Developmental delay in a resource-constrained environment: Screening, surveillance and diagnostic assessment

Abstract

The range and severity of developmental delays vary, and a systematic approach to ensuring early detection for early intervention is essential. The formative years are considered critical for nurturing and maximising developmental potential. In this article, the authors describe a clinical approach to developmental delay within resource-constrained environments of South Africa. The article unpacks the history and examination, developmental screening, surveillance and diagnostic assessment and social determinants of health. For timely interventions to occur, early and accurate assessment is necessary. Medical officers and other health professionals such as nurses, general practitioners and therapists working in low-resourced contexts may use this information in their approach to the assessment of developmental delay.

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

“…4 Whilst some care is possible at the PHC level, referrals to the various levels of the healthcare system (district-regional-tertiary) would occur depending on the underlying aetiology and diagnostic workup required. 1 Provision of specialised services may also occur outside of the PHC setting. With this, we have the interaction of the DSD (with early childhood development programmes) and department of education (DOE) (responsible for monitoring of child who enters the school system) interfacing with the health With a reduction in mortality rates of children under 5 years, in low-and middle-income countries, the responsibility to provide quality care to the increased number of surviving children becomes essential.…”

“…The timely and accurate assessment of a child's development can serve to detect developmental delays (DDs) earlier in childhood 1 and aid in focused early intervention. 2 The recent re-emphasis on early intervention for children with DD in low-and middle-income countries 3 calls for action that is contextually situated and relevant.…”

“…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…”