title: Validation and adaptation of rapid neurodevelopmental assessment instrument for infants in Guatemala.
abstract: BACKGROUND
  Timely detection of neurodevelopmental impairments in children can prompt referral for critical services that may prevent permanent disability. However, screening of impairments is a significant challenge in low-resource countries. We adapted and validated the rapid neurodevelopmental assessment (RNDA) instrument developed in Bangladesh to assess impairment in nine domains: primitive reflexes, gross and fine motor development, vision, hearing, speech, cognition, behaviour and seizures.
  
  
  METHODS
  We conducted a cross-sectional study of 77 infants (0-12 months) in rural Guatemala in July 2012 and July 2013. We assessed inter-rater reliability and predictive validity between the 27-item RNDA and the 325-item Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and concurrent validity based on chronic malnutrition, a condition associated with neurodevelopmental impairments. For both RNDA and BSID-III, standardized scores below 80 were defined as borderline impairment.
  
  
  RESULTS
  Children came from rural households (92%), were born to indigenous women of Mayan descent (73%) and had moderate or severe growth stunting (43%). Inter-rater reliability for eight RNDA domains was of moderate to high reliability (weighted κ coefficients, 0.49-0.99). Children screened positive for impairment in fine motor (17%) and gross motor (14%) domains using the RNDA. The RNDA had good concurrent ability; infants who were growth stunted had higher mean levels of impairment in gross motor, speech and cognition domains (all p < 0.001). The RNDA took 20-30 min to complete compared with 45-60 min for BSID-III.
  
  
  CONCLUSIONS
  Wide-scale implementation of a simple, valid and reliable screening tool like the RNDA by community health workers would facilitate early screening and referral of infants at-risk for neurodevelopmental impairment.
authors.affiliation: Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Thompson
authors.affiliation: Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Peñaloza
authors.affiliation: Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Stormfields
authors.affiliation: Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Kooistra
authors.affiliation: Global Health Sciences, University of California, San Francisco, CA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Valencia-Moscoso
authors.affiliation: Department of Pediatric Neuroscience, Dhaka Shishu (Children's) Hospital, Dhaka, Bangladesh.
authors.forename: H
authors.initials: H
authors.lastname: Muslima
authors.affiliation: Department of Pediatric Neuroscience, Dhaka Shishu (Children's) Hospital, Dhaka, Bangladesh.
authors.forename: N Z
authors.initials: NZ
authors.lastname: Khan
mesh_terms: D001459:Bangladesh; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000175:diagnosis*; D005260:Female; D006166:Guatemala; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012424:Rural Population
keywords: Latin America; community health workers; developmental disabilities; infant; malnutrition; poverty