Peer-reviewed article
Developmental Disparities and Associated Factors Among Children Aged 36-59 Months in Four Pakistani Provinces.
Syed Sikandar Shah, Ashfaq Ahmad Shah Bukhari, Jamil Ahmad, Aftab Alam, Junaid Asghar ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined developmental outcomes for children aged 3-5 years across four Pakistani provinces using national survey data from 2017-2020. Developmental attainment varied significantly by province, ranging from 39.1% in Balochistan to 59.4% in Punjab, with literacy-numeracy being the weakest domain. Early childhood education attendance was associated with better development, and substantial wealth-related inequalities existed in every province.
Key points
- Overall developmental attainment met Early Childhood Development Index criteria in 59.4% of children in Punjab, 54.6% in Khyber Pakhtunkhwa, 47.5% in Sindh, and 39.1% in Balochistan
- Literacy-numeracy was the least frequently attained domain across all provinces (14.6% to 27.2%), while physical development exceeded 90% in all provinces
- Early childhood education attendance was associated with 29% higher odds of meeting overall developmental criteria (adjusted prevalence ratio 1.29)
- Richest-poorest differences in developmental attainment ranged from 18.8 to 35.6 percentage points across provinces
- Stunting and functional difficulty were associated with lower developmental attainment
Limitations
The surveys were cross-sectional, so causal relationships cannot be established. The association between early childhood education attendance and development may be affected by selection bias and unmeasured confounding.
Abstract
BACKGROUND/OBJECTIVES: Early childhood developmental attainment varies across Pakistan, but provincial averages may obscure differences across developmental domains and socioeconomic groups. We examined developmental attainment and associated factors among children aged 36-59 months in four Pakistani provinces. METHODS: We analyzed four provincially representative UNICEF-supported Multiple Indicator Cluster Surveys (MICS) conducted between 2017 and 2020. Development was assessed using the original Early Childhood Development Index (ECDI). Survey-design-based analyses estimated overall and domain-specific prevalence, adjusted prevalence ratios (aPRs), and wealth-related inequalities. Province-specific associations were summarized using random-effects meta-analysis. RESULTS: Among 46,067 children, 59.4% met the overall ECDI criteria in Punjab, 54.6% in Khyber Pakhtunkhwa, 47.5% in Sindh, and 39.1% in Balochistan. This ordering persisted after age-sex standardization. Literacy-numeracy was the least frequently attained domain, ranging from 14.6% to 27.2%, whereas physical-domain attainment exceeded 90% in all four provinces. Early childhood education (ECE) attendance was associated with higher overall ECDI attainment (pooled aPR 1.29, 95% CI 1.22-1.37). Stunting and functional difficulty were associated with lower overall attainment, while associations with adult stimulation varied across provinces. Richest-poorest differences in overall ECDI prevalence ranged from 18.8 to 35.6 percentage points. CONCLUSIONS: Among children aged 36-59 months in four Pakistani provinces, developmental attainment differed substantially between provinces and across developmental domains, and these differences persisted after age-sex standardization. Socioeconomic inequalities were evident in every province. ECE attendance was associated with higher developmental attainment, but this association should be interpreted cautiously because the surveys were cross-sectional and may be affected by residual confounding and selection into ECE.