A new approach for neurological evaluation of infants in resource-poor settings

Abstract

Research assessing the neurological development of infants in developing countries is scanty as no suitable standardised tests are available for field-use in constrained circumstances. We describe the development and application of two simple assessments. Firstly, we aimed to develop a test suitable for assessing acute neurological disturbances caused by such diverse effects as infections, drugs or toxins. This test (Shoklo Neurological Test) is aimed at infants between 9 and 36 months. The second test (Shoklo Developmental Test) is aimed not only to follow the evolution of the signs tested initially in the acute phase but also to evaluate later neurodevelopmental sequelae which might be caused by the same events. The latter test is suitable for infants aged from 3 to 12 months. Both tests can be performed easily in non-optimal conditions. The examinations were tested in a cohort of infants from a Karen refugee camp and administered in a rural setting by health workers, after appropriate training. In order to validate the tests we also applied them to a cohort of London infants. The Griffiths Developmental Scales were applied in the same infants and both the Shoklo Neurological and the Shoklo Developmental Tests showed good correlation with this standardised neurodevelopmental assessment.

Artesunate-mefloquine combination therapy in acute Plasmodium falciparum malaria in young children: a field study regarding neurological and neuropsychiatric safety

“…The neurological assessment included evaluation of tonus, coordination, the status of consciousness, the emotional status and the social orientation [15]. In accordance with the presented data, this study showed no deterioration or deficits in coordination and tonus due to mefloquine-artesunate therapy, the other parameters showed no deterioration either, but were not directly comparable to items in our study.…”

“…This study was conducted from 1994 to 1997 in ninety-eight Asian children and used a specified neurological assessment for children (Shoklo Neurological Test and Shoklo Developmental Test [15]). Repeated assessments in children aged three months to five years were conducted until day 28 after first intake of mefloquine-artesunate therapy.…”

Neonatal Hyperbilirubinemia in a Marginalized Population on the Thai-Myanmar Border: a study protocol

“…The infant neurodevelopment will be assessed using the Shoklo Developmental Test at 3, 6, and 12 months [14]. Scoring will be based on a pass/fail system for each item of the test; the global score of the test will be obtained by adding up all the passed scores of the following categories; eye-hand coordination, gross motor, social and speech development.…”

Safety of artemether-lumefantrine in pregnant women with malaria: results of a prospective cohort study in Zambia

“…The development of infants was assessed by the investigators either through a general assessment (e.g. smiling, lifting head, sitting unsupported, standing without assistance, crawling) or the Shoklo neurodevelopment assessment [17], or both.…”