Project Lead(s): Aarti Kumar
Issue
In developing countries, more than 200 million children aged five years or under fail to reach their developmental and cognitive potential.
Early identification of children at risk for developing neurodevelopmental impairments, and timely and locally relevant interventions – both behavioural and therapeutic – can prevent and mitigate impairments, but scalable public health solutions remain a challenge.
Solution
The team sought to develop and assess the potential of a tablet-based application for lay health workers to assess the neurodevelopmental status of children between birth and two years, and to act as a decision support tool to advise parents for necessary intervention.
The goal of the intervention was early identification of problems so that timely interventions could prevent permanent impairment.
The team began by compiling existing tools for neurodevelopmental assessment in the age range of birth to two years. These tools included both open tools (like the Kilifi Development Inventory and the Malawi Development Assessment Tool (MDAT)) as well as proprietary tools (such as Ages and Stages-III, Bayley Scales – BSID-II, Mullens Scales, etc.)
A composite developmental checklist was created consisting of items for multiple sources in the following domains: gross motor, fine motor, communication, cognitive development, personal-social and activities for daily living.
The app was piloted with 96 babies in the age range of birth to 24 months.
A media repository consisting of photographs and videos of developmental milestones was also compiled to aid parental reporting.
Outcome
The project successfully created a platform to link developmental assessment to behavioural risk factors and corresponding interventions at the level of lay health workers.
While current community-based assessment tools are used primarily for measurement, and have seldom led to interventions, assessment-linked intervention is an effective model that also facilitates behaviour change at the family level.
Six community-based workers trained on developmental assessment of babies up to 18 months, as well as behavioural assessment and counseling of families, conducted the assessment of 224 babies using the app.
They successfully identified children at risk and provided counseling to 217 families regarding one or more behavioural risk factors, including nutrition (especially complementary feeding), hygiene, developmental stimulation, interaction (including responsivity and communication) and setting up a conducive home environment for child development.
In order to successfully address a broader gamut of risk factors for early child development, the assessment-linked intervention paradigm of the app needs to be extended in both directions, i.e., for pregnancy and possibly pre-conception, as well as for babies in the 18–36 month range. This is linked to the objectives of an existing grant from Grand Challenges Canada (1000 Dreams).
Based on the findings of the 1000 Dreams study, the team will apply for Transition to Scale funding.