Table 3.
Risk factors of suspected developmental delays among Nepalese children (N = 2870).
| Variables | Categories | Odds ratio (95% confidence interval) | ||||
|---|---|---|---|---|---|---|
| Model 1a | Model 2b | Model 3c | Model 4d | Model 5e | ||
| Child characteristics | ||||||
| Age of children | 36–47 months (ref.) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 48–59 months | 0.51 (0.41–0.64)*** | 0.22 (0.15–0.32)*** | 0.20 (0.14–0.30)*** | 0.19 (0.13–0.29)*** | 0.19 (0.13–0.29)*** | |
| Sex of children | Boys (ref.) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Girls | 0.96 (0.80–1.17) | 0.88 (0.63–1.23) | 0.90 (0.64–1.26) | 0.90 (0.64–1.27) | 0.88 (0.62–1.24) | |
| Birth order | 1 (ref.) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| 2–4 | 1.88 (1.41–2.51)*** | 2.60 (1.70–3.96)*** | 1.76 (1.14–2.73)** | 1.56 (0.99–2.46) | 1.41 (0.89–2.22) | |
| ≥ 5 | 2.24 (1.44–3.50)*** | 3.83 (1.89–7.76)*** | 1.98 (0.87–4.49) | 1.55 (0.67–3.58) | 1.20 (0.52–2.79) | |
| Stunting | No (ref.) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Yes | 1.69 (1.38–2.08)*** | 2.43 (1.69–3.51)*** | 2.08 (1.44–2.99)*** | 1.93 (1.33–2.81)** | 1.78 (1.22–2.58)** | |
| Parent’s characteristics | ||||||
| Mother’s age | 15–24 years (ref.) | 1.00 | 1.00 | 1.00 | 1.00 | |
| 25–34 years | 1.11 (0.88–1.40) | 1.14 (0.75–1.73) | 1.35 (0.87–2.08) | 1.54 (0.99–2.38) | ||
| 35 years and above | 1.22 (0.87–1.69) | 0.60 (0.32–1.13) | 0.78 (0.41–1.49) | 1.07 (0.56–2.06) | ||
| Mother’s education | No education (ref.) | 1.00 | 1.00 | 1.00 | 1.00 | |
| Basic education | 0.58 (0.45–0.75)*** | 0.44 (0.28–0.70)*** | 0.51 (0.32–0.83)** | 0.67 (0.41–1.08) | ||
| Secondary education | 0.34 (0.27–0.44)*** | 0.16 (0.09–0.27)*** | 0.22 (0.13–0.38)*** | 0.30 (0.17–0.52)*** | ||
| Higher education | 0.18 (0.10–0.30)*** | 0.05 (0.02–0.12)*** | 0.09 (0.03–0.26)*** | 0.12 (0.05–0.34)*** | ||
| Household-level characteristics | ||||||
| Household socio-economic status | Poorest (ref.) | 1.00 | 1.00 | 1.00 | ||
| Poorer | 0.75 (0.55–1.04) | 0.56 (0.32–0.97)* | 0.47 (0.26–0.85)* | |||
| Middle class | 0.56 (0.42–0.75)*** | 0.44 (0.25–0.77)** | 0.33 (0.18–0.62)** | |||
| Richer | 0.53 (0.37–0.76)*** | 0.53 (0.29–0.96)* | 0.41 (0.21–0.79)** | |||
| Richest | 0.24 (0.16–0.37)*** | 0.15 (0.07–0.33)*** | 0.13 (0.05–0.31)*** | |||
| Household size | 1–4 persons (ref.) | 1.00 | 1.00 | 1.00 | ||
| 5–6 persons | 0.93 (0.74–1.15) | 0.89 (0.59–1.34) | 0.87 (0.58–1.32) | |||
| > 6 persons | 1.11 (0.82–1.49) | 1.07 (0.65–1.79) | 1.08 (0.64–1.80) | |||
| Iodine level in the salt consumed | None (0 ppm) (ref.) | 1.00 | 1.00 | 1.00 | ||
| Inadequate (< 15 ppm) | 1.18 (0.72–1.94) | 0.93 (0.37–2.33) | 0.96 (0.38–2.42) | |||
| Adequate (≥ 15 ppm) | 1.11 (0.70–1.74) | 0.86 (0.37–1.99) | 1.00 (0.43–2.32) | |||
| Community-level characteristics | ||||||
| Place of residence | Urban area (ref.) | 1.00 | 1.00 | |||
| Rural area | 1.41 (1.12–1.75)** | 1.27 (0.83–1.94) | ||||
| Province | Province 1 (ref.) | 1.00 | 1.00 | |||
| Madhesh province | 2.64 (1.75–3.98)*** | 6.37 (3.03–13.37)*** | ||||
| Bagmati Province | 1.18 (0.78–1.78) | 2.24 (1.07–4.67)* | ||||
| Gandaki Province | 0.86 (0.54–1.37) | 1.01 (0.43–2.39) | ||||
| Lumbini Province | 2.22 (1.44–3.42)*** | 4.01 (1.96–8.21)*** | ||||
| Karnali Province | 2.72 (1.72–4.30)*** | 2.34 (0.99–5.53) | ||||
| Sudhurpashchim Province | 2.23 (1.45–3.37)*** | 2.57 (1.19–5.56)*** | ||||
| Random-effects parameters | ||||||
| Community level | Variance | 1.66 | 1.12 | 1.03 | 0.75 | |
| ICC | 0.15 | 0.10 | 0.10 | 0.07 | ||
| Household level | Variance | 6.23 | 6.39 | 6.43 | 6.50 | |
| ICC | 0.70 | 0.70 | 0.69 | 0.69 | ||
| Model comparison | ||||||
| Likelihood ratio testf | Chi-square statistic | 314.86 | 289.15 | 277.51 | 257.21 | |
| P value | < 0.001 | < 0.001 | < 0.001 | < 0.001 | ||
| AIC | 3097 | 3026 | 2854 | 2831 | ||
| BIC | 3144 | 3103 | 2977 | 2996 | ||
ref. reference category, ppm parts per million, SD standard deviation, SE standard error.
***p < 0.001, **p < 0.01, *p < 0.05.
aModel 1: crude models.
bModel 2: only child characteristics were included in the model.
cModel 3: additionally adjusted for parental characteristics.
dModel 4: additionally adjusted for household related characteristics.
eModel 5: additionally adjusted for community characteristics.
fBased on the results on likelihood ratio tests, estimates of multilevel logistic regression models were preferred than fixed effect models.