Effects of Disability on Early Childhood Development in 3 to 4-Year-Old Children in South Asian Countries: Evidence from Multiple Indicators Cluster Surveys

Abstract

Background The Sustainable Development Goals (SDGs) prioritize optimal early childhood development (ECD) for all children, emphasizing the principle of leaving no one behind. Country-level initiatives to address ECD, particularly for children with disabilities, are evident due to their heightened risk of not achieving developmental milestones. Despite this focus, the association between disability and ECD remains largely unknown in low- and middle-income countries. This study aims to investigate the impact of disability on ECD among 3 to 4-year-old children in South Asian countries. Methods Data from 56,841 children were analyzed, extracted from six rounds of Multiple Indicator Cluster Surveys conducted in Bangladesh, Nepal, and Pakistan between 2017 and 2020. The outcome variable considered was the early childhood development index (ECDI) and its domains (physical, learning, emotional, and social well-being). Disability status and types of disability served as the main explanatory variables. The association between explanatory and outcome variables was determined using a multilevel logistic regression model, adjusting for potential covariates. Results Approximately 44% of children in South Asian countries were not developmentally on track, with prevalence increasing to 58-76% among children with disabilities. Children with disabilities exhibited significantly higher odds of not being developmentally on track across all domains compared to those without disabilities. Country-specific variations were evident, with Nepal consistently showing lower odds than Bangladesh and Pakistan. Likelihoods of poor ECDI and its domains were also observed across types of disability. Conclusion The findings emphasize that children with disabilities face challenges in achieving developmental milestones, indicating a long-term burden. This poses a risk to the achievement of SDGs related to inclusivity and early childhood development. Implementing inclusive education policies, especially in rural areas, and creating supportive environments for individuals with disabilities are crucial for addressing these challenges.