RATIONALE. The timely identification of children with psycho social problems is very important in facilitating early intervention. Detection of these children in the community setting requires the development of an easy-to-use screening tool that can be used by community health workers.

OBJECTIVE. To develop a valid and reliable screening tool that can be easily used by community health workers for the detection of psycho social problems in Filipino children. Specifically, 1) To develop a Filipino version of the Pictorial Pediatric Symptom Checklist (PPSC) for use by community health workers; and 2) To culturally validate the PPSC-Filipino version in a low-income urban community.

METHODS. This study consisted of three phases: Phase 1 (Exploratory Study) consisted of focus group discussions and key informant interviews for content validation. Phase 2 (Questionnaire Development) involved refinement of the Filipino translation of the PPSC. In Phase 3 (Actual Survey), the PPSC was administered by health workers to 127 primary caregivers of children aged 4 to 7 years residing in a low-income community in Pandacan, Manila. Data gathered were subjected to reliability testing and factor analysis for construct validation. Chi-square analyses were done to determine the association of sociodemographic factors to overall PPSC results.

RESULTS. Construct and content validity were confirmed. The Filipino PPSC showed high internal consistency (Cronbachs alpha 0.89). Factor analysis resulted in three new domains: 1) Attention & Externalizing Problems, 2) Internalizing Problems, and 3) School & Learning Problems. Among the 127 children screened, 24 (18.9%) were positive for psychosocial problems. Externalizing behaviors (fighting, rule-breaking, teasing) dominated among those who screened positive. The child age and number of siblings were the factors significantly associated with the overall PPSC results.

CONCLUSIONS. The Pictorial Pediatric Symptom Checklist-Filipino Version is a valid and reliable tool in screening for psychosocial problems in children aged 4 to 7 years old residing in a low-income urban community. Administration by community health workers is feasible and its use in the community setting is particularly relevant since many cases of psychosocial disorders remain undetected.

Factor Analysis, Statistical ; Focus Groups ; Early Intervention (education) ; Caregivers ; Community Health Workers ; Checklist ; Translations ; Poverty ; Bullying ; Attention

OBJECTIVE: To explore the effects of pesticide exposure on the auditory system, specifically on hearing status based on auditory brainstem responses.

METHODS: A cohort of pregnant women was identified in several communities in a rural area from April 2002 to February 2003 and followed up until delivery. Mother-infant dyads were assessed for exposure to pesticides. Maternal and fetal exposures to environmental toxic products were determined by measuring levels in maternal hair and blood, and infant cord blood, hair, and meconium, respectively. Hearing status was measured using otoacoustic emissions (OAE) and confirmed by diagnostic auditory brainstem responses (ABR) measured at 80, 60, and 40 decibels. Waves I, III, V were identified and absolute latencies measured, including inter-peak latencies from waves 11III, I-V, and III-V. Pesticide exposure was then correlated with latencies of Waves I, III, V, and interpeak latencies of waves I-III, IIV, and III-V. Hearing loss and pesticide exposures were correlated with Griffiths Mental Development Scores (GMDS).

RESULTS: Significant delays in the ABR wave latencies were noted in the group with exposure to pesticides. Propoxur was the most common toxic product detected in infants and meconium the best substrate for its detection. There was a 1.4% risk of hearing loss with exposure to propoxur (RR=0.52 (0.12-2.30), p = 0.06), a 6.25% risk with cypermethrin exposure (RR= 4.53 (0.61133.64), P = 0.10) and 6.25% risk with pretilachlor exposure (3.13 (0.44-22.30), p = 0.07). Griffith's Mental Developmental Scale scores (GMDS- hearing and speech subscale and general quotient scores) were not significantly different between exposed and unexposed groups. However, three infants with positive exposures and hearing loss had below average, or low to average scores using this scale.

CONCLUSION: Maternal exposure to environmental toxic products may affect the auditory pathway in infants at birth. Pregnant women should limit their exposure to such toxic products in order to avoid neurodevelopmental effects particularly on hearing because this is very important in the critical stage of language and speech development.

Human ; Male ; Female ; Infant Newborn ; Auditory Pathways ; Maternal Exposure ; Meconium ; Speech ; Otoacoustic Emissions, Spontaneous ; Hearing Loss ; Deafness ; Hearing Tests ; Acetanilides ; Pesticides ; Hair

BACKGROUND: To determine prevalence of delay in 5 developmental domains among Filipino children at 6, 12 and 24 months and investigate influence of socioeconomic status, maternal intelligence, gender and home stimulation. Variations and developmental domains as reliable indicators of potential delay were determined.

METHODS: 754 maternal/ infant dyads were followed up until 2 years old. The Griffiths Mental Development Scales determined sub-quotient scores in locomotor, personal/social, hearing/language, eye-hand coordination and performance subscales before averaging for General Quotient(GQ) score. Score < 85 was considered delayed.

RESULTS: Low GQ scores were noted in 5.4% at 6 months, 19.1% at 12 months and 11.0% at 24 months old. GQ scores were lowered by performance subscale at 6 months, hearing/language and performance at 12 months and hearing/language at 24 months. No single subscale consistently lowered GQ across time. Only 4.2% maintained low GQ scores in all three ages.

CONCLUSION: Prevalence of developmental delay varied across 24 months with highest rates noted at 12 months of age. No developmental domain consistently lowered test scores and no test age was predictive of future outcome but focused early intervention according to age is suggested. Home environment, higher socioeconomic status, maternal IQ and supervision were associated with improved potential.

Human ; Infant ; Child ; Prevalence