Determinants of early child development among children aged 24-59 months in Ethiopia: 2024-25 Demographic and Health Survey

Background: The 2024-25 Ethiopia Demographic and Health Survey (EDHS) is Ethiopia's first national survey to measure early childhood development using UNICEF's Early Childhood Development Index 2030 (ECDI2030). This provides a national estimate for Sustainable Development Goal (SDG) indicator 4.2.1, the proportion of children aged 24-59 months who are developmentally on track. We estimated the prevalence of being developmentally on track and examined its child, maternal, household and community determinants in Ethiopia. Methods: This cross-sectional study analysed 3,731 children aged 24-59 months (weighted n = 3,514) of 3,232 mothers in 771 clusters. Children were on track if they achieved the age-specific minimum number of the 20 ECDI2030 milestones. Prevalence was estimated with design-based methods. Four three-level mixed-effects logistic regression models (children within mothers within clusters) were fitted, and interviewer effects were assessed. Results: Overall, 36.3% (95% CI 33.4-39.3) of children were developmentally on track. Prevalence ranged from 23.3% in Southwest Regional State, Ethiopia, to 77.7% in Addis Ababa. In the null model, 21.5% of the variation lay between clusters (median odds ratio 3.24). In the final model, the odds of being on track were lower at 36-47 months (adjusted odds ratio [AOR] 0.57, 95% CI 0.44-0.74) and 48-59 months (AOR 0.39, 0.30-0.51) than at 24-35 months. They were also lower after a preceding birth interval under 24 months (AOR 0.75, 0.57-0.99), after recent diarrhoea, fever or cough (AOR 0.59, 0.45-0.77), and where distance to a health facility was a big problem (AOR 0.61, 0.48-0.79). Odds were higher for girls (AOR 1.38, 1.12-1.70), with maternal education (more than secondary vs none: AOR 2.08, 1.19-3.63) and with weekly media exposure (AOR 2.15, 1.51-3.06). The covariates explained 55.9% of the between-cluster variance. Conclusions: Nearly two in three Ethiopian children aged 24-59 months are not developmentally on track, and children fall further behind as they age. Interventions should target maternal education, access to information and health services, birth spacing and childhood illness, with priority for the lowest-performing regions and communities.