Record of Early Childhood Growth and Development: 0-6 Years
The Human Development Programme (HDP) is an initiative of Aga Khan University (AKU). The basic objective of this programme is to enhance human development through early childhood development (ECD). The AKU-HDP is operating with four inter-dependent components related to ECD: (i) community-based ECD and parenting model interventions; (ii) advocacy and constituency building; (iii) credit and non-credit training and education activities; (iv) inter-disciplinary, field-based research, monitoring, and evaluation activities. Research-based evidence is prerequisite to functionally interlink all these four domains.
Research instruments to assess child capabilities are mainly developed by the western world, which are not culturally appropriate for other regions of the world. The major reason for lack of reliable data from developing countries is non-availability of local standardized instruments to assess child growth and development simultaneously. In Pakistan, such important research endeavours are lacking, consequently the case for early childhood development at national level has not gained momentum. In this context, AKU-HDP felt the need to develop 'Record for Child Growth and Development, and Suggestions for the Caregivers' to enable caregivers as well as health and education service providers to understand the child status that will facilitate them in creating a reasonable environment for optimal nurturance and care of child.
Based on the experience gained in a community-based study on child development and social environment in Sindh (2002), a process of tool development was initiated with a team of experts from diverse fields, including psychologists, physicians, community health nurses, public health practitioners, epidemiologists, sociologists and educationists.
The child record development was completed primarily in seven major stages:
(Stage I) Conceptualization: theoretical framework of the instrument was developed on the basis of extensive literature review, discussions and opinions from the experts.
(Stage II) Consolidation: physical structure of the research instrument was established by finalization of the contents, layout and illustrations. The record has two components: a) child assessment: it provides the opportunity to assess the child growth and development; b) caregiver education: it provides opportunity to communicate information to the caregiver to create a conducive environment for the child through better rearing practices.
(Stage III) Pilot Testing: It was conducted at two levels, that is, community workers and children. Ambiguities or errors were removed from the record on its basis.
(Stage IV) Pre-testing: It was performed with three specific purposes: a) feasibility and operationalization of the record in a community setting; b) comprehension of the illustrations by the caregivers; c) to identify the norms of physical growth and mental development in a Pakistani context. A cross sectional study was conducted on 1000 children in the semi-urban settlements of Karachi (Qayyumabad and Manzoor Colony). Eligibility criteria encompassed all those children who were of 0-3 years of age, during March and April 2004. Verbal informed consent was taken from their caregivers. Children with diagnosed severe mental retardation, physical disability or physical illness at the time of assessment were excluded from the study. The assessment was performed at the household level with approximate time of 30 - 45 minutes per child. Data management team at AKU- HDP managed the data.
(Stage V) Data Analysis: Quantitative analysis was performed to: i) demonstrate the demographic characteristics of the study population; ii) describe physical growth status of the children; iii) assess the validity of psychometric measurement and any ambiguities, errors or difficulty in understanding; iv) to modify the record on the basis of distribution of the item of developmental status for the respective age group. On the basis of qualitative analysis, common themes from the caregiver's suggestions and comments were identified and sketches were modified accordingly. Demographic characteristics of study participants were representative of middle socioeconomic class of Pakistani population.
(Stage VI) Revision: Consequently, record was revised on statistical basis as well as through feedback and discussion. After review of each item, modification was considered for its illustration, descriptor or mode of administration.