Developmental health and vulnerability among young children in Pakistan: Findings from a large-scale early childhood development assessment in Karachi

• We found that one in four children in Pakistan was at risk of poor development. • The risk of developmental vulnerability was higher for boys and subgroups of children who experienced social disadvantages. • Findings emphasize the need for universal and targeted interventions to reduce childhood vulnerability in Pakistan. Assessing and supporting early childhood development is a global priority—however, our understanding of the developmental health of young children from Lower and Middle-Income Countries (LMICs), including Pakistan remains limited. Using an Urdu translation of the Early Years Development Instrument (EDI), this study assessed the developmental health and vulnerability of 9,372 kindergarten-aged children ( Mean age = 6.2; SD = 1.1; 53.9 % female) in 397 schools in Karachi, Pakistan. We also examined differences in vulnerability in physical, social-emotional and cognitive domains based on the children’s gender, family income, and ethnic background. Results from logistic regression analyses revealed that 10 % of children were vulnerable in each developmental domain, and 28 % were vulnerable in one or more domains. Boys, children from low-income families, and children with ethnic minority backgrounds were more likely to be vulnerable in any of the domains. The findings highlight that children in our study who experienced social disadvantages were more likely to be developmentally vulnerable, which may negatively impact their further development and success in school. Our findings underscore the need for universal and targeted interventions to reduce childhood vulnerability in Pakistan. This includes supporting at-risk subgroups of children and promoting equity from an early stage in life.