Assessing Early Childhood Development in Cambodian Children
Over 200 million children worldwide under the age of five do not reach their full developmental potential, primarily as a result of poverty, poor health and nutrition, and inadequate care (WHO, 2011). Failure to detect developmental delays can have lifelong consequences for children. Early identification and treatment can help improve the lives of children and reduce the severity of functional limitations.
In an effort to promote early detection of developmental delays, AHC, with financial support from GIZ and scientific contribution from Dr Piet de Mey, developed the first-ever Cambodian-appropriate screening tool for developmental milestones in Cambodian children.
Identifying a need for a culturally-adapted assessment tool, AHC hospital director Dr Pheaktra and board member Lina Saem Stoey co-developed the Cambodian Developmental Milestone Assessment Tool (cDMAT). The assessment tool facilitates early identification of delays and disability in Cambodian children using the the Denver Development Screening Tool (DDST II) milestones modified for the Cambodian setting.
Historically worldwide, the DDST II has been the most widely used childhood screening tool. Like many developmental assessment tools, however, this has been created based on western norms. In low-income countries like Cambodia, western tools and performance reference charts can be inappropriate and invalid. A culturally-sensible and environmentally-appropriate tool is needed to assess their performance and detect disabilities at an early stage. This is particularly the case when identifying and characterising functional limitations across social, language, cognitive, and physical domains in children.
Studies conducted by Prof Alfred Scherzer, a volunteer at AHC, have showed that over 25% of children at AHC failed to achieve one or more age-appropriate developmental milestones using western tools. Results from the cDMAT large-scale observational study showed that a child’s school enrolment played a part in the development of Cambodian children, while gender, poverty and the mother’s education level were not found to be confounding factors – ultimately, highlighting the need for an assessment tool that is culturally, linguistically, and environmentally appropriate to Cambodia.
Childhood development milestones are the essential skills that define how children participate in their environment socially, physically, and intellectually. cDMAT assesses four milestone domains, according to the age of a child: gross motor functions, fine motor functions, language/cognitive, and personal/social performance. The tool can be used by medical staff as an initial screen to then refer patients for further medical diagnostic testing if needed. The tool is currently in use at AHC with plans for it to be used country-wide.
The cDMAT team has also developed a community-based (called CB-DMAT) version of the tool for health centre staff, mothers, and teachers to use, so that specialised trained medical staff is not needed to be present. This modified version of the tool is essential for it to be applied to the rural-majority population of Cambodia.
The cDMAT and the CB-DMAT belong to the public domain – anyone can use it. The implementation, dissemination and improvement of both tools are facilitated by the cDMAT Core Group, headed by Dr Pheaktra and Mrs Stoey.
AHC is aiming for formal adoption and integration of the tool into protocol by the Ministry of Health. Already, international institutions like USAID, Humanity & Inclusion (formally Handicap International), Save The Children and United Nations Research Institute for Social Development (UNRISD) have endorsed the dissemination of cDMAT to other institutions in Cambodia. The tool has received support from the National Paediatric Hospital in Phnom Penh, and is listed in the World Bank database.