Silent Struggles: Early detection of multidomain communication risks in resource-constrained early childhood development
1
Audiology, University of KwaZulu-Natal, Durban, South Africa
2
Speech Language Pathology, University of Massey, Auckland, New Zealand
3
Institute of Neurology, University College London (UCL), London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Children from low-income families face a disproportionately high risk of undiagnosed multidomain developmental (MDD) delays, often arising from sensory and functional impairments such as vision, speech-language, and hearing disorders [1-3]. Across Africa, data on the prevalence of these risks remain scarce, despite their impact on early literacy and long-term developmental outcomes[4-5]. Africa is home to 40% of the world's children, and South Africa has over 5.8 million children aged 0–5 years, with 2.1 million attending Early Childhood Development Centres (ECDCs), many of which are located in underserved communities with unknown developmental risk profiles [5-7].
AIM:
To identify and characterise children at risk of multidomain developmental communication disorders using a screening battery composed of literature-based, previously validated tools adapted for economic, cultural, and feasibility needs in low-resource ECDCs.
METHODS:
A quantitative, cross-sectional observational study was conducted across 28 ECDCs in Phoenix, Inanda, Ntuzuma, and KwaMashu (PINK), Durban. Sampling followed a multi-stage approach: convenience sampling was used to select the outreach provider, geographical cluster allocation was employed to identify ECDCs, and census sampling was used to recruit all eligible children. A total of 595 children (aged 3 months–6 years) underwent vision screening (Birth to Three Functional Vision Screening Tool; LEA Symbols), speech-language screening (Ages and Stages Questionnaire), and hearing screening (otoscopy, Tympanometry, otoacoustic emissions, pure tone audiometry).
RESULTS:
Screening identified 17 children (3%) at risk for vision impairment, 171 (28.7%) with developmental delays, and 205 (34%) with potential hearing disorders. Only 3% of referred children accessed diagnostic follow-up.
CONCLUSIONS:
Significant multidomain communication developmental risks were detected, yet follow-up rates were critically low, reflecting systemic barriers. Strengthened referral pathways, caregiver support, and accessible diagnostic services are crucial to ensuring timely intervention and promoting developmental equity. Contribution: Multidomain screening offers a feasible and holistic approach for resource-limited settings.
Children from low-income families face a disproportionately high risk of undiagnosed multidomain developmental (MDD) delays, often arising from sensory and functional impairments such as vision, speech-language, and hearing disorders [1-3]. Across Africa, data on the prevalence of these risks remain scarce, despite their impact on early literacy and long-term developmental outcomes[4-5]. Africa is home to 40% of the world's children, and South Africa has over 5.8 million children aged 0–5 years, with 2.1 million attending Early Childhood Development Centres (ECDCs), many of which are located in underserved communities with unknown developmental risk profiles [5-7].
AIM:
To identify and characterise children at risk of multidomain developmental communication disorders using a screening battery composed of literature-based, previously validated tools adapted for economic, cultural, and feasibility needs in low-resource ECDCs.
METHODS:
A quantitative, cross-sectional observational study was conducted across 28 ECDCs in Phoenix, Inanda, Ntuzuma, and KwaMashu (PINK), Durban. Sampling followed a multi-stage approach: convenience sampling was used to select the outreach provider, geographical cluster allocation was employed to identify ECDCs, and census sampling was used to recruit all eligible children. A total of 595 children (aged 3 months–6 years) underwent vision screening (Birth to Three Functional Vision Screening Tool; LEA Symbols), speech-language screening (Ages and Stages Questionnaire), and hearing screening (otoscopy, Tympanometry, otoacoustic emissions, pure tone audiometry).
RESULTS:
Screening identified 17 children (3%) at risk for vision impairment, 171 (28.7%) with developmental delays, and 205 (34%) with potential hearing disorders. Only 3% of referred children accessed diagnostic follow-up.
CONCLUSIONS:
Significant multidomain communication developmental risks were detected, yet follow-up rates were critically low, reflecting systemic barriers. Strengthened referral pathways, caregiver support, and accessible diagnostic services are crucial to ensuring timely intervention and promoting developmental equity. Contribution: Multidomain screening offers a feasible and holistic approach for resource-limited settings.
| eISSN: | 2654-1459 |
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