The second session in this on-going seminar series on Building capacity on disability in low- and middle-income countries will be given my Prof. Charles Newton and Dr. Melissa Gladstone. The theme of this session is the Identification, diagnosis and management of neurodisabilities in LMICs.
Details of the two talks are provided below:
‘Neurodisability in Resource Poor Countries’
Prof. Charles Newton
Bio: Professor Charles Newton is the Cheryl & Reece Scott Professor of Psychiatry, Department of Psychiatry and St John’s College, University of Oxford, and the Scientific Director of the Muhimbili-Wellcome Programme, Dar-es-Salaam, Tanzania as well as the Head of Neurosciences, KEMRI-Wellcome Collaborative Programme, Kilifi Kenya. Professor Newton conducts research on the epidemiology and behavioural consequences of children experiencing a range of adversities in the low-income countries of insults, in particular the association of autism and developmental disorders with infections of the central nervous system (particularly malaria, HIV and bacterial meningitis).
‘Early childhood screening and surveillance for developmental disorders in low income settings’
Dr. Melissa Gladstone, Institute of Translational Medicine, University of Liverpool
Developmental delay is common in low income settings. More than 200 million children have developmental delay. Structured programmes in high income settings recommend surveillance programmes with the use of developmental tools to assess children to support health workers to make decisions about when children might be likely to need support. Evidence as to the efficacy of these programmes in terms of their specificity and sensitivity is very limited. The most efficacious programmes at present are those for hearing screening and blood spot screening for certain neonatal disorders which cause developmental delay. Furthermore, programmes supporting parents most at risk are most efficacious.
In low income settings, the tools to assess children are not well validated, often not simple to use and are in no way universal. Furthermore, the structures for these programmes are not in place and there are limited services for rehabilitation. Without these structures, children may be identified but no support provided. This may be distressing for families and cause them to spend resources that they do not have hunting for services which do not exist.
Integrated programmes to support developmental stimulation, early communication and nutrition have been shown to be effective in improving short term developmental and long term psychosocial and cognitive outcomes in later life although for these to be effective they will also require infrastructure, funding and clear supervisory structures. Children with disabilities could be incorporated into these programmes and can benefit from these programmes. These do not rely on the developmental age of the child but purely look at provision of support to families. This is likely to be more effective.
A shift from surveillance and screening to provision of integrated support programmes from infancy for children at risk is likely to make the biggest inroads to reducing developmental delay and for supporting parents of children with disabilities. These require good training, supportive supervision and effective integration into systems of care which have adequate resources to enable this.
Bio: Dr Melissa Gladstone is a Senior Lecturer in Paediatric Neurodisability at the Institute of Translational Medicine, University of Liverpool. Her focus is in improving low cost interventions and outcomes for children with neurodevelopmental disorders in low income settings. Together with her team she has developed the Malawi Developmental Assessment Tool (MDAT), a tool to assess child development in rural African settings that has been applied widely in Africa.
For more info, please see: www.mchw.org/?p=883