Amoebic liver abscess: Outcomes of percutaneous needle aspiration vs drain placement in paediatric population.

OBJECTIVE: To compare the effectiveness of percutaneous catheter drain placement with percutaneous needle aspiration in terms of hospital stay, time to resolution of symptoms and cost of intervention performed. Methods: The retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients with amoebic liver abscess from, January 2006 to December 2016 which was collected using non-probability purposeful sampling. Primary outcome included length of hospital stay, time to resolution of symptoms and cost of intervention. Secondary outcomes included development of complications, need for re-intervention and abscess resolution. SPSS 22 was used for data analysis. . Results: Of the 62 patients, 36(58%) underwent percutaneous needle aspiration Group A, and 26(42%) were treated with percutaneous catheter drain placement Group B. Both groups were malnourished and anaemic at presentation. Overall, 56(90.3%) patients had single abscess and 44(71%) had it in the right lobe. Mean duration of symptoms was less in Group B compared to Group A (11.2±4.5 versus 16.4±3.2 days). Mean abscess size was 6.13cm ± 9.75cm in Group A and 7.40cm ± 8.40cm in Group B. The mean length of hospital stay Group A was shorter than in Group B (p=0.047) with earlier resolution of symptoms (p=0.027). Conclusion: Both methods were found to be effective in treating amoebic liver abscess in children, but percutaneous needle aspiration was more effective.

[Effectiveness and cost of management of severe acute malnutrition with complications in Kaya, Burkina Faso]. / Performance et coût de la prise en charge de la malnutrition aiguë sévère avec complications à Kaya, Burkina Faso.

INTRODUCTION: The consequences of severe acute malnutrition are measured in terms of health and survival, but also of cognitive development, its productivity and the overall national economy. Its management requires enormous financial resources. The purpose of this study was to assess the effectiveness of treating severe acute malnutrition versus cost of treatment of severe acute malnutrition in children. METHODS: We conducted a retrospective study of 199 children aged 0-59 months admitted to the Centre for Nutritional Recovery and Education in Kaya, Burkina Faso, from January to December 2014. The cost of treatment, the length of stay in the Centre for Nutritional Recovery and Education, daily weight gain and the speed of recovery were analyzed based on the standards calculation methods. Mann-Whitney test and Kruskall-Wallis test were used to compare the medians (0.05 threshold). RESULTS: As expected, children aged 6-23 months were the most affected (51.8%) and acute respiratory infections were the most associated diseases (57.9%). The median length of stay in the Centre for Nutritional Recovery and Education was 9.0 (7.0-13.0) days, the mean speed of recovery was 100.0 (65.8 - 143.3) g/day and the average daily weight gain was 18.1 (11.6 - 27.7) g/kg/day. The average cost of treatment in a malnourished child is estimated to be 15 715,3 FCFA (25.2 USD). CONCLUSION: The cost of treatment is hardly affordable by the parents of malnourished children; hence the necessity for government and development partners interventions.

El helado elaborado de musa paradisíaca y probióticos mejora los niveles séricos de calcio, hierro y potasio en una población infantil / Ice cream prepared with musa paradisiaca and probiotic improves the serum levels of calcium, iron and potassium in a children population

La desnutrición afecta la sociedad, principalmente a niños de recursos limitados, siendo los bajos niveles de minerales su consecuencia directa. Se desarrolló una investigación explicativa, con diseño experimental para evaluar la efectividad del consumo de un helado a base de Musa paradisiaca suplementado con probióticos en una población infantil de Cúcuta-Colombia. De una población de 238 escolares, 33 niños de 4 a 6 años tuvieron déficit séricos de Ca, Fe y K y se dividieron aleatoriamente en dos grupos. Durante 60 días se les suministró diariamente el helado prueba al Grupo A y al Grupo B un helado placebo, registrándose peso, talla, niveles séricos de Ca, Fe y K antes, durante y después del suministro. Incrementaron significativamente (p = 0,01) los niveles de hierro y calcio en el Grupo A; mientras en el Grupo B permanecieron sin cambios. En ambos grupos aumentaron significativamente los niveles de potasio (p<0.05), con (p = 0.01) en el Grupo A. El peso corporal y talla de los niños evidenció un cambio significativo dentro de cada grupo (p < 0,05), aunque, no se observaron diferencias significativas entre grupos luego de la intervención. El consumo del helado a base de plátano suplementado con probióticos representa una alternativa para el abordaje del déficit de minerales en la población infantil(AU)

Malnutrition affects society, mainly children with limited resources, with low levels of minerals being the direct consequence. An explanatory research was developed, with experimental design to evaluate the effectiveness of the consumption of an ice cream of Musa paradisiaca supplemented with probiotics in a child population of Cúcuta-Colombia. From 238 schoolchildren, a sample of 33 children aged 4 to 6 years with serum deficits of Ca, Fe and K participated and they were randomly divided into two groups. For 60 days the ice cream was supplied to Group A and Group B a placebo ice cream, registering weight, height, serum levels of Ca, Fe and K before, during and after the ice cream administration. There was a significant increase (p = 0.01) in the iron and calcium levels in Group A; with no significant changes for Group B. In both groups potassium was significantly increased (p <0.05). The body weight and height of the children was increased although there were no differences (p>0.05) between both groups. The consumption of banana-based ice cream supplemented with probiotics represents an alternative to address the deficit of minerals in children(AU)

Subjective Global Nutritional Assessment: A Reliable Screening Tool for Nutritional Assessment in Cerebral Palsy Children.

OBJECTIVE: To determine the prevalence of undernutrition in children with cerebral palsy and to compare subjective and objective methods of nutritional assessment. METHODS: This was a hospital based analytical observational study in which 180 children of cerebral palsy, aged 1-12 y, attending tertiary level hospital, Jaipur from March, 2012 through March, 2013 were included. Subjective assessment was done by questionnaire (Subjective Global Nutritional Assessment; SGNA) in which questions related to nutrition history and physical examination, signs of fat, muscle wasting and edema was done while objective assessment was done by weight, height and triceps skinfold thickness (TSFT) measurements. RESULTS: In this study prevalence of undernutrition by subjective method (SGNA) was 76.67% while by objective measurement (weight, height, TSFT) was 48.89%, 77.78% 35.18% respectively. There was fair to moderate agreement between the SGNA and objective assessments including weight and height (k = 0.341, p = 0.000; k = 0.337, p = 0.000 respectively) while for TSFT agreement between both methods was poor (k = 0.092, p = 0.190). In the index study, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SGNA was for weight was 95%, 37%, 56%, 90%; for height 84%, 50%, 85%, 47%; for TSFT 81%, 30%, 38%, 75% respectively. CONCLUSIONS: The prevalence of undernutrition is high in cerebral palsy children. SGNA can be a reliable tool for assessing nutritional status in children with cerebral palsy and is a simple, comprehensive, noninvasive, and cost-effective tool for screening undernutrition in children of cerebral palsy.

Malnutrition among Hospitalized Children in the United States: Changing Prevalence, Clinical Correlates, and Practice Patterns between 2002 and 2011.

BACKGROUND: Pediatric malnutrition has been associated with adverse clinical outcomes, longer lengths of stay, and higher health care costs. OBJECTIVE: To characterize prevalence, temporal trends, and short-term clinical outcomes of coded diagnoses of pediatric malnutrition (CDM) across sociodemographic, clinical, and hospital characteristics from 2002 to 2011. DESIGN: This study is a retrospective cross-sectional analysis of nationally representative data from the Nationwide Inpatient Sample and the Kids' Inpatient Database. PARTICIPANTS/SETTING: The study sample included pediatric inpatient hospitalizations in the United States. MAIN OUTCOME MEASURES: International Classification of Diseases-9th Revision-Clinical Modification diagnosis codes were used to identify CDM and coded malnutrition subtypes based on an etiology-related definition of pediatric malnutrition. STATISTICAL ANALYSES: The national frequency and prevalence of CDM overall and across patient- and hospital-level characteristics were estimated for children aged 1 month to 17 years. Logistic regression was used to assess the association between CDM and each characteristic. Analyses evaluated conditions associated with the highest burden and risk of CDM, and compared clinical outcomes across malnutrition subtypes. Joinpoint regression was used to describe temporal trends in CDM. RESULTS: Of the 2.1 million pediatric patients hospitalized annually, more than 54,600 had CDM, a national prevalence of 2.6%. Considerable variation was observed based on primary diagnosis, with fluid and electrolyte disorders contributing the most malnutrition cases. Highest CDM rates were among patients with stomach cancer, cystic fibrosis, and human immunodeficiency virus. Patients with CDM experienced worse clinical outcomes, longer lengths of stay, and increased costs of inpatient care. The overall prevalence of CDM increased from 1.9% in 2002 to 3.7% in 2011, an 8% annual increase, and temporal increases were observed in nearly all population subgroups. CONCLUSIONS: Despite improvements, pediatric malnutrition remains underdiagnosed in inpatient settings when relying exclusively on International Classification of Diseases-based codes, which underscores the need for a national benchmarking program to estimate the true prevalence, clinical significance, and cost of pediatric malnutrition.

Household social capital and socioeconomic inequalities in child undernutrition in rural India.

Social capital has gained attention for poverty reduction efforts in low- and middle-income countries, but questions remain about people's unequal access to and benefits from social capital-especially for addressing child health inequalities. Analyzing 2005 India Human Development Survey data on 9008 rural-dwelling children and their families, we test hypotheses regarding how SES shapes household access to and child health benefits from three different forms of social capital located inside and outside the community. Specifically, we examine households' memberships in bonding and bridging organizations, which respectively connect people who are socio-demographically similar and dissimilar, and linking ties to representatives of formal institutions (health care, education, and government) who have power and privilege in society. Results indicate that greater household wealth is associated with each social capital form and amplifies the extent that linking ties to medical and educational institutions, and within-village bridging organizations are associated with lower odds of child underweight. Our findings warrant considering the unequal distribution, differential utility, and geographic location of social capital in designing efforts to address health inequalities.

Pediatric Nutrition Assessment.

Pediatric patients with chronic illnesses or diseases or who require long-term nutrition support are most vulnerable to nutrition-related issues. Malnutrition in a pediatric patient may negatively affect long-term growth and development. Children also become malnourished much more quickly than adults. A comprehensive nutrition assessment that includes food and nutrition-related history, anthropometric measurements, biochemical data, medical tests and procedures, nutrition-focused physical findings, and patient history should be completed on these patients as no one parameter is a comprehensive indicator of nutrition status. Anthropometric measurements provide important information on the growth and nutrition status of a child, yet many times it is difficult to get accurate and valid measurements due to physical limitations of the child or improper technique. Inaccurate measurements may result in a missed diagnosis of malnutrition or may lead to an incorrect diagnosis of a healthy child. Knowledge of appropriate anthropometric measurements and alternatives is crucial when assessing growth in all children and essential for those who are physically handicapped or critically ill. The purpose of this review is to present key components of a pediatric nutrition assessment so proper nutrition-related diagnosis, including malnutrition, can be accomplished, a nutrition care plan established, and expected outcomes documented.

Non random distribution of child undernutrition in Ethiopia: spatial analysis from the 2011 Ethiopia demographic and health survey.

BACKGROUND: Child undernutrition showed geographical inequalities due to variations in contextual determinants from area to area which indicates that location is an important factor in child undernutrition. However, there are limited studies on spatial epidemiology of child undernutrition in Ethiopia. This study was aimed to identify the SaTScan spatial clusters of child undernutrition in Ethiopia. METHODS: Nutritional indices of children (0-59 months) with Global Positioning System (GPS) location data were accessed from the 2011 Ethiopia Demographic and Health Survey (EDHS) after getting permission from the MEASURES Demographic and Health Survey (DHS) Program. The Bernoulli Model was fitted using SaTScan™ software, version 9.4. for SaTScan cluster analysis. Log Likelihood Ratio (LLR) test was used for each SaTScan cluster and size of the scanning SaTScan cluster to test the alternative hypothesis that there is an elevated risk within the SaTScan cluster compared to outside the SaTScan cluster. Less than 0.05 for LLR was considered as statistically significant level. RESULTS: The SaTScan spatial analysis result detected Liben, Afder and Borena administrative zones around the South East Ethiopia as the most likely primary spatial SaTScan clusters (LLR = 28.98, p < 0.001) for wasting. In the Northern, Middle, North East and North West areas of Ethiopia particularly from all administrative zones of Amhara, Tigray, Afar, Ben. Gumz regional states and East Welega and North Showa zones from Oromiya Regional State (LLR = 60.27, p < 0.0001) were detected as the most likely primary SaTScan clusters for child underweight. Also in the Northern, Middle, North East and North West areas of all administrative zones of Tigray, Amhara, Ben. Gumz and Afar regional states and West and North Showa and East Welega from Oromiya Regional States (LLR = 97.28, P < 0.0001) were primary SaTScan clusters for child stunting. CONCLUSION: The study showed geographical variability of child stunting, underweight and wasting in the Country which demands risk based local nutritional interventions. Further study will be important to assess the temporal nature of the problem and to identify community level factors that create this spatial variation.

Association of Low-Birth Weight with Malnutrition in Children under Five Years in Bangladesh: Do Mother's Education, Socio-Economic Status, and Birth Interval Matter?

BACKGROUND: Malnutrition in children under five years remains a significant problem in Bangladesh, despite substantial socio-economic progress and a decade of interventions aimed at improving it. Although several studies have been conducted to identify the important risk factors of malnutrition, none of them assess the role of low birth weight (LBW) despite its high prevalence (36%). This study examines the association between LBW and malnutrition using data from the Bangladesh Demographic and Health Survey (BDHS) 2011 and provides practical guidelines for improving nutritional status of children. METHODS: Malnutrition in children is measured in terms of their height-for-age, weight-for-height, and weight-for-age. Children whose Z-scores for either of these indices are below two standard deviations (-2SD) from median of WHO's reference population are considered as stunted, wasted or underweight, respectively. The association between malnutrition and LBW was investigated by calculating adjusted risk-ratio (RR), which controls for potential confounders such as child's age and sex, mother's education and height, length of preceding-birth-interval, access to food, area of residence, household socio-economic status. Adjusted RR was calculated using both Cochran-Mantel-Haenszel approach and multivariable logistic regression models controlling for confounder. RESULTS: The prevalence of malnutrition was markedly higher in children with LBW than those with normal birth-weights (stunting: 51% vs 39%; wasting: 25% vs 14% and underweight: 52% vs 33%). While controlling for the known risk factors, children with LBW had significantly increased risk of becoming malnourished compared to their counter part with RR 1.23 (95% CI:1.16-1.30), 1.71 (95% CI:1.53-1.92) and 1.47 (95% CI: 1.38-1.56) for stunting, wasting and underweight, respectively. The observed associations were not modified by factors known to reduce the prevalence of malnutrition, such as higher education of mother, better household socio-economic conditions and longer birth-interval. CONCLUSIONS: Higher education of mother, better household socio-economic conditions and prolonged birth intervals alone are not sufficient in bringing about substantial reductions in prevalence of child malnutrition in Bangladesh. Targeted interventions should be designed to reduce prevalence of LBW in addition to improving mother's education and other socio-demographic conditions.

Early Child Development and Nutrition: A Review of the Benefits and Challenges of Implementing Integrated Interventions.

Poor nutrition (substandard diet quantity and/or quality resulting in under- or overnutrition) and the lack of early learning opportunities contribute to the loss of developmental potential and life-long health and economic disparities among millions of children aged <5 y. Single-sector interventions representing either early child development (ECD) or nutrition have been linked to positive child development and/or nutritional status, and recommendations currently advocate for the development and testing of integrated interventions. We reviewed the theoretical and practical benefits and challenges of implementing integrated nutrition and ECD interventions along with the evidence for best practice and benefit-cost and concluded that the strong theoretical rationale for integration is more nuanced than the questions that the published empirical evidence have addressed. For example, further research is needed to 1) answer questions related to how integrated messaging influences caregiver characteristics such as well-being, knowledge, and behavior and how these influence early child nutrition and development outcomes; 2) understand population and nutritional contexts in which integrated interventions are beneficial; and 3) explore how varying implementation processes influence the efficacy, uptake, and cost-benefit of integrated nutrition and ECD interventions.

The importance of nutritional care in HIV-infected children in resource-limited settings.

Renewed efforts to provide proper nutritional care are essential for appropriate pediatric HIV management. Current studies support the use of vitamin A and macronutrients that increase caloric and protein intake. With additional research on key issues such as the needed composition and timing for nutritional supplementation, we can determine the best strategies to support the growth and development of HIV-infected children in resource-limited settings. Malnutrition among children is common in the resource-limited settings where HIV infection is most prevalent. While malnutrition is associated with higher morbidity and mortality for HIV-infected children, there is only limited evidence to guide the use of nutritional support for HIV-infected children. The best studied is vitamin A, which is associated with improved mortality and clinical outcomes. Zinc and multivitamin supplementation have not consistently been associated with clinical benefits. Limited research suggests macronutrient supplementation, which typically uses enriched formulas or foods, improves key anthropometrics for HIV-infected children, but the optimal composition of nutrients for supplementation has not been determined. More research is needed to understand the most efficient and sustainable ways to ensure adequate nutrition in this vulnerable population.

Update on the burden of Campylobacter in developing countries.

PURPOSE OF REVIEW: Recent work has added to the understanding of the burden of Campylobacter jejuni, C. coli, and non-jejuni/coli Campylobacter strains in children living in the developing world. RECENT FINDINGS: New diagnostic modalities and carefully designed field studies are demonstrating that the burden of Campylobacter diarrhea in children in the developing world has been greatly underestimated. Furthermore, there is emerging recognition of an association between Campylobacter infection and malnutrition. Important progress has been made toward a Campylobacter jejuni vaccine. Finally, evidence of antibiotic resistance continues to be an important issue that is accentuated by the realization that the burden of disease is greater than previously recognized. SUMMARY: Additional research is needed to refine our understanding of the epidemiology of Campylobacter infections in developing countries, in particular to improve estimates of the burden of Campylobacter diarrhea in endemic settings, to determine the impact of recurrent Campylobacter infections on child development, and to describe the prevalence and clinical significance of non-jejuni/coli Campylobacter infections. Progressive antibiotic resistance of isolates argues for augmented and expanded control measures of antibiotics in livestock. Continued work in vaccine development is warranted as is the extension of data available on the serotypes related to burden in different areas of the world and the relationship of serotypes to disease severity.

Review of nutritional assessment and clinical outcomes in pediatric surgical patients: does preoperative nutritional assessment impact clinical outcomes?

INTRODUCTION: Malnourished adult patients who undergo surgical procedures tend to have worse clinical outcomes compared to well-nourished patients. In the pediatric surgical patient, nutritional assessment is considered a critical aspect of the initial evaluation, but a correlation between preoperative malnutrition and poor surgical outcomes is not clear. We hypothesized that an evidence-based review would reveal that measures of nutritional assessment in children would not correlate pre-operative malnutrition with poor surgical outcomes. MATERIALS AND METHODS: A search of major English language medical databases (Medline, Cochrane, SCOPUS) was conducted for the key words nutritional assessment, pediatric, children, surgery, and outcomes. All methods of nutritional assessment in pediatric surgery were evaluated for their relevance and relation to outcomes after surgery. The Oxford Center for Evidence Based Medicine (CEBM) classification for levels of evidence was used to develop grades of clinical recommendation for each variable studied. RESULTS: 35 articles were evaluated after an exhaustive literature search, of which six met inclusion criteria for this review. There is a paucity of high quality evidence correlating preoperative malnutrition in pediatric surgical patients with clinical outcomes. Factors contributing to the low level of evidence include a lack of high quality randomized controlled trials, a lack of consensus in study design and methods, and utilization of incongruous methods of nutritional assessment, including methods that may be unproven in the study population. CONCLUSION: Larger multi center randomized studies are needed to offer higher level of evidence to support nutritional intervention prior to major elective pediatric surgery.

Nutritional assessment of Ethiopian Beta-Israel children: a cross-sectional survey.

BACKGROUND: Malnutrition is a public health problem of significant importance in developing countries. The main aim of this survey is to assess the nutritional status of children of the Beta-Israel community in Gondar, Ethiopia, with special emphasis on the anthropometric growth patterns of infants under 5 years of age. METHODS: This is a descriptive cross-sectional survey of 794 preschool children of the Beta-Israel community. The survey comprised socioeconomic and demographic data, evaluation of anthropometric measurements, and clinical evaluation of children for nutrition-related health problems. The clinical variables included assessments for vitamin A, iodine, and iron deficiencies. RESULTS: Underweight, stunting, and wasting were seen in 14.6%, 37.2%, and 4.5% of the children, respectively. Moreover, severe underweight, severe stunting, and severe wasting were seen in 2.9%, 14.8%, and 0.5% of the children, respectively. Malnutrition affected 41.4% of all the children, with those 12-23 months old suffering the most (66.7%). Multivariate analysis noted that smaller family size and younger age were related to higher occurrence of malnutrition among children. An overall rate of stunting of 37.2% exceeds the urban average rate for Ethiopia (29.8%). All the children had been breastfed at least for some time, and among those older than 6 months, 46.8% were exclusively breastfed for 6 months. Of the infants, 82.9% were breastfed for over 2 years. No correlation existed with pattern or duration of breastfeeding and degree of malnutrition in infants over 6 months. CONCLUSIONS: The urban Beta-Israel Jewish pediatric population in Gondar, Ethiopia suffers from a high rate of malnutrition manifested primarily by stunting (height for age), reflecting a state of chronic malnutrition after 6 months of life secondary to inadequate sources of complementary feeds for the breastfeeding infant.

Nutritionally acquired immune deficiency syndromes (NAIDS): common but often not diagnosed early.

It has been the perception in some pacific island countries that the textbook presentation of kwashiorkor has decreased in incidence possibly due to improved public health services and economic development of the country. However, the diagnosis and treatment is nonetheless crucial to child survival. This paper discusses the clinical courses of 2 children with kwashiorkor whose presentation were not of that taught to medical students or even junior doctors. Their presentation together with their subsequent nutritionally acquired immune deficiency syndrome (NAIDS) is illustrated to raise awareness of the complexities in diagnosis and management of such patients.

[Assessment of the intervention in a therapeutic feeding center for children in Nicaragua]. / Evaluación de la intervención terapéutica realizada en un centro de recuperación nutricional infantil de Nicaragua.

INTRODUCTION: Child malnutrition carries a high morbimortality worldwide. Therapeutic feeding centers are essential in the treatment of malnourished children. OBJECTIVE: To evaluate the effectiveness of the therapeutic intervention in under-5 undernourished children in a Therapeutic Feeding Center. METHODS: A retrospective descriptive research was made through the revision of the clinical histories of children under 5 years that entered the Nutritional Recovery Center for Children in Matagalpa, Nicaragua, from January 2006 to July 2010. RESULTS: Median age at admission was 17.2 months (p25:10.7-p75:27.2) and median stay in the center was 92 days (p25:61.5-p75:134.5). Prevalence of patients with severe acute malnutrition was 45%, moderate acute malnutrition 24% and risk for malnutrition 31%. At discharge 86% of patients were properly nourished. Median weight gain percentage after the first month in the center was 15% (p25:12.6-p75:17.4). Median weight gain was 3.7 g/kg/day (p25:2.6-p75:5.4), being higher in children under 6 months (4.6 g/kg/day; p25:4.3-p75:7.5). Cured rate in the center was 87.5%, being the death rate 0% and the abandonment rate 9%. DISCUSSION: The center evaluated works adequately, and fulfills the internationally recommended quality indicators. However, recommended average stay of 1-2 months and average weight gain of 8 g/kg/day are far of being fulfilled. Therefore, the Nutritional Recovery Center performs an effective intervention, but it's not efficient enough.

Undernutrition among children in South and South-East Asia.

Undernutrition remains a major public health problem among children living in Asia. Although the burden is maximal among poorer, rural and Indigenous communities, the problem affects the majority in many Asian countries, especially in South Asia. In order to prevent the pervasive consequences of undernutrition, strategies that address this burden are required. Successful implementation of strategies may be limited by the complex aetiology of undernutrition, including the political setting. Rising food insecurity because of climate change, land use for biofuel production and the recent global financial crisis threaten to exacerbate childhood malnutrition. In this review, we describe the burden of undernutrition among Asian children and discuss contributing factors and potential solutions.

The Malawi Developmental Assessment Tool (MDAT): the creation, validation, and reliability of a tool to assess child development in rural African settings.

BACKGROUND: Although 80% of children with disabilities live in developing countries, there are few culturally appropriate developmental assessment tools available for these settings. Often tools from the West provide misleading findings in different cultural settings, where some items are unfamiliar and reference values are different from those of Western populations. METHODS AND FINDINGS: Following preliminary and qualitative studies, we produced a draft developmental assessment tool with 162 items in four domains of development. After face and content validity testing and piloting, we expanded the draft tool to 185 items. We then assessed 1,426 normal rural children aged 0-6 y from rural Malawi and derived age-standardized norms for all items. We examined performance of items using logistic regression and reliability using kappa statistics. We then considered all items at a consensus meeting and removed those performing badly and those that were unnecessary or difficult to administer, leaving 136 items in the final Malawi Developmental Assessment Tool (MDAT). We validated the tool by comparing age-matched normal children with those with malnutrition (120) and neurodisabilities (80). Reliability was good for items remaining with 94%-100% of items scoring kappas >0.4 for interobserver immediate, delayed, and intra-observer testing. We demonstrated significant differences in overall mean scores (and individual domain scores) for children with neurodisabilities (35 versus 99 [p<0.001]) when compared to normal children. Using a pass/fail technique similar to the Denver II, 3% of children with neurodisabilities passed in comparison to 82% of normal children, demonstrating good sensitivity (97%) and specificity (82%). Overall mean scores of children with malnutrition (weight for height <80%) were also significantly different from scores of normal controls (62.5 versus 77.4 [p<0.001]); scores in the separate domains, excluding social development, also differed between malnourished children and controls. In terms of pass/fail, 28% of malnourished children versus 94% of controls passed the test overall. CONCLUSIONS: A culturally relevant developmental assessment tool, the MDAT, has been created for use in African settings and shows good reliability, validity, and sensitivity for identification of children with neurodisabilities.