Assessing the impact of the model of enhancing early detection of disabilities for mothers with children under 6 years old in Hoai Duc district - Hanoi city in the period 2014 - 2016

LIST OF TABLES

Table 2.1. Sample distribution 37

Table 3.1. Distribution of disability types of children with disabilities before and after intervention 48

Table 3.2. General information about mothers with children aged 0 - 12 months 49

Table 3.3. Average age of children through stages of early detection of disabilities by month50 Table 3.4. Average age of children through stages of PHSKT and time from first detection of DHBT to definitive diagnosis by type of disability51

Table 3.5. Multivariate regression model to determine factors related to the time of first detection of DHBT 52

Table 3.6. Multivariate regression model identifying factors associated with the time when children were diagnosed with disabilities 54

Table 3.7. Knowledge about disabilities and disability prevention measures of mothers with children aged 0-12 months before and after intervention 56

Table 3.8. Knowledge of PHSKT of mothers with children aged 0-12 months before and after intervention 56

Table 3.9. Knowledge of signs of autism of mothers with children aged 0 - 12 months before and after intervention 57

Table 3.10. General knowledge of PHSKT of mothers with children aged 0 - 12 months before and after intervention 57

Table 3.11. Views/attitudes towards TKT of mothers with children aged 0 - 12 months in the pre-intervention and post-intervention groups 58

Table 3.12. Concepts/beliefs about the role of mothers in PHSKT of mothers with children aged 0-12 months in the pre-intervention and post-intervention groups 58

Table 3.13. Attitudes towards PHSKT in the community of mothers with children aged 0-12 months in the pre-intervention and post-intervention groups 59

Table 3.14. Attitudes towards participating in PHSKT activities in the community of mothers with children aged 0 - 12 months before and after intervention 59

Table 3.15. General PHSKT attitudes of mothers with children aged 0-12 months before and after intervention 60

Table 3.16. Practices of monitoring child development signs of mothers with children aged 0-12 months before and after intervention 60

Table 3.17. Practice of monitoring signs of gross and fine motor development of mothers with children aged 0-12 months before and after intervention 61

Table 3.18. Practice of monitoring signs of visual impairment in mothers with children aged 0 and over

-12 months old before and after intervention 61

Table 3.19. Practice of monitoring signs of intellectual disability of mothers with children aged 0 - 12 months before and after intervention 62

Table 3.20. Practices of searching and using PHSKT documents of mothers with children aged 0-12 months before and after intervention 62

Table 3.21. General PHSKT practices of mothers with children aged 0-12 months before and after intervention 63

Table 3.22. Average scores of knowledge, attitudes and practices of PHSKT of mothers with children aged 0-12 months before and after intervention 63

Table 3.23. Association between intervention activities and knowledge, attitudes and practices of PHSKT of mothers with children aged 0 – 12 months 64

Table 3.24. Average age of early detection stages before and after intervention 66

Table 3.25. Average age in months of early detection stages before and after intervention by type of disability 67

Table 3.26. Average age in months from first detection of DHBT to diagnosis before and after intervention by type of disability 68

LIST OF CHARTS

Chart 3.1. Average age of disabled children by month 47 years old

Figure 3.2. Gender distribution and birth order of children with disabilities before and after intervention 47

Figure 3.3. Distribution of disabilities in children and causes of disabilities 48

Figure 3.4. Distribution of mothers with disabilities receiving PHSKT information (n=220) 49

Figure 3.5. Distribution of TKT examined and diagnosed before screening (n=220) 50

LIST OF IMAGES

Figure 1.1. Model to enhance early detection of disabilities for mothers with children under 6 years old in Hoai Duc district - Hanoi city 23

Figure 1.2. Information, motivation, and behavioral skills model 25

Figure 1.3. Administrative map of Hoai Duc district - Hanoi city 30

Figure 2.1. Research design diagram 33

Figure 2.2. Theoretical framework for applying the IMB model in enhancing early detection of defects 44

LIST OF ABBREVIATIONS

ASQ

Ages & Stages Questionaires
BHBT	Abnormal manifestations
Labor, War Invalids and Social Affairs	Labor, War Invalids and Social Affairs
Medical staff	Health Officer
CTS	Early intervention
DHBT	Abnormal signs
GVMN	Preschool teacher
ICF	In ternational Classification of Functioning Disability and Health (International Classification of Functioning, Disability and Health)
IMB	Information, Motivation and Behavioral Skills Model (Mo information, encouragement, behavioral skills)
KAP	Knowledge Attitude Practical
KT	Disability
M-CHAT	Modifier – Checklist Autism in Toddle Modified Childhood Illness
NCS	PhD student
NKT	People with disabilities
PHS	Early detection
PHSKT	Early detection of defects
PHS – CTS	Early detection - early intervention
PHCN	Rehabilitation
PHCNDVCĐ	Community-based rehabilitation
Decision of the Ministry of Health	Decision – Ministry of Health
QH	National Assembly
TB	Medium
TDHV	Education level
TQS	Ten Questions Screen

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TKT

Children with disabilities
TP	City
Medical Center	Medical Center
TYT	Medical Station
Secondary School	Junior High School
High School	High school
SSC	Standard error
UNESCO	United Nations Educational Scientific and Cultural Organization (United Nations Educational, Scientific and Cultural Organization)
UNFPA	United Nations Population Fund (United Nations Population Fund)
UNICEF	United Nations Children's Fund
WHO	World Health Organization (WHO)

PROBLEM STATEMENT

Childhood is a critical period of growth and development because experiences during this period can influence an individual's entire life [92], [109]. For children with disabilities (CDs), early detection (ID) and early intervention (II) during this period are very important because they help them maximize their potential and create opportunities for them to integrate into society, reducing the burden on their families and society [109], [139]. A type of disability plays an important role not only in establishing a CTS program but also in determining the success of a CTS program for that type of disability [74]. However, up to half of children with disabilities are not identified before going to school. This causes children to lose the opportunity to receive CTS and increases the cost to society in the later intervention process [119]. According to Shonkoff, if children with disabilities are detected and intervened before kindergarten, society can save from $30,000 to $100,000 per child with disabilities [139].

In developed countries, early detection of disabilities (ED) in children is a fundamental part of child health care [87]. This activity is often integrated into the activities of health systems, education and other social care services [84]. In low- and middle-income countries, the implementation of EID has not received due attention and its implementation remains a major challenge [80], [135].

In Vietnam, one of the first programs with PHSKT content for children is the community-based rehabilitation program (PHCNDVCĐ). Besides the PHCNDVCĐ program, there are also a number of PHSKT projects for children implemented by the government, non-governmental organizations and individuals, but according to the assessment of the Ministry of Health, this activity is still underdeveloped [9].

PHSKT is the responsibility of the whole community, including the responsibility of the family [8], [9]. In the family, mothers are the closest to children, they often observe and pay attention to children's development and they tend to compare their children with other people's children to form assessments or they compare development from simple cognitions and behaviors to complex thinking skills [88]. They themselves seek and use information about development at the most basic level [129]. There have been many studies

Studies have shown that mothers are early in recognizing developmental abnormalities (DAD) in their children and that maternal concerns about their children's development are as sensitive and specific as quality screening tools. These studies have also shown that maternal concerns about their children's development and behavior are directly related to screening results for developmental and behavioral problems [90], [91].

Glascoe pointed out the advantages of PHSKT through mothers such as: The cooperation of mothers with medical staff is significantly improved, when mothers detect abnormal signs in their children, the time for diagnosis is significantly shortened. PHSKT in children through mothers eliminates challenges such as children not cooperating, afraid, sleepy or sick... when medical professionals directly measure the skills of children. PHSKT through mothers has significantly improved the rate of early detection of children with autism [95] . However, many international surveys have shown that many parents need advice on methods to detect DHBTs in child development [47], [72].

In Vietnam, there have been only a few studies on knowledge, attitudes and practices of PHSKT in children on the group of parents of children with disabilities [4], [38]. These studies have shown that most parents of children with disabilities lack knowledge about their children's psychophysiological development, lack knowledge and skills to detect types of disabilities (KT) related to the brain such as intellectual disability, behavioral disorders and especially cerebral palsy, so they did not promptly detect signs of developmental delay in their children [4], [26], [38].

In Hoai Duc district - Hanoi, the PHCNDVCB program is managed by the Public Health Department of the health center (TTYT). However, the program's current activities only stop at synthesizing and reporting data. According to statistics from the TTYT, Hoai Duc district has 3,138 people with disabilities (PWD) but there is no data on PWD under 6 years old. In Hoai Duc district, there has not been any research on knowledge, attitudes and practices of PHSKT in children of mothers [35].

To study the current status of PHSKT in children and initially evaluate the impact of interventions to enhance PHSKT in children for mothers in Hoai Duc district, we conducted a study "Evaluating the impact of the model to enhance early detection of disabilities for mothers with children under 6 years old in Hoai Duc district - Hanoi city in the period 2014 - 2016" .

Assessing the impact of the model of enhancing early detection of disabilities for mothers with children under 6 years old in Hoai Duc district - Hanoi city in the period 2014 - 2016 - 2

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