Khan, NZ; (1991) Identifying disabilities in children by means of a brief 'observation of function' for use in developing countries. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This study was an offshoot of a collaborative survey called the 'Rapid Epidemiological Assessment of Childhood Disabilities' (REA) undertaken in three developing countries, Bangladesh, Jamaica and Pakistan, aiming to develop a screening procedure for two-to-nine year old children for disabilities of movement, hearing, vision, speech, cognition and epilepsy. To facilitate physicians doing comprehensive neurodevelopmental assessments of large numbers of children within the community, this study aimed to verify whether a brief procedure of observing children perform a simple set of tasks, called the 'Observation of Function' (OF), could identify disability validly and reliably (first part of the study). Subsequently, the OF was used by community workers (CWs) doing field work, to verify whether they too could use it validly and reliably (second part of the study). The analysis of the first part was done on 1626 children from five sites in Bangladesh, who had either been screened positive by the REA study or assessed as controls. Over half of the total number of disabilities were identified by the procedure, including most serious problems. It did best for motor disabilities; hearing and vision were the least identified, especially isolated problems. Significantly more younger children were identified. The yield of the OF was best when combined with the mother's history. The CWs did not do as well with the procedure. Poor sensitivity in case identification was seen as an absence of 'internalized standards' of child development. However, some problems were identified consistently, as evidenced by the high reliability scores, suggesting future potential for improving the capacity of the CWs for using the OF. Thus this study suggests that the OF can be a valuable neuroepidemiological tool to be used by physicians during field work. It may also aid them in busy clinical settings to focus on function-specific evaluation. The value of involving CWs in the screening as well as the evaluatory (OF) stage of identifying childhood disabilities in developing countries holds practical significance, and ways of improving their further training is discussed.

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