Mung'ala-Odera V, Newton C R J C
Center for Geographic Medicine-Coast, Kenya Medical Research Institute, P.O. 428 Kilifi, Kenya.
Child Care Health Dev. 2007 May;33(3):249-56. doi: 10.1111/j.1365-2214.2006.00714.x.
The burden of neurological impairment (NI) in children living in resource-poor countries (RPCs) is unknown. This lack of data is caused by inappropriate case detection techniques. In RPCs, the most appropriate method should be inexpensive, simple, rapid and accurate. This article reviews methods used to identify children with NI and disability in RPCs, evaluating their effectiveness and suitability.
A search of relevant articles was performed using the National Library of Medicine via PubMed and Medline search engines. In addition, bibliographies of reviews were also browsed to identify additional articles, particularly those from World Health Organization and United Nations sources and from government and unpublished reports. Key phrases used included impairment, disability or handicap and the following terms: identification, screening, prevalence and developing countries. Studies included were those that fulfilled the following criteria; performed in RPCs, presented data in detail to allow reanalysis and provided data on cost and validity of the methods.
Use of the national census, key informants and methods using rapid rural appraisal have low sensitivity and are not able to provide adequate information on diagnostic categories or risk factors. House-to-house surveys using questionnaires have high sensitivities (63-100%) in the detection of impairment, but this approach remains relatively expensive and cannot be applied to an entire population (e.g. a region or country) and is thus less useful for assessing the needs of disability. Furthermore, the sensitivity is decreased in the detection of some domains, e.g. cognition.
Most of the approaches used for identifying individuals with NI or disability suffer from inadequacies, the main ones being low sensitivity and underreporting. To assess the burden, nationwide censuses combined with surveys in selected areas of the country may be useful. These systems, however, require validation to establish their suitability.
生活在资源匮乏国家（RPCs）的儿童神经功能障碍（NI）负担尚不明确。缺乏相关数据是由不恰当的病例检测技术所致。在资源匮乏国家，最合适的方法应具备成本低廉、操作简单、快速且准确的特点。本文回顾了在资源匮乏国家用于识别患有神经功能障碍和残疾儿童的方法，评估了其有效性和适用性。
通过美国国立医学图书馆，利用PubMed和Medline搜索引擎检索相关文章。此外，还浏览了综述的参考文献以识别其他文章，特别是来自世界卫生组织和联合国的资料以及政府和未发表报告中的文章。使用的关键词包括功能障碍、残疾或残障以及以下术语：识别、筛查、患病率和发展中国家。纳入的研究需满足以下标准：在资源匮乏国家开展、详细呈现数据以便重新分析，并提供有关方法成本和有效性的数据。
使用全国人口普查、关键 informant 和采用快速农村评估的方法敏感性较低，无法提供关于诊断类别或风险因素的充分信息。使用问卷进行挨家挨户调查在检测功能障碍方面具有较高敏感性（63 - 100%），但这种方法仍然相对昂贵，且无法应用于整个人口（如一个地区或国家），因此对于评估残疾需求的作用较小。此外，在检测某些领域（如认知）时敏感性会降低。
用于识别患有神经功能障碍或残疾个体的大多数方法都存在不足，主要是敏感性低和报告不充分。为了评估负担，全国人口普查与在该国选定地区进行的调查相结合可能会有所帮助。然而，这些系统需要进行验证以确定其适用性。
原文中“key informant”未明确给出中文释义，可根据具体语境理解，这里暂保留英文。
