Paediatrica Indonesiana
VOLUME 48 May ‡
Risk factors of developmental delay:
a community-based study
Mei Neni Sitaresmi1, Djauhar Ismail1, Abdul Wahab2
Abstract
Background 'HYHORSPHQWDO GHOD\ LV D FRPPRQ SUREOHP LQ
children. Early detection of this disorders is mandatory in order
WRSURYLGHHDUO\LQWHUYHQWLRQV,GHQWLILFDWLRQRIWKHULVNIDFWRUVLV
important for strategic intervention.
Objective 7R LGHQWLI\ ULVN IDFWRUV RI GHYHORSPHQWDO GHOD\ LQ
children under five years old.
Methods $ FRPPXQLW\EDVHG VWXG\ RI GHYHORSPHQWDO VFUHHQLQJ
was conducted, in Bambanglipuro, Bantul district, Province of
<RJ\DNDUWDEHWZHHQ6HSWHPEHUDQG2FWREHU'HYHORSPHQWDO
screening was performed using a Kuesioner Pra Skrining Perkembangan
(KPSP).
NUMBER 3
Original Article
'
evelopmental and behavioral problems
are considered to be a new morbidity
LQ SHGLDWULF SUDFWLFH DFFRXQWHG IRU 
 RI 86 FKLOGUHQ DQG  RI
Indonesian children3. The first few years of life is a
critical as well as golden period for child development
because of rapid brain development. In spite of the
susceptibility of the brain to insult, a recovery is often
possible with early intervention. A number of studies
have shown that early intervention programs are not
Results 2XWRIFKLOGUHQDJHGWRPRQWKVKDG RQO\FRVWHIIHFWLYHEXWWKH\DOVROLIHORQJEHQHILWVDQG
QRUPDOGHYHORSPHQWGRXEWIXODQGVXVSHFWHG optimal developmental attainment. The earlier the
GHYHORSPHQWDOGHOD\$QXPEHURIIDFWRUVLGHQWLILHGDVWKHULVN intervention the greater the benefit will be.
RIVXVSHFWHGGHYHORSPHQWDOGHOD\ZHUHXQGHUQRXULVKHG25
&,ORZELUWKZHLJKW25&,ORZ
(DUO\FRJQLWLYHDQGVRFLRHPRWLRQDOGHYHORSPHQWV
HGXFDWLRQDOOHYHORIPRWKHU25&,ZRUNLQJ are strong predictors for later academic performance
PRWKHU25&,DQGSRRUVRFLRHFRQRPLFVWDWXV both in developing and developed countries. Children
6(6 IDPLOLHV 25  &,   0XOWLYDULDWH ORJLVWLF with developmental delay in the first years of life are at
UHJUHVVLRQDQDO\VLVVKRZHGWKDWSRRU6(6ZDVWKHVWURQJHVWULVN ULVNIRUSRRUDFDGHPLFDFKLHYHPHQW,WPD\UHVXOWLQORZ
IDFWRURIVXVSHFWHGGHYHORSPHQWDOGHOD\DGMXVWHG25&,
 productivity that leads to have low income. They will
Conclusions Poverty, low maternal educational level and provide poor care for their children, thus contributing
intrauterine malnutrition during as well as malnutrition during to the intergenerational transmission.8
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strategies should be conducted to solve the problems to prevent
more children suferred from developmental delay. [Paediatr
Indones 2008;48:161-5].
)URPWKH'HSDUWPHQWRI&KLOG+HDOWK0HGLFDO6FKRRO*DGMDK0DGD
Keywords: children, developmental delay, risk fac- 8QLYHUVLW\ <RJ\DNDUWD ,QGRQHVLD 016',1 7KH 'HSDUPHQW RI
tors, screening developmental, questionnaire &RPPXQLW\+HDOWKDQG1XWULWLRQ5HVHDUFK/DERUDWRU\0HGLFDO6FKRRO
*DGMDK0DGD8QLYHUVLW\<RJ\DNDUWD,QGRQHVLD$:

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Paediatr Indones, Vol. 48, No. 3, May 2008‡161

 Mei Neni Sitaresmi et al:5LVNIDFWRUVRIGHYHORSPHQWDOGHOD\

&KLOG·VGHYHORSPHQWLVLQIOXHQFHGE\SV\FKRVRFLDO
and biological factors as well as genetic factors.
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delay in early stage will provide some strategic
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study of developmental delay conducted in Bandung,
3URYLQFHRI:HVW-DYDGLGQRWLGHQWLI\WKHULVNIDFWRUV on demographic and history of delivery were obtained
2XU VWXG\ ZDV FDUULHG RXW WR LGHQWLI\ ULVN IDFWRUV RI
developmental delay in community setting.
Methods
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VWDWXV6(6ZDVFDWHJRUL]HGDFFRUGLQJWRWKHWRWDOOLIH
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XVHGEDVHGRQWKHPHDQWRWDOOLYHH[SHQVHSHUIDPLO\
LQ%DQWXOGLVWULFWIURP1DWLRQDO6RFLRHFRQRPLFVXU
YH\147KHIDPLO\·V6(6ZDVFDWHJRUL]HGDVSRRU
LIWKHWRWDOOLIHH[SHQVHOHVVWKDQWKHWKUHVKROG'DWD
IURPFDUHJLYHUV3UHVFUHHQLQJGHYHORSPHQWWHVWDQ
thropometric measurement and data collecting were
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0DWHUQDO'HSDUWPHQW0HGLFDO6FKRRO*DGMDK0DGD
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tested using the Chi square test. Univariate associations
RIYDULDEOHVZLWKRXWFRPHVZHUHH[SUHVVHGE\RGGVUDWLR
ZDVFRQGXFWHGLQ%DPEDQJOLSXURVXEGLVWULFW%DQWXO 25ZLWKFRQILGHQFH0XOWLYDULDWHDVVRFLDWLRQV
GLVWULFW3URYLQFHRI<RJ\DNDUWDEHWZHHQ6HSWHPEHU IRUVLJQLILFDQWULVNIDFWRUVZHUHWHVWHGE\PXOWLSOHORJLV
DQG2FWREHU6XEMHFWVZHUHVHOHFWHGE\VWUDWLILHG
random sampling based on the number of children
under five years old in each village. All children aged
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with congenital anomalies or refused to participate
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'HYHORSPHQWDOVFUHHQLQJZDVSHUIRUPHGE\XV
ing a Kuesioner Pra Skrining Perkembangan (KPSP), a
modification version of prescreening developmental
WLFUHJUHVVLRQVWRGHPRQVWUDWHWKHDGMXVWHG25$25
Informed consent was obtained from care givers. This
study was approved by the Ethics Committee of Medical
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Results
6L[KXQGUHGVDQGWKLUW\WZRFKLOGUHQDJHGPRQWKV
TXHVWLRQQDLUH3'4WKDWZDVGHYHORSHGIURP'HQ were enrolled in this study. The characteristics of the
YHU'HYHORSPHQWDO6FUHHQLQJ7HVW''67 This subject are shown in Table 1. The proportion of male
TXHVWLRQQDLUHZDVHVWDEOLVKHGE\'HSDUWPHQWRI+HDOWK DQGIHPDOHZDVVLPLODUZLWKWKHPHGLDQRIDJHRI
Republic of Indonesia, and was revised by Growth PRQWKV7KLVVWXG\IRXQGWKDWFKLOGUHQZHUH
DQG 'HYHORSPHQW6RFLDO 3HGLDWULF :RUNLQJ *URXS XQGHUQRXULVKHGDQGKDGKLVWRU\RIORZELUWK
,QGRQHVLDQ3HGLDWULF6RFLHW\7KLVLQVWUXPHQWKDVEHHQ ZHLJKW0RVWPRWKHUVZHUHKRXVHZLIHDQGPRVW
XVHGLQ,QGRQHVLDVLQFHZLWKDVHQVLWLYLW\RI RIWKHPKDGDQLQWHUPHGLDWHHGXFDWLRQDOOHYHO
DQGDVSHFLILFLW\RIFRPSDUHGWR'HQYHU,,WHVW 2XWRIFKLOGUHQZHUHLGHQWLILHG
,WFRQVLVWVRILWHPVWKDWUDQJHGIURPWRPRQWKV WR KDYH QRUPDO GHYHORSPHQW   ZLWK
IURPPRQWKVROGHYHU\WKUHHPRQWKVDQGIURP GRXEWIXOGHYHORSPHQWDOGHOD\DQGVXVSHFWHG
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domains of development i.e, gross motor, fine motor,
ODQJXDJHDQGSHUVRQDOVRFLDO7KHRSWLRQVRIUHVSRQVHV
IRUHDFKLWHPDUH´\HVµRU´QRµZKLFKVFRUHGDVRU
This test is interpreted as normal development, doubt
and suspected development delay according to the total
VFRUHRIRU< 6, respectively.
Nutritional status was assessed using weight for
developmental delay. Ideally, a doubtful result should
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catagorize it into normal or suspected developmental
GHOD\$UHVFUHHQLQJZDVQRWSHUIRUPHGEHFDXVHRI
WLPH DQG IXQGLQJ OLPLWDWLRQV 7KHUHIRUH WKH ULVN
factor analysis was only performed for normal and
suspected results.
This study showed that children older than two
DJH = VFRUH :$= LQGH[ DFFRUGLQJ WR :+2  \HDUV ROG ZHUH PRUH OLNHO\ WR VXIIHU IURP VXVSHFWHG
child growth chart standard. Nutritional status was GHYHORSPHQWDO GHOD\  YV  3  2WKHU
interpreted as undernourished, normal and overweight IDFWRUVZHUHLGHQWLILHGDVULVNRIVXVSHFWHGGHYHORSPHQWDO
DFFRUGLQJWRWKH:$=LQGH[EHORZ6'6'WR GHOD\QDPHO\ORZELUWKZHLJKW25&,
6' DQG DERYH  6' UHVSHFWLYHO\13 6RFLRHFRQRPLF XQGHUQRXULVKHG25&,PDWHUQDOORZ

162‡Paediatr Indones, Vol. 48, No. 3, May 2008

 Mei Neni Sitaresmi et al:5LVNIDFWRUVRIGHYHORSPHQWDOGHOD\

HGXFDWLRQDO OHYHO 25  &,   ZRUNLQJ finding was similar to that of study in Equador.
PRWKHU25&,DQGSRRU6(6IDPLOLHV This study also revealed that low birth weight, poor
25&,Table 2 6(6PDOQRXULVKHGORZHGXFDWLRQDOOHYHORIPRWKHU
/RJLVWLFUHJUHVVLRQDQDO\VLVVKRZHGWKDWSRRU6(6 DQG ZRUNLQJ PRWKHU ZHUH ULVN IDFWRUV RI VXVSHFWHG
ZDVWKHVWURQJHVWULVNIDFWRURIVXVSHFWHGGHYHORSPHQWDO developmental delay.
delay (Table 3 5LVN RI VXVSHFWHG GHYHORSPHQWDO
delay was not influenced by gender, mode of delivery,
H[FOXVLYHO\EUHDVWIHHGLQJRUWKHDJHRIPRWKHUV
Discussion
The prevalence of low birth weight in our study
was similar to that in other developing countries.16
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times higher to have developmental delay than those
ZLWK QRUPDO ELUWK ZHLJKW 6RPH VWXGLHV IRXQG WKDW
ORZELUWK ZHLJKW LQIDQWV ZLWK LQWUDXWHULQH JURZWK
This study showed that developmental delay was
more frequently observed in children older than
two years old than that in younger children. This
UHWDUGDWLRQ,8*5KDGORZHUGHYHORSPHQWDOOHYHOV
than those with normal birth weight.  IUGR
indicates constrains in fetal nutrition during critical
Table 2. Risk factors of developmental delay

Table 1. Characteristics of subjects Developmental

screening
Characteristics n (%) Risk factors OR 95%CI P
Normal Suspected
Sex (407) (43)
Male 324 (51) Age
Female 308 (49) 3-12 months 106 (95) 6 (5) 1
Age (months), mean +SD 28.6 +16.4 12-24 months 110 (96) 5 (14) 0.8 (0.8; 5.0) 0.71
3-12 months 135 (21) 24-60 months 192 (85) 32 (15) 2.9 (1.1; 7.2) 0.01
12-24 months 158 (25) Gender
24-60 months 339 (54) Male 195 (48) 24 (55) 1
Breastfeeding Female 213 (52) 19 (45) 1.3 (0.4; 1.3) 0.20
Six months exclusive 204 (32) Exclusive breastfeeding
Birth weight yes 140 (89) 17 (11) 1
Normal weight (2.500 – 4.000 gram) 567 (91) no 226 (92) 20 (8) 1.3 (0.4; 4) 0.38
Low birth weight (<2.500 gram) 59 (9) Nutritional status
Delivery Normal 354(87) 32 (74) 1
Spontaneously 550 (87) Undernourished 53 (13) 11 (26) 2.3 (1.0; 4.8) 0.02
Vacuum extraction or SC 82 (13) Birth weight
Nutritional status Normal 370 (91) 35 (9) 1
Underweight 103 (16) Low birth weight 32 (80) 8 (20) 2.6 (1.1; 6.1) 0.02
Normal 516 (82) SES
Overweight 12 (2) Prosperous 218 (94) 13 (6) 1
Order of child Poor 184 (86) 30 (14) 2.7 (1.3; 5.4) 0.003
First child 299 (47) Mother’s educational
Second child 203 (32) status 341 (92) 29 (8) 1
Third child or more 130 (21) High 66 (83) 14 (17) 2.5 (1.3; 4.9) 0.008
Mothers Low
Age: mean, median (years) 30.7 +6.1; 30 Mother’s occupation 292 (92) 25 (8) 1
Educational status Housewife 114 (86) 18 (14) 1.8 (1.0; 3.5) 0.05
low (< 6 years) 120 (19) Employee
intermediate ( 6-9 years) 433 (69)
high (> 9 year) 79 (12)
Occupation
housewife 439 (70) Table 3. Multivariate analysis of risk factors of developmental
employee 192 (30) delay
Social-economic status
Factor AOR 95%CI P
Poor 307 (49)
Prosperous 318 (51) Undernourished 1.8 0.8; 4.0 0.14
Developmental screening Low birth weight 1.9 0.7; 5.0 0.14
Normal 407 (64) Low educational level of mother 2.1 1.0; 4.5 0.04
Doubt 182 (28) Working mother 2.3 1.2; 4.5 0.01
Suspected 43 (8) Poor socio-economic status 2.8 1.4; 5.7 0.004

Paediatr Indones, Vol. 48, No. 3, May 2008‡163

 Mei Neni Sitaresmi et al:5LVNIDFWRUVRIGHYHORSPHQWDOGHOD\
period of brain development. In developing countries,
it is mainly due to poor maternal nutrition. The effect
of IUGR may persists until adolescence or even longer,
depends on the severity and duration of IUGR.
We noted that malnourished children have greater
ULVNIRUGHYHORSPHQWDOGHOD\$V\VWHPDWLFDOUHYLHZIRXQG
that in young children, underweight and stunting are also
related to apathy, less positive affect, lower levels of play
and more insecure attachment. The review also showed
that undernourished children have poorer attention and
poorer social relationships at school age.
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low educational level were two times higher to have
developmental delay. It is not surprising that their
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of stimulation for their development.
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delay. Poverty is related with inadequate food, poor
sanitation and hygiene that lead to increase infections
and malnutrition in children. Poverty is also correlated
to poor maternal education, increased maternal stress
and depression that lead to inadequate stimulation
at home. All these factors contribute to delay
achievement of child development.
The limitation of this study is that we did not
analyze children with doubt results. More children might
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Birnbaum R et al6FUHHQLQJIRUGHYHORSPHQWDOGHOD\LQ
the setting of a community pediatric clinic: a prospective
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be identified as suspected developmental delay. Further  'KDPD\DQWL0.XHVLRQHUSUDVNULQJSHUNHPEDQJDQ.363
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educational level and malnutrition during intrauterine 137KH'HQYHU3UHVFUHHQLQJ'HYHORSPHQWDO4XHVWLRQHU
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of developmental delay. Integrated strategies should be
conducted to solve the problems in order to prevent
more children suffers from developmental delay.
Acknowledgments
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manuscript. Our project is supported by HOPE Project.
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164‡Paediatr Indones, Vol. 48, No. 3, May 2008
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Paediatr Indones, Vol. 48, No. 3, May 2008‡165