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Developmental Difficulties in Early Childhood Prevention, early identification, assessment …

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WHO. World Health Organization. Developmental Difficulties in Early Childhood Prevention, early identification, assessment and intervention in low- and middle-income countries: A Review, 2012.

The majority of the world’s children live in low- and middle-income (LAMI) countries. Often, in these countries, the health care system is the only system that has the potential to reach most young children and their families. For centuries, clinicians, researchers and advocates around the world have been working to prevent, diagnose and treat childhood illness, so that children can enjoy good health and reach adulthood. This task continues to be a challenge. There is still an unacceptable disparity between high-income and LAMI countries with respect to indicators for child survival and health. Equally unacceptable is the disparity between countries in the range of supports available to help children develop optimally, and to prevent, detect and manage developmental difficulties during infancy and early childhood.

Despite long experience in fighting childhood illness and mortality, health care providers in LAMI countries face new challenges in promot-ing child development. There is, nevertheless, a wealth of information on this topic, generated by researchers and clinicians working in resource-poor conditions. The main premise of the present review lies in the words of the late Professor Mujdat Basaran, a renowned paediatrician in Turkey: “We must generate our own science. We must search and research for information that is pertinent for our own circumstances and we must contribute to the production of the science that will help us move forward.” This review therefore compiles the wealth of information that has already accumu-lated in a systematic framework that can be used by health care providers in LAMI countries.

In this review, the term “developmental dif-ficulties” is used to refer to a range of difficulties experienced by infants and young children, including developmental delay in the areas of cognitive, language, social-emotional, behav-ioural and neuromotor development. “Early childhood” and “young children” relate to the age range 0 to 3 years. Since economic status is the most important factor determining human development, countries are categorized as high-income or low- and middle-income according to the World Bank definition.

Developmental difficulties during early childhood are increasingly recognized in LAMI countries as important contributors to morbidity in children and adults. Health care systems in high-income countries provide multiple oppor-tunities for the prevention, early identification and management of developmental difficulties in young children. Interventions to improve the development of young children are becoming increasingly available in LAMI countries, and include low-cost strategies, such as addressing malnutrition and iron deficiency, training car-egivers, increasing psychosocial stimulation and providing community-based rehabilitation.

Infancy and early childhood are the best time for the prevention and amelioration of problems that could potentially cause developmental dif-ficulties and affect brain development across the lifespan. A focus on prevention and early inter-vention for developmental difficulties requires an understanding of the magnitude and nature of the problems, to ensure a match between the nterventions delivered and what is needed by the children, their families and their communities.

Many families have contact with the health care system most often – and sometimes only – when their children are young. Health care encounters for young children are, therefore, important opportunities for clinicians in LAMI countries to have a positive influence on development.

In most LAMI countries, the health care sys-tem does not have a model for the promotion and monitoring of the development of children, prevention and early identification of risk factors associated with developmental difficulties, and early interventions. Health care providers may not have appropriate knowledge and expertise, and service delivery systems may be inadequate. However, by building local capacity, a systematic approach, specific to the needs of LAMI countries, can be developed. This review seeks to help health care providers and systems in LAMI countries to build such local capacity.

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