Building capacity in neurodevelopment assessment of children in sub-Saharan Africa: A quality assurance model to implement standardized neurodevelopment testing

Abstract

Compromised neurodevelopment (ND) among infants and children is prevalent in sub-Saharan Africa. Standardized testing of ND is frequently prohibitive in these contexts, as tests require skilled staff for their application. In this paper, we present a quality assurance (QA) model (QualiND) for standardized ND testing, discussing findings and implications from our experience applying the Kaufman Assessment Battery for Children second edition (KABC-II). The QualiND model was implemented within IMPAACT P1104s study, a multisite, prospective study including 615 children affected by HIV. From 2014 to 2016, the QualiND managed 18 testers across 6 sites located in 4 African countries applying the KABC-II in 9 local languages. The QualiND is a multilevel, video-assisted iterative model incorporating remote evaluation, feedback, and supervision roles. Using an ad hoc rubric, videos of test application were evaluated by experienced staff in a centralized QA center. At each study site, testers and supervisors reviewed feedback from videos received via email from the QA center and devised an action plan to address testing errors and deficiencies. There were few instances of invalid tests and few barriers to test completion. Over 97% of KABC-II tests across sites were considered to be valid by the QA center. Overall, the QualiND model was a useful platform for remote supervision to nonspecialist and minimally trained research staff. The QualiND model may be useful to researchers and organizations involved in measuring early child development using standardized tests in low and middle-income countries.

African Multi-Site 2-Year Neuropsychological Study of School-Age Children Perinatally Infected, Exposed, and Unexposed to Human Immunodeficiency Virus

“…The tests outcomes were previously described in a validation study of the present neuropsychological measures [6]. The quality assurance process for administering the tests has also been previously described [10], as has adaptation of all tests in the local languages [1].…”

Neurodevelopmental performance among pre-schoolers treated for severe anaemia at Lira Regional Referral Hospital, Uganda

“…Deficits in neurocognition in children may significantly impact future learning, class performance and academic attainment [ 20 ]. However, in routine clinical practice in the African setting, assessment of neurodevelopment in children surviving illnesses like SA is not integrated in routine clinical care [ 21 , 22 ]. An earlier study that examined neurodevelopmental outcomes amongst Ugandan children < 5 years surviving severe malaria anaemia (SMA), a form of complicated malaria showed that SMA was associated with long-term cognitive impairment [ 23 ].…”

Reliability and Validity of an Adapted and Translated Version of the Mullen Scales of Early Learning (AT‐MSEL) in Rural Guatemala

“…Results are also consistent with those reported for other tests of early childhood development adapted and translated for Ethiopian (Hanlon et al, ) and Nepalese (Ranjitkar et al, ) children. Although other previous studies in low resource settings have documented adequate interrater reliability for tests developed for school‐age children (Ruiseñor‐Escudero et al, ), it is encouraging that high interrater reliability is also being achieved for early childhood assessments, as these assessments generally require a higher level of skill and training of test administrators and so are more vulnerable to errors in administration and scoring.…”