The INDIGO Study

Exploring the diagnostic utility of items on developmental tools in Uganda, Malawi and Pakistan for screening for neurodevelopmental disorders.


Image of Doctor evaluating child

‌We know that many children in low and middle income countries (LMICs) have neurodisabilities and neurodevelopmental disorders (NDDs), where the brain has not developed normally or has suffered an insult to normal development for one reason or another.

These children include those with general developmental delay, autism, vision and hearing problems, behavioural problems and motor difficulties such as cerebral palsy. We suspect that these are more common in LMIC settings where children are more commonly exposed to infections, environmental toxins (including drugs and alcohol), nutritional deficiencies, and other potential injuries. These can occur in the womb, during the period of birth or after birth in the first few years of life. Early detection and intervention in these disorders is vital and can make a big difference to children and their families.

At present we do not exactly know how common these disorders are or what causes them. This is particularly the case because we have no reliable and valid tools for conclusive diagnosis.  Often the available tools are validated for use in high income settings and are therefore culturally specific and expensive to use. They are also often not appropriate for workers at community level in LMIC settings. Furthermore, there have been very few professionals in LMIC settings who can diagnose children, so there has been limited research done on creating tools that can identify children with NDDs in this setting.

The INDIGO study, funded by the MRC, will create the first network of professionals and researchers who are specifically interested in identifying and creating better feasible and valid tools for use in identifying children in the early years with NDDs in LMIC settings.

Expertise is already in place in the CHAIN NDD study, part of the larger CHAIN network.  This is a multicentre study, with sites in Malawi, Uganda and Pakistan. This group will aim to understand which items in developmental screening tools are the most useful for identifying children with NDDs in these countries during the first three years of life.

MDAT baskets used in the CHAIN study

MDAT Baskets used in the CHAIN Study