Child development and disability in resource poor settings.

Abstract

This virtual edition of Child: care, health and development brings together a series of eight papers published over the last five years reporting a rich mix of studies addressing important issues for child disability and developmental impairment in culturally diverse, resource poor settings. Whilst raising fascinating issues relating to the cultural context of childhood they point the way ahead towards common standards for our efforts to address the needs of ALL children. If we are to recognize, assess and provide intervention for developmentally impaired children families first need an understanding of typical early development. Ertem and colleagues (2007) use a 20-item Knowledge of Child Development Inventory to demonstrate this knowledge is lacking among urban Turkish mothers. Gladstone and colleagues (2010) use qualitative data from Malawi to take a culturally relativist position suggesting what is valued in the developing child is culturally variable and proceed to the development of a more culturally appropriate developmental assessment tool. This in turn begs the question is there a single norm for human child development? It would appear from the work of Reyes and colleagues (2010) in the Philippines that ‘language’ and ‘performance’ norms among Philippine 0- to 2-year-olds do differ from UK counterparts using the Griffiths Development scales. Readers wishing to explore this fascinating area further are directed to the excellent ‘cross-cultural reader’ in Anthropology and Child Development recently published by Robert Levine (Levine & New 2008). Ascertaining developmentally impaired children is a challenge. Most methods under-report impairment. Mung'ala-Odera and Newton (2007) provide a useful overview of the pros and cons of different approaches and urge us to validate better ways of estimating the size of the problem. As the second child survival revolution progresses we urgently need more data to ensure child development is recognized to be the next priority. Perhaps incorporating validated markers into Demographic Health Surveys is the way forward. No matter where children live families experience stress. Khan and colleagues (2008) in Bangladesh use a Self-Report Questionnaire to investigate the stress experienced by mothers attending their child development centre. Interestingly, stress levels reported by mothers of children with impairments were little different from a control group of those typically developing – and did not appear to have any simple relationship with child development centre attendance. Clearly, the determinants of maternal stress are multifactorial. Saloojee and colleagues (2009) adapt the Measure of Processes of Care to a South African setting and find that respectful and supportive care along with the provision of information and advice to families of children with impairments is as highly valued in Southern Africa as in North America. How care is delivered is important: de Souza and colleagues (2006) in India demonstrate limited coverage of a centre-based developmental support programme despite the support of the Anganwadi community health workers. They recommend home visiting programmes, the mode of delivery adopted by a ‘Learning through Play’ programme evaluated in a randomized controlled trial in Pakistan by Rahman and colleagues (2009). This programme was universal (rather than targeted for children with identified impairments) and found increases in mothers' knowledge and attitudes about infant development, but no difference in maternal stress. A common theme seems to be the need for more emphasis in families and health systems on understanding and facilitating preschool child development . . . readers of this virtual issue of Child: care, health and development can help to make up this deficit, aided by the evidence presented in these papers.