Table 5

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 reliableYesICCs 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 scoresYesAge range of items: 6–36 months‡
Enjoyable for children to take (eg, interactive, colourful materials)Yes
Relatively easy to adapt to various culturesYesAdapted 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;
Easy to use in low-resource settings, for example, not requiring much materialYesSee Murray et al, for image of kit†; cost <GBP 120.00; no fee per use; manuals and forms freely available at
Not too difficult to obtain or too expensiveYesSee above
Able to be used in a wide age rangeModerately narrow age range22–30 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 workersYesCentiles
ReliableYesSee above
ValidYesSee above
Acceptable to caregiversYes
Provides information that is relevant to primary care providersYesCentiles
Information that can be used for referrals of early interventionYesCentiles
Information that is useful for anticipatory guidanceUnknown
Results understood by caregiversYes
Staff members have the expertise to answer questionsYesSession on maternal questions and responses included in training package.
Access to applicationYesFreely accessible at
Training involvedYesTime 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 tool15 min
Cover multiple areas of child developmentYesCognition, language, fine and gross motor skills and behaviour (positive, negative and global)‡
Cost of the toolMinimalCost of kit <GBP 120.00; no fee per use; manuals and assessment forms freely available at Tablet/phone based data collection application (INTER-NDA E-form) optional.
Minimal adaptation neededYesSessions on cultural customisation and translation included in training
Educational level of staff membersSecondary educationResults of comparison between field workers and specialists presented in online supplementary table S6 and in text.
How many staff members to administer the tool1
Local norms availableInternational references availableNormative 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.
SpaceMinimalStorage 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.