Table 3

Examples of CDATs (children <5 years) used in LMIC countries sourced from published literature

Tool and countryType of tool and item selection (translation±adaptation)ReliabilityValidityComments
Method of assessmentInternal consistencyCriterion
Kilifi Developmental Checklist (KDC) Kenya28Mixture of items from government local screening test, Western tools and LMIC tools developed elsewhereExcellent*Items range from poor to good correlation with parental report†Aimed to be used by low-skilled workers. Identified that secondary school level education was minimal for an assessor.
Direct and ReportExcellent‡
11–109 monthsExcellent‡Done
Kilifi Developmental Inventory (KDI) Kenya30Assessment based on KDC with additional items from western toolsExcellent*Good correlation with maternal reports†Designed to monitor changes over time. Involved parental focus groups so procedures acceptable to community.
Direct observationExcellent‡Sensitive to neurodevelopmental disorders and underweight children.
6–35 monthsExcellent‡
Developmental Milestone Checklist
Items from Western tools
Good*Very good correlation with KDI†.30Structured interview. Future plans to develop cut-offs using clinical samples. Can be administered by those with little training.
ReportStunted children had lower scores.
3–24 monthsGood‡Done
Guide to monitoring child development. Turkey46Screening
Core ideas were adapted from three seminal western models of child development.
Excellent*Excellent agreement with comprehensive evaluation§
Sensitivity 0.88; 95% CI 0.69 to 0.96
Specificity 0.93; 95% CI 0.83 to 0.97
Brief, open-ended precoded interview with parent. No specific cognitive domain questions. May not be appropriate for monitoring ‘at-risk’ populations.
0–24 months
Rapid neurodevelopmental assessment RNA 0–2 years
Mixture of neurological examination and neurodevelopment from western tools
Significant differences in scores in children with neurodevelopment impairmentUsed in a small high-risk population and identified infants requiring intervention for retinopathy of prematurity. RNA identified additional problems such as impairments in vision and hearing.
DirectExcellent§Detected difference in scores between urban rural children in older age groups
0–24 months
Rapid neurodevelopmental assessment. RNA 2–5 years
Mixture of neurological exam and development assessment from western tools
Sensitivity 80–90%
Specificity 60–78%
Comparison with ‘gold-standard’ tests already developed for Bangladesh.
DirectExcellent§Stunted children had lower scores.
24–60 months
Malawi Developmental Assessment Tool. Malawi32Screening
Western developmental tool and new items locally devised
Excellent49Good strategy to devise socioemotional items.
Direct and report60–80% of items at least fair§Sensitivity 97%
Specificity 82%
Sensitive to malnutrition except social developmental domain
0–72 months99–100% scoring at least fair§Good predictive validity50 51
INTERGROWTH-21st Neurodevelopment Assessment29Screening
Items from selection of Western and LMIC tools
Project specific criteria to create a tool for use in children from middle-class and upper class families across low-income, middle-income and high-income settings, carried out by non-specialists. Also evaluates vision, hearing and sleep-wake cycle.
Direct and reportGood
24 monthsExcellent
Systematic approach to assess nutritional influences. Indonesia17Assessment
Items from selection of Western tools
Items at least fair*Clear hypothesis driven tool creation. May not be suitable as a general developmental assessment.
DirectAt least fair agreement¶Expected relationship with maternal depression and maternal education
22–55 monthsItems at least fair†
Interpretation of statistical tests are listed below.16 52 These need to be interpreted in context of application and population.17 53
Levels of κ Levels§, R†, intraclass‡ correlation and α coefficients*.Level of proposed agreement¶ (%)Levels of clinical or practical significance
  • CDAT, child development assessment tool; LMICs, low-income and middle-income countries.