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，有超过5300万名五岁以下儿童患有发育障碍，他们需要有效的干预措施来支持其健康与福祉。然而，由于各种障碍，尤其是在低收入和中等收入国家，干预措施的提供仍面临挑战。本研究通过一项全球系统性综合回顾，评估了针对五岁以下儿童发育障碍相关功能结果（包括预防、早期检测和康复干预）的证据。我们聚焦于全球普遍存在的残疾，并确定了基于证据的干预措施。我们对Medline、Embase、PsychINFO和Cochrane Library进行了检索，以获取2013年1月1日至2023年4月14日期间的相关文献。采用叙事综合方法对纳入的荟萃分析结果进行总结。结果以描述性方式呈现，包括研究特征、评估的干预措施和报告的结局。此外，作为二次分析的一部分，我们展示了2019年全球每种残疾的患病率，并确定了负担最重的地区及前十位受影响国家。本研究已在PROSPERO注册，编号为CRD42023420099。我们纳入了883篇文献中的18篇综述，涉及来自30个国家的251项研究，共计1273444名五岁以下患有或存在发育障碍风险的孩子。具备充分数据的条件包括脑瘫、听力损失、认知障碍、自闭症谱系障碍（ASD）和注意力缺陷多动障碍。ASD是最普遍的目标残疾（共有8篇综述，占44%）。大多数综述（12篇，占67%）评估了支持行为功能和运动障碍的早期干预。在综述中，只有33%（10/30）的研究来自中等收入国家，没有来自低收入国家的研究。关于质量，一半的综述被评为高置信度（9/18，50%），7篇为中等（39%），2篇（11%）为低。我们发现了地理和残疾相关的差异。高收入环境之外缺乏证据。该研究强调了关于预防、识别和干预的证据空白，揭示了现有证据基础与发育障碍高患病率地区之间的显著不匹配。