Extending the Developmental Milestones Checklist for use in a different context in Sub-Saharan Africa

Abstract

Aim: Sub-Saharan Africa bears a disproportionate amount of global diseases related to neurodevelopmental delays in infancy, including malnutrition, malaria and HIV. Evaluating interventions to prevent such delays requires developmental assessment tools appropriate for Sub-Saharan Africa. This study aimed to develop and evaluate such a tool. Methods: The Developmental Milestones Checklist (DMC) was developed in Kenya to provide motor, language and personal-social scores for children aged from 3 to 24months. We developed an extended version (DMC-II) in Burkina Faso, West Africa, and then evaluated the reliability and sensitivity of the scores to age and nutritional and environmental measures. Results: The internal, interinterviewer and test-retest reliability of the DMC-II scores were >0.7. In 214 children aged 11.6-25.4months, each score correlated with age (rs>0.7). In 1123 children aged 16.8-19.9months, the scores were sensitive to stunting, wasting and underweight (effect sizes 0.31-0.87 SD). The scores also showed expected correlations with measures of play materials in the home and activities with caregivers (rs=0.13-0.41). Conclusion: The DMC-II is easily used by trained fieldworkers with no previous experience in developmental assessment. It is a practical, reliable and sensitive tool for evaluating motor, language and personal-social development in different contexts in Sub-Saharan Africa.