gms | German Medical Science

Research question: A central demand of the global strategy for women’s, children’s and adolescents’ health is that every child should be able to reach its full potential. This includes the provision of optimal development opportunities for the child. Numerous tools exist that monitor children’s development and allow early identification of developmental delay. Identifying and addressing these is key to an equitable approach to quality health care in children. The Ministry of Health of Bhutan added a set of 11 child development screening tools (BCDST) for children aged between 10 weeks and 60 months to the vaccination table and other screening tools in the patient-held Mother and Child Health (MCH) handbook in 2019. Each BCDST contains 9 to 14 structured questions allowing yes/no answers that health workers were instructed to assess routinely. Here, we aim to assess the completeness of the BCDST according to the child’s age in comparison to the vaccination records. Our cross-sectional study uses quantitative information extracted from the MCH handbooks using data abstraction forms. We collected the information about the BCDST and vaccination records. In addition, we recorded basic demographic information such as date of birth. We performed a binominal regression with the statistical analysis tool R-Studio. To calculate the mean completeness of the BCDST and the vaccinations we chose the 95% confidence interval [CI 95%]. We extracted the MCH handbook data in two districts, Tsirang and Trongsa.

Results: We collected a total number of 745 BCDST and 614 vaccination entries. The mean overall completeness of the BCDST checklists was 57.3% [CI 95% 53.7%; 60.8%]. However, the completeness has differed between the two data collection fields. In Tsirang, the mean BCDST completeness was 45.7% [CI 95% 41.4%; 50%]. By contrast, Trongsa reached a mean completeness of 84.4% [CI 95% 79%; 88.6%]. In comparison, the mean completeness of the vaccinations was much higher. Both locations combined came up to 96.4% [CI 95% 94.6%; 97.6%], whereas Tsirang reached 95.2% [CI 95% 92.7%; 96.9%] and Trongsa reached 99% [CI 95% 96%; 99.7%] mean vaccination completeness.

Discussion: There are substantial differences in the completeness of the BCDST between Tsirang and Trongsa. The difference in BCDST completeness between both locations was statistically significant. Gaps between developmental screening records could negatively affect proper developmental evaluation and might lead to developmental risks due to late recognition of developmental delay. Reasons for the discrepancy between the vaccination records and the BCDST records should be identified, developmental delays detected and addressed early, and support provided. More broadly, our study could contribute to quality improvement in primary health care of children in Bhutan.

Note: Bhutanese names usually consist of one or two given names, and no family names. But due to technical reasons Lastname cannot be empty.