1. Development and inter-rater reliability of the "Care for Development - appraisal tool“(CDA): Assessment and monitoring of child development during first three years ISCI conference York July 27-29, 2011 Sanober Nadeem, Bilal Iqbal Avan, Ghazala Rafique, Aga Khan University - Pakistan

2. Assessment of the needs of young children Developmental assessment of children is very important for the identification of developmental delays and disability A child's development during the early years consists of: –physical (both health and nutritional status) –motor development (gross and fine motor skills), –psycho-social and emotional development (in terms of social relationships, culturally appropriate behavior, values, and self-esteem), and –cognitive and language development.

3. Child Development Indicators Measuring the status of children requires indicators that capture the different aspects of Early Child Development International agreement has been reached only for indicators of health and nutritional status. Many instruments exist to assess development of young children, however, none of them is accepted as a universal standard. Mainly developed by the western world and not always appropriate because of cultural differences.

4. Care for Development - appraisal tool(CDA): First three years CDA simultaneously: –monitors child growth and development during the first three years; –advises parents on how to enhance their nurturing skills; and –can be used by community based workers after appropriate training

5. CDA Manual and Tool

6. Introduction Developmental assessment of children is primarily done by trained professionals in health care settings and high correlation is found amongst them However, there is a scarcity of child development screening tools that could be used by community based workers with reliability

7. Aims and Objectives The current study was undertaken to determine the Inter- rater reliability of the CDA tool when used by trained community workers as compared to Experts (psychologists)

8. Methods A cross sectional survey was conducted in the AKU-HDP field site in Tando Jam, Sindh on 277 children aged less than three years For inter observer reliability measures, each ECDWs pair and one expert assessed children independently in the home setting

9. Results Very high inter-rater correlation was observed in the paired assessments (r =.951 to.995, p<.001) on all developmental domains of the CDA tool There is no significance difference in the distribution of mean difference (95% CI) among the experts and ECDWs observer rating for all developmental domains of the CDA tool

12. Graph 1: Degree of Agreement on Gross Motor (GM) among Expert and ECDWs

13. Conclusion This study concludes that CDA …… is a reliable tool for use in community settings by trained community based workers