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A new approach for neurological evaluation of infants in resource-poor settings
Leena Haataja1, Rose McGready, Ratree Arunjerdja
1Department of Paediatrics, Imperial College, Hammersmith Hospital, London, UK.
Insights
Two new, simple neurological assessments were developed for infants in resource-limited settings. The Shoklo Neurological Test and Shoklo Developmental Test show good correlation with established measures, aiding infant neurodevelopmental research.
Area of Science:
- Pediatric Neurology
- Global Health
- Developmental Psychology
Background:
- Limited availability of standardized, field-usable neurological assessment tools for infants in developing countries.
- Need for assessments to evaluate acute neurological disturbances and long-term neurodevelopmental sequelae in infants.
Purpose of the Study:
- To develop and validate two simple, easily administered neurological assessments for infants in resource-constrained environments.
- To assess acute neurological disturbances (Shoklo Neurological Test) and track neurodevelopmental outcomes (Shoklo Developmental Test).
Main Methods:
- Development of the Shoklo Neurological Test (9-36 months) and Shoklo Developmental Test (3-12 months).
- Field testing in infants from a Karen refugee camp by trained health workers in rural conditions.
- Validation against the Griffiths Developmental Scales in both refugee and London infant cohorts.
Main Results:
- Both Shoklo tests were successfully developed and administered in non-optimal field conditions.
- The Shoklo Neurological Test and Shoklo Developmental Test demonstrated good correlation with the Griffiths Developmental Scales.
- The assessments proved suitable for evaluating both acute neurological issues and later developmental sequelae.
Conclusions:
- The Shoklo Neurological Test and Shoklo Developmental Test provide valuable, accessible tools for infant neurodevelopmental assessment in diverse settings.
- These validated assessments can significantly improve research and clinical monitoring of infant neurological health globally.
- The development addresses a critical gap in pediatric research methodology for low-resource areas.
Abstract:
Research assessing the neurological development of infants in developing countries is scanty as no suitable standardised tests are available for field-use in constrained circumstances. We describe the development and application of two simple assessments. Firstly, we aimed to develop a test suitable for assessing acute neurological disturbances caused by such diverse effects as infections, drugs or toxins. This test (Shoklo Neurological Test) is aimed at infants between 9 and 36 months. The second test (Shoklo Developmental Test) is aimed not only to follow the evolution of the signs tested initially in the acute phase but also to evaluate later neurodevelopmental sequelae which might be caused by the same events. The latter test is suitable for infants aged from 3 to 12 months. Both tests can be performed easily in non-optimal conditions. The examinations were tested in a cohort of infants from a Karen refugee camp and administered in a rural setting by health workers, after appropriate training. In order to validate the tests we also applied them to a cohort of London infants. The Griffiths Developmental Scales were applied in the same infants and both the Shoklo Neurological and the Shoklo Developmental Tests showed good correlation with this standardised neurodevelopmental assessment.