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Identifying children with neurological impairment and disability in resource-poor countries
V Mung'ala-Odera1, C R J C Newton
1Center for Geographic Medicine-Coast, Kenya Medical Research Institute, P.O. 428 Kilifi, Kenya. vodera@kilifi.kemri-wellcome.org
Insights
Identifying neurological impairment (NI) in children in resource-poor countries (RPCs) is challenging due to inadequate detection methods. House-to-house surveys show promise but are costly, while other methods lack sensitivity for accurate burden assessment.
Area of Science:
- Global Health
- Pediatric Neurology
- Public Health Surveillance
Background:
- The prevalence and impact of neurological impairment (NI) in children within resource-poor countries (RPCs) remain largely unquantified.
- Existing case detection methods in RPCs are often unsuitable, lacking the required simplicity, cost-effectiveness, and accuracy.
- Effective identification strategies are crucial for understanding and addressing the burden of childhood NI in these settings.
Purpose of the Study:
- To review and evaluate the effectiveness and suitability of various methods for identifying children with neurological impairment and disability in RPCs.
- To assess the strengths and limitations of different diagnostic and screening approaches in low-resource contexts.
- To inform the development of more appropriate and accurate methods for NI detection in RPCs.
Main Methods:
- A comprehensive literature search was conducted using PubMed and Medline, supplemented by bibliographies of reviews and reports from international organizations (WHO, UN).
- Studies were included if performed in RPCs, provided detailed data for reanalysis, and reported on the cost and validity of identification methods.
- Key search terms included impairment, disability, identification, screening, prevalence, and developing countries.
Main Results:
- Methods like national censuses and key informant approaches demonstrate low sensitivity and limited diagnostic detail.
- House-to-house surveys using questionnaires exhibit high sensitivity (63-100%) for impairment detection but are expensive and impractical for large-scale population assessment.
- The sensitivity of these methods decreases for specific domains, such as cognitive impairments.
Conclusions:
- Current methods for identifying NI or disability in children in RPCs are frequently inadequate, characterized by low sensitivity and underreporting.
- Nationwide censuses combined with targeted regional surveys may offer a viable approach for burden assessment, but require further validation.
- There is a critical need for validated, sensitive, and cost-effective methods to accurately determine the burden of childhood neurological impairment in resource-poor settings.
Background:
The burden of neurological impairment (NI) in children living in resource-poor countries (RPCs) is unknown. This lack of data is caused by inappropriate case detection techniques. In RPCs, the most appropriate method should be inexpensive, simple, rapid and accurate. This article reviews methods used to identify children with NI and disability in RPCs, evaluating their effectiveness and suitability.
Methods:
A search of relevant articles was performed using the National Library of Medicine via PubMed and Medline search engines. In addition, bibliographies of reviews were also browsed to identify additional articles, particularly those from World Health Organization and United Nations sources and from government and unpublished reports. Key phrases used included impairment, disability or handicap and the following terms: identification, screening, prevalence and developing countries. Studies included were those that fulfilled the following criteria; performed in RPCs, presented data in detail to allow reanalysis and provided data on cost and validity of the methods.
Results:
Use of the national census, key informants and methods using rapid rural appraisal have low sensitivity and are not able to provide adequate information on diagnostic categories or risk factors. House-to-house surveys using questionnaires have high sensitivities (63-100%) in the detection of impairment, but this approach remains relatively expensive and cannot be applied to an entire population (e.g. a region or country) and is thus less useful for assessing the needs of disability. Furthermore, the sensitivity is decreased in the detection of some domains, e.g. cognition.
Conclusions:
Most of the approaches used for identifying individuals with NI or disability suffer from inadequacies, the main ones being low sensitivity and underreporting. To assess the burden, nationwide censuses combined with surveys in selected areas of the country may be useful. These systems, however, require validation to establish their suitability.
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