Screening tools for early identification of children with developmental delay in low- and middle-income countries: a systematic review

Abstract

ObjectiveTo systematically review, identify and report the screening tools used for early identification of developmental delay in low- and middle-income countries.DesignSystematic review.Data sourcesFour bibliographic databases: Medline (1946 to 13 July 2020), Embase (1974 to 13 July 2020), Scopus (1823 to 11 July 2020) and PsycINFO (1987 to July week 1 2020).Eligibility criteriaPeer-reviewed original articles published in English addressing validated culturally sensitive developmental screening tools among children aged <5 years were included in this review.Data extraction and synthesisOne author (CK, medical librarian) developed the search strategy. Three authors conducted the database search (phase I: CK; phase II: IJ and MKI). Three authors (TF, IJ and MKI) independently screened the title and abstracts. TF, MKI and GK independently performed the full-text review of the screened articles. During each step of the study selection process, disagreements were resolved through discussion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the systematic review. Data extraction and analysis were performed using MS Excel. Meta-analysis was not possible due to heterogeneity of the study findings.ResultsWe identified 3349 articles, of which 18 studies from 10 countries, reporting 16 screening tools, were selected for qualitative synthesis. Six cultural contexts were explored. Twelve general, two motor and two speech-language tools were identified. Seven of them found to be parent-completed ones. Five screening tools (American Speech-Language and Hearing Association, Guide for Monitoring Child Development, Infant Neurological International Battery, New Delhi-Development Screening Questionnaire and Woodside Screening Technique) reported relatively higher sensitivity (82.5%–100%) and specificity (83%–98.93%).ConclusionsLimited number of culturally sensitive developmental screening tools were validated for children aged <5 years in low- and middle-income countries. Revising existing screening tools in different ethnic and cultural settings and subsequent validation with normative value should be a research priority.

Agreement and Reliability of Parental Reports and Direct Screening of Developmental Outcomes in Toddlers at Risk

“…The effective users of the CARE booklet in this study were the 85.2% of receivers who used it for 1 month at home. The high level of CARE report use has considerable positive implications for the whole monitoring, screening and surveillance cycle to track a child’s developmental progress ( Faruk et al, 2020 ), known as the detection-intervention-prevention continuum.…”

“…However, recent studies reported low delay prevalence in DS ( Ozturk-Ertem et al, 2019 ) and the higher prevalence in our study must be interpreted with caution. If excluding participants to receive the CARE booklet after first screening is a recruitment bias, it is an opportunity for methodological improvement since several barriers to the identification of developmental delay using tools adapted for LMIC have recently been reported ( Faruk et al, 2020 ). Indeed, other screening studies include samples that did not share comparable sociodemographic characteristics to our participants, such as lower socioeconomic status ( Murphy et al, 2020 ).…”

Developmental delay in a resource-constrained environment: An approach to early intervention

“…Appropriate screening, surveillance and assessment for early identification with relevant tools for DD in low to middle income countries (LMICs). 1 , 10 …”

“…To review the tools used and promote use of appropriate instruments or tests within a PHC context. Govender et al 1 and Faruk et al 10 in a systematic review highlight possible screening tools or tests for LMIC contexts.…”

“…Utilisation of the Road to Heath Care Chart is ineffective in rural districts for under-5 child health management11 • To review the tools used and promote use of appropriate instruments or tests within a PHC context. Govender et al1 and Faruk et al10 in a systematic review highlight possible screening tools or tests for LMIC contexts. • Further education required for PHC workers Development screening as part of well-baby clinics regularly lack the knowledge to correctly identify and refer children with DD12…”