Prevalence, Patterns, and Correlates for Suspected Developmental Delay Among Preschool-aged Children in the Estate Sector of Galle, Sri Lanka: A Cross-sectional Study

Abstract

Background: Early childhood (ages 2-5 years) represents a critical period to prevent the onset of noncommunicable diseases and mental health conditions later in life. Globally, South Asia carries the highest prevalence of developmental delays and disabilities. In Sri Lanka, limited data are available on early childhood developmental outcomes, especially in socioeconomically disadvantaged group such as the tea or rubber plantation communities (referred as the estate sector). This study aims to address this evidence gap and identify intervention priorities by (1) assessing the prevalence and patterns of developmental delays among children aged 2–5 years in Sri Lanka's estate sector, and (2) examining correlates of suspected developmental delay, focusing on services use and family environment. Methods: A cross-sectional study was conducted from July to December 2025 among 176 primary caregivers of children aged 2–5 years in plantation communities of Galle District, Sri Lanka. Face-to-face survey interviews were conducted to assess suspected developmental delay using two caregiver-reported screening tools: Survey of Well-being of Young Children-Milestones (SWYC-Milestones) and Child Health Development Record-Checklist (CHDR-Checklist). Caregiver awareness, service utilization, family-related psychosocial factors, and demographic data were also collected. The prevalence of suspected developmental delay was calculated and stratified by correlates. Bivariable and multivariable regression analyses were performed to identify correlates of suspected developmental delay. Results: The two screening tools identified a prevalence of suspected developmental delay between 24.7% (CHDR) to 30.4% (SWYC). Over half of the older preschool-aged children were unable to meet language and cognitive related milestones. Multiple psychosocial factors were prevalent in the home environment of these children: 33% of caregivers reported smoking, 58.6% of caregivers were screened positive for depression, and food insecurity was reported as occasional in 36.4% and frequent in 37.5% of households. By contrast, 86.9% of the caregivers reported having no concerns about their child’s development and only 46.6% of caregivers have read the developmental milestone information in the CHDR. Higher prevalences of suspected developmental delay were found among children with older age in months (Crude PRswyc=1.05, 95%CI= 1.02–1.08), who had one sibling compared to no sibling (Crude PRswyc=2.52, 95%CI=1.11-5.70; Crude PRchdr=1.76, 95%CI=0.89–3.49), and who were taken care by the grandmother compared to mother (Crude PRswyc=1.91, 95%CI=1.11–3.29; Crude PRchdr=1.76, 95%CI=0.98–3.16). Greater caregiver service use was associated with a lower prevalence of suspected developmental delay (Adjusted PRswyc=0.86, 95%CI=0.64–1.15; Adjusted PRchdr=0.72, 95%CI=0.53–0.98). Conclusions: This is the first study providing data on suspected developmental delay among children in the estate sector in Sri Lanka. Prevalence and association estimates need confirmation in larger, more representative samples. Nonetheless, the findings highlight the urgent need for further research and targeted efforts to improve screening and early intervention for developmental delay in the estate sector.