Egyptian Developmental Screening Test For Infants From Birth Up To 30 Months CURRENT STATUS:

Background: Detecting developmental delays in infants is an ongoing world commitment, especially for those below three years old. it provides appropriate services to them, early inspection enhances the communal quality of resolving difficult issues of this critical period of age. Thus, our main objective lies in developing a sufficient screening test for early evaluation of mental and motor development for infants. Methods : 54 items of motor and mental developmental milestones were adopted from the Baroda Screening Test. Then, researchers enrolled 1600 subjects based on certain inclusion and exclusion criteria. 97 pass level of developmental achievements resembles the threshold of which infants below which, infants are considered delayed. Results: The designed Egyptian Developmental Screening Tool (“EDST”) from birth up to 30 monthswith 50% and 97% pass level curves proves efficacy, reliability, cultural adaptability, and simplicity to use when compared with other peer screening tools. Results revealed a statistically significant difference between Egyptian and Baroda chart at 50% and 97% pass level. A z-score chart for motor and mental development follow up designed by calculating each age group. Conclusions: Developmental screening tests from birth up to 30 months proved consistent reliability and versatility to use in Egypt for early development delay detection. The wide variation of Egyptian infants 'developmental ages on both Egyptian and Baroda charts underpins the Egyptian chart to the Egyptian public. The z-score chart is a rapid and easy follow-up chart for Egyptian infants' development.

However, relying exclusively on clinical judgments may deliver misleading results. Screening tools are, thus, indispensable to identify children for further testing and follow-up procedures. A screening tool can be feasibly administered to parents or tested on the child. In this respect, providing parentadministered screening tools are of great value, especially in cases of children's sleepiness, irritability, and illness. Ranges from 70% to 80% of sensitivity and specificity, as Urkin et al. demonstrated, denote acceptable remarks for developmental screening tests. 2 Moreover, developmental screening is ardently desired whenever an issue identified during the developmental surveillance or when concerns are raised by parents, caregivers, or by child-health professionals. What provides more accurate outcome herewith lies in conducting standardized assessments of children's developmental status rather than simple clinical impressions. In this regard, the American Academy of Pediatrics recommended the administration of standardized screening tools at the ages of 9, 11, 24, or 30 months in order to produce effective developmental surveillance.
Nonetheless, performing repeated developmental screening surpasses single assessments in their accuracy and validity levels. 3 One of the effectual screening tests is the Baroda Developmental Screening Test (BDST)by Phatak& Khurana. Besides its simplicity, rapidness, and cost-efficiency, the test is outsourced from normal developmental milestones in India. A total of 54 items was selected from Bayley Developmental Screening Test. Any child failed items in his/her chronological age group was screened out for further detailed study. The screening test was in effect during a field survey, as well as in clinical practices (particularly well-baby clinics). Worth mentioning is that reported sensitivity and specificity have reached65-95%. 4 In the current study, the Egyptian Developmental Screening Test (to be referred to in this article as "EDST") was developed in the conventional chart format of which many features from the BDST are adopted for ease of administration; it is versatile enough to fit in the Egyptian environment.

Methods
It is an across-sectional study n the Menoufia governorate in Egypt. All infants and their mothers were enrolled in the study from January 2019 to August 2019 (8 months). Then, authors contacted the study subjects personally at the governmental family health units and vaccination centers. The study adheres to the Helsinki Declaration and was approved by the ethics committee at the Menoufia Faculty of Medicine. In terms of privacy, all respondents submitted written informed consent, stating their volunteering participation in the study.

Participants
The total number of admitted subjects was 1600 infants aged from birth to 30 months. Participants were then grouped month-wise for the first 12 months, three monthly for the next three months, and six-monthly for the next 12 months according to barooda methodology.100 infants in a subsequent age category. 4

Data Collection
The study was undertaken within a span of 8 months-from January 2019 to August 2019. Involved children have met the inclusion and exclusion criteria as to be full-term, received all vaccines dues according to their corresponding age categories, prosperity, no NICU admission normal anthropometric measures (i.e., weight, stature, and head circumference). Also, authors made sure that participants have not experienced chronic infections cardiac, hematological, chest, or endocrinal problems.
Afterward, they were thoroughly examined, and their mothers were interviewed. Firstly, a questionnaire was piloted to obtain socioeconomic and demographic factors using Fahmy socioeconomic scale in Egypt. 5 Secondly, a checklist of motor and mental milestones that contain 54 items (22 motors and 32 mental) was adopted from the Baroda test to reuse in the questionnaire.
Before the item adoption, an acceptance letter has been received from the Baroda test authors to use Baroda screening test items with modifications . The researchers then translated the questionnaire items into Arabic and culturally simplified them to the parents. Inquiries regarding the test's milestones were either observed or directed the mothers to answer. 97% is determined referentially the passing percentage of developmental milestones. Hence, any infant failed to achieve above the 97% pass level criterion was considered 'delayed'.

Data Analysis
Collected data was adequately processed by SPSS software for statistical analysis (ver. 21). 6 Data was, then, described using minimum, maximum, mean, standard deviation. For that, categorical variables were described using absolute frequency and percentage attributes. Moreover, comparisons were carried out between two studied dependent normally distributed variables using the paired T-test. 7 Additionally, z-scores were calculated for age groups individually. 8

Discussion
Since developing a developmental screening tool that targets the community, the tool should be perceived simple, cost-efficient, and less time consuming, and most importantly, easy to understand by community health workers and parents. As expounded by Chauhan et al., the tool ought to consider cultural differences and reflect all developmental domains. 10 The suggested (EDST), per se, does meet these criteria for early detection of developmental delay of Some researchers such as Chunsuwan et al. claimed that using instruments developed mainly for a single culture may not provide the same results in another due to the cultural influence, which is called then a deviant development. 12 Nevertheless, other studies have contended the importance of doing more efforts in development of screening tools that respect the local differences. 13 However, Western developmental tools (e.g., Bayley scales, and the Denver II) have been primarily designed and validated in Western countries -a fact that might reveal a sort of exclusivity in nature.
Even though Gladstone and his colleagues advocated that rendering translations of tests to different languages may bring about misinterpretation of results, as translation may not meet local typicality and culture specificity. 14 Likewise, Junejetet.al affirmed that all Western tests have some items that are culturally inappropriate for rural Africa, such as prepares cereal, 'play board games' and other uncommon activities. 15 Another testing tool that we could have adopted in our study but rejected because of its laborious structure is the Ages & Stages Questionnaire (ASQ) which is a parent report tool widely studied in the West. It is a 19-questionnaire set (30 items per questionnaire) investigating the age range of 2 to 60 months with an overall sensitivity of 75% and specificity of 86%. 15 Another study established to validate the Egyptian screening tool by Ages and Stages Questionnaire (ASQ), and the study showed a good correlation of results and approved the Egyptian screening test is valid. The sensitivity is 84.38% and specificity is 98.36 %. The study is under publish eshafie et al 2020 .
A Z-score was developed from our chart facilitates following up infants' motor and mental developments. In this regard, a child plotted above (-2SD) curve is considered normal, while whoever recognized below -2 SD is deemed developmentally delayed and thus to follow-up his/her progress in further visits. Z-score was calculated for each age group at the following: -3,-2,-1,0,

This research work encourages a full application of the Egyptian screening test in clinical practices
and field surveys across Egypt. Z-score charts of the Egyptian screening test is recommended to deploy due to their seamless functionality.

Declarations
Ethics :Ethics approval and cosent to participate : The study adheres to the Helsinki Declaration and was approved by the ethics committee at the Menoufia Faculty of Medicine. In terms of privacy, all respondents submitted written informed consent, stating their volunteering participation in the study.
Consent : Consent for publication has been obtained from parents of children participants in the study .

Availability of data:
The datasets used and analysed during the current study are available from the corresponding author on reasonable request . raw data and all data generated or analysed during this study are included in this published article and its supplementary information files available from the corresponding author on reasonable request.
Contributions: SF and MB are responsible for collecting raw data . AS , ZA and WB are responsible for interpretation and analysis of data . SB is responsible for data transfer to soft copy ,statistical analysis and drawing curves.
All authors have read and approved the manuscript.
Funding: authors confirmed that no fund received from any organization and the research done by their own.
Competing interest ; this article aims to early detection of developmental delay in infants and to make their life healthy. There is no financial benefits to authors. Authors aim to help infants growing well and early detection of any undiserable effect on them.

ACKNOWLEDGMENTS
We thank participant children, their guardians, and workers at the child vaccination centers for their active participation in our study. The contents of this article and its opinions expressed within are those of the authors.    Table 3:Socio-economic standard of the sample study Age "-3" Z "-2" Z "-1" Z "0" Z "1" Z "2" Z