Cambodian Developmental Milestone Assessment Tool (cDMAT): Performance reference charts and reliability check of a tool to assess early childhood development in Cambodian children.

BACKGROUND: Childhood development milestones are essential skills that define how children participate in their environment socially, physically, and intellectually. A culturally-sensible and environmentally-appropriate tool is needed to assess their performance and detect disabilities at an early stage. METHOD: This observational study aimed to create reference charts of performances among healthy rural and semi-rural Cambodian children aged 0-83 months for each milestone using the Denver II-based Cambodian Development Milestone Assessment Tool (cDMAT). Inter-observer reliability testing yielded Kappa scores. RESULTS AND CONCLUSION: 1330 children included in the analyses represented an average population sample with similar gender balance, expected poverty distribution and the illiteracy rate among their mothers (81% with no or attended <7th-grade education). While gender, poverty and the mother's education level were not found to be confounding factors, the child's school enrolment status was (p < 0.005). The performance reference charts document the PASS ratios from which age onwards <25%, 25-75%, 75-90%, 90-99% and 99-100% of the children in each monthly cohort can perform a particular milestone. The mean inter-observer reliability ranged from substantial (Kappa 0.61 for delay) to excellent (Kappa 0.84 for immediate) in all domains. The performance reference charts of a culturally-sensible and environmentally-appropriate cDMAT can be used in Cambodia with special attention given to the child's school enrolment as it was found to be a confounding factor affecting child development. Creating a small-scale pilot program linking the cDMAT to early intervention would help raise awareness and create local expertise on early childhood development.

Immunogenicity and safety of an adjuvanted inactivated polio vaccine, IPV-Al, following vaccination in children at 2, 4, 6 and at 15-18 months.

BACKGROUND: Availability of affordable inactivated polio vaccines (IPV) is of major importance to meet the increasing global supply needs. The results presented here demonstrate non-inferiority of a reduced-dose, aluminium hydroxide-adjuvanted IPV (IPV-Al) to standard IPV. METHODS: A phase 3, observer-blinded, randomised, clinical trial was conducted in Panama in infants who received either IPV-Al (n = 400) or standard IPV (n = 400) at age 2, 4 and 6 months. In the booster trial, subjects received a single dose of IPV-Al at age 15-18 months. The primary endpoint was type-specific seroconversion, defined as an antibody titre ≥4-fold higher than the estimated maternal antibody titre and a titre ≥8, one month after the primary vaccination series. In the booster trial, the primary endpoint was the type-specific booster effects (geometric mean titre (GMT) post-booster (Day 28)/GMT pre-booster (Day 0). RESULTS: Seroconversion rates following primary vaccination with IPV-Al vs IPV were: 96.1% vs 100% (type 1); 100% vs 100% (type 2); and 99.2% vs 100% (type 3) respectively. IPV-Al was non-inferior to IPV, as the lower 95% confidence limits of the treatment differences were above the pre-defined -10%-point limit: 3.94% (-6.51; -2.01) for type 1; 0.0% (-1.30; -1.37) for type 2; -0.85 (-2.46; 0.40) for type 3. The booster effects for the group primed with IPV-Al versus the group primed with IPV were 25.3 vs 9.2 (type 1), 19.1 vs 6.5 (type 2) and 50.4 vs 12.5 (type 3). IPV-Al had a comparable safety profile to that of IPV. CONCLUSIONS: Non-inferiority of IPV-Al to standard IPV with respect to seroconversion after vaccination at 2, 4 and 6 months was confirmed for all three poliovirus serotypes. A robust booster response was demonstrated following vaccination with IPV-Al, regardless of the primary vaccine received. Both vaccines were well tolerated. ClinicalTrials.gov identifiers: NCT03025750 and NCT03671616. FUNDING: Bill & Melinda Gates Foundation.

Creating a Cambodia-specific developmental milestone screening tool - a pilot study.

BACKGROUND: Approximately 600 million people are living with various types of disabilities throughout the world and over 200 million children under age of 5 years old not reach their developmental potential. These adverse outcomes can be prevented through early detection and treatment. To accurately assess the development of children, a culturally appropriate screening tool must be used. Cambodia lacks such tool and other studies have shown that western tools are not valid in other cultures. AIMS: This study aimed at creating a culturally appropriate screening tool - called the Angkor Hospital for Children Developmental Milestone Assessment Tool (AHC DMAT) - for screening neurodevelopmental disability in Cambodian children. STUDY DESIGN, SUBJECT, OUTCOME MEASURES: Western milestones from the DDST II were used with cultural modifications. Children of both genders and aged from 1 month to 6 years assumed to have normal development were included in two pilot screenings (N=100 and N=63) with further modifications to the AHC DMAT made as necessary after each screening. RESULTS: The final AHC DMAT consists of 140 milestones (49% directly from DDST II, 17% modified DDST II, 34% added through expert opinion). CONCLUSION: Extensive revision of the DDST II was needed in order to create a more valid Cambodian screening tool. This study was the first step to create a Cambodian-specific screening tool but further large-scale testing of the AHC DMAT is needed to strengthen the tool's validity and to identify the age-range percentiles of each milestone before it can be used for neurodevelopment screening.