P2B213: Evaluation of the Cerebral Palsy and Developmental Disabilities Early Screening and Treatment (CDEST) Project: An International Community Access to Child Health (ICATCH) Sponsored Project

Background: The burden of children with developmental disabilities (DDs) is highest in low-and-middle-income countries. Despite this, there are no existing programmes for the early identification of children with DDs in Nigeria. Therefore, this study aimed to evaluate the feasibility and acceptability of early identification of DDs in young children by training community health nurses (CHNs) in immunization clinics. Secondly, we aimed to evaluate the referral rates and pathways to an early intervention clinic for children with cerebral palsy and other DDs.

Methods: We undertook a mixed-methods study using both qualitative methodology and quantitative methods for process evaluation in three primary healthcare centres in Ile-Ife, Nigeria linked to a central University hospital. Immunization clinics run every weekday with 4-5 nurses seeing 20-50 infants daily. We conducted 20 key informant interviews with CHNs, doctors and parents in our pre-implementation phase using a topic guide to understand issues relating to the feasibility and acceptability of our newly proposed developmental screening (DS) program. We audio recorded, transcribed and translated these verbatim. We then adapted the training as well as the screening tool and referral pathway and implemented training with 45 nurses. Following implementation, we conducted a process evaluation where we collected data on pre and post-training knowledge with the nurses as well as the changes in referral. Data was collected and analyzed in Stata 15 software for the quantitative study and the NVivo software for the qualitative study.

Results: At the pre-implementation stage, we identified specific barriers to the integration of DS into routine clinic services. These included: organizational structural deficits (training and leadership), limited organizational resources and procedures (time constraints, lack of tools, language barriers, overcrowding) but also parental factors such as parental perceptions relating to the stigma and understanding of DDs. At the stage of implementing training we adapted and produced a simpler screening tool - the-MDAT-sign tool which included prompts for parents and CHNs as well as wall posters and table cards explaining the referral pathway—as well as visual cards for developmental surveillance by parents (Figure 1). Early DS using the MDAT sign tool commenced in January 2022 (following training of CHNs) with a 40% increase in the total number of referrals. (Table 1). There was a statistically significant increase in the mean knowledge of the nurse's pre and post-training (t=-6.190, p= < 0.001).

Conclusion: Through understanding the needs before implementation, we adapted training suitable for busy immunization clinics in Nigeria and improved rates of referrals for DDs. To support this, there is a need for more advocacy, stakeholder engagement, staff re-training, and programmes for improving parental support and training. Future directions include the implementation of this training program at other facilities, and the expansion of the pilot early intervention clinic to provide family-centered services.