Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. e581-e589 (doi:10.1542/peds.2007-1771)

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ARTICLE

A Guide for Monitoring Child Development in Low- and Middle-Income Countries

Ilgi O. Ertem, MD^a, Derya G. Dogan, MD^a, Canan G. Gok, MSc^a, Sevim U. Kizilates, MD^a, Ayliz Caliskan, MD^a, Gulsum Atay, MD^b, Nilgun Vatandas, MD^b, Tugba Karaaslan, MSc^a, Sevgi G. Baskan, MD^a and Domenic V. Cicchetti, PhD^c

^a Developmental-Behavioral Pediatrics Unit, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
^b Department of Pediatrics, Baskent University School of Medicine, Ankara, Turkey
^c Child Study Center and Departments of Psychiatry, Epidemiology, and Public Health in Biometry, Yale University School of Medicine, New Haven, Connecticut

OBJECTIVE. In low- and middle-income countries, methods for clinicians to address difficulties in language, social-emotional, cognitive, behavioral, or neuromotor development during early childhood are lacking. To fill this gap, we designed, in Turkey, the Guide for Monitoring Child Development, which aims to aid clinicians in monitoring and supporting child development and the early detection and management of developmental difficulties. The Guide for Monitoring Child Development monitoring component is a practical, open-ended interview that catalyzes communication between clinicians and caregivers and obtains a portrayal of the child's development. We report on the development and psychometric properties of the Guide for Monitoring Child Development monitoring component for children aged 0 to 24 months.

METHODS. We examined the ages of attainment of Guide for Monitoring Child Development milestones and internal consistency in a cross-sectional study of healthy children receiving well-child care (study 1). In 2 clinical samples, we studied the interrater reliability between medical students and a child development specialist administering the guide (study 2), as well as the concurrent validity of the guide administered during a health visit and a comprehensive developmental assessment (study 3).

RESULTS. In study 1 (N = 510), item-total scale correlations ranged from 0.28 to 0.91. An age-dependent attainment pattern was seen in all of the milestones. In study 2 (N = 92), interrater reliability between medical-student pairs and between the child development specialist and students was high (kappa scores were 0.83–0.88). In study 3 (N = 79), the sensitivity, specificity, and positive and negative predictive values were 0.88, 0.93, 0.84, and 0.94, respectively.

CONCLUSIONS. The Guide for Monitoring Child Development is an innovative method for monitoring child development that is designed specifically for use by health care providers in low- and middle-income countries. Studies in Turkey provide preliminary evidence for its reliability and validity.

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Key Words: child development • developing countries • surveillance and monitoring • developmental screening • screening tools

Abbreviations: LAMI—low and middle income • GMCD—Guide for Monitoring Child Development • WHO—World Health Organization • UNICEF—United Nations International Children's Education Fund

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Accepted Jul 31, 2007.

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