | ||||||||
․ Behavioral problems in children | ||||||||
Gil et al. (2020) [ |
National health surveys (household surveys) | Household Surveys | 36-59 months | Mauritania | Mauritania: 38.4 | Mauritania: 4,512 | ․ Early child development module from national health surveys, which covered four developmental domains (physical, social- emotional, learning, literacy- numeracy) and provides a combined indicator (early child development index, ECDI) of whether children are on track | ․ Poverty |
Algeria | Algeria: 29.2 | Algeria: 5,403 | ․ Scarcity of health and educational resources | |||||
Iraq | Iraq: 27.7 | Iraq: 13,669 | ․ Rural areas are systematically worse in terms of ECDI | |||||
Jordan | Jordan: 30.4 | Jordan: 3,670 | ||||||
Qatar | Qatar: 13.4 | Qatar: 820 | ||||||
Palestine | Palestine: 26.5 | State of Palestine: 3,274 | ||||||
Tunisia | Tunisia: 22.1 | Tunisia: 1,152 | ||||||
Koul et al. (2012) [ |
A prospective study | Sultan Qaboos University Hospital | 5 years or less | Oman | NA | 110 (patients with GDD) | ․ Karyotyping and other genetic tests | ․ NA (data were analyzed to determine the underlying etiology) |
․ Metabolic tests on blood | ||||||||
․ Electrophysiological studies Neuroimaging (brain CT, MRI) | ||||||||
Sarhat et al. (2019) [ |
Cross-sectional study | Al-Batool Teaching Hospital in Ba'aquba, Iraq | Under 3 years | Ba'aquba, Iraq | 8.0 | 200 (children of age between 6-36 months) | ․ Questionnaire containing demographic and personal information; drug history (the questionnaire covers the five developmental milestones; gross motor skills, fine motor skills, communication skills, problem solving/cognition skills, and social/personal interaction) | ․ Problems during pregnancy |
․ Hospitalization | ||||||||
․ Severe jaundice | ||||||||
․ Serious disease | ||||||||
․ Family history of mental or congenital disorder | ||||||||
․ Male sex (male-to-female ratio of 1.2:1) | ||||||||
Al-Naddawi et al. (2013) [ |
Cross-sectional study | Children Welfare Teaching Hospital, Baghdad | 8 months to 5.5 years | Iraq | NA | 75 (patients, ranging in age from 8 months to 5.5 years, with GDD) | ․ Physical examination | ․ Male sex (male-to-female ratio of 1.5:1) |
․ DDST II | ․ Preterm (weight less than 2.5 kg) | |||||||
․ CT, MRI, EMG, EEG | ․ Complications during pregnancy | |||||||
․ Visual and hearing assessment | ․ Maternal educational level, | |||||||
․ Screening for metabolic diseases | ․ Perinatal complications include asphyxia | |||||||
․ Thyroid function test | ||||||||
Abo El Elella et al. (2017) [ |
Cross-sectional study | Menoufia Governorate cities and villages | 24-60 months | Menoufia | 3.4 | 1,012 (children aged 24–60 months) | ․ ASQ-3 | ․ Male sex |
․ Consanguinity | ||||||||
․ Parental education | ||||||||
Abou El-Ella et al. (2017) [ |
Cross-sectional study | Menoufia Governorate cities and villages | 24-60 months | Governorate, Egypt Menoufia, Egypt | 3.6 | 502 (children from the age group 24–60 months) | ․ ASQ-3 | ․ Paternal and maternal education |
․ Consanguinity | ||||||||
․ Male sex | ||||||||
Sinno et al. (2018) [ |
Secondary data analysis | Arabic-speaking population | 4-36 months | Lebanon | NA | 733 (8 age groups: 4, 8, 12, 16, 20, 24, 30, and 36 months) | ․ ASQ-2 | ․ Male sex |
․ Mother's education and work status | ||||||||
․ Type of care provider | ||||||||
․ Language | ||||||||
․ Income and place of residence |
ASQ, Age and Stage Questionnaire; CT, computed tomography; DDST, Denver Developmental Screening Test; ECDI, Early Child Development Index; EEG, electroencephalogram; ELBW, extremely low birth weight; EMG, electromyography; GDD, global developmental delay; GMDS, Griffith Mental Development Scales; MRI, magnetic resonance imaging; NA, not available; PDMS, Peabody Developmental Motor Scale; UAE, United Arab Emirates; WPPSI, Wechsler Preschool and Primary Scale of Intelligence.
Summary of the Prevalence of Developmental Disability Domains among Preschool Children in the Arab World (
Author (year) | Country/population | DD prevalence | No. of participants with DDs in each study |
Single DD domain proportion |
|||||
---|---|---|---|---|---|---|---|---|---|
Intellectual/cognitive domain |
Communication |
Fine motor |
Gross motor |
Problemsolving |
Personal/socialemotional |
||||
% | n | % | % | % | % | % | % | ||
Charafeddine et al. (2014) [ |
Lebanon/100 | 37.0 | 37 | 14.7 | NA | NA | NA | NA | NA |
Salhi et al. (2021) [ |
Iraq/4,999 | 28.8 | 1,440 | 11.9 | NA | NA | NA | NA | 20.6 |
Lebanon/300 | 20.3 | 61 | 5.3 | 17.3 | |||||
Palestine/1,488 | 31.6 | 470 | 7.8 | 26.6 | |||||
Shatla and Goweda (2020) [ |
Saudi Arabia/948 | 16.4 | 156 | NA | 5.6 | NA | NA | 5.5 | 4.6 |
Abolfotouh et al. (2018) [ |
Saudi Arabia/117 | 39.2 | 46 | NA | NA | NA | NA | NA | NA |
Eapen et al. (2006) [ |
UAE/ 694 | 8.4 | 58 | NA | NA | NA | NA | NA | NA |
Sarhat et al. (2019) [ |
Iraq/200 | 8.0 | 16 | NA | NA | NA | NA | NA | NA |
Abo El Elella et al. (2017) [ |
Egypt/1,012 | 3.4 | 34 | NA | 2.4 | 2.2 | 0.0 | 3.0 | 1.0 |
Abou El-Ella et al. (2017) [ |
Egypt/502 | 3.6 | 18 | NA | 2.4 | 2.2 | 0.0 | 3.0 | 1.0 |
Gil et al. (2020) [ |
Mauritania/4,512 | 38.4 | 1,733 | 18.6 | NA | NA | 7.5 | NA | 33.9 |
Algeria/5,403 | 29.2 | 1,578 | 9.8 | 4.1 | 29.5 | ||||
Iraq/13,669 | 27.7 | 3,795 | 10.4 | 5.1 | 22.3 | ||||
Jordan/3,670 | 30.4 | 1,116 | 9.2 | 1.1 | 29.0 | ||||
Qatar/820 | 13.4 | 110 | 11.1 | 6.1 | 23.7 | ||||
Palestine/3,274 | 26.5 | 868 | 7.1 | 1.9 | 28.2 | ||||
Tunisia/1,152 | 22.1 | 255 | 6.3 | 3.1 | 24.3 | ||||
Total | 42,890 | 11,791 | |||||||
Crude prevalence |
27.5 |
The total number of participants with DDs divided by the total number of participants in all studies;
The total number of study participants multiplied by the prevalence of DD in the study;
DDs, developmental disabilities; NA, not available; UAE, United Arab Emirates.