The outcome of growth and development assessment of under-fives using a new tool, the SMAT Score

Abstract

Background: The death of growth and development screening tools in developing countries has grave implications for child health outcomes. The aim of the study was to determine the effectiveness of a novel screening tool in a rural Nigerian community.
Method: Speech and language, Motor, Appearance and Temperament (SMAT) parameters of under- fives were queried using a novel tool, the SMAT Score. The effectiveness of the tool was assessed in three phases. In the first two phases the tool was administered to 210 under- fives (Subjects) independently. Those screened as having anomalies are classified as NOT SMAT while those screened otherwise as SMAT. In the third phase all NOT SMAT subjects and a number of randomly selected SMAT subjects were clinically evaluated. Outcomes of SMAT Score administration and clinical evaluation were subjected to psychometric assessments.
Results: There were 210 subjects with age range of 0.5 to 4.9 years (mean 2.3 ± 1.3 years) studied. Out of these 34 (16.2%) were screened as NOT SMAT. All the 90 (51.1%) randomly selected SMAT subjects as against 1 (2.9%) of the NOT SMAT subjects were clinically evaluated as normal. Inter rater and test – retest agreement rate in SMAT Score administrators was 100%. SMAT Score sensitivity and negative predictive value was 100% respectively in all age groups. The specificity was 98.9% overall and 96.3% among infants. Higher SMAT Score positive predictive value (97.1%) was observed with the entire study population as against 87.5% among infants.
Conclusion: SMAT Score effectively identified subjects with growth and developmental disorders. Its use has potential for improving health systems and consequently child health outcomes in developing countries.

Keywords: Growth, Development, Assessment, Tool, Under-fives