@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2020;7(4):263-273

Background
...[1]. Attention to the early years of childhood is one of the social determinants of health. Meeting the various needs of children during this period can promote emotional, social, and thinking skills, and it is associated with important consequences such as academic, economic, and social success [2].
Previous Studies
Children's development is related to their physical changes; in contrast, evolution refers to the development of physical, mental, verbal, and social abilities that a child acquires throughout life [3]. A developmental delay refers to a child who has not gained the developmental skills expected of him or her compared to others of the same age [4]. …[5-7]. Studies show that a wide range of variables, including hereditary and biological to psychological and environmental factors, affect a child's development [8-10]. Awareness and practice of parents to provide learning opportunities to children have an essential role in child development. However, studies show that parents have limited knowledge about their children's development [11, 12]. The child's developmental characteristics depend on their first social interactions in a family, especially with their parents. Based on the available evidence, interaction with children and attention to developmental care, such as the regular reading of books for children, storytelling, and play with children stimulates the child socially and psychologically as well as has a significant role in improving the child's development [13-15]. …[16].
Aim(s)
This study aimed to investigate the relationship between mothers' awareness of different symptoms and dimensions of child development and parental care behaviors with developmental delay in children under 5 years old.
Research type
This is a case-control study.
Research society, place and time
This study was carried out on mothers with children under 5 years old living in Hamedan in April and August 2017.
Sampling method and number
The minimum sample size in each group of this study was determined 230, considering that the number of variables in this study was 23 [17]. The case group included mothers with children with developmental delays diagnosed by a physician at the Child Development Comprehensive center of Hamedan. The children with the initial diagnosis of developmental delay in Hamedan are referred to the Comprehensive Development Center. Therefore, we referred to this center for preparing the list of children in the case group. In the next step, the health centers and health houses providing services to these children were determined using the integrated health system (SIB). The study was carried out on the cases of Hamedan. The children in areas except Hamedan were excluded from the study. The mothers of eligible children were invited to participate in the study by phone call. The control group included a random sample of children under 5 years old in Hamedan who did not have developmental delays. The subjects in the control group were selected through the Health Care Center, which provides the services to the children in the case group. The ratio of the case to control group was one. Mothers with children with natural abnormalities were excluded from both study groups. In both groups, mothers who were willing to participate in the project, after expressing their consent filled a questionnaire measuring the study variables.
Used devices&materials
Developmental delays in children were diagnosed using the age and stage screening tool (ages and stages questionnaire) [18]. The ages and stages questionnaires are valid tools for determining development delay with a validity of 0.84, reliability of 0.94, and the testability of more than 96% [19]. Independent variables included demographic and contextual variables, mothers' awareness of children's development, and developmental care. Demographic and contextual variables include the age of child and parents, sex, birth rank, number of children, occupation and education of parents, type of birth, birth weight, type of pregnancy, history of hospitalization, and use of tobacco products by parents at home, regular use of iron and vitamin drops, and breastfeeding. The CKCDI (Caregiver Knowledge of Child Development Inventory) questionnaire was used to assess mothers' awareness about children's development [20]. ...[21-24]. Validity-content and structure indicators and the reliability of this tool have been confirmed in the study of Artem et al. [20]. A multi-step approach was used to translate the questionnaire into the Persian language. In the first step, the questionnaire was translated from English to Persian using 2 qualified translators. The two versions of the translated questionnaires were combined to achieve a single version. The mentioned version was presented to another translator for its edit, who did not know the original text of the questionnaire. The re-translated questionnaire was matched with the original version of the questionnaire and the necessary changes were made in the temporary version of the questionnaire. Finally, the questionnaire was tested by a group, including 30 mothers with children under 5 years old, similar to the target group. In the present study, according to Artem et al.'s report, the internal correlation of the domains of this questionnaire was acceptable (Cronbach's alpha <0.6). Educational behaviors, developmental care related to children's play and entertainment at home and adult participation, and support for child learning were investigated using the tools used to study in the Iran Multiple-Indicator Demographic and Health Survey (IrMIDHS) [25]. This study was approved by the Ethics Committee of the Vice Chancellor for Research of Hamedan Medical Sciences University. After collecting questionnaires and extracting data, a logistic regression test was used to determine the relationship between the factors of developmental delay. Data were analyzed using Stata 11 software with a significance level of 5%.
Findings by Text
462 mothers with children under 5 years old were categorized into two groups: case (231) and control (231). Differences between the two groups in terms of demographic and contextual variables are shown in Table 2. Based on the results of the Chi-square test, there was a significant difference between the two groups in terms of children age (p<0.001), birth weight of children (p =0.005), gestational age at birth (p=0.014), history of hospitalization of children (p<0.001), consumption of supplements in children (p=0.025), use of tobacco products by at least one parent at home (p<0.001) and kindergarten membership (p=0.002). More than 90% of children did not participate in the training classes, and a small number of them went to kindergarten, which this rate was significantly lower in children in the control group (3%) than children in the case group (7%) (p=0.002). About 30% of children did not have children's books, and there was no significant difference between the two groups in this regard. The highest sources of parental training in both groups were television (38%), comprehensive health service centers (33.5%), cyberspace (26%), books (20%), and families (15%), respectively (Table 2). There was no significant difference in the play type and entertainment in the house between the two study groups (p=0.635). Factory toys, home vehicles, TVs, and tablets or parents' mobile phones had the highest rates of use as entertainment tools for the children, respectively. Children played at home with an average of 2 and 3 vehicles in the case and control groups (Table 2). In a quarter of the children, no adults read the book to them, and they didn't look at the pictures together. For about a third of the children, no adults had told stories. Most parents in both groups, especially fathers, were involved in getting the child out of the house. Most parents in both groups, especially fathers, played with the child. Almost a quarter of the children did not experience some activities such as drawing, naming, and counting things with adults. There was no statistically significant difference between the case and control groups in the parents' educational behaviors. Shouting at the child and hitting different parts of the child's body were the most common training behaviors in the two groups, respectively. Parents often used negative training behaviors, including physical and verbal punishment, to teach the right behaviors or correct the child's behavioral problems. The results also showed that mothers in the case group had less awareness than the control group in cognitive and motor development areas. No one had read a lullaby or a poem for one in 5 children in the case group and one in 10 children in the control group. In the case group children, the highest delay was observed in the field of communication (38.5%), and the least delay was observed in the personal-social area (19%) (Table 3). The results of logistic regression analysis showed a significant relationship between maternal age (OR=1.04, %95CI: 1.00-1.08), history of child hospitalization (OR=2.57, %95CI: 1.4-63.05), tobacco use by parents (OR=2.09, %95CI: 1.20-3.64) and maternal awareness (OR=0.44, %95CI: 0.0-25.82) with children's developmental delay (Table 4).
Main comparison to the similar studies
The results showed that the highest and lowest rates of developmental delay were in the field of communication and the personal-social field, respectively. In the study of Soleimani et al. the highest and lowest rates of developmental delay in children were reported in the field of communication and the problem-solving field [8]. Also, in the study of Afraz et al. the highest and lowest rates of delay were reported in the large motor skills and personal-social areas, respectively [6]. Maternal age had a significant role in increasing the chance of developmental delay among the demographic variables, and the results of Karami et al.'s study are consistent with this study [26]. It was found that there was a significant relationship between the history of child hospitalization and developmental delay by examining the relationship between contextual variables and developmental delay in children. In the study of Gozashtehnegar Soltani et al. no significant relationship was found between the duration of hospitalization and developmental delay in the children [27]. …[28, 29]. The results of this study showed that non-use of iron drops does not have a significant effect on the development delay of children. However, in the study of Sidrak et al. It was reported that iron deficiency is more likely to be associated with developmental delays in children [30]. The use of tobacco products can affect the development of children. In the study of Jules et al. it was reported that the use of tobacco products by the mother can be associated with a decrease in scores of various areas of children's development [31]. …[32-35]. The rate of father and mothers' participation in activities such as reading books, playing, and painting with children were 29.8% and 69.7%, respectively. Sajedi et al. in their research concluded that 25.7% of parents never told a childish story to their child, and 11.4% of them had never sung to a child [33]. According to the results, the use of tablets and mobile phones in children with developmental delays was more than the control group. The study of Aghajani et al. showed that the type of play, use of toys, and playtime are related to the child's mental development including social skills and intelligence [36]. The results showed that there was no significant difference between the maternal care behaviors, and development delay. The results of the study of multiple indicators in the health and population area in 2010 are consistent with the results of this study [32]. …[37-42].
Suggestions
No cases have been suggested.
Limitations
One of the limitations of this study was the use of self-report. The data obtained by this method are affected by social acceptance and reminder bias. The case and control groups were matched based on the service provider center, and individual matching was not performed.
Conclusions
Mothers with children under the age of 5 need to be educated on various aspects of development and child care behaviors that protect children from developmental delays.
Acknowledgments
The authors thank the esteemed staff of the Comprehensive Center for Child Development of the Farshchian Sina Hospital and the Health Center of Hamedan for their cooperation in conducting this study.
Conflict of interest
The article is retrieved from the master's thesis in the field of health education and promotion (design number: 9712147833).
Ethical Permissions
The present study is approved by the Research Ethics Committee of Hamedan University of Medical Sciences with the ID of IR.UMSHA.REC.1397.881.
Funding Sources
The research was conducted with the financial support of the Vice-Chancellor for Research and Technology of Hamedan University of Medical Sciences.

TABLES and CHARTS

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