Online Program

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

Monday, November 2, 2015

Scott Weinreb, BS, Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY
Nancy Rumaldo, Socios en Salud Sucursal Peru, Lima, Peru
Maribel Muñoz, Socios en Salud Sucursal Peru, Lima, Peru
Sonya S. Shin, MD, MPH, Department of Global Health Equity, Brigham and Women’s Hospital, Boston, MA
Adrianne Katrina Nelson, MPH, MSc, Community Outreach and Patient Empowerment Program, Gallup, NM
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.

Learning Areas:

Assessment of individual and community needs for health education
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
Describe why more infants with Neurodevelopmental Delay were identified in the community than in the clinic setting. Evaluate barriers to developmental screening of children living in extreme poverty.

Keyword(s): Maternal and Child Health, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a medical student with an interest in pediatric health and development who helped design this study, conduct the interviews and collect data, and analyze the relevant data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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