Validation and adaptation of rapid neurodevelopmental assessment instrument for infants in Guatemala

• Published in: Child : care, health & development Vol. 41; no. 6; pp. 1131 - 1139
• Main Authors: Thompson, L., Peñaloza, R. A., Stormfields, K., Kooistra, R., Valencia-Moscoso, G., Muslima, H., Khan, N. Z.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.11.2015
• Subjects: At risk; Babies; Bangladesh; Child development; Children; Clinical assessment; Cognition; Community health workers; Convulsions & seizures; Cross-Sectional Studies; Detection; developmental disabilities; Developmental Disabilities - diagnosis; Disability; Female; Guatemala; Health services; Hearing; Households; Humans; Indigenous peoples; Infant; Infants; Interrater Reliability; Latin America; Male; Malnutrition; Mass Screening - methods; Maya (People); Mayans; Medical screening; Motor development; Neurological disorders; poverty; Predictive validity; Predictive Value of Tests; Referral; Reflexes; Reliability; Reproducibility of Results; Risk assessment; Rural communities; Rural Population; Speech; Toddlers; Validity; Women; Young Children; Guatemala; Bangladesh; developmental disabilities; malnutrition; poverty; infant; community health workers; Latin America
• ISSN: 0305-1862; 1365-2214
• DOI: 10.1111/cch.12279

Background Timely detection of neurodevelopmental impairments in children can prompt referral for critical services that may prevent permanent disability. However, screening of impairments is a significant challenge in low‐resource countries. We adapted and validated the rapid neurodevelopmental assessment (RNDA) instrument developed in Bangladesh to assess impairment in nine domains: primitive reflexes, gross and fine motor development, vision, hearing, speech, cognition, behaviour and seizures. Methods We conducted a cross‐sectional study of 77 infants (0–12 months) in rural Guatemala in July 2012 and July 2013. We assessed inter‐rater reliability and predictive validity between the 27‐item RNDA and the 325‐item Bayley Scales of Infant and Toddler Development, Third Edition (BSID‐III) and concurrent validity based on chronic malnutrition, a condition associated with neurodevelopmental impairments. For both RNDA and BSID‐III, standardized scores below 80 were defined as borderline impairment. Results Children came from rural households (92%), were born to indigenous women of Mayan descent (73%) and had moderate or severe growth stunting (43%). Inter‐rater reliability for eight RNDA domains was of moderate to high reliability (weighted κ coefficients, 0.49–0.99). Children screened positive for impairment in fine motor (17%) and gross motor (14%) domains using the RNDA. The RNDA had good concurrent ability; infants who were growth stunted had higher mean levels of impairment in gross motor, speech and cognition domains (all p < 0.001). The RNDA took 20–30 min to complete compared with 45–60 min for BSID‐III. Conclusions Wide‐scale implementation of a simple, valid and reliable screening tool like the RNDA by community health workers would facilitate early screening and referral of infants at‐risk for neurodevelopmental impairment.