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Validation of a home-based neurodevelopmental screening tool for under 2-year-old children in Bangladesh
N Z Khan1, H Muslima, A B Shilpi
1Child Development Centre, Department of Paediatric Neuroscience, Dhaka Shishu Children's Hospital, Sher-e-Bangla Nagar, Bangladesh. naila.z.khan@gmail.com
Insights
A new screening tool effectively identifies young children at risk for neurodevelopmental impairments (NDIs) in Bangladesh. The Developmental Screening Questionnaire shows high accuracy, especially for vision and hearing, aiding early intervention services.
Area of Science:
- Global child health
- Developmental pediatrics
- Public health screening
Background:
- Home-based screening is crucial for early identification of neurodevelopmental impairments (NDIs) in young children in Bangladesh.
- Targeting intervention services requires validated tools for children under two years.
Purpose of the Study:
- To validate the Developmental Screening Questionnaire for identifying children under 2 years at risk for NDIs.
- To assess the tool's reliability and validity in an urban Bangladeshi community.
Main Methods:
- Administered the Developmental Screening Questionnaire to mothers of children aged 0-<2 years.
- Assessed screen-positive children and a sample of screen-negative children for NDIs by professionals.
- Calculated inter-rater reliability, sensitivity, and specificity.
Main Results:
- High inter-rater reliability (kappa=0.95) and excellent specificity (84-100%) across developmental domains.
- Identified 17% of screened children as positive; screen-positivity varied by income and was higher in stunted children.
- Achieved 100% sensitivity for vision/hearing, 70% for speech, and 45-63% for other domains.
Conclusions:
- The Developmental Screening Questionnaire demonstrates potential for frontline workers to screen large populations for NDIs.
- The tool effectively identifies children with vision, hearing, and speech impairments, and shows promise for other developmental domains.
- This validated tool can guide the targeting of essential child neurodevelopmental intervention services.
Background:
Home-based screening to identify young children at risk for neurodevelopmental impairments (NDIs) is needed to guide the targeting of child neurodevelopmental intervention services in Bangladesh. This study aimed to validate such a tool for children under age 2 years.
Methods:
A Developmental Screening Questionnaire was administered to mothers of children aged 0-<2 years in an urban community. Inter-rater reliability among the interviewers, who were high school graduates, was determined. All children who were screen positive and a proportion of screen negatives were subsequently assessed for NDIs by professionals. Sensitivity and specificity were calculated by comparing screening with assessment results.
Results:
Mean kappa coefficient of agreement among interviewers was 0.95. A total of 197 children were screened, of whom 17% screened positive. Fifty-one children, including 24 screen negatives, were assessed for NDIs. Screen-positivity was significantly different between income groups (P = 0.019), and higher in stunted children (odds ratio = 5.76, 95% confidence interval = 1.72-19.28), indicating good discriminant validity Specificity was excellent (84-100%) for all developmental domains. Sensitivity was 100% for vision and hearing; 70% for speech; and 63%, 53%, 48%, and 45% for gross motor, behaviour, fine motor and cognitive impairments, respectively.
Conclusion:
A tool for screening <2-year-old children at risk for NDIs showed high specificity; and was able to identify all children at risk for vision and hearing impairments, nearly three-fourths with speech impairments, two-thirds with gross motor impairments, and about half with behavioural, cognitive and fine motor impairments. The Developmental Screening Questionnaire tool has potential for use by frontline workers to screen large populations and to link to definitive assessment as well as intervention services.
