Background Renewed global commitment to the improvement of early child development outcomes, as evidenced by the focus of the United Nations Sustainable Development Goal 4, highlights an increased need for reliable and valid measures to evaluate preventive and interventional efforts designed to affect change. Our objective was to create a new tool, applicable across multicultures, to measure development from 0 to 3 years through metadata synthesis.
Methods Fourteen cross-sectional data sets were contributed on 21 083 children from 10 low/middle-income countries (LMIC), assessed using seven different tools (caregiver reported or directly assessed). Item groups, measuring similar developmental skills, were identified by item mapping across tools. Logistic regression curves displayed developmental trajectories for item groups across countries and age. Following expert consensus to identify well-performing items across developmental domains, a second mapping exercise was conducted to fill any gaps across the age range. The first version of the tool was constructed. Item response analysis validated our approach by putting all data sets onto a common scale.
Results 789 individual items were identified across tools in the first mapping and 129 item groups selected for analysis. 70 item groups were then selected through consensus, based on statistical performance and perceived importance, with a further 50 items identified at second mapping. A tool comprising 120 items (23 fine motor, 23 gross motor, 20 receptive language, 24 expressive language, 30 socioemotional) was created. The linked data sets on a common scale showed a curvilinear trajectory of child development, highlighting the validity of our approach through excellent coverage by age and consistency of measurement across contributed tools, a novel finding in itself.
Conclusions We have created the first version of a prototype tool for measuring children in the early years, developed using novel easy to apply methodology; now it needs to be feasibility tested and piloted across several LMICs.
- child health
- indices of health and disease and standardisation of rates
- community-based survey
- cross-sectional survey
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MG and MJ contributed equally.
Handling editor Seye Abimbola
Contributors GAL, MG, MJ, PK and TD planned and designed the study, with assistance throughout from GMC and JC, and comprise the core working group. PK, MJ and MG carried out the mapping exercises. GM conducted the statistical analysis with contribution from GAL and AT. MG, PK, DMC, GF, AA, JDH and FT contributed data sets. AA, AT, DMC, GAL, GMC, JC, JDH, MG, MJ, PK and TD participated in the consensus workshop. GAL wrote the first draft. All authors contributed to the critical revision of the manuscript and approved the final draft.
Funding This work was funded by the Grand Challenges Canada and the Bernard van Leer Foundation as an agency grant to the World Health Organization.
Competing interests GAL, GMC, AT, PK, MG, MJ, JC and TD were funded by an agency grant to WHO from Grand Challenges Canada and Bernard van Leer Foundation.
Patient consent Not required.
Ethics approval Ethical approval was given at each site for the original studies. Approval was also obtained from the ethics committee of the WHO in Geneva. Data were anonymised with all individual identifiers removed before transfer. Investigators confirmed in writing that any requirements by governing institutional review boards within contributing countries were met and that data could be shared for secondary analysis.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The ASQ data sets for India, Indonesia and Peru are available from the World Bank Water Sanitation Impact Evaluations at: http://microdata.worldbank.org/index.php/catalog/1554/data_dictionary#page=F2&tab=data-dictionary http://microdata.worldbank.org/index.php/catalog/1555/data_dictionary#page=F2&tab=data-dictionary http://microdata.worldbank.org/index.php/catalog/2033/data_dictionary#page=F3&tab=data-dictionary. We had approval to access all data we used for the purposes of this study. The PRIDI data are publicly available at: http://www.iadb.org/en/topics/education/initiative-pridi/about,20396.html. Secondary use of all other contributed data sets should be requested from the original site-specific chief investigators.
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