One-third of children in low- and middle-income countries fail to reach developmental milestones  

African Kids.Ghana

For immediate release: June 7, 2016

With data on almost 100,000 children, new research reveals extent of developmental setbacks among 3- and 4-year-olds in low- and middle-income countries

Boston, MA ─ In developing countries, one-third of children 3 and 4 years old don’t reach basic milestones in cognitive and/or socioemotional growth, according to a new study from Harvard T.H. Chan School of Public Health, funded by the Government of Canada through Grand Challenges Canada.

The study authors estimate that 80.8 million of the roughly 240 million preschool-aged children in the world’s 132 low- and middle-income countries fail to develop a core set of age-appropriate skills that allow them to maintain attention, understand and follow simple directions, communicate and get along with others, control aggression, and solve progressively complex problems.

These early abilities are associated with subsequent development, mental and physical health, and ultimately, better learning in school and more productive lives as adults.

The study, published June 7, 2016, in PLOS Medicine, draws on data provided by the caregivers of almost 100,000 children living in 35 low- and middle-income countries between 2005 and 2015. The data were collected as part of UNICEF’s Multiple Indicator Cluster Survey program, Demographic and Health Surveys, and global data from the Nutrition Impact Model Study.

This is the first study to directly estimate the global extent of cognitive and/or socioemotional development deficits; earlier estimates of this unmet potential globally were based on proxy measures of development including poor physical growth and exposure to poverty.

The researchers found that among 3- and 4-year-olds in low- and middle-income countries, the problem is most acute in sub-Saharan Africa (29.4 million children not reaching developmental milestones; 44% of all 3- or 4-year-olds), followed by South Asia (27.7 million; 38%) and the East Asia and Pacific region (15.1 million; 26%). A significant burden is also notable in Latin America/Caribbean (4.1 million, 19%) and North Africa, Middle East and Central Asia (4.5 million, 18%).

Low development scores were associated with stunting, poverty, male gender, rural residence, and lack of cognitive stimulation.

Says lead author Dana McCoy, assistant professor of education at the Harvard Graduate School of Education: “In addition to the 33% of children overall who did not meet the selected cognitive and socioemotional milestones, we estimate that 17% were physically stunted, meaning that approximately half of the children in these countries are developing poorly in one way or another.”

The importance of children thriving, not just surviving, is emphasized in the United Nations Sustainable Development Goals and is central to the Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescent’s Health.

“Achieving optimal early child health and development is critical for attaining success in school, and has significant lifelong implications for the health and economic wellbeing of individuals, families and communities,” says the project’s principal investigator, Wafaie Fawzi, professor and chair of the Department of Global Health and Population at Harvard Chan School.

He added that quantifying the burden of failing to reach developmental milestones at national and global levels is important to monitoring progress towards the Sustainable Development Goals.

An estimate of the global economic cost of this unrealized human potential is the focus of a companion study conducted at Harvard, also funded by Grand Challenges Canada, with publication planned for later this year.

These studies are part of a larger project to estimate the epidemiologic and economic impacts of risk factors for child development, involving a multidisciplinary team of clinicians, economists, psychologists, epidemiologists, nutritional scientists, disease and risk factor modelers and statisticians at Harvard Chan School, Imperial College LondonAga Khan University (Pakistan), and Ifakara Health Institute, Tanzania.

“When one in three children is failing to reach their full potential, we are looking at one of the world’s grandest challenges. This research helps shine an ever brighter light on the value of investing in a child’s earliest years — for the benefit of our children, our world and our future,” said Peter A. Singer, Chief Executive Officer of Grand Challenges Canada.

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Note: To receive the Appendix listing the estimated prevalence of children with low development scores by country, please contact Marge Dwyer at

For more information:

Harvard T. H. Chan School of Public Health
Marge Dwyer

Grand Challenges Canada
Liam Brown
+1-647-328-2021 / +1-416-673-6542

Terry Collins
+1-416-538-8712 / +1-416-878-8712



Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.

Grand Challenges Canada is dedicated to supporting Bold Ideas with Big Impact® in global health. We are funded by the Government of Canada and we support innovators in low- and middle-income countries and Canada. The bold ideas we support integrate science and technology, social and business innovation – we call this Integrated Innovation®. Grand Challenges Canada focuses on innovator-defined challenges through its Stars in Global Health program and on targeted challenges in its Saving Lives at Birth, Saving Brains and Global Mental Health programs. Grand Challenges Canada works closely with Canada’s International Development Research Centre (IDRC), the Canadian Institutes of Health Research (CIHR) and Global Affairs Canada to catalyze scale, sustainability and impact. We have a determined focus on results, and on saving and improving lives.

Saving Brains is a partnership of Grand Challenges Canada, Aga Khan Foundation Canada, the Bernard van Leer Foundation, Bill & Melinda Gates Foundation, The ELMA Foundation, Grand Challenges Ethiopia, Maria Cecilia Souto Vidigal Foundation, the Palix Foundation, the UBS Optimus Foundation and World Vision Canada. It seeks and supports bold ideas for products, services and implementation models that protect and nurture early brain development relevant to poor, marginalized populations in low- and middle-income countries.