A 9-year retrospective cohort study of the monitoring and screening of childhood developmental delay in Thailand.

BACKGROUND: Developmental delay in early childhood can have negative long-term cognitive and psychiatric sequelae, along with poor academic achievement, so early screening and surveillance are paramount. The aim of this study is to evaluate the impact of screening and surveillance on child developmental delay using the Developmental Surveillance and Promotion Manual (DSPM) and the Thai Early Developmental Assessment for Intervention (TEDA4I) for Thai children aged 0-5 years old. METHODS: Data were obtained from the routine developmental screening for specific disorders at ages 9, 18, 30, 42 and 60 months conducted using DSPM and TEDA4I from 2013 to 2021. Descriptive statistics were used to analyse the data, and the results are visualised graphically herein. RESULTS: Only 56% of the children were screened for child developmental delay using DSPM. The proportion of children screened increased from <1% in 2013 to 90% in 2021. Suspected developmental delay prevalence increased significantly from 3.91% in 2013-2015 to 10.00% in 2016-2018 and 26.48% in 2019-2021. Moreover, of the children with suspected developmental delay who received developmental stimulation within a month, only 87.9% returned for follow-up visits when they were evaluated again using TEDA4I to ascertain any abnormalities and specific areas of deficit. The overall proportion of children diagnosed with developmental delay was 1.29%. During the pandemic, the proportion of screening tests for child developmental delay at routine vaccination visits and follow-ups decreased but was still at least 80% in each region. CONCLUSIONS: Since 1%-3% of children have suspected developmental delay, early detection is key to treating it as soon as possible. We anticipate that our findings will raise awareness in parents and caregivers about childhood developmental delay and lead to the implementation of early intervention and follow-up at the rural level in Thailand.

Risk factors of relapse within eight weeks after an acute asthma exacerbation in Thai children.

BACKGROUND: Acute asthma relapse following treatment and discharge from hospital remains a substantial problem. Various potential risk factors for relapse have been reported including age, sex, frequency of hospitalization and emergency medications. All these factors, however, may not be generalized for all patients because of difference in prevalence, trigger factors, types of allergens, medical accessibility and psychosocial problems. OBJECTIVE: To identify factors associated with relapse following treatment for acute asthma within the next 8 weeks in Thai children. MATERIAL AND METHOD: The authors prospectively followed 91 children discharged from Ramathibodi Hospital after treatment of an asthma attack from June 1999 to December 2000. Parents were surveyed concerning their child's medical history, trigger factors, psychosocial and economic variables. Data on severity of the attack, asthma scores, emergency treatment, and response to treatment were recorded. Investigations included eosinophil count, total IgE, serum eosinophil cationic protein (ECP), skin test, methacholine bronchial challenge test, and IQ test were performed and recorded. RESULTS: Within the first week, only 6.6 per cent had relapsed and increased to 29.7 per cent by 8 weeks. Patients who suffered relapse were more likely associated with age at asthma diagnosis (OR, 2.90; 95% CI, 1.1-7.5) and 6 years of age or under (OR 4.49, CI 1.22-16.54). From the investigation results including eosinophil count, total IgE, serum ECP, skin test, methacholine bronchial challenge test, and IQ test, there was no significant difference in the factors between patients who suffered relapse and those who did not. From the psychosocial evaluation, 18 out 39 (46.2%) studied cases had significant psychosocial disorders. They were 4 cases with delayed development and mental retardation, 9 cases with parent-child relation problems, and 2 cases with serious intrafamilial disorders. Most of these patients were non-relapse cases. However, the relationship between asthma relapse and psychosocial disorders could not be ascertained since psychosocial evaluation was only performed in one-third of the study population. CONCLUSION: Among patients following acute asthma therapy, 29.7 per cent will have a relapse. The authors identified the age at onset of asthma before the age of 6 years as an important risk factor. This may help to decrease the relapse rate by more intensive and comprehensive management among patients at high risk.