Overall mean scores of children with malnutrition (weight for height <80%) were also significantly different from scores of normal controls (62.5 versus 77.4 ) scores in the separate domains, excluding social development, also differed between malnourished children and controls. Using a pass/fail technique similar to the Denver II, 3% of children with neurodisabilities passed in comparison to 82% of normal children, demonstrating good sensitivity (97%) and specificity (82%). We demonstrated significant differences in overall mean scores (and individual domain scores) for children with neurodisabilities (35 versus 99 ) when compared to normal children. Reliability was good for items remaining with 94%–100% of items scoring kappas >0.4 for interobserver immediate, delayed, and intra-observer testing. We validated the tool by comparing age-matched normal children with those with malnutrition (120) and neurodisabilities (80). 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 examined performance of items using logistic regression and reliability using kappa statistics. We then assessed 1,426 normal rural children aged 0–6 y from rural Malawi and derived age-standardized norms for all items. After face and content validity testing and piloting, we expanded the draft tool to 185 items.
Following preliminary and qualitative studies, we produced a draft developmental assessment tool with 162 items in four domains of development.
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