Evaluation of the INTER-NDA against pre-established feasibility criteria for use of an early child development assessment in a low-income and middle-income setting
| Does INTER-NDA fulfil the criteria? | Additional details | |
| World Bank Toolkit for Examining ECD* | ||
| Psychometrically adequate, valid and reliable | Yes | ICCs 0.74 and 0.88 (p<0.001) between BSID-III and INTER-NDA for cognitive, language and motor domains; internal consistency 0.56–0.80†. Inter-rater reliability: k = 0.70, 95% CI 0.47 to 0.88); test–retest reliability: k=0.79, 95% CI 0.48 to 0.96‡. |
| Balanced in terms of no of items at the lower end to avoid children with low scores | Yes | Age range of items: 6–36 months‡ |
| Enjoyable for children to take (eg, interactive, colourful materials) | Yes | |
| Relatively easy to adapt to various cultures | Yes | Adapted via cultural customisation session during training and currently in use in 12 countries (Brazil, India, Italy, Kenya, Pakistan, Thailand, South Africa, Mexico, Grenada, Finland, Guatemala, Democratic Republic of Congo; www.inter-nda.com) |
| Easy to use in low-resource settings, for example, not requiring much material | Yes | See Murray et al, for image of kit†; cost <GBP 120.00; no fee per use; manuals and forms freely available at www.intergrowth21.org.uk |
| Not too difficult to obtain or too expensive | Yes | See above |
| Able to be used in a wide age range | Moderately narrow age range | 22–30 months |
| Fischer et al’s feasibility criteria for use of developmental screening tools at primary healthcare level in low-middle income settings§ | ||
| Results understood by health workers | Yes | Centiles |
| Reliable | Yes | See above |
| Valid | Yes | See above |
| Acceptable to caregivers | Yes | |
| Provides information that is relevant to primary care providers | Yes | Centiles |
| Information that can be used for referrals of early intervention | Yes | Centiles |
| Information that is useful for anticipatory guidance | Unknown | |
| Results understood by caregivers | Yes | |
| Staff members have the expertise to answer questions | Yes | Session on maternal questions and responses included in training package. |
| Access to application | Yes | Freely accessible at www.intergrowth-21.org.uk |
| Training involved | Yes | Time taken to train assessors in the INTER-NDA: 1 day for ≤3 assessors, 2 days for 3–5 assessors, 3 days for 5–10 assessors |
| How long it takes to administer the tool | 15 min | |
| Cover multiple areas of child development | Yes | Cognition, language, fine and gross motor skills and behaviour (positive, negative and global)‡ |
| Cost of the tool | Minimal | Cost of kit <GBP 120.00; no fee per use; manuals and assessment forms freely available at www.intergrowth21.org.uk. Tablet/phone based data collection application (INTER-NDA E-form) optional. |
| Minimal adaptation needed | Yes | Sessions on cultural customisation and translation included in training |
| Educational level of staff members | Secondary education | Results of comparison between field workers and specialists presented in online supplementary table S6 and in text. |
| How many staff members to administer the tool | 1 | |
| Local norms available | International references available | Normative sample drawn from a prospectively recruited sample of 2 years from Brazil, India, Italy, Kenya and the UK with confirmed optimal nutritional, health and developmental status during the first 1000 days of life. |
| Space | Minimal | Storage of kit and forms/table. See Murray et al, for image of kit.† |
*Fernald et al.3
†Murray et al.16
‡Fernandes et al.15
§Fischer et al.4
BSID, Bayley Scales of Infant Development; ECD, early child development; ICCs, intraclass correlations; INTER-NDA, INTERGROWTH-21st Neurodevelopment Assessment.