Applicability of the Guide for Monitoring Child Development as a Telehealth Delivered Intervention During the Pandemic.

Background: Early intervention delivered through telehealth is critically needed during crises, particularly for children in low and middle-income countries (LMICs). We aimed to determine the applicability of the international Guide for Monitoring Child Development (GMCD) intervention delivered through telehealth during the COVID-19 lockdown in Turkey. Methods: Using a mixed-methods longitudinal design, we recruited children with developmental difficulties aged 0-42 months with an appointment during the first lockdown at Ankara University Developmental Pediatrics Division and seen face-to-face only once before. Developmental pediatricians applied the GMCD intervention during a single telephone call. As a novel intervention component, caregivers were asked to record and send back videos of the child's development when there were doubts about the child's functioning. Caregivers were called 1 year later by blinded independent researchers and a semi-structured interview on applicability was conducted. Applicability of the caregiver recorded video component of the intervention was assessed by a blinded observer using the GMCD Video Observation Tool. Results: Of 122 children that received the telehealth delivered GMCD intervention, 114 (93.4%) were included in the 1-year outcome study. Most were boys (51.8%); median age was 16.5 (IQR: 10.0-29.0) months, 51.0% had chronic health conditions, and 66.7% had developmental delay. All caregivers that received the intervention were mothers; 75.4% had at least high school education. The intervention was reported as applicable by 80.7% with high levels of satisfaction. On multivariate regression analysis, absence of chronic health related conditions was significantly associated with applicability (OR = 2.87, 95% CI = 1.02-8.09). Of 31 caregivers that were asked for videos, 19 sent back 93 videos that were technically observable. One or more developmental domains were observed in all videos; in 52.6%, caregivers provided early learning opportunities. Conclusions: The findings of this study imply that the telehealth delivered GMCD intervention for children with developmental difficulties is applicable during the pandemic. The intervention content and frequency needs to be augmented for children with chronic health conditions. Further research is required to examine applicability and effectiveness of the GMCD intervention in other settings, particularly in LMICs.

Hybrid type 1 effectiveness/implementation trial of the international Guide for Monitoring Child Development: protocol for a cluster-randomised controlled trial.

Introduction: More than 40% of children under 5 years of age in low-income and middle-income countries are at risk of not reaching their developmental potential. The international Guide for Monitoring Child Development (GMCD) early intervention package is a comprehensive programme to address developmental difficulties using an individualised intervention plan for young children and their families. We will conduct a hybrid type 1 effectiveness-implementation evaluation of the GMCD intervention in rural India and Guatemala. Methods and analysis: Using a cluster-randomised design, 624 children aged 0-24 months in 52 clusters (26 in India, 26 in Guatemala) will be assigned to usual care or the GMCD intervention plus usual care delivered by frontline workers for 12 months. After 12 months, the usual care arm will cross over to the intervention, which will continue for 12 additional months (24 total). The intervention will be delivered using a digital mobile device interface. Effectiveness will be assessed for developmental functioning (Bayley Scales of Infant Development, 3rd edition) and nurturing care (Home Observation for Measurement of the Environment Scale) outcomes. Implementation will be assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. Explanatory qualitative analysis guided by the Consolidated Framework for Implementation Research will explore determinants between clusters with high versus low implementation effectiveness. Ethics and dissemination: The study has been approved by the Institutional Review Boards of Brigham and Women's Hospital, Mahatma Gandhi Institute of Medical Sciences and Maya Health Alliance; and by the Indian Council of Medical Research/Health Ministry Screening Committee. Key study findings will be published in international open-access journals. Trial registration number: NCT04665297, CTRI/2020/12/029748. Protocol version: 1.0 (12 November 2020).

Abordaje del desarrollo en la primera infancia y sus dificultades en Turquía: programa de capacitación para las unidades de pediatría del desarrollo / Addressing early childhood development and developmental difficulties in Turkey: a training program for developmental pediatrics units

Introducción. El abordaje del desarrollo en la primera infancia (DPI) y las dificultades del desarrollo (DD) en los países de ingresos bajos o medios (PIBM) requiere de programas aplicables y sostenibles. Se evaluó el programa de capacitación para las unidades de pediatría del desarrollo (UPD) en los centros de referencia tras siete años. Población y métodos. Diseño transversal con métodos cualicuantitativos para evaluar los servicios, la capacitación, la investigación y la promoción de las UPD. Resultados. Se mantuvieron los servicios clínicos, la capacitación, investigación y promoción. En total, 23710 niños fueron derivados. La motivación y resistencia del personal, el respaldo de los administradores y la satisfacción del paciente facilitaron el programa, aunque la invisibilidad dentro del sistema de salud fue un obstáculo. Conclusiones. En Turquía, y posiblemente otros PIBM, el programa de capacitación para las UPD es aplicable y sostenible si se abordan los obstáculos del sistema de salud.

Introduction. Addressing early childhood development (ECD) and developmental difficulties (DDs) in low and middle-income countries (LMICs) requires applicable and sustainable programs. Seven years after its implementation in 2010, we evaluated the Developmental Pediatrics Unit (DPU) Training Program in pediatric referral centers in Turkey. Population and methods. We applied crosssectional design and quantitative/qualitative methods to assess services, training, research and advocacy of the DPUs. Results. Five of six established DPUs sustained clinical services, training, research, and advocacy. A total of 23,710 children (9085 new cases in 2017) had been referred mainly for perinatal risks and chronic illness, all centers contributed with similar proportions of children. Staff motivation and endurance, hospital administrator support, and client satisfaction facilitated the program; whereas invisibility within the performance based healthcare system was a barrier. Conclusions. In Turkey and possibly other LMICs, the DPU Training Program is applicable and sustainable if health system barriers are addressed

Addressing early childhood development and developmental difficulties in Turkey: a training programfor developmental pediatrics units. / Abordaje del desarrollo en la primera infancia y sus dificultades en Turquía: programa de capacitación para las unidades de pediatría del desarrollo.

INTRODUCTION: Addressing early childhood development (ECD) and developmental difficulties (DDs) in low and middle-income countries (LMICs) requires applicable and sustainable programs. Seven years after its implementation in 2010, we evaluated the Developmental Pediatrics Unit (DPU) Training Program in pediatric referral centers in Turkey. POPULATION AND METHODS: We applied crosssectional design and quantitative/qualitative methods to assess services, training, research and advocacy of the DPUs. RESULTS: Five of six established DPUs sustained clinical services, training, research, and advocacy. A total of 23,710 children (9085 new cases in 2017) had been referred mainly for perinatal risks and chronic illness, all centers contributed with similar proportions of children. Staff motivation and endurance, hospital administrator support, and client satisfaction facilitated the program; whereas invisibility within the performance based healthcare system was a barrier. CONCLUSIONS: In Turkey and possibly other LMICs, the DPU Training Program is applicable and sustainable if health system barriers are addressed.

Introducción. El abordaje del desarrollo en la primera infancia (DPI) y las dificultades del desarrollo (DD) en los países de ingresos bajos o medios (PIBM) requiere de programas aplicables y sostenibles. Se evaluó el programa de capacitación para las unidades de pediatría del desarrollo (UPD) en los centros de referencia tras siete años. Población y métodos. Diseño transversal con métodos cualicuantitativos para evaluar los servicios, la capacitación, la investigación y la promoción de las UPD. Resultados. Se mantuvieron los servicios clínicos, la capacitación, investigación y promoción. En total, 23 710niños fueron derivados. La motivación y resistencia del personal, el respaldo de los administradores y la satisfacción del paciente facilitaron el programa, aunque la invisibilidad dentro del sistema de salud fue un obstáculo. Conclusiones. En Turquía, y posiblemente otros PIBM, el programa de capacitación para las UPD es aplicable y sostenible si se abordan los obstáculos del sistema de salud.

Perinatal encephalopathy, the syndrome of intracranial hypertension and associated diagnostic labels in the Commonwealth of Independent States: a systematic review.

BACKGROUND: The WHO reports excessive rates of ill-defined neurological diagnoses and ineffective and potentially harmful drug treatments in children in the Commonwealth of Independent States (CIS). Collectively termed perinatal encephalopathy and the syndrome of intracranial hypertension (PE-SIH), these diagnoses are important contributors to perceived childhood morbidity and disability in the CIS. A systematic compilation of information on PE-SIH is lacking. METHODS: We systematically reviewed publications between 1970 and 2020 on PE-SIH in Azerbaijani, English, Russian and Ukrainian languages and summarised information on PE-SIH. RESULTS: We identified 30 publications (70% in Russian) published 1976-2017. The diagnosis of PE-SIH was either based on unreported criteria (67% of reports), non-specific clinical features of typically developing children or those with common developmental disorders (20% of reports) or cranial ultrasound (13% of reports). The reported proportion of children with PE-SIH in the study samples ranged from 31% to 99%. There were few published studies on reassessments of children diagnosed with PE-SIH, and these did not confirm neurological disease in the majority of children. Treatments included multiple unlicenced drugs without established effectiveness and with potential unwanted effects. CONCLUSION: This review suggests that PE-SIH is a medical diagnostic label that is used in numerous children without substantive associated disease. The diagnosis and treatment of PE-SIH is a multidimensional, iatrogenic, clinical and public health problem in the CIS. With increasing use of evidence-based medicine guidelines in the region, it is hoped that PE-SIH will gradually disappear, but actions to accelerate this change are nevertheless needed.