Child disability services in Bangladesh: Scherzer et al. reply

Abstract

SIR–We welcome the supportive comments of McConachie and Salt about our review, which concludes that there is a great need for incorporating early evaluation and intervention programs into routine pediatric care. However, it should be kept in mind that a major focus of this paper is the need for continuous surveillance by practitioners at all levels whenever there is clinical contact, with early referral for further and more detailed evaluation, parental education and support, and early intervention as circumstances permit. The problem often encountered in lowand middle-income countries is that too often practitioners have little or no training in child development, or indeed any awareness of potential developmental problems that should be addressed in addition to the concern presented by the parent. Our focus, therefore, is on the need for training of all staff to enable regular developmental surveillance, and the supplemental use of a simple reminder, a chronological age check-off sheet, such as was trialled in Cambodia. The Rapid Neurodevelopmental Assessment (RNDA) for Bangladeshi children validated by Khan et al. is an outstanding step forward, and is among other emerging tools in lowand middle-income countries such as the caregiver developmental reports in Kenya, the Malawi Developmental Assessment Tool (MDAT), and the Brigance developmental assessment tool for Aboriginal children in Australia. However, like the RNDA, these tools require specially trained staff, and can best perform at a secondary level by providing detailed evaluation for children referred through regular surveillance by practitioners. Such screening instruments do need to be further developed and validated; however, they do not take the place of training for regular developmental surveillance and the possible use of a supplemental reminder mechanism to ensure that all practitioners on every level think developmentally and refer early.