Social inequalities and nurturing care determinants of early language developmental delay among Ecuadorian children aged 12–42 months

OBJECTIVES: Early language development is a key indicator of child well-being and is influenced by social, environmental, and biological factors. The study aimed to estimate the prevalence of language developmental delay and identify associated factors among Ecuadorian children aged 12-42 months. STUDY DESIGN: Cross-sectional analytical study using nationally representative survey data. METHODS: Cross-sectional analytical study using data from the 2018 Ecuadorian National Health and Nutrition Survey (ENSANUT). We included a nationally representative sample of 8446 children aged 12-42 months. Language delay was defined as scores below the 10th percentile on the MacArthur-Bates Communicative Development Inventories using age- and sex-specific national reference curves. Survey-weighted logistic regression models assessed associations according to the UNICEF early childhood development framework. RESULTS: The prevalence of language developmental delay was 14.5%. Delay was associated with male sex (aOR 1.46, 95% CI 1.18-1.81), increasing age (aOR 1.03 per month, 95% CI 1.02-1.05), prematurity (aOR 1.38, 95% CI 1.04-1.84), and greater daily screen exposure (aOR 1.07 per hour/day, 95% CI 1.01-1.15). Protective factors included higher HOME stimulation (aOR 0.61, 95% CI 0.48-0.79), playing with ≥3 toy types (aOR 0.75, 95% CI 0.57-0.98), and more children's books (aOR 0.90 per book, 95% CI 0.84-0.96). Structural socioeconomic factors were not significant. CONCLUSIONS: Approximately one in seven Ecuadorian children aged 12-42 months experienced language developmental delay. Lower home stimulation, fewer children's books, limited play opportunities, greater screen exposure, prematurity, male sex, and older age were independently associated with delay.