Strategies for addressing the needs of children with or at risk of developmental disabilities in early childhood by 2030: a systematic umbrella review

There are over 53million children worldwide under five with developmental disabilities who require effective interventions to support their health and well-being. However, challenges in delivering interventions persist due to various barriers, particularly in low-income and middle-income countries.We conducted a global systematic umbrella review to assess the evidence on prevention, early detection and rehabilitation interventions for child functioning outcomes related to developmental disabilities in children under 5 years. We focused on prevalent disabilities worldwide and identified evidence-based interventions. We searched Medline, Embase, PsychINFO, and Cochrane Library for relevant literature from 1st January 2013 to 14th April 2023. A narrative synthesis approach was used to summarise the findings of the included meta-analyses. The results were presented descriptively, including study characteristics, interventions assessed, and outcomes reported. Further, as part of a secondary analysis, we presented the global prevalence of each disability in 2019 from the Global Burden of Disease study, identified the regions with the highest burden and the top ten affected countries. This study is registered with PROSPERO, number CRD42023420099.We included 18 reviews from 883 citations, which included 1,273,444 children under five with or at risk of developmental disabilities from 251 studies across 30 countries. The conditions with adequate data were cerebral palsy, hearing loss, cognitive impairment, autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder. ASD was the most prevalent target disability (n = 8 reviews, 44%). Most reviews (n = 12, 67%) evaluated early interventions to support behavioural functioning and motor impairment. Only 33% (n = 10/30) of studies in the reviews were from middle-income countries, with no studies from low-income countries. Regarding quality, half of reviews were scored as high confidence (n = 9/18, 50%), seven as moderate (39%) and two (11%) as low.We identified geographical and disability-related inequities. There is a lack of evidence from outside high-income settings. The study underscores gaps in evidence concerning prevention, identification and intervention, revealing a stark mismatch between the available evidence base and the regions experiencing the highest prevalence rates of developmental disabilities

全球范围内，5岁以下发育性残疾儿童数量超过5300万，此类群体亟需有效的干预措施以保障其健康与福祉。但受多重障碍因素制约，干预措施的落地推广始终面临挑战，在低收入与中等收入国家中这一问题尤为突出。本研究开展了一项全球性系统性伞状综述（umbrella review），旨在评估针对5岁以下发育性残疾儿童的功能结局相关的预防、早期筛查与康复干预措施的现有证据。研究聚焦全球高发残疾类型，筛选出了循证认可的干预方案。我们检索了2013年1月1日至2023年4月14日期间Medline、Embase、PsychINFO及Cochrane Library数据库中的相关文献，采用叙述性综合法（narrative synthesis）对纳入的荟萃分析（meta-analysis）结果进行总结，研究结果以描述性形式呈现，涵盖研究特征、评估的干预措施及报告的结局指标。此外，作为二次分析的一部分，我们还呈现了2019年全球疾病负担研究（Global Burden of Disease）中各类残疾的全球患病率，明确了疾病负担最重的区域以及受影响最严重的前十大国家。本研究已在PROSPERO平台注册，编号为CRD42023420099。
本研究最终从883条引用文献中纳入18篇综述，这些综述涵盖了来自30个国家的251项研究，涉及1273444名5岁以下患有或存在发育性残疾风险的儿童。数据充足的残疾类型包括脑瘫、听力损失、认知障碍、孤独症谱系障碍（Autism Spectrum Disorder, ASD）以及注意缺陷/多动障碍。其中孤独症谱系障碍是最主要的目标残疾（共8篇综述，占比44%）。大部分综述（12篇，占比67%）针对用于改善行为功能与运动功能受损的早期干预措施开展了评估。纳入综述的研究中仅33%（10/30）来自中等收入国家，未纳入任何低收入国家的相关研究。在质量评价方面，半数综述被评为高置信度（9/18，50%），7篇为中等置信度（39%），2篇为低置信度（11%）。
本研究揭示了地理分布与残疾类型相关的健康公平性失衡问题。高收入地区之外的相关研究证据极为匮乏。本研究凸显了发育性残疾的预防、筛查与干预相关证据的缺口，反映出现有证据基础与发育性残疾患病率最高的区域之间存在显著错配。