Journal Article

Performance of the UNICEF/UN Washington Group tool for identifying functional difficulty in rural Zimbabwean children

Chasekwa, Bernard, Majo, Florence, Mutasa, Batsirai, Prendergast, Andrew J., Chandna, Jaya, Humphrey, Jean H., Dunne, Thomas Frederick, Tavengwa, Naume, Ntozini, Robert, Gladstone, Melissa J.

2022

Overview

Over one billion people live with disability worldwide, of whom 80% are in developing countries. Robust childhood disability data are limited, particularly as tools for identifying disability function poorly at young ages. A subgroup of children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (a cluster-randomised, community-based, 2x2 factorial trial in two rural districts in Zimbabwe) had neurodevelopmental assessments at 2 years of age. We evaluated functional difficulty prevalence in HIV-exposed and HIV-unexposed children using the Washington Group Child Functioning Module (WGCFM), comparing absolute difference using chi-squared or Fisher's exact tests. Concurrent validity with the Malawi Developmental Assessment Tool (MDAT) was assessed using logistic regression with cohort MDAT score quartiles, linear regression for unit-increase in raw scores and a Generalised Estimating Equation approach (to adjust for clusters) to compare MDAT scores of those with and without functional difficulty. A 3-step, cluster-adjusted multivariable regression model was then carried out to examine risk factors for functional difficulty. Functional Difficulty prevalence was 4.2% (95%CI: 3.2%, 5.2%) in HIV-unexposed children (n = 1606) versus 6.1% (95%CI: 3.5%, 8.9%) in HIV-exposed children (n = 314) (absolute difference 1.9%, 95%CI: -0.93%, 4.69%; p = 0.14). Functional difficulty score correlated negatively with MDAT: for each unit increase in WGCFM score, children completed 2.6 (95%CI: 2.2, 3.1) fewer MDAT items (p = 0.001). Children from families with food insecurity and poorer housing were more at risk of functional difficulty. Functional difficulty was identified in approximately 1-in-20 children in rural Zimbabwe, which is comparable to prevalence in previous studies. WGCFM showed concurrent validity with the MDAT, supporting its use in early childhood.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Age / Biology and Life Sciences / Child / Child development / Child, Preschool / Children / Children & youth / Clusters / Data collection / Developing countries / Disability / Disabled children / Distribution / Evaluation / Field study / Food insecurity / Food security / Health risks / Health surveys / HIV / HIV Infections - epidemiology / Human immunodeficiency virus / Human nutrition / Humans / Hygiene / Infant / Infant nutrition / LDCs / Medicine and Health Sciences / Motor ability / People and Places / Pregnancy / Quartiles / Questionnaires / Regression models / Risk analysis / Risk factors / Rural Population / Sanitation / Social Sciences / Subgroups / United Nations / Vagina / Washington / Zimbabwe - epidemiology