The Malawi Developmental Assessment Tool (MDAT): The Creation, Validation, and Reliability of a Tool to Assess Child Development in Rural African Settings
The Malawi Developmental Assessment Tool (MDAT): The Creation, Validation, and Reliability of a Tool to Assess Child Development in Rural African Settings
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DOI：
10.1371/journal.pmed.1000273
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发表时间：
2010-05-01
期刊：
影响因子：
15.8
通讯作者：
Smyth, Rosalind L.
中科院分区：
文献类型：
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作者：
Gladstone, Melissa;Lancaster, Gillian A.;Smyth, Rosalind L.
背景：虽然80%的残疾儿童生活在发展中国家，但很少有适合这些环境的文化上合适的发展评估工具。西方的工具往往在不同的文化背景下提供误导性的结果，其中一些项目是不熟悉的，参考值与西方人群的不同。方法和结果：经过初步和定性的研究，我们编制了一个包含四个发展领域的162个项目的发展评估工具草案。经过表面和内容效度测试和试点，我们将草稿工具扩展到185个项目。然后，我们评估了马拉维农村地区1,426名0-6岁的正常农村儿童，并得出了所有项目的年龄标准化常模。我们使用Logistic回归检验项目的性能，并使用kappa统计检验项目的可靠性。然后，我们在一次协商一致的会议上审议了所有项目，并删除了表现不佳和不必要或难以管理的项目，将136个项目留在最后的马拉维发展评估工具(MDAT)中。我们通过将年龄匹配的正常儿童与营养不良儿童(120名)和神经残疾儿童(80名)进行比较来验证该工具。对于观察者间即时测试、延迟测试和观察者内测试，94%-100%的项目Kappas>；0.4得分的项目具有良好的可靠性。我们发现神经残疾儿童的总体平均分数(和个人领域分数)有显著差异(35分对99分[p
Background: Although 80% of children with disabilities live in developing countries, there are few culturally appropriate developmental assessment tools available for these settings. Often tools from the West provide misleading findings in different cultural settings, where some items are unfamiliar and reference values are different from those of Western populations.Methods and Findings: Following preliminary and qualitative studies, we produced a draft developmental assessment tool with 162 items in four domains of development. After face and content validity testing and piloting, we expanded the draft tool to 185 items. We then assessed 1,426 normal rural children aged 0-6 y from rural Malawi and derived age-standardized norms for all items. We examined performance of items using logistic regression and reliability using kappa statistics. We then considered all items at a consensus meeting and removed those performing badly and those that were unnecessary or difficult to administer, leaving 136 items in the final Malawi Developmental Assessment Tool (MDAT). We validated the tool by comparing age-matched normal children with those with malnutrition (120) and neurodisabilities (80). Reliability was good for items remaining with 94%-100% of items scoring kappas >0.4 for interobserver immediate, delayed, and intra-observer testing. We demonstrated significant differences in overall mean scores (and individual domain scores) for children with neurodisabilities (35 versus 99 [p