Factors Associated with Being On Track for Early Childhood Development in Kinshasa: A Community-Based Cross-Sectional Study

Background: Early child development is strongly shaped by household socioeconomic conditions and child health. We examined associations between household socioeconomic status (SES), child nutrition, and developmental status using the Early Childhood Development Index 2030 (ECDI2030) among children aged 24–59 months in the Mont Ngafula health zone in Kinshasa. Methods: We performed a crosssectional analysis of 348 children (analytical n = 302 for multivariable models). The outcome was being developmentally “on track” (ONTRACK) by ECDI2030. Key exposures included SES (tertiles: poor, middle, rich) and stunting (binary). We estimated unadjusted prevalences and fitted multivariable logistic regression models adjusted for child age, sex, respondent sex, caregiver education, household size, improved water and sanitation, wasting, and a continuous individual dietary diversity score (IDDS). Sensitivity analyses used multiple imputations (20 imputations) for missing anthropometry measurements. The model diagnostics included VIF, Hosmer–Lemeshow, linktest, and classification metrics. Findings: Overall, 245/348 children (70.4%) were classified as on track. ONTRACK prevalence rose across SES tertiles (poor 59.5%, middle 69.8%, rich 81.9%; Pearson χ2 = 14.01, p = 0.001). In the adjusted analyses (n = 302), children who attended preschool education had higher odds of being on track (aOR 4.77, 95% CI 2.23–10.21, p < 0.001). The children in the rich tertile had higher odds of being on track than those in the poor tertile (adjusted odds ratio [aOR] 3.15, 95% CI 1.55–6.41, p = 0.002); the middle tertile showed a weaker association (aOR 1.80, 95% CI 0.97–3.33, p ≈ 0.062). Child age categories (36–47 months: aOR 0.55, 95% CI 0.31–0.96, p = 0.037; 48–59 months: aOR 0.26, 95% CI 0.12–0.56, p = 0.001) and stunting (aOR 0.42, 95% CI 0.20–0.89, p = 0.024) were inversely associated with being developmentally on track. These results were found to be consistent with the multiple imputation sensitivity analyses. Interpretation: Preschool attendance and a higher household socioeconomic position are strongly associated with better early developmental outcomes, while an age of 48–59 months and stunting are associated with a markedly lower likelihood of being developmentally on track. Integrated policies that reduce household poverty, promote early education, and prevent/treat early faltering growth could improve early childhood developmental trajectories.