Evaluating the limitations of clinic-based screening of infant neurodevelopmental delay in a setting of extreme poverty in Lima, Peru

Background: In the Carabayllo district in the outskirts of Lima, Peru, the non-profit organization Socios en Salud (SES) is providing a community-based early intervention to infants age 6-24 months, living in extreme poverty and at risk of Neurodevelopmental Delay (NDD). SES expected to identify more infants with NDD in Ministry of Health (MINSA) clinics than through outreach conducted by community health workers (CHW); however, of the 69 participants enrolled in the first phase of the intervention, 61 (88%) were identified by CHWs, and 8 (12%) were identified by MINSA health professionals.

Objectives: To describe why more infants with NDD were identified in the community and to evaluate barriers to developmental screening of children living in extreme poverty.

Methods: One-on-one interviews were conducted with 4 health professionals and 3 CHWs involved in subject recruitment. Interviews were coded and organized into themes for analysis using Dedoose software.

Results: Preliminary results indicate that fewer subjects were identified in MINSA clinics primarily because of low pediatric check-up attendance. Explanations for low clinic attendance include inadequate maternal education regarding the pertinence of check-ups, long clinic wait-times, maternal work commitments, and distrust of health services. A second explanation of lower recruitment in the clinics is that, in a resource-limited environment, MINSA clinics prioritize vaccinations, height/weight measurements, and iron-deficiency anemia above NDD screening.

Conclusions: These interviews suggest that an effective NDD screening strategy for Carabayllo would include clinic and community-based components. Potential interventions could involve coupling community-based NDD screening with maternal education encouraging regular pediatric check-up attendance.