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High rates of childhood neurodisability are reported among the Roma, Europe’s largest ethnic minority community. Interventions targeting early child development (ECD) during the first 2 years of life can improve neurodevelopmental outcomes in vulnerable children; however, evidence from Roma preschoolers is scarce. In a quasi-experimental observational study, we compared neurodevelopmental outcomes at age 2 years, measured on the INTERGROWTH-21st Project Neurodevelopmental Assessment (INTER-NDA), between Roma children receiving a community-based ECD intervention (RI, n = 98), and age- and sex-matched Roma and non-Roma children (RC, n = 99 and NRC, n = 54, respectively) who did not receive the intervention in Eastern Slovakia. The intervention was delivered between 3 weeks and 20 months in weekly home-based sessions by trained Roma women from matched settlements to RIs. Compared with RC, RI had higher 2-year cognitive (B = 0.15; 95% CI, 0.04, 0.25), language (B = 0.25; 95% CI, 0.11, 0.38) and fine motor (B = 0.08; 95% CI, 0.01, 0.16) scores. After adjustment for covariates, cognitive delay decreased by 88% in RI compared with RC (aOR, 0.12; 95% CI, 0.03, 0.53). Linear growth at 24 months was a key predictor of developmental scores for both groups (range, B = 0.04–0.14; 95% CI, 0.01, 0.07 and 0.09, 0.20). Conclusions: Our results highlight that, without directly intervening on nutritional and poverty status, a community-based ECD intervention, delivered by trained Roma women to Roma children, can significantly improve neurodevelopmental outcomes at age 2 years. What is Known: • The Roma are Europe’s largest ethnic minority. High rates of neurodisability, malnutrition and poverty are reported in Roma preschoolers. • Optimal early child development (ECD) is foundational to lifecourse health and wellbeing. Early interventions improve ECD outcomes in vulnerable children; however, evidence from Roma communities is limited. What is New: • The Omama project is a community-based ECD intervention, delivered by trained Roma women to Roma children aged 3 weeks to 20 months living in impoverished settlements in Eastern Slovakia. • Roma children receiving the intervention had (i) higher cognitive, language and fine motor scores and (ii) lower rates of cognitive delay compared with controls. [ABSTRACT FROM AUTHOR]

Abstract Background Adaptation of standardized early child development (ECD) assessments to low- and middle-income countries can be challenging because of culture-specific factors relating to language, content, context, and tool administration, and because the reliance of these tests on specialist healthcare professionals limits their scalability in low resource settings. Methods We report the cross-cultural adaptation of an international, standardized ECD instrument, the INTERGROWTH-21st Project Neurodevelopment Assessment (INTER-NDA), measuring cognitive, language, motor and behavioural outcomes in 2-year-olds, from a UK-based English-speaking population to the English-speaking Caribbean. Children aged 22-30 months were recruited from a pre-existing randomized controlled neurodevelopment intervention study in Grenada, West Indies. Results Eight of 37 INTER-NDA items (22%) were culturally and linguistically adapted for implementation in the Caribbean context. Protocol adherence across seven newly-trained non-specialist child development assessors was 89.9%; six of the seven assessors scored ≥80%. Agreement between the expert assessor and the non-specialist child development assessors was substantial (κ = 0.89 to 1.00 (95% CI [0.58, 1.00]). The inter-rater and test-retest reliability for non-specialist child development assessors was between κ = 0.99 -1.00 (95% CI [0.98, 0.99]) and κ = 0.76 - 1.00 (95% CI [0.33, 1.00]) across all INTER-NDA domains. Conclusions The current study provides evidence to support the use of the adapted INTER-NDA by trained, non-specialist assessors to measure ECD prevalence in the English-speaking Caribbean. It also provides a methodological template for the adaptation of child developmental measures to cultural and linguistic contexts that conform to the cultural standards of the countries in which they are utilized to aid in the measurement of neurodevelopmental impairments (NDIs) in a variety of global clinical settings.

Background: Adaptation of standardized early child development (ECD) assessments to low- and middle-income countries can be challenging because of culture-specific factors relating to language, content, context, and tool administration, and because the reliance of these tests on specialist healthcare professionals limits their scalability in low resource settings.Methods: We report the cross-cultural adaptation of an international, standardized ECD instrument, the INTERGROWTH-21st Project Neurodevelopment Assessment (INTER-NDA), measuring cognitive, language, motor and behavioural outcomes in 2-year-olds, from a UK-based English-speaking population to the English-speaking Caribbean. Children aged 22-30 months were recruited from a pre-existing randomized controlled neurodevelopment intervention study in Grenada, West Indies.Results: Eight of 37 INTER-NDA items (22%) were culturally and linguistically adapted for implementation in the Caribbean context. Protocol adherence across seven newly-trained non-specialist child development assessors was 89.9%; six of the seven assessors scored ≥80%. Agreement between the expert assessor and the non-specialist child development assessors was substantial (κ = 0.89 to 1.00 (95% CI [0.58, 1.00]). The inter-rater and test-retest reliability for non-specialist child development assessors was between κ = 0.99 -1.00 (95% CI [0.98, 0.99]) and κ = 0.76 - 1.00 (95% CI [0.33, 1.00]) across all INTER-NDA domains.Conclusions: The current study provides evidence to support the use of the adapted INTER-NDA by trained, non-specialist assessors to measure ECD prevalence in the English-speaking Caribbean. It also provides a methodological template for the adaptation of child developmental measures to cultural and linguistic contexts that conform to the cultural standards of the countries in which they are utilized to aid in the measurement of neurodevelopmental impairments (NDIs) in a variety of global clinical settings. [ABSTRACT FROM AUTHOR]