Reduction in number of children at risk of poor development to 249.4 million in LMIs: True progress?

postWe all know, whether intuitively or by research evidence, that early childhood development sets the foundation for the quality of life in adulthood.  Knowing, then, the number and prevalence of children at risk of poor development ought to facilitate the process of making projections at the social and economic levels which will hopefully influence policy decisions.

To date, there have been two attempts at estimating these figures in low- and middle-income countries (LMIs)  using data on stunting (i.e. low height for age) and poverty (living on less than US$1.25 per day) among children under age five. In the 2007 Lancet Child Development in Developing Countries Series,[1] an estimate of 219 million children was given using data from 156 countries in 2004. With improvements in the availability of data and revisions to the definitions of stunting and poverty, another team of researchers was able to adjust this earlier figure and also provide estimates for 2010. According to their re-calculations, in 2004 there were 279 million children (95% CI 250.4 million – 307.4 million) at risk, which reduced to 249.4 million (209.3 million – 292.6 million) in 2010.[2] Additionally, prevalence of children at risk was reported as declining from 51% (95% CI 46-56) to 43% (36-51). These figures may be encouraging, particularly when viewed against the increase in the total population of children under five years old from 547 million to 575.6 million.

But has there really been a decline? Are we capturing all known factors to give a holistic view of children at risk? The researchers appropriately highlighted the fact that there are several other developmental risk factors not necessarily associated with stunting or poverty, such as maternal depression, low maternal education, exposure to violence, or adverse environmental conditions. The point was convincingly substantiated by their citation of another study on low maternal schooling and child maltreatment, demonstrating the impact of these other factors which substantially increased the percentage of children at risk by twelve percentage points.

Whether current figures are over- or under-estimated, it is clear that action is needed to counteract if not eliminate the multiple factors that threaten optimal development of our children.

Total population aged <5 years
(in millions)
Prevalence of stunting
(in millions)
Number at risk
(US$1.25; in millions)
2004 2010 2004 2010 2004 2010
East Asia and the Pacific 136.2 145.7 34.1

(25%)

29.6

(20%)

54.7

(40%)

41.7

(29%)

Europe and Central Asia 25.4 27.9 4.8

(19%)

4.8

(17%)

5.6

(22%)

5.4

(19%)

Latin America and the Caribbean 56.8 54.1 9.1

(16%)

8.0

(15%)

11.6

(21%)

9.7

(18%)

Middle East and North Africa 32.3 36.5 8.0

(25%)

8.6

(24%)

8.7

(27%)

9.1

(25%)

South Asia 171.4 168.1 80.6

(47%)

67.6

(40%)

110.9

(65%)

88.8

(53%)

Sub-Saharan Africa 124.9 143.3 53.9

(43%)

55.1

(38%)

87.6

(70%)

94.8

(66%)

Total 547.0 575.6 190.6

(35%)

173.7

(30%)

279.1

(51%)

249.4

(43%)

Table 1: Regional estimates of number (in millions) and prevalence of children at risk of poor development in 2004 and 2010

Adapted from Lu, Black, & Richter (2016)

[1]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. Lancet, 369, 60-70.

[2]Lu, C., Black, M., & Richter, L.M. (2016). Risk of poor development in young children in low-income and middle-income countries: An estimation and analysis at the global, regional, and country level. Lancet Global Health. doi: 10.1016/S2214-109X(16)30266-2.