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Building capacity in neurodevelopment assessment of children in sub-Saharan Africa: A quality assurance model to
Horacio Ruiseñor-Escudero1, Itziar Familiar1, Mary Nyakato2
1a Psychiatry Department , Michigan State University , East Lansing , USA.
Insights
A new quality assurance (QA) model, QualiND, effectively supports standardized neurodevelopment (ND) testing in sub-Saharan Africa. This video-assisted model ensures high validity of tests like the KABC-II, even with minimally trained staff.
Area of Science:
- Global Health
- Developmental Psychology
- Clinical Research Methods
Background:
- Neurodevelopmental (ND) assessment challenges persist in sub-Saharan Africa due to the need for skilled personnel.
- Standardized ND testing is crucial for understanding child development but often impractical in low-resource settings.
Purpose of the Study:
- To introduce and evaluate the QualiND (Quality Assurance for Neurodevelopment) model for standardized ND testing.
- To assess the efficacy of the QualiND model in a multisite study involving children affected by HIV in Africa.
Main Methods:
- Implementation of the QualiND model, a multilevel, video-assisted, iterative QA system.
- Remote evaluation and feedback using video recordings of KABC-II (Kaufman Assessment Battery for Children, second edition) test administration.
- Centralized quality assurance with site-level action plans for addressing testing deficiencies.
Main Results:
- The QualiND model successfully managed 18 testers across 6 sites in 4 African countries.
- Over 97% of KABC-II tests administered were deemed valid by the centralized QA center.
- Few instances of invalid tests or barriers to test completion were observed.
Conclusions:
- The QualiND model provides a robust platform for remote supervision of non-specialist research staff in ND testing.
- This QA model is valuable for researchers and organizations conducting standardized child development assessments in low- and middle-income countries.
Abstract:
Compromised neurodevelopment (ND) among infants and children is prevalent in sub-Saharan Africa. Standardized testing of ND is frequently prohibitive in these contexts, as tests require skilled staff for their application. In this paper, we present a quality assurance (QA) model (QualiND) for standardized ND testing, discussing findings and implications from our experience applying the Kaufman Assessment Battery for Children second edition (KABC-II). The QualiND model was implemented within IMPAACT P1104s study, a multisite, prospective study including 615 children affected by HIV. From 2014 to 2016, the QualiND managed 18 testers across 6 sites located in 4 African countries applying the KABC-II in 9 local languages. The QualiND is a multilevel, video-assisted iterative model incorporating remote evaluation, feedback, and supervision roles. Using an ad hoc rubric, videos of test application were evaluated by experienced staff in a centralized QA center. At each study site, testers and supervisors reviewed feedback from videos received via email from the QA center and devised an action plan to address testing errors and deficiencies. There were few instances of invalid tests and few barriers to test completion. Over 97% of KABC-II tests across sites were considered to be valid by the QA center. Overall, the QualiND model was a useful platform for remote supervision to nonspecialist and minimally trained research staff. The QualiND model may be useful to researchers and organizations involved in measuring early child development using standardized tests in low and middle-income countries.
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