Developmental screening in South Africa : comparing the national developmental checklist to a standardized tool

Background: Worldwide, more than 200 million children in low- and middle-income countries have developmental delays and/or disabilities. In South Africa the only nationally implemented developmental 'screening' tool is integrated as part of 'The Road to Health Booklet (RTHB). Method: The study employed a comparative cross-sectional within-subject design to evaluate the accuracy of the RTHB developmental checklist against a standardized international tool i.e. the PEDS tools, consisting of the PEDS and PEDS: DM. A total of 201 participants were included through convenience sampling at primary health care facilities in Tshwane, South Africa. Results: Sensitivity of the RTHB developmental checklist is low, but specificity is high. The RTHB developmental checklist failed to identify more than half the infants at risk of delays or disorders. The nationally implemented developmental checklist is ineffective to identify at-risk infants. It should be adapted and validated or replaced in order to improve identification of at-risk infants

Early detection of communication delays with the PEDS tools in at-risk South African infants

Background: Prevalence of communication delays or disorders is increasing, possibly because of various environmental risk factors. Selection and implementation of effective screening tools are important to detect at-risk infants as early as possible. This study aimed to evaluate the accuracy of the Parents' Evaluation of Developmental Status (PEDS), PEDS-Developmental Milestones and PEDS tools to detect communication delays in infants (6-12 months) in a South African primary healthcare context. Method: A comparative study design evaluated the accuracy of the PEDS tools to detect communication delays, using an internationally accepted diagnostic assessment tool, the Rossetti Infant-Toddler Language Scale (RITLS). A convenience sample of 201 infants was selected at primary healthcare clinics. Results: Expressive and receptive language sensitivity scores were low across all three screens (ranging between 14% and 44%). The PEDS tools had high sensitivity (71%) and specificity (73%) ratings for the receptive and expressive language and socio-emotional domain in combination. Conclusion: In the sample population, the PEDS tools did not accurately detect receptive and expressive language delays; however, communication delays in general were identified. Future research determining accuracy of the PEDS, PEDS-Developmental Milestones and PEDS tools for children aged 2-5 years in detecting communication delays should be prioritised

Early detection of developmental delays in vulnerable children by community care workers using an mHealth tool

Developmental delays are increasing worldwide, as a result of exposure to environmental risk factors. Early detection services are often inaccessible in low- and middle-income countries (LMIC). An mHealth developmental screening programme with community care workers (CCWs) was investigated. CCWs administered a smartphone application to vulnerable families during home-based services. One-hundred and thirty-eight children were screened and those who failed were rescreened. CCWs completed a questionnaire regarding their perceptions of community-based mHealth-assisted screening. The overall referral rate was 69%. Older children (19–38 months old) had a significantly higher (p < .05; Chi-Square) referral rate (84%; n = 62) compared to those aged 0–18 months (52%; n = 33). CCWs perceived mHealth screening as valuable in terms of utility, outcomes and contribution to developmental knowledge for community members and CCWs. Community-based services are a promising platform to implement mHealth-assisted early developmental screening programmes. CCWs and mHealth-assisted developmental screening can facilitate better access to early detection and developmental surveillance for vulnerable populations.http://www.tandfonline.com/loi/gecd202019-12-04hj2019Speech-Language Pathology and Audiolog

Early detection of communication delays with the PEDS tools in at-risk South African infants

BACKGROUND : Prevalence of communication delays or disorders is increasing, possibly because of various environmental risk factors. Selection and implementation of effective screening tools are important to detect at-risk infants as early as possible. This study aimed to evaluate the accuracy of the Parents’ Evaluation of Developmental Status (PEDS), PEDS-Developmental Milestones and PEDS tools to detect communication delays in infants (6–12 months) in a South African primary healthcare context. METHOD : A comparative study design evaluated the accuracy of the PEDS tools to detect communication delays, using an internationally accepted diagnostic assessment tool, the Rossetti Infant-Toddler Language Scale (RITLS). A convenience sample of 201 infants was selected at primary healthcare clinics. RESULTS : Expressive and receptive language sensitivity scores were low across all three screens (ranging between 14% and 44%). The PEDS tools had high sensitivity (71%) and specificity (73%) ratings for the receptive and expressive language and socio-emotional domain in combination. CONCLUSION : In the sample population, the PEDS tools did not accurately detect receptive and expressive language delays; however, communication delays in general were identified. Future research determining accuracy of the PEDS, PEDS-Developmental Milestones and PEDS tools for children aged 2–5 years in detecting communication delays should be prioritised.The Mellon Foundation for funding the vulnerable children programme of the Faculty of Humanities, University of Pretoria, the COPC Living Laboratory of the University of Pretoria and the National Research Foundation.http://www.ajod.orgam2016Speech-Language Pathology and Audiolog

Risques associes a des retards de communication verbale chez les nourrissons des communautes sud-africaines non desservies

BACKGROUND :For optimal development young children need warm, responsive, enriched and communicative environments for learning social, language, and other skills. Infants and toddlers exposed to psychosocial risk lack enriched environments and may present with communication delays. AIM : To investigate the relationship between psychosocial risks and communication delays in infants from underserved communities in South Africa. SETTING : Primary healthcare facilities in Tshwane district, South Africa. METHODS : A parent interview and Rossetti Infant Toddler Language Scales were used to collect data from caregivers of 201 infants aged 6–12 months, selected through convenience sampling. Associations between communication delays and risks were determined (Chi-square and Fisher’s exact tests). A log-linear model analysis was used to model the simultaneous effect of significant risks on the probability of having communication delays. RESULTS : Communication delays were present in 13% of infants. Infants with two or more siblings, born from mothers aged 18–29 years who own their house, had a 39% chance of presenting with communication delays. CONCLUSION : Developmental screening and early intervention is important in primary healthcare contexts in South Africa, as a clear relationship has been established between three risk factors and communication delays in infants.CONTEXTE : Pour s’épanouir complètement les jeunes enfants ont besoin d’un environnement chaud, réceptif, enrichi et communicatif pour apprendre le langage social et d’autres compétences. Les nourrissons et les tout-petits exposés à des risques psychosociaux souffrent d’un manque d’environnements enrichissants et pourraient souffrir de retards de communication verbale. OBJECTIF : Pour étudier la relation entre les risques psychosociaux et les retards de communication verbale chez les nourrissons des communautés non desservies en Afrique du Sud. LIEU : Services de soins primaires dans le district de Tshwane, en Afrique du Sud. METHODES : Une entrevue avec les parents et l’Echelle de Compétence linguistique pour les Nourrissons de Rossetti ont été utilisés pour rassembler les données de 201 nourrissons de 6 à 12 mois provenant de leurs gardiens, sélectionnés au moyen d’échantillonnages de proximité. On a remarqué un lien entre les retards et les risques de communication verbale (tests Chi carré et de Fisher). On a utilisé un modèle d’analyse log-linéaire pour modéliser l’effet simultané des risques importants sur la probabilité d’avoir des retards de communication verbale. RESULTATS : On a trouvé des retards de communication verbale chez 13% des nourrissons. Les nourrissons qui vivent avec deux frères ou soeurs ou plus, nés de mères âgées de 18 à 29 ans qui ont leur propre maison, avaient 39% plus de chance d’avoir des retards de communication verbale.http://www.phcfm.orgam201

Management of an Early Detection Program: Supporting Helpful Features

Purpose of Review Young children and families need access to a system that can efficiently identify delay and/or disability. However, challenges exist in many communities where early detection efforts are mismanaged. The goal of this article is to describe current challenges with the management of an effective screening program, and describes possible management solutions. Recent Findings We found that a process-based model often used in the field of business can offer a useful heuristic for health, education, and social service fields engaged in early detection of delay/disability in early childhood. Summary In addition to offering a management model, we conclude with a sample case study providing illustrating family and professional collaboration in the early identification process

Detecting developmental delays in infants from a low-income South African community : comparing the BSID-III and PEDS tools

Detecting developmental delays is essential for early intervention in low to middle-income countries. A cross-sectional, within-subject, comparative design was employed to determine the performance of the Parents Evaluation of Developmental status (PEDS) tools smartphone application and the Bayley Scales of Infant and Toddler Development III (BSID III) to detect developmental delays in 174 young children aged 3–18 months. Data were collected at a primary healthcare (PHC) clinic in an underserved high-risk community in South Africa. The PEDS tools identified 56% (n = 97), and the BSID-III 35% (n = 61) of the 158 children with possible developmental delays, with an overall agreement of 65% between tests. The PEDS tools referral rate was significantly higher (p = 0.004) than that of the BSID-III. The high-risk nature and age group may have contributed to poor agreement across tools. A combination of tools for screening and assessment in infants in a South African PHC context may be necessary.http://www.tandfonline.com/loi/gecd202020-12-12hj2019Speech-Language Pathology and Audiolog

Developmental screening-evaluation of an m-Health version of the parents evaluation developmental status tools

BACKGROUND : Developmental delays are more prevalent in low-income countries and access to developmental screening is severely limited. INTRODUCTION : This study evaluated an m-Health version of a standard developmental screening tool, Parents Evaluation Developmental Status (PEDS) and PEDS: Developmental Milestones (PEDS:DM) for use by community health workers (CHWs) in terms of (1) correspondence with conventional paper-based testing by a speech language pathologist (SLP) and (2) inter-rater reliability compared to an SLP. METHOD : CHWs were trained in a primary healthcare (PHC) setting to administer the newly developed smartphone application version of the PEDS tools. One SLP and two CHWs recruited 207 caregivers who were attending a baby wellness clinic. Caregivers were tested by one CHW using the smartphone application of the PEDS tools; a qualified SLP simultaneously recorded and scored the PEDS tools on the same participants. RESULTS : High positive (100%) and negative correspondence (96%) was found between the paper-based PEDS tools and the smartphone application PEDS tools and between the SLP and CHW. Almost perfect (Cohen’s Kappa) inter-rater agreement between conditions was demonstrated (j = 0.873 to j = 0.961). CONCLUSION : Outcomes of the smartphone application, operated by a CHW, corresponded closely to the gold standard PEDS tools operated by a health professional. Trained CHWs can conduct accurate developmental screening using the smartphone version of the PEDS tools.http://online.liebertpub.com/TMJ2017-12-30Speech-Language Pathology and Audiolog

Early childhood development and iranian parents' knowledge: A qualitative study

Background: Early childhood is the most important step throughout the lifespan and it is a critical period continuing to the end of 8-year-old. Mothers' knowledge is one of the important aspects of child development. The goals of this study were to determine the situation of knowledge in Iranian parents about the concept and the importance of early childhood development (ECD) and determining the sources of parental knowledge about ECD from the perspective of parents and grandparents. Methods: This qualitative study was conducted based on the directional content analysis in 2016. The purposive sampling method is utilized to select 24 participants among parents and grandparents in Tehran. The inclusion criteria consisted of speaking in Persian and having a child or grandchild <3-year-old. Data were collected through four focus group discussions and four individual interviews. Results: Iranian parental knowledge about integrative ECD is not enough, their knowledge about motor development and speech and language are relatively better, about cognitive development is little and socialemotional is very little. They said parents and other caregivers influence the process of children's development. Parents' knowledge resources about ECD included human resources, physical resources, virtual space, and the media. According to the majority of participants, “pediatricians are the most reliable source of parents' knowledge about ECD” even though the main focus of pediatricians is on treating diseases, physical health, and growth of children. Conclusions: According to the results, the knowledge of Iranian parent is not enough about ECD; therefore, actions must be taken to increase their knowledge in these domains. Parents look for reliable and valid sources to enhance their knowledge and they rely the most on pediatricians in this regard. Therefore, more studies on assessing parents' knowledge in community and the practical methods for knowledge promotion in this field is recommended

Developmental Screening—Evaluation of an m-Health Version of the Parents Evaluation Developmental Status Tools

BACKGROUND : Developmental delays are more prevalent in low-income countries and access to developmental screening is severely limited. INTRODUCTION : This study evaluated an m-Health version of a standard developmental screening tool, Parents Evaluation Developmental Status (PEDS) and PEDS: Developmental Milestones (PEDS:DM) for use by community health workers (CHWs) in terms of (1) correspondence with conventional paper-based testing by a speech language pathologist (SLP) and (2) inter-rater reliability compared to an SLP. METHOD : CHWs were trained in a primary healthcare (PHC) setting to administer the newly developed smartphone application version of the PEDS tools. One SLP and two CHWs recruited 207 caregivers who were attending a baby wellness clinic. Caregivers were tested by one CHW using the smartphone application of the PEDS tools; a qualified SLP simultaneously recorded and scored the PEDS tools on the same participants. RESULTS : High positive (100%) and negative correspondence (96%) was found between the paper-based PEDS tools and the smartphone application PEDS tools and between the SLP and CHW. Almost perfect (Cohen’s Kappa) inter-rater agreement between conditions was demonstrated (j = 0.873 to j = 0.961). CONCLUSION : Outcomes of the smartphone application, operated by a CHW, corresponded closely to the gold standard PEDS tools operated by a health professional. Trained CHWs can conduct accurate developmental screening using the smartphone version of the PEDS tools.http://online.liebertpub.com/TMJ2017-12-30Speech-Language Pathology and Audiolog