Challenges for Evidence-Based Care for Children With Developmental Delays in Nicaragua

Evidence of successful models for promoting early childhood development and for effectively addressing developmental delays is available, yet the adoption of evidence-based strategies is limited in low-income countries. Nicaragua, a low-income country on the Central American isthmus, faces policy-, organizational-, and community-level obstacles which prevent families from receiving the benefits of early child development programs as well as other necessary services for children at risk of or with developmental delays. Failing to address developmental delays in a timely manner leads to detrimental social and economic consequences for families and society at large. In this article, we examine existing information on early childhood development in Nicaragua and discuss some programmatic implications for the recognition and early intervention of developmental delays in Nicaragua.Keywords: Nicaragua; developmental delays; barriers to care; evidence-based careImproved access to skilled birth attendance and management of childhood infectious diseases in low-income countries have led to important reductions in the mortality rates of infants and children younger than 5 years of age (Lozano et al., 2011). This situation has increased the number of survivors as well as the number of children who need specialized healthcare services but without parallel developments in infrastructure and healthcare workforce capacity. For children with development delays and those with special healthcare needs, important lapses in the provision of services remain in the developing world (Scherzer, Chhagan, Kauchali, & Susser, 2012). The situation is aggravated by an increased burden of risk factors for developmental delays in low-income countries such as maternal complications (Sen, Yayla, & Levene, 2003), macro- and micronutrient deficiencies (Black et al., 2008), recurrent diarrheal and parasitic infections (Rodriguez, Cervantes, & Ortiz, 2011), poor mother-child interactions (Walker, Chang, Powell, Simonoff, & Grantham-McGregor, 2007; Walker, Wachs, et al., 2007), and toxic exposures (Ballew et al., 1999; Little et al., 2009). The confluence of adverse exposures often results in lifelong morbidity and decreased life expectancy (Walker, Wachs, et al., 2007).National data on developmental delays are lacking for many low-income countries, which constitute a significant roadblock for the recognition of the importance of early childhood development and for addressing the impact of developmental delays. However, some statistical estimations have been made. Using a combination of nutritional (i.e., growth retardation) and educational measures (i.e., school achievement and cognition) with data from more than 150 countries, Grantham-McGregor and colleagues (2007) estimated that more than 200 million children worldwide do not fulfill their developmental potential in growth and educational outcomes. Most children were from the developing world, which plays a significant role in the perpetuation of the cycle of poverty in low-income countries (Grantham-McGregor et al., 2007). If left unchecked, a significant proportion of developmental delays will progress to lifelong disabilities with greater use of services and significant costs to families and society as a whole (Maulik & Darmstadt, 2007).If developmental delays are recognized early and adequate interventions are provided in a timely manner, their effects can be ameliorated effectively. There is ample evidence of successful models for promoting early childhood development and addressing developmental delays (Simeonsson, 1991; Walker, Chang, Powell, & Grantham-McGregor, 2005; Walker, Chang, VeraHernandez, & Grantham-McGregor, 2011). However, the adoption of evidence-based strategies remains insufficiently integrated in low-income countries. To address this gap, it is necessary that practitioners, researchers, and policy makers focus on identifying the challenges which specific low-income countries face in the adoption and dissemination of evidence-based interventions (Blackman, 2002; Scherzer et al. …