Psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS) for use in population studies involving Brazilian children aged 0-59 months

Abstract Objective: To analyze the psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS). Methods: This methodological study was comprised of two axes. The first one aimed to analyze the instrument's construct validity (discriminant and concurrent validity) and internal consistency, and the second one examined test-retest reliability, involving two different samples and procedures. For construct validity and internal consistency, the sample was recruited in Embu das Artes-SP, Brasilia-DF and Recife-PE during the immunization campaign in 2017, involving caregivers of 2005 children under 60 months of age (1295 under 36 and 710 from 37 to 59 months). For the test-retest analysis the sample consisted of 30 children aged 0-59 months old that attended daycare centers in Embu das Artes-SP in 2018. Results: Multivariate analyses of construct validity showed that the QAD-PIPAS was able to identify the association between the outcome (suspected child development delays) and expected risk and protective factors based on Nurturing Care Framework (OMS/UNICEF). A significant positive correlation was achieved between the scores of the QAD-PIPAS and CREDI in six of the eight age groups analyzed, with the most significant correlations being in the age groups from 25 to 30 and 31-36 months. Acceptable internal consistencies were identified in all age groups, with better performance above 36 months of age (Cronbach's alpha between 0.61 to 0.80). We also found an adequate test-retest reliability (global Kappa 0.81). Conclusion: The QAD-PIPAS showed evidence of construct validity and reliability to be used in population studies involving children aged 0-59 months during multi-vaccination campaigns in Brazil.

Psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS) for use in population studies involving Brazilian children aged 0-59 months.

OBJECTIVE: To analyze the psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS). METHODS: This methodological study was comprised of two axes. The first one aimed to analyze the instrument's construct validity (discriminant and concurrent validity) and internal consistency, and the second one examined test-retest reliability, involving two different samples and procedures. For construct validity and internal consistency, the sample was recruited in Embu das Artes-SP, Brasilia-DF and Recife-PE during the immunization campaign in 2017, involving caregivers of 2005 children under 60 months of age (1295 under 36 and 710 from 37 to 59 months). For the test-retest analysis the sample consisted of 30 children aged 0-59 months old that attended daycare centers in Embu das Artes-SP in 2018. RESULTS: Multivariate analyses of construct validity showed that the QAD-PIPAS was able to identify the association between the outcome (suspected child development delays) and expected risk and protective factors based on Nurturing Care Framework (OMS/UNICEF). A significant positive correlation was achieved between the scores of the QAD-PIPAS and CREDI in six of the eight age groups analyzed, with the most significant correlations being in the age groups from 25 to 30 and 31-36 months. Acceptable internal consistencies were identified in all age groups, with better performance above 36 months of age (Cronbach's alpha between 0.61 to 0.80). We also found an adequate test-retest reliability (global Kappa 0.81). CONCLUSION: The QAD-PIPAS showed evidence of construct validity and reliability to be used in population studies involving children aged 0-59 months during multi-vaccination campaigns in Brazil.

Development and validation of an instrument for monitoring child development indicators / Elaboração e validação de um instrumento para monitoramento de indicadores do desenvolvimento infantil

Abstract Objective: To create and validate an instrument for child development monitoring. Methods: Methodological study, based on the World Bank's proposition to monitor child development indicators in low- and middle-income countries. The stages of the study included the following: development of an inventory of items for child development evaluation, based on open access instruments; content validation by a group of experts on the topic, using consensus techniques; selection of questions to describe children and their families; pre-test of the instrument during the vaccination campaign in 2016 in three municipalities, and conducting cognitive interviews. Results: A total of 431 items were sent for the evaluation of the specialists; 77 were initially excluded and the others were evaluated in-person by the group, with 162 items covering the motor, cognitive, language, and socio-emotional domains, distributed in ten age ranges. Questions about health, nutrition, early learning, protection and safety, and responsive care were also included. The instrument was applied by volunteer undergraduate students to 367 mothers of children under 5 years, showing good adherence of the caregivers. The time of application of the questionnaire was, on average, 20 minutes. The cognitive interviews allowed the final adjustment of 19 items of the instrument for better understanding by the caregivers. Conclusions: The instrument created and validated by experts fills a gap, as it allows a comprehensive evaluation of the development of children under 5 years at the population level, using a fast and inexpensive tool, and can be useful for monitoring indicators of development in Brazilian children in vaccination campaigns.

Resumo Objetivo: Elaborar e validar um instrumento para o monitoramento de indicadores do desenvolvimento infantil. Métodos: Estudo metodológico baseado na proposta do Banco Mundial para medir indicadores do desenvolvimento infantil em países de baixa e média renda. As etapas do estudo contemplaram: elaboração de um inventário de itens para avaliação do desenvolvimento infantil, com base em instrumentos de livre acesso; validação de conteúdo por um grupo de especialistas no tema, com técnicas de consenso; seleção de questões para descrever as crianças e suas famílias; pré-teste do instrumento durante a campanha de vacinação de 2016 em três municípios e realização de entrevistas cognitivas. Resultados: Foram enviados 431 itens para avaliação dos especialistas, 77 foram excluídos e os demais apreciados presencialmente pelo grupo. No fim foram selecionados 162 itens que abrangeram os domínios motor, cognitivo, de linguagem e socioemocional, distribuídos em 10 faixas etárias. Foram incluídas questões sobre saúde, nutrição, aprendizagem precoce, proteção e segurança e cuidado responsivo. O instrumento foi aplicado por universitários voluntários a 367 mães de crianças menores de cinco anos, mostrou boa adesão dos cuidadores. O tempo médio de aplicação do questionário foi 20 minutos. As entrevistas cognitivas permitiram ajustar 19 itens do instrumento para melhor compreensão dos cuidadores. Conclusões: O instrumento construído e validado por especialistas preenche uma lacuna, que permite uma avaliação abrangente do desenvolvimento de crianças menores de cinco anos, em nível populacional, de forma rápida e barata, pode ser útil para o monitoramento de indicadores do desenvolvimento em campanhas de vacinação.

Development and validation of an instrument for monitoring child development indicators.

OBJECTIVE: To create and validate an instrument for child development monitoring. METHODS: Methodological study, based on the World Bank's proposition to monitor child development indicators in low- and middle-income countries. The stages of the study included the following: development of an inventory of items for child development evaluation, based on open access instruments; content validation by a group of experts on the topic, using consensus techniques; selection of questions to describe children and their families; pre-test of the instrument during the vaccination campaign in 2016 in three municipalities, and conducting cognitive interviews. RESULTS: A total of 431 items were sent for the evaluation of the specialists; 77 were initially excluded and the others were evaluated in-person by the group, with 162 items covering the motor, cognitive, language, and socio-emotional domains, distributed in ten age ranges. Questions about health, nutrition, early learning, protection and safety, and responsive care were also included. The instrument was applied by volunteer undergraduate students to 367 mothers of children under 5 years, showing good adherence of the caregivers. The time of application of the questionnaire was, on average, 20minutes. The cognitive interviews allowed the final adjustment of 19 items of the instrument for better understanding by the caregivers. CONCLUSIONS: The instrument created and validated by experts fills a gap, as it allows a comprehensive evaluation of the development of children under 5 years at the population level, using a fast and inexpensive tool, and can be useful for monitoring indicators of development in Brazilian children in vaccination campaigns.

Promotion of exclusive breast-feeding at scale within routine health services: impact of breast-feeding counselling training for community health workers in Recife, Brazil.

OBJECTIVE: Breast-feeding counselling has been identified as the intervention with the greatest potential for reducing child deaths, but there is little experience in delivering breast-feeding counselling at scale within routine health systems. The study aim was to compare rates of exclusive breast-feeding associated with a breast-feeding counselling intervention in which community health agents (CHA) received 20 h of training directed at counselling and practical skills with rates pre-intervention when CHA received 4 h of didactic teaching. DESIGN: Cross-sectional surveys of breast-feeding practices were conducted pre- and post-intervention in random samples of 1266 and 1245 infants aged 0-5.9 months, respectively. SETTING: Recife, Brazil, with a population of 2 million. SUBJECTS: CHA (n 1449) of Brazil's Family Health Programme were trained to provide breast-feeding counselling at home visits. RESULTS: Rates of exclusive breast-feeding improved when CHA were trained to provide breast-feeding counselling and were significantly higher by 10-13 percentage points at age 3-5.9 months when compared with pre-intervention rates (P < 0.05). Post-intervention point prevalence of exclusive breast-feeding for infants aged <4 months was 63% and for those aged <6 months was 50%. CONCLUSIONS: Multifunctional CHA were able to deliver breast-feeding counselling at scale within a routine health service and this was associated with a significant increase in rates of exclusive breast-feeding. The study reinforces the need to focus training on counselling and practical skills; a key component was an interactive style that utilized the knowledge and experience of CHA. The findings are relevant to the call by international organizations to scale up breast-feeding counselling.

[Evaluation of the historical series of live births at a tertiary health service--1991 to 2000]. / Avaliação da série histórica dos nascidos vivos em unidade terciária de Pernambuco--1991 a 2000.

OBJECTIVES: This study aimed to analyze some variables found in the Birth Certificates at the Instituto Materno Infantil de Pernambuco, Recife, from July 1991 to December 2000, according to Sinasc (National Information's data base of Births). METHODS: The statistical analysis was performed using the chi-square test for trend (p<0.05) on EpiInfo software (version 6.0), considering the years 1993 to 2000. RESULTS: The sample comprised a predominance of non-surgical deliveries, adequate gestational age of newborns, weight > 2500 g, Apgar score 1st min and 5th min between 8-10 and mature mothers who had attended from 4 to 6 appointments at prenatal care system. It showed the following rates: cesarean-section of 29.4% to 35.2% (chi2 = 73.7; p<0.01), low weight at birth of 15.9% to 22.8% (chi2 = 170.6; p < 0.01); premature newborns of 9.7% to 23.8% (chi2 = 503.6; p<0.01); teenage mothers of 24.1% to 28.8% (chi2 = 13.3; p<0.01), moreover a high percentage of newborns with Apgar index lower than 3 at the 1st minute (3.4% to 5.%) and (0.7% to 1.6%) at the 5th minute. CONCLUSION: These results confirm the role of IMIP as an institution for referral of high-risk pregnancies in Pernambuco.

Avaliação da série histórica dos nascidos vivos em unidade terciária de pernambuco: 1991 a 2000 / Evaluation of the historical series of live births at a tertiary health service: 1991 to 2000

OBJETIVO: Analisar a série temporal dos Nascidos Vivos do Instituto Materno Infantil de Pernambuco (IMIP) - Recife, segundo algumas variáveis, no período de julho de 1991 a dezembro de 2000. MÉTODOS: Utilizou-se o banco de dados do Sistema de Informação sobre Nascidos Vivos (Sinasc). Para análise estatística considerou-se os anos de 1993 a 2000 e foi realizado o Qui-quadrado de tendência (p < 0,05) no Epi Info (versão 6.0). RESULTADOS: Apesar da predominância de parto vaginal, peso > 2500g, idade gestacional > 37 semanas, Apgar no 1° e 5° minutos entre 8 e 10, mães adultas, 4 a 6 consultas de pré-natal, encontrou-se percentuais elevados e tendência progressiva na década para: partos cesarianos (29,4 por cento a 35,2 por cento, chi2 = 73,7; p < 0,01); baixo peso (15,9 por cento a 22,8 por cento, chi2 = 170,6; p < 0,01); pré-termos (9,7 por cento a 23,8 por cento, chi2 = 503,6; p < 0,001); mães adolescentes (24,1 por cento a 28,8 por cento, chi ² = 13,3; p < 0,01) além de um alto percentual de bebês com índice de Apgar menor que 3 no 1° minuto de 3,4 por cento a 5,5 por cento e no 5° minuto de 0,7 por cento a 1,6 por cento). CONCLUSÕES: Os resultados ratificam a caracterização do IMIP como hospital de complexidade terciária e de referência para gestantes e recém-nascidos de alto risco no Estado de Pernambuco.

Vigilância de óbitos infantis como indicador da efetividade do sistema de saúde - estudo em um município do interior do Nordeste brasileiro / Infant death surveillance as an indicator of health care system effectiveness - a study conducted in northeastern Brazil

Objetivo: avaliar, a partir do óbito infantil, o acesso e a qualidade da atenção Ó saúde prestada as crianças no município, durante a doença que levou ao óbito. Métodos: estudo descritivo de corte transversal, censitário, desérie de casos de óbitos infantis ocorridos em Bom Conselho, Pemambuco, no período de 1/1/1999 a 31/12/1999, identificados atravÚs do Sistema de Informação sobre Mortalidade, unidades de saúde, cartórios, cemitérios, agentes de saúde e parteiras. Os dados foram coletados mediante entrevistas domiciliares e revisÒo deprontußrios, em instrumentos específicos. Resultados: foram investigados 71 dos 72 óbitos identificados,com perda de 1,4por cento. A maioria (69,4por cento) ocorreu no periodo pós-neonatal. Do total, 67,6por cento aconteceram no domicilio, 77,5por cento procuraram assistÛncia pelo menos uma vez, sendo as emergências as mais procuradas (65,1por cento), porém 22,5 por cento não foram levados a nenhum serviço de saúde. A maioria dos serviços de saúde (90,9por cento ) estava a menos de uma hora de distância dos domiclios, 78,5por cento, localizados no município de residência, e 97 por cento dos atendimentos foram realizados por mÚdicos. Das 88 consultas realizadas, 39,8por cento terminaram com intemamento, e 27,3por cento foram atendidos e dispensados sem marcação da consulta de retomo, e 84 por cento receberam todas as medicaçÕes gratuitamente. Conclusões: através da vigilância dos óbitos, foi possível...

[Infant death surveillance as an indicator of health care system effectiveness--a study conducted in northeastern Brazil]. / Vigilância de óbitos infantis como indicador da efetividade do sistema de saúde--estudo em um município do interior do Nordeste brasileiro.

OBJECTIVE: To evaluate the access to and quality of health care administered to infants based on postmortem data. METHODS: A descriptive cross-sectional census-based study was carried out to assess the infant deaths that occurred in the town of Bom Conselho, state of Pernambuco, between January 1st 1999 and December 31st 1999. Home interviews and inspection of medical records were used for data collection. Deaths were identified by consulting the Mortality Information System, health centers, public notary services, cemeteries, health workers, and midwives. RESULTS: Seventy-one of 72 deaths were investigated, with a loss of 1.4%. The majority (69.4%) of deaths occurred in the postneonatal period and 67.6% of them occurred at home. In 77.5% of the cases medical help was sought at least once, most frequently at emergency units (65.1%). However, 22.5% of the patients were not taken to any kind of health care service. Most health care services (90.9%) were less than one hour away from the patient's home, 78.5% were located in the town of residence and 97% of the consultations were carried out by doctors. Of 88 consultations, 39.8% resulted in hospitalization and 27.3% in discharge without arrangement of a follow-up appointment. In 84% of the cases the medication was provided free of charge. CONCLUSIONS: Death surveillance revealed restricted access to medical care and poor quality of health care administered to infants living in the referred town. The high rate of home deaths is related to access, whilst the journeys made by some of the mothers to health care units, during the illness that caused the death of their infants, points to the precarious organization of those services.