European Journal of Pediatrics

, Volume 177, Issue 5, pp 691–697 | Cite as

Sociocultural risk factors for developmental delay in children aged 3–60 months: a nested case-control study

  • Aylin DemirciEmail author
  • Mehtap Kartal
Original Article


Identifying children at risk for developmental delay (DD) is important for improving prognosis. In this sense, we estimated sociocultural factors that may be associated with DD in early childhood. In our nested case-control study, 95 were included in the case group and 190 were randomly selected to control group. To identify the risk factors, we conducted a backward conditional logistic regression and a final multivariable model was developed. Maternal age of ≥35 years, low maternal and paternal education level, low socioeconomic level, consanguineous marriage, and delivery by cesarean section increased the risk of DD. After adjustment, the risk of DD was significantly increased by maternal age ≥ 35 years (odds ratio (OR) 3.04, 95%CI 1.38–6.70), maternal education level of primary school or lower (OR 14.56, 95%CI 5.40–39.24), consanguineous marriage (OR 3.99, 95%CI 1.69–9.40), and delivery by cesarean section (OR 3.34, 95%CI 1.80–6.18).

Conclusion: DD can be identified early during well-child visits. In such cases, it is critical for the health of the child and community to screen for possible risk factors, eliminate the causes, and refer families to rehabilitation services.

What is known:

The causes of DD may be classified into prenatal, perinatal, and postnatal factors.

Early identification may improve later outcomes of DD. Most studies conducted on this topic have focused on prematurity.

What is new:

This study focused on maternal, paternal, and sociocultural factors that may be associated with DD in early childhood in this study that was conducted on a community-based sample.

The risk of DD was increased by maternal age ≥ 35 years, maternal education level of primary school or lower, consanguineous marriage and delivery by cesarean section.


Developmental delay Ages and Stages Questionnaires Risk factors Child 



Ages and Stages Questionnaire-Turkish Version


Confidence interval


Developmental delay


Odds ratio


Primary healthcare centers



We thank the executive support of the Ministry of Health, the Dokuz Eylul University School of Medicine, and Maya Academia. The ASQ-TR was provided by Maya Academia. We also acknowledge the sincere cooperation of Dr. Dilek Guldal, Dr. Nilgun Ozcakar, and Dr. Ferhat Demirci and all the family physicians who helped in this study.

Authors’ Contributions

Aylin Demirci, Mehtap Kartal conceived the project, prepared the questionnaires, analyzed the data, and wrote the paper. Aylin Demirci applied the ASQ-TR and the prepared questionnaires to mothers on a voluntary basis via face-to-face interview.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

The Non-Interventional Research Ethics Committee of Dokuz Eylul University School of Medicine (resolution number 2012/41–01 dated 17.12.2012) approved the study. Necessary permissions were also obtained from the Ministry of Health, Turkish Public Health Institution, and the Governorship of Izmir, Director of Public Health, to conduct the study in primary healthcare centers (PHC). The families and/or primary care physicians of children who were found to be at risk for DD at the end of the evaluation were given additional information about monitoring and further examination. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Due to the nature of the research present, however, no informed consent was required from the individual participating in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Bayrakli District Directorate of HealthIzmirTurkey
  2. 2.Department of Family MedicineDokuz Eylul University School of MedicineIzmirTurkey

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