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Item type Presentation

Format Text-based Document

Title Selecting an Early Child Development Assessment Tool inRural Limpopo, South Africa

Authors Milbrath, Gwyneth Rhiannon; Ogendi, Audrey; Compton,Madison B.; Gopinath, Vidya V.; Constance, Claire M.

Downloaded 31-May-2018 08:23:35

Link to item http://hdl.handle.net/10755/603206

Selecting an Early Child Development Assessment Tool in

Rural Limpopo, South Africa

Gwyneth Rhiannon Milbrath, RN MSN MPH

University of Virginia School of Nursing

University of Northern Colorado

Co-Authors: Claire Constance, Vidya Gopinath, MD, Audrey Ogendi, Madison Compton

University of Virginia

Research Questions

• Purpose – to compare the acceptability and feasibility of two pediatric assessment tools (ASQ and CAT/CLAMS) to track child development in a rural health district in Limpopo, South Africa. – Is a child development monitoring program feasible in

this community?– What is the most appropriate child development

assessment tool?– What is the perception of local public health nurses

about the importance of child development?– What are the barriers to implementing a child

development project in this community?

Limpopo, South Africa

• Population – 1.3 million

• 93% use public health care

• 38.7% unemployment

• Language -Tshivenda (69%) and Xitsonga (27%)

• 15% of households have running water

• Health care – 112 clinics, 8 community health centers, 6 public hospitals

Water and Health in Limpopo

Child Brain Development

• Brain development is most rapid during the first years of life

• Interruptions in these processes can effect the brain’s capacity to learn and function

• Four Major Areas of Development– Motor– Language– Adaptive/Cognitive– Personal/Social

• Developmental Delay - a child who is unable to reach certain developmental milestones at the expected age, after accounting for individual variations in development

Risk Factors for Developmental Delay

• Inadequate cognitive stimulation

• Stunted grown

• Nutritional deficiencies

• Intrauterine growth restriction

• Malaria

• Lead exposure

• Maternal Depression

• Exposure to Violence

• Low Parental Education

• Commanding Parenting Styles

• Mental Health Problems in Parents

• Single Parents

• Multiple Siblings

• Poor Social Support

• Minorities

Protective Factors for Developmental Delay

• Early interventions

• Maternal Education

• Community Support

• Maternal Attachment

Screening for Developmental Delay

• Most delays are detectable between 6 – 32 months

• Recommended routine, repeated screening

• Clinical judgment alone is not sensitive to Developmental delay

• The United States uses over 20 developmental screening tools – not validated in developing countries

Ages and Stages (ASQ)

• Screening for ages 2-66 months assessing gross motor, fine motor, communication, problem solving, personal-social

• Self-report from caregivers, completed at home prior to clinic visit– Administration time approximately 15 minutes

• ASQ used in US, Turkey, Holland, Brazil, Korea, Taiwan– No use in sub-Saharan Africa

• ASQ correlated well with Bayley Scales

CAT/CLAMS

• Screening up to 36 months assessing cognitive and language skills

• Uses instruments (toys) to directly observe child’s abilities during the clinic visit– Administration time 15 – 20 minutes

• Originally developed for screening high-risk children, used now in general populations

• Assessment builds on previously completed tasks

Methodology

• Two focus groups of public health nurses in Limpopo • What did you like about the assessment tool?• What was difficult or challenging about the assessment

tool?• How confident do you feel using the assessment tool on

a child in your clinic?• How do you see this assessment tool fitting into your

work with young children in the clinics?

• Qualitative analysis using versus coding was used to compare ASQ versus CAT/CLAMS and Group 1 versus Group 2

Data Analysis

• Transcripts and field notes from focus groups• Versus Coding

– Group 1 vs Group 2– ASQ vs CATCLAMS

• Codes were grouped into categories and clustered into themes– 150 unique data – 16 codes– 6 categories– 2 themes

Current Practice

• No system for screening children for developmental delay

• “Road to Health” card

• Knowledge deficit

• Delay of care

Usability

CAT/CLAMS• Calculates developmental

score• Well suited for hospital or

school environment• Feasible for use in clinic work

flow • Described as costly, time

consuming, and difficult to calculate

• Score calculation is moderately challenging

• Better suited for low-volume days

Ages and Stages• Described as easy, practical,

uncomplicated, and simple• Uncomplicated administration• Visual graph to show where a

child falls in relation to “cut off” scores

• Identified as primary assessment tool

• Feasible for use in clinic work flow

• Requires assessor to be literate• Score calculation is mildly

challenging

Resource Management

CAT/CLAMS

• High cost of toys

• Long administration time

Ages and Stages

• Low cost

• Utilization of CHW

• Minimal time commitment for nurses

• Cost of copying assessment surveys

• Insufficient numbers of CHW to complete home assessments

Cultural Adaptations

CAT/CLAMS

• Moderate amount of translating needed

• Expensive toys which are not all culturally appropriate

Ages and Stages

• Substantial amount of translating needed

• Poor access to copiers and printers

• Requires cultural modification of survey assessment questions

Patient and Parent Factors

CAT/CLAMS• Direct observation of child’s

abilities• Can use toys to teach mothers

about meaningful play• Spend more time with patients• Nurses want to assess their own

children using the tool • Parents may not understand the

importance of “play” during assessment and become impatient and leave

• Child may be afraid of the nurse and underperform

Ages and Stages

• Assessment done in-home

• Nurse can teach parents about results when they score the assessment tool

• Nurses distrust accuracy of information reported by parents

New Knowledge

• Either tool would improve child health through– Improved surveillance– More contact with health providers– Parental education about meaningful play

“It is important for us [nurses] to educate the home-based carer [CHW], to educate the people in the community, to know the importance of child health in the community.”

Conclusions

• What is the most appropriate child development assessment tool?

• Is a child development monitoring program feasible in this community?

• What is the perception of local public health nurses about the importance of child development?

• What are the barriers to implementing a child development project in this community?

Conclusions

• Limitations– Generalizability– Cultural Barriers

• Future Research– Train public health nurses about child development and screening

tools– Adaptation and validation of assessment tool in this population– Longitudinal pilot study

• Significance– First to investigate child development in rural Limpopo, South Africa– First to investigate child development assessment tools in rural, sub-

Saharan Africa– Long-term improvements in child health and injury prevention

Acknowledgements

• Vhembe Health District professional nurses

• Mrs. Violet Sebola Mabunda, Manager PHC Vhembe District

• Mrs. Tsakani Baloyi and the staff at the Tiyani Health Center

• Professor Lizzy Netshikweta, Professor Vhonani Netshandama, Professor Cornelius Hagenmeier, Professor Mary Maluleke, Dean Khoza – University of Venda

• Dr. Plews-Ogan, Dr. Cathy Campbell, Dr. Rebecca Scharf, Dr. Rebecca Dillingham

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