|Year : 2019 | Volume
| Issue : 2 | Page : 78-83
Evaluation of evolutionary status of 4–60-month-old children in Kashan and Aran-Bidgol and its related factors in 2016–2017
, Hamideh Ghaffarian2, Fatemeh Atoof3
, Davarkhah Rabbani4, Maryam Ahmadishad5
1 Department of Medicine Community, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
2 Kashan University of Medical Sciences, Kashan, Iran
3 Department of Biostatistics, Health Faculty, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
4 Department of Environmental Health Engineering, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
5 Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
|Date of Submission||23-Dec-2018|
|Date of Decision||31-Jan-2019|
|Date of Acceptance||13-Mar-2019|
|Date of Web Publication||29-May-2019|
Dr. Fatemeh Atoof
5th of Qotb – e Ravandi Blvd., P. O. Box: 8715981151, Kashan
Source of Support: None, Conflict of Interest: None
Background: Paying attention to Children's evolutionary status help to improve their mental capacity and make them more intelligent and creative adults. The present study aimed to investigate the developmental status in 4–60-month-old children of Kashan and Aran-Bidgol and its related factors in 2016–2017. Methods: This descriptive cross-sectional study was performed on 656 children aged 4–60 months in Kashan and Aran-Bidgol that were recruited by a stratified random sampling method. Data were collected through self-report using Ages and Stages Questionnaire (ASQ) and demographic and clinical questionnaire. The ASQ consists of 30 questions in five domains including communication, gross motor, fine motor, problem-solving, and personal-social skills. The inter-rater agreement coefficient of 93%, the Cronbach's alpha coefficient of 0.51–0.87, and the 2-week test–retest correlation of 0.75 are reported for this questionnaire. Data were analyzed using descriptive statistics as well as Chi-square, ANOVA, and t-test. The significance level was considered <0.05. Results: The results showed that 527 (80.3%) of the 656 children were healthy, and the rest had a disorder at least in one of the developmental domains, including 1.5% disorders in communication skills, 6.2% in gross motor, 1.2% in fine motor skills, 1.2% in problem-solving, and 0.9% in the personal-social area. There was a significant relationship between developmental disorders with the child's gender and birth weight. Among maternal characteristics, there was a significant relationship between the mother's job and age with developmental delay. Conclusion: Despite the normal evolution in most children of Kashan and Aran-Bidgol, a significant number of them had a disorder at least in one of the evolutionary domains. It is essential to sensitize the families about the developmental process of their children and encourage them to alleviate the risk factors to prevent early complications of these disorders in the future.
Keywords: Ages and Stages Questionnaire, developmental disorder, evolution, pediatrics
|How to cite this article:|
Moraveji SA, Ghaffarian H, Atoof F, Rabbani D, Ahmadishad M. Evaluation of evolutionary status of 4–60-month-old children in Kashan and Aran-Bidgol and its related factors in 2016–2017. Int Arch Health Sci 2019;6:78-83
|How to cite this URL:|
Moraveji SA, Ghaffarian H, Atoof F, Rabbani D, Ahmadishad M. Evaluation of evolutionary status of 4–60-month-old children in Kashan and Aran-Bidgol and its related factors in 2016–2017. Int Arch Health Sci [serial online] 2019 [cited 2020 Jun 4];6:78-83. Available from: http://www.iahs.kaums.ac.ir/text.asp?2019/6/2/78/259333
| Introduction|| |
Discussing the growth and development of children is very important. Evolution or development is defined as the changes that human gain for the promotion of physical, mental, and social health during their life. Early childhood development (ECD) includes cognitive, speech, emotional, social, physical, mental, and spiritual functions that are widely influenced by genetic and environmental factors. It has a significant impact on learning, academic achievement, the possibility of physical-mental illness, and economic and social performance in the future.
Around the world, there are at least 200 million children under 5 years of age that do not reach their maximum level of cognitive, social, and emotional performance., In the United States, there are about 2 million children with evolutionary disabilities (one in every six children) that costs about $ 40 billion annually.
Given that children are a huge capital of a nation and they have the potential to become innovative and active adults in the future, therefore, a suitable condition must be provided for their growth and development, and it is necessary to identify and resolve the physical, social, and environmental problems that cause the evolutionary delay., For only 30% of children with behavioral and evolutionary problems are identified by primary health-care providers, the American Academy of Pediatrics recommends screening for healthy children.
Shahshahani et al. conducted a study on 197 healthy children aged 4–60 months and the results of Ages and Stages Questionnaire (ASQ) and Denver Developmental Screening Test-II tests reported that 37% and 18% of children had developmental delay, respectively. About 24% of these children had problems in gross motor skills, 18% in speaking skills, 6% in the personal-social skills, and 5% had problems in fine motor skills. Another earlier study conducted on 129 children with an average age of 22 months in Peru, reported that 38.7% of the children had suspicious results for at least one of the five subscales of ASQ. The results demonstrated 15.5% of evolutionary disorder in communication skills, 3.8% in gross motor skills, 10% in fine motor skills, 13.9% in problem-solving, 4.5% in personal-social skills, and 13 children with delay in more than one area. The results of another study conducted in Iran showed that the prevalence of growth and developmental delay among children aged 4–60 months was 18%.
The national program of the ECD is designed only for children with severe and unknown developmental problems and does not consider the evolutionary status of healthy children. Several studies have been conducted to assess the evolutionary status of children in different cities of Iran,,,,,, but considering that the environmental and socioeconomic factors highly affect the evolutionary status of children in different cultures; and since no study has been carried out in Kashan and Aran-Bidgol so far, this study aimed to investigate the developmental status in 4–60-month-old children of Kashan and Aran-Bidgol and its related factors in 2016–2017.
| Methods|| |
This is a descriptive cross-sectional study that was carried out on 690 children aged 4–60 months in health-care centers of Kashan and Aran-Bidgol in 2016–2017.
To determine the sample size, for estimating the proportion (P) of evolutionary disorders in different areas of ASQ, with considering the α = 95% and d = 10%–20% and based on the proportion of the developmental disorders in the study of Shahshahani et al., finally with considering the proportion of 10%–15%, α = 95%, and d = 0.003, and considering the attrition rate 3%, the sample size was calculated 690.
To select the study individuals, a list of children aged 4–60 months in health-care centers of both cities was provided (from the Children's Healthcare Registry office). A stratified sampling method was used. The children were randomly selected from the sampling frame based on the age groups of 4–60 months according to the population of each group in each health center. Therefore, the number of samples from each health center was obtained.
In this study, the second edition of the ASQ screening test was used for 19 age groups (4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, 36, 42, 48, 54, and 60 months, respectively). This questionnaire is used to assess the developmental status of the children in different ages and identify the probable developmental disorders. It consists of 30 questions in five areas including communication skills, gross motor skills, fine motor skills, problem-solving, and personal-social skills. Each area consists of six questions that score as yes = 10, not yet = 0, and sometimes = 5 concerning whether the child can perform the activity. The total score for each area ranges between 0 and 60. The calculated scores of the areas were compared to cutoffs that indicate whether the child's development appears to be on schedule. In different studies, the inter-rater agreement coefficient was 93%, the Cronbach's alpha coefficient was 0.51–0.87, and the 2-week test–retest correlation was 0.75 for this questionnaire. The test also has 92% sensitivity, 95% property, 92% positive predictive value, and 95% negative predictive value for examining the development status.,,,,
Demographic and clinical characteristics questionnaire included the child's characteristics (gender, birth weight, and growth level) and maternal characteristics (mother's age, job, and level of education).
Inclusion criteria were children aged 4–60 months that were covered by the health-care centers (100% of the children will be covered by one health-care center on the 3rd day after birth) and parent's written consent to participate in the study. Children with known congenital physical or psychological disorder that were under treatment, and also children diagnosed with a disorder during this study were excluded from the study.
For collecting the data, the number and name of the children were determined for each age group. Before delivering the questionnaires, families were informed about the aim of the study and necessity of answering all of the questions and returning the questionnaires in the specified time frame. The questionnaire was delivered to the parent by the health-care provider to complete and return it to the center within 1 week. If parents were illiterate, any literate person in the family could complete it. All the questionnaires were returned.
The data were analyzed and corrected of probable errors. Statistical analysis was carried out using SPSS Software (Version 16). Descriptive statistics are presented as means and standard deviations (Mean ± SD) for quantitative variables and as frequencies and percentages for categorical variables. To investigate the probable relationship between variables and appropriate tests were carried out according to the type of variables such as Chi-square test for qualitative variables and ANOVA or t-test for quantitative variables. The significance level is considered <0.05.
This study was approved by the Research Council and Ethics Committee of Kashan University of Medical Sciences (approved research code: 93,162). All the individuals participated in the research with written consent. The parents were assured that there is not going to conduct a therapeutic intervention on their child and the results do not have any interference with receiving a synthetic milk coupon, and the information would be completely confidential.
| Results|| |
Most of the children were boys (51.3%) and also had a birth weight of 3500–3000 g (40.3%). In terms of growth status, most children (87.5%) had a normal condition. The results showed that 80.3% of the children were healthy and 19.7% had a disorder in at least one of the domains, which is presented in [Table 1].
|Table 1: Frequency distribution of disorders in different areas of the Ages and Stages Questionnaire|
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The results of the study indicated that among the demographic and clinical variables of the children, birth weight had a significant relationship with communication (P = 0.019) and gross motor skills (P = 0.005). Furthermore, gender had significant relationship with communication (P = 0.028), fine motor skills (P = 0.009), and personal-social skills (P = 0.002). Detailed reports are presented in [Table 2].
|Table 2: Distribution of disorders in different areas of the Ages and Stages Questionnaire in terms of demographic and clinical variables of the children|
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The results of the present study showed that among the maternal variables, mother's age had significant relationship with problem-solving (P = 0.001), gross motor (P = 0.01), and fine motor skills (P = 0.035). Furthermore, the job had a significant relationship with problem-solving, fine motor, and personal-social skills (P = 0.001). Detailed reports are also presented in [Table 3].
|Table 3: Distribution of disorders in different domains of Ages and Stages Questionnaire in terms of maternal demographic variables|
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| Discussion|| |
In the present study, the developmental status of children aged 4–60 months in Kashan and Aran-Bidgol was investigated in 2016. The results indicated that among 656 children, 80.3% were healthy and only 19.7% had a disorder at least in one of the developmental areas. Similarly, Karimi et al. found that the prevalence of developmental delay among children aged 4–60 months in Tehran was 18%. In another study conducted by Karami et al. it was reported that 7.9% of 1-year-old children in Khorramabad had disorders in all of the developmental areas and 16.3% of them had a disorder at least in one of the areas. Furthermore, Shahshahani et al. (2017) reported that the prevalence of developmental delay among children aged 0–60 months was estimated 12%. In the study of Kazeroono et al. conducted in Yasooj, 37.5% of the studied children had a disorder at least in one of the developmental areas. The difference between the prevalence of developmental disorders in different studies may be due to the different environmental and socioeconomic condition in various contexts. This should be pointed that as a comparison between the results of the earlier studies,, and the present study, a rising trend is observed in the prevalence of disorders, despite the advancements in screening methods. The present study showed that the highest percentage of developmental disorders (6.2%) was related to gross motors skills. Similarly, Shahshahani et al. reported that the most prevalent disorders (24%) were related to the gross motors skills. However, Ghorbanzadeh et al. indicated that most of the children aged 4–60 months in Jahrom had delayed evolution in communication skills. Furthermore, Zareipour et al. reported that the highest and lowest incidence of the developmental delay was related to the communication (7.1%) and gross motors skills (0.9%).
In the present study, among all of the studies characteristics of the children, only there was a significant relationship between child's gender and disorders in communication, fine motor, and personal-social skills. Furthermore, birth weight was significantly related to the disorders in the areas of communication and gross motor skills. Karami et al. also reported that birth weight is correlated to developmental disorders. In another study, Karimi et al. indicated that the disorders in the areas of gross and fine motor skills and problem-solving were significantly higher in the low birth weight (LBW) children. Furthermore, Ali Abadi et al., and Sajedi and Ali-Zadeh showed that infants with LBW are significantly more incapable than normal infants in terms of disorders in gross motor skills and it is one of the most effective risk factors for the developmental disorder. In the study of Ruiz in Spain, a 2-year follow-up of infants with a history of the Neonatal Intensive Care Unit admission, the incidence of cerebral palsy has been reported 6.8%, with more chance in the weights <1500 g. Developmental disabilities in LBW infants include cognitive disorder (lower IQ), speech difficulties, and sustained motor neurological disorders, including difficulty in balance, coordination, and perceptual problems. The agreement of the results of the studies in this area indicates the high sensitivity of the issue. LBW infants need to be monitored more sensitively in terms of developmental growth. However, Dorre and Fattahi Bayat reported no significant relationship between gender and birth weight with different developmental delays. However, the results of Karami et al. study showed no significant relation between gender and evolutionary disorders. These discrepancies may be due to the differences in samples of different studies in terms of demographic and clinical characteristics.
The present study showed that along with the clinical characteristics of the child, there are other factors contributing to the developmental disorders. The results indicate that there is a significant relationship between gross and fine motors skills and problem-solving with the mother's age. Similarly, Karami et al. indicated the relationship between mother's age and child developmental delay. Undoubtedly, the mother's physical and mental health is very important for the child growth, especially in children under the age of 3 who are more vulnerable and are highly dependent on their mother for nutrition and stimulation. These results are also consistent with the results of Soleimani et al. In this review study, the mother's age is mentioned as one of the important factors affecting developmental disorders in children. Increasing the age of the mother increases the prevalence of chromosomal anomalies and developmental disorder in infants. Studies show that mothers under the age of 20 years and over 35 years give birth babies with LBW more than women aged 20–29 years, which is directly related to developmental disorders. Furthermore, in the present study, a significant relationship was observed between disorder in fine motor skills, problem-solving, and personal-social development with mother's job. Another study confirms the strong relationship between mother's exposure to stressful situations such as social postures and incidence of developmental delay in her child. However, no significant relation was found in this area in the study of Karami et al.
| Conclusion|| |
The results of the present study indicate that despite the normal developmental status of most children in Kashan, a significant number of them had a minimal disorder in one of the developmental areas. Factors such as child's gender and birth weight and maternal factors such as mother's age and job contribute to the developmental delay in children. Therefore, it is essential to sensitize the families about the developmental process of their children and encourage them to alleviate the risk factors to prevent early complications of these disorders in the future.
One of the limitations of this research was the lack of willingness of families to cooperate due to the belief that it was unnecessary. Mothers were informed about the importance of identifying the developmental disorders and timely treatment for having an intelligent, innovative, and creative child, and finally, they became eager to cooperate and complete the questionnaire. Another limitation of the study was that some parents who refused to cooperate due to concern about identifying a possible developmental disorder in their child and fearing to reveal this issue to the public. By explaining to the mother that the information is completely confidential they were encouraged to participate in the study.
Financial support and sponsorship
This study was supported by Research Deputy at Kashan University of Medical Sciences.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Marcdante KJ, Kliegman R. Nelson Essentials of Pediatrics. 7th
ed. Philadelphia: Elsevier/Saunders; 2015.
Soleimani F, Sajedi F, Amir Ali Akbari S. Developmental delay and related factors. Adv Nurs Midwifery 2014;24:61-70.
Amirkhani M, Oliaeemanesh A, Barakati H, Beheshtian M, Khazaii S, Zakery M. Early Childhood Care and Development. Tehran: Children Health Office, Population Health, Family and Schools Office, Ministry of Health and Medical Education; 2000. p. 18.
Boskabadi H, Bagheri F, Askari Hosseni Z. Developmental disorders in preterm neonates during the first two years of life using the ages and stages questionnaire. J Babol Univ Med Sci 2016;18:7-13.
Shahshahani S, Vameghi R, Sajedi F, Azari N, Kazem-Nejad A. Comparing the Ddst-Ii and Asq in motor development domains of 4-60 months old children in Tehran city. Arch Rehabil 2013;13:49-56.
Kyerematen V, Hamb A, Oberhelman RA, Cabrera L, Bernabe-Ortiz A, Berry SJ, et al.
Exploratory application of the ages and stages (ASQ) child development screening test in a low-income Peruvian Shanty town population. BMJ Open 2014;4:e004132.
Shahshahani S, Vameghi R, Sajedi F, Biglarian A. Comparing the results of developmental screening of 4 to 60-month-old children in tehran using parents evaluation of developmental status and ages and stages questionnaires. Iran J Pediatr 2017;27:e6179.
Karimi M, Fallah R, Dehghanpoor A, Mirzaei M. Developmental status of 5-year-old moderate low birth weight children. Brain Dev 2011;33:651-5.
Shahshahani S, Vameghi R, Azari N, Sajedi F, Kazemnejad A. Validity and reliability determination of denver developmental screening test-II in 0-6 year-olds in Tehran. Iran J Pediatr 2010;20:313-22.
Kazeroono S, Keshavarz K, Abasi R, Zoladl M, Asadi S, Sharafieyan C, et al
. Status of development of premature children from 4 to 12 months in the neonatal intensive care unit (NICU) admission based on the ASQ questionnaire. Armaghane Danesh 2014;19:780-7.
Karami K, Abbasi L, Moridi F, Fallah F, Bayat Z, Pourvakhshoori N. Evaluation criteria and factors associated with the development of one year old children in Khorramabad. Iran J Pediatr Nurs 2015;3:57-64.
Zareipour M, Farrokh-Eslamlou H, Ghelichi Ghojogh M. Evaluation of the developmental growth of children in the first year of life based on ASQ Questionnaire. Iran J Pediatr Nurs 2017;4:25-31.
Dorre F, Fattahi Bayat G. Evaluation of children's development (4-60mo) with history of NICU admission based on ASQ in Amir kabir Hospital, Arak. J Ardabil Univ Med Sci 2011;11:143-50.
Ghorbanzadeh M, Nasimi F, Zeraati H. Survey of growth and development in children 4 to 24 months covered by health centers in Jahrom based on age-stage questionnaire. Iran J Pediatr Nurs 2018;5:52-7.
Ali Abadi F, Nazi S, Maghfori B. Gross motor development of low birth weight infants with the history of being in Aliasghar hospital corrected aged 8 to 12 months. Mod Rehabil 2011;5:35-40.
Sajedi F, Ali-Zadeh V. Study of prevalence and influence factor in delayed motor development in high risk infants. Arch Rehabil 2005;5:7-12.
Ruíz-Extremera A, Robles-Vizcaino C, Salvatierra-Cuenca MT, Ocete E, Lainez C, Benitez A. Neurodevelopment of neonates in neonatal intensive care units and growth of surviving infants at age 2 years. Early Hum Dev 2001;65 Suppl: S119-32.
Singla DR, Kumbakumba E, Aboud FE. Effects of a parenting intervention to address maternal psychological wellbeing and child development and growth in rural Uganda: A community-based, cluster randomised trial. Lancet Glob Health 2015;3:e458-69.
Bae J, Park JH, Park YK, Kim JY, Lee SW, Park SW. Changes in the distribution of maternal age and parity and increasing trends in the low birth weight rate in Korea between 1995 and 2005. J Prev Med Public Health 2011;44:111-7.
Herring S, Gray K, Taffe J, Tonge B, Sweeney D, Einfeld S, et al.
Behaviour and emotional problems in toddlers with pervasive developmental disorders and developmental delay: Associations with parental mental health and family functioning. J Intellect Disabil Res 2006;50:874-82.
[Table 1], [Table 2], [Table 3]