Validation and adaptation of rapid neurodevelopmental assessment instrument for infants in Guatemala
L Thompson1, R A Peñaloza1, K Stormfields1
1Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, USA.
Insights
Early detection of neurodevelopmental impairments in infants is crucial. The Rapid Neurodevelopmental Assessment (RNDA) tool showed good reliability and validity in rural Guatemala, offering a faster screening option.
Area of Science:
- Global child health
- Developmental pediatrics
- Public health interventions
Background:
- Early detection of neurodevelopmental impairments is vital for timely intervention and preventing long-term disability.
- Screening for these impairments presents a significant challenge in low-resource settings.
- The Rapid Neurodevelopmental Assessment (RNDA) tool was adapted and validated for assessing nine developmental domains.
Purpose of the Study:
- To adapt and validate the Rapid Neurodevelopmental Assessment (RNDA) instrument in rural Guatemala.
- To assess the reliability and validity of the RNDA compared to the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III).
- To evaluate the RNDA's concurrent validity with chronic malnutrition.
Main Methods:
- A cross-sectional study involving 77 infants aged 0-12 months in rural Guatemala.
- Assessed inter-rater reliability and predictive validity of the RNDA against BSID-III.
- Evaluated concurrent validity using chronic malnutrition as a marker for neurodevelopmental impairment.
Main Results:
- The RNDA demonstrated moderate to high inter-rater reliability across eight domains.
- Prevalence of impairment detected by RNDA: 17% in fine motor and 14% in gross motor domains.
- RNDA showed good concurrent validity, with growth-stunted infants exhibiting higher impairment levels in gross motor, speech, and cognition (p < 0.001).
- RNDA completion time (20-30 min) was significantly shorter than BSID-III (45-60 min).
Conclusions:
- The RNDA is a simple, valid, and reliable screening tool for infants.
- Community health worker implementation of the RNDA can facilitate early identification and referral of at-risk infants.
- Widespread use of the RNDA can improve developmental outcomes in low-resource settings.
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.
