1
|
Williams EH, Thompson NM, McCray G, Crespo-Llado MM, Bhavnani S, Gajria D, Mukherjee D, Del Bianco T, Lockwood-Estrin G, Mason L, Ngoma V, Namathanga C, Nkhata R, Bennie A, Ranjan A, Kawelama U, Midha N, Singh A, Mpakiza I, Gautam A, Gulati S, Johnson MH, Lancaster G, Belmonte MK, Jones E, Patel V, Chandran S, Mbale E, Divan G, Gladstone M, Chakrabarti B. Scalable Transdiagnostic Early Assessment of Mental Health (STREAM): a study protocol. BMJ Open 2024; 14:e088263. [PMID: 38871663 DOI: 10.1136/bmjopen-2024-088263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Early childhood development forms the foundations for functioning later in life. Thus, accurate monitoring of developmental trajectories is critical. However, such monitoring often relies on time-intensive assessments which necessitate administration by skilled professionals. This difficulty is exacerbated in low-resource settings where such professionals are predominantly concentrated in urban and often private clinics, making them inaccessible to many. This geographic and economic inaccessibility contributes to a significant 'detection gap' where many children who might benefit from support remain undetected. The Scalable Transdiagnostic Early Assessment of Mental Health (STREAM) project aims to bridge this gap by developing an open-source, scalable, tablet-based platform administered by non-specialist workers to assess motor, social and cognitive developmental status. The goal is to deploy STREAM through public health initiatives, maximising opportunities for effective early interventions. METHODS AND ANALYSIS The STREAM project will enrol and assess 4000 children aged 0-6 years from Malawi (n=2000) and India (n=2000). It integrates three established developmental assessment tools measuring motor, social and cognitive functioning using gamified tasks, observation checklists, parent-report and audio-video recordings. Domain scores for motor, social and cognitive functioning will be developed and assessed for their validity and reliability. These domain scores will then be used to construct age-adjusted developmental reference curves. ETHICS AND DISSEMINATION Ethical approval has been obtained from local review boards at each site (India: Sangath Institutional Review Board; All India Institute of Medical Science (AIIMS) Ethics Committee; Indian Council of Medical Research-Health Ministry Screening Committee; Malawi: College of Medicine Research and Ethics Committee; Malawi Ministry of Health-Blantyre District Health Office). The study adheres to Good Clinical Practice standards and the ethical guidelines of the 6th (2008) Declaration of Helsinki. Findings from STREAM will be disseminated to participating families, healthcare professionals, policymakers, educators and researchers, at local, national and international levels through meetings, academic journals and conferences.
Collapse
Affiliation(s)
- Elin H Williams
- Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Nicholas M Thompson
- Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | | | - Maria M Crespo-Llado
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | | | - Debarati Mukherjee
- Indian Institute of Public Health, Bengaluru, Public Health Foundation of India, Kamataka, India
| | - Teresa Del Bianco
- Centre for Brain & Cognitive Development, Birkbeck University of London, London, UK
- School of Social Sciences and Professions, London Metropolitan University, London, UK
| | | | - Luke Mason
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vukiwe Ngoma
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | - Allan Bennie
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | | | | | | | - Akshat Gautam
- Indian Institute of Technology Bombay, Mumbai, Maharashtra, India
| | - Sheffali Gulati
- Center of Excellence & Advanced Research for Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Mark H Johnson
- Department of Psychology, University of Cambridge, Cambridge, UK
| | | | - Matthew K Belmonte
- The Com DEALL Trust, Bengaluru, Karnataka, India
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Emily Jones
- Centre for Brain & Cognitive Development, Birkbeck University of London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Sharat Chandran
- Indian Institute of Technology Bombay, Mumbai, Maharashtra, India
| | - Emmie Mbale
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Bhismadev Chakrabarti
- Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Department of Psychology, Ashoka University, Sonipat, India
- India Autism Center, Kolkata, India
| |
Collapse
|
8
|
Arora NK, Nair MKC, Gulati S, Deshmukh V, Mohapatra A, Mishra D, Patel V, Pandey RM, Das BC, Divan G, Murthy GVS, Sharma TD, Sapra S, Aneja S, Juneja M, Reddy SK, Suman P, Mukherjee SB, Dasgupta R, Tudu P, Das MK, Bhutani VK, Durkin MS, Pinto-Martin J, Silberberg DH, Sagar R, Ahmed F, Babu N, Bavdekar S, Chandra V, Chaudhuri Z, Dada T, Dass R, Gourie-Devi M, Remadevi S, Gupta JC, Handa KK, Kalra V, Karande S, Konanki R, Kulkarni M, Kumar R, Maria A, Masoodi MA, Mehta M, Mohanty SK, Nair H, Natarajan P, Niswade AK, Prasad A, Rai SK, Russell PSS, Saxena R, Sharma S, Singh AK, Singh GB, Sumaraj L, Suresh S, Thakar A, Parthasarathy S, Vyas B, Panigrahi A, Saroch MK, Shukla R, Rao KVR, Silveira MP, Singh S, Vajaratkar V. Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India. PLoS Med 2018; 15:e1002615. [PMID: 30040859 PMCID: PMC6057634 DOI: 10.1371/journal.pmed.1002615] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/15/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.
Collapse
Affiliation(s)
| | - M. K. C. Nair
- Kerala University of Health Sciences, Medical College PO, Thrissur, Kerala, India
| | - Sheffali Gulati
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Devendra Mishra
- Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
| | - Vikram Patel
- Sangath, Bardez, Goa, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ravindra M. Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Bhagabati C. Das
- Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | | | - G. V. S. Murthy
- Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Thakur D. Sharma
- Himachal Foundation, Dharamshala, Kangra, Himachal Pradesh, India
| | - Savita Sapra
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Satinder Aneja
- Department of Paediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Monica Juneja
- Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
| | - Sunanda K. Reddy
- Centre for Applied Research and Education on Neurodevelopmental Impairments and Disability related Health Initiatives (CARENIDHI), New Delhi, India
| | - Praveen Suman
- Department of Paediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Rajib Dasgupta
- Department of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - Poma Tudu
- The INCLEN Trust International, New Delhi, India
| | | | - Vinod K. Bhutani
- Department of Paediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, California, United States of America
| | - Maureen S. Durkin
- Department of Population Health Sciences and Paediatrics, and Waisman Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Jennifer Pinto-Martin
- University of Pennsylvania School of Nursing and School of Medicine, Philadelphia, United States of America
| | - Donald H. Silberberg
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Science, New Delhi, India
| | - Faruqueuddin Ahmed
- Integral Institute of Medical Sciences & Research, Integral University, Lucknow, Uttar Pradesh, India
| | - Nandita Babu
- Department of Psychology, Delhi University, New Delhi, India
| | - Sandeep Bavdekar
- Department of Paediatrics, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Vijay Chandra
- Department of Neurology, Paras Hospital, Gurugram, Haryana, India
| | - Zia Chaudhuri
- Department of Ophthalmology, Lady Hardinge Medical College, New Delhi, India
| | - Tanuj Dada
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rashna Dass
- Department of Paediatric Disciplines, Health City Hospital, Guwahati, Assam, India
| | - M. Gourie-Devi
- Department of Neurology, Institute of Human Behaviour and Allied Sciences & Department of Neurophysiology, Sir Ganga Ram Hospital, New Delhi, India
| | - S. Remadevi
- School of Health Policy and Planning, Kerala University of Health Sciences, Thiruvananthapuram, Kerala, India
| | - Jagdish C. Gupta
- Ali Yavar Jung National Institute of Speech and Hearing Disabilities, Department of Empowerment of Persons with Disabilities, Kasturba Niketan, New Delhi, India
| | - Kumud K. Handa
- Department of ENT & Head Neck Surgery, Medanta Medicity, Gurugram, Haryana, India
| | - Veena Kalra
- Department of Paediatrics, Indraprastha Apollo Hospital, New Delhi, India
| | - Sunil Karande
- Department of Paediatrics, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Ramesh Konanki
- Department of Paediatric Neurology, Rainbow Children’s Hospital, Hyderabad, Telengana, India
| | - Madhuri Kulkarni
- Department of Paediatrics, Mumbai Port Trust Hospital, Mumbai, Maharashtra, India
| | - Rashmi Kumar
- Department of Paediatrics, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Arti Maria
- Department of Neonatology, Post Graduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, Delhi, India
| | - Muneer A. Masoodi
- Department of Community Medicine, Government Medical College, Srinagar, Kashmir, India
| | - Manju Mehta
- Department of Psychiatry, All India Institute of Medical Science, New Delhi, India
| | - Santosh Kumar Mohanty
- National Trust, Department of Empowerment of Persons with Disabilities, Ministry of Social Justice & Empowerment, Government of India, Delhi, India
| | - Harikumaran Nair
- Kerala University of Health Sciences, Medical College PO, Thrissur, Kerala, India
| | - Poonam Natarajan
- Vidya Sagar (formerly The Spastics Society of India), Chennai, Tamil Nadu, India
| | - A. K. Niswade
- Department of Paediatrics, Government Medical College, Nagpur, Maharashtra, India
| | - Atul Prasad
- Social Welfare Department, Government of Bihar, Patna, India
| | - Sanjay K. Rai
- Department of Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Paul S. S. Russell
- Department of Child & Adolescent Psychiatry and Facility for Children with Intellectual Disability, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rohit Saxena
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shobha Sharma
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arun K. Singh
- Rashtriya Bal Swasthya Karyakram, Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi, India
| | - Gautam B. Singh
- Department of Otorhinolaryngology and Head and Neck Surgery (ENT), Lady Hardinge Medical College, New Delhi, India
| | - Leena Sumaraj
- Child Development Centre, Medical College Campus, Thiruvananthapuram, Kerala, India
| | | | - Alok Thakar
- Department of Otolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sujatha Parthasarathy
- Department of Pediatric Neurology, The Hospital for Sick Children (SickKids), The Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Bhadresh Vyas
- Department of Paediatrics, M.P. Shah Government Medical College & G.G. Hospital, Jamnagar, Gujarat, India
| | - Ansuman Panigrahi
- Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Munish K. Saroch
- Department of ENT, Dr. Rajender Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Rajan Shukla
- Indian Institute of Public Health, Hyderabad, Telangana, India
| | - K. V. Raghava Rao
- RVM Institute of Medical Sciences and Research Center, Laxmakkapally, Telangana, India
| | - Maria P. Silveira
- Department of Paediatrics, Goa Medical College, Bambolim, Goa, India
| | - Samiksha Singh
- Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Vivek Vajaratkar
- Sangath, Bardez, Goa, India
- Department of Orthopedic Surgery, Goa Medical College, Bambolim, Goa, India
| |
Collapse
|