eveRy newboRn Simplified management integRating...

RepoRt on

eveRy newboRn Simplified management integRating longitudinal

neuRodevelopment and gRowth (en-Smiling)

data ColleCtoR tRaining

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aCknowledgementThe data collector training was jointly organized and funded by London School of Hygiene and Tropical Medicine, CIFF, UNICEF Nepal, Nepal Health Research Council, Ministry of Health and Golden Community. We would like to extend our sincere gratitude to Pokhara Academy of Health Sciences (PAHS) for their continuous support in EN-BIRTH as well as EN-SMILING. We are also very obliged to Ministry of Health, Nepal Health Research Council and Institutional Review Board, PAHS for their monitoring and supervision of the program. Likewise, we would like to greatly acknowledge UNICEF for the guidance and facilitation throughout the training.

We would like to thank Professor Joy Lawn, Kate Miller, Jena Derakhshani Hamadani, Carla Stephan, Dorothy Boggs and team in the guidance for conducting the training.

Last but not the least, we are very grateful to all the participants of the training including the mothers/caregivers, children, hospital administrators, doctors, nurses and the assessors whose assistance and participation facilitated this training reach its objective.

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aCRonymS

NCU Newborn Care Unit

UNICEF United Nations Children’s Fund

CIFF Children’s Investment Fund Foundation

PAHS Pokhara Academy of Health Sciences

NHRC Nepal Health Research Council

MOH Ministry of Health

LSHTM London School of Hygiene and Tropical Medicine

IYCD Indicators of Infant and Young Child Development

MDAT Malawi Development Assessment Tool

CREDI Caregiver Reported Early Development Instrument

mFCI Modified Family Care Indicators

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RepoRt on eveRy newboRn Simplified management integRating longitudinal neuRodevelopment and gRowth (en-Smiling)

1.0 baCkgRoundIn low- income and middle-income countries (LMIC), a marked decline in mortality among children under 5 years of age has begun and is accelerating. Within this increasing survivor group in LMICs, it is estimated that more than 200 million children have developmental delay or disability whose existence must be recognized and dealt with in all health practice and planning. Hence, global emphasis has shifted beyond reducing child survival rates to improving health and developmental trajectories in childhood.

Although newborn and early child health are an opportunity for early detection and intervention, the current ECD measurement approaches are too complex, costly, time intensive and often require specialist involvement. Further, the basic interventions improve newborn survival but ECD outcome following these are understudied. EN-SMILING responds to this as its one of the objective is to design a simplified ECD measurement approach form birth to age of 5 years which could lead to earlier identification and improved access to evidence based early intervention for child with developmental delays.

EN-SMILING builds on research EN-BIRTH led by Prof. Joy Lawn and LSHTM team with WHO, UNICEF and country partners as part of the Every Newborn Action Plan (ENAP). EN-BIRTH is multi country (Bangladesh, Tanzania and Nepal) observational study which involves comparison of observed care with data recorded in routine registers, and with maternal recall where at least 20,000 births will be observed. EN-SMILING involves follow-up for newborn cohort who received basic newborn interventions (bag and mask resuscitation, Kangaroo Mother Care and Treatment for presumed neonatal infection) compared to matched unexposed cohort at participating health facility sites in Tanzania, Bangladesh and Nepal from birth to 5 years.

Multiple ECD tools like will be applied from birth to the age of 3 years at 6,9,12,18,24,36. For example, WHO IYCD (Indicators of Infant and Young Child Development) tool, the Caregiver Reported Early Development Instruments (CREDI), the Malawi Developmental Assessment Tool (MDAT) and Rapid Neurodevelopmental Assessment (RNDA) will be used up to 3 years. A workshop training of trainers on child development measurement was carried out in Bangladesh and trainers from respective countries were responsible for training of the assessors and interviewers before data collection.

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2.0 Rationale foR the tRaining of data ColleCtoRSThe rationale for training was to orient data collectors regarding EN-BIRTH and EN-SMILING and henceforth prepare them to administer different early child development (ECD) screening tools alongside other EN-SMILING data collection tools, such as health questionnaires. It includes clinical testing with children and their caregivers/mothers, as well as interview training for phone call follow up system.

3.0 obJeCtiveS

Primary objective

• For assessors to individually and competently conduct full EN-SMILING testing using the study tools (both in training simulation and in a clinical setting) with children and their caregivers/mothers.

• For phone interviewers to competently conduct follow up phone interviews with caregivers/mothers.

Secondary objectives

• To understand the purpose, objectives, plans for this study and the value of your roles

• To understand early child development and the importance of screening

• To learn best practice on how to perform interviews, both in person and over the phone

• To learn about the different ECD tools and how best to administer them

• To recognise the value of reliable and high-quality data

• To review of data collection tools

• To learn how to complete all study data collection tools completely and accurately

• To obtain competency by practising data collection and interviewing skills

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4.0 SummaRy of tRainingSN. Contents Description

1. Name of the training EN-SMILING Training of Data Collectors

2. Objective

For assessors to competently conduct full EN-SMILING testing using the study tools (both in training simulation and in a clinical setting) with children and their caregivers/mothers.

For phone interviewers to competently conduct follow up phone interviews with caregivers/mothers.

3. Participants Details

Date Venue Number of participants

20-29 May 2018

Pokhara Academy of Health Sciences, Pokhara

Total 12

4. Training Methods Presentations, group discussions, group quiz, videos, simulation exercises, role play, demonstration, practical session.

5. Training Materials Training Modules, Trainers Handbook, Handouts, Meta-cards, Newsprint, Marker, Pencil, Pen, Sharpener, Eraser, Diary, Bag.

6. Facilitators

The facilitators available for all sessions were as follows:

1. Dr. Ashish KC

2. Ms. Rejina Gurung

3. Ms. Elisha Joshi

4. Ms. Asmita Poudel

8. Output of the training

• Explain the importance of objective, standardised testing and interviewing.

• Describe informed consent and why it is important.

• Describe how competency in interviewing and observation is determined.

• Describe how criteria are used to determine skills performance.

9. Conclusion

The major objective was to make the data collectors competent to conduct full EN-SMILING testing using the study tools (both in training simulation and in a clinical setting) with children and their caregivers/mothers. The participants were enthusiastic regarding learning and using the various ECD tools and health questionnaires. They exclaimed the training proved to be very effective and suggested more practical sessions to enhance their skills.

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5.0 paRtiCipantS’ ChaRaCteRiSitCSA total of 14 participants attended this ten days training. The trainees were health workers with health related backgrounds (Nursing, Bachelor in Public Health) who will be working as assessors and phone interviewers for EN-SMILING.

6.0 pRoCeSSTeaching Learning Approaches

The teaching learning approaches adopted for the training included brief theory sessions via Power- Point presentations followed by discussions and simulations, role play using dummies and study tools. The teaching materials used for the training included Projector for Power-Point presentations, audio-visual aids (videos and posters), newsprint, meta-card, print outs and case studies. The practice sessions included children of different age bands accompanied by their caregivers.

To ensure effective learning, an interactive and informal environment was maintained. At the same time, queries from participants were duly addressed to increase the understanding of the study and ECD tools.

The detailed description of training is as follows (See Annex for detailed training schedule):

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opening SeSSionOfficial Opening

The formal session of the training was led by Mr. Kanchan Thapa, Golden Community whereby the session was steered by chairperson, Dr. Shree Krishna Shrestha, Head of Department Pediatric (HOD), Pokhara Academy of Health Sciences (PAHS) in the presence of dignitaries: Hospital Director, Nursing Director, Institutional Review Committee representative from PAHS, Nepal Health Research Council (NHRC) representative, Nursing In charges.

The participants were officially welcomed by Dr. Arjun Acharya, Hospital Director, Pokhara Academy of Health Sciences (PAHS). Dr Acharya acknowledged the significance of generating evidence on early child development. He also expressed his continuous support for Every Newborn Birth Indicator Research Tracking in Hospitals (EN-BIRTH) and its extension, Every Newborn- Simplified Measurement Integrating Longitudinal Neurodevelopment and Growth (EN-SMILING).

It was then followed by detailed presentation of Mrs. Rejina Gurung, Program Manager, Golden Community, who initially gave an update on objective of the data collector training and its outcome. Further, Mrs Gurung also gave an overview of both the projects and how EN-BIRTH and EN-SMILING are connected. She also stressed on the need to assess the neurodevelopmental outcome of the children as health care must be recognized as a concept involving ongoing child development and not be restricted to reduction in morbidity or mortality. It was then followed by remarks of Mr. Bijaya Kumar Jha, Nepal Health Research Council, NHRC who assured that the quality assurance and ethical clearance has been one of the priority of NHRC and this project has duly fulfilled each of these aspects. The closing remarks were then delivered by Dr. Shree Krishna Shrestha, Head of Department Pediatric, PAHS who enlightened us with the importance of recognizing the extent of childhood delays and disabilities in developing country like ours.

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DAY 1 (20th May)

The objectives of the day were:• To formally inaugurate the program.

• To get introduction from all the participants.

• To orient on EN-BIRTH and EN-SMILING.

• To explain about their roles and responsibilities of data collectors.

• To describe about data flow system

• To enlighten about Early Childhood Development

• To explain interview skills

• To elucidate importance of high quality data.

• To orient on the study tools on data extraction.

Session/Facilitator(s) Contents and Discussion

Introduction sessionMrs Rejina Gurung

After the formal session, the training commenced with ice breaking session with introduction of the participants and facilitators.

Then, Mrs Gurung led the session with brief background on the current global context of developmental outcomes of children below 5 years. She emphasized that there is an urgent need to recognize that improving the quality of life of the surviving children must complement mortality reduction in health care practice and programs. She also gave an overview of EN-BIRTH and its accomplishment. Further, she gave detailed description about EN-SMILING and its objectives.

Roles and ResponsibilitiesMs. Elisha Joshi

Ms Joshi’s presentation focussed on the different roles and responsibilities of the supervisors, site coordinators, clinical and technical supervisors, assessors and interviewers.

The participants queried about if their role as an assessor or interviewer has already been decided or not. This was duly addressed as the role of assessor and interviewer will be assigned after the training.

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Data FlowMrs. Ashmita Poudel

Her presentation was based on the systematic schematic flow showing how and when the first contact to the mother will be done and how the different ECD tools will be applied. She also flagged that it is not rigid to follow the preferred schedule as one can modify it according to the situation.

Activity IB: Understanding the study and different roles

The session comprised of the participants divided into three groups and each of the group were assigned to present about the study and the different roles. It was an interactive session where the participants used met cards to explain about the study and role play to demonstrate the different roles and responsibilities.

Introduction to Early Childhood Mrs Rejina Gurung

Mrs. Gurung stressed that a good start to life within a nurturing environment id the basic foundation for the child’s future growth and development. She highlighted the importance of the early years. “Human brain development starts before birth and continues into adulthood. The quality of the brain architecture is affected by early childhood experiences, resulting in a strong or a fragile foundation for the learning, health and behavior that follow.”

ECD ToolsMs. Elisha Joshi

Ms Joshi then explained about the different ECD tools to be used in EN-SMILING. She projected the differences between the different tools in terms of age range, psychometrics, cost, domains and administration. The participants queried about

Activity IC: Understanding ECD and ECD tools

The participants were then divided into groups and asked to present on the different ECD tools. The participants then presented the different ECD tools WHO IYCD, CREDI, MDAT and RNDA.

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Interviewing skillsMs. Elisha Joshi

Ms Joshi stressed that it is important to master the interviewing skills for both the assessors and phone interviewers. Ms Joshi and Ms Poudel demonstrated a case scenario for hesitant mother and how the assessor should handle the case.

Activity ID: Mock Practice Interviews The participants then practiced in pairs the different scenarios andnta what interview skills one should implement. The practice session ended with further feedback from the facilitators.

Why are high quality data important? Mrs Poudel then gave a brief presentation on the significance of the quality data. She elaborated with examples the common data collection errors and also about the inter-rater reliability. She also explained about the confidentiality and how the information should be discussed with the supervisors through use of study ID.

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Session/ Facilitators Content and Discussion

Welcome SessionKanchan Thapa

The second day of the training commenced with the formal session welcoming our guests Mr. Liladhar Poudel, MOHP and Mr. Rajendra Shrestha and Dr Ashish KC, UNICEF Nepal. The session was then headed with a brief presentation by Mrs Gurung about EN-BIRTH and EN-SMILING. She emphasized on the need of neurodevelopmental assessment of the children for early identification of developmental delays.

It was then followed by key annotations by Dr KC who strongly believed that it is crucial to work toward generating evidence on developmental outcomes of children who survived. He indicated that this project EN-SMILING is based on survive, thrive and transform.

The next remarks were delivered by the Mr. Poudel who suggested that such program should later be implemented in other parts of Nepal as well.

DAY2 (21st May)

The training continued with formal session as follows:

The objectives for the day were:• To welcome delegates from UNICEF Nepal and Ministry of Health and Population(MOHP)

• To assess knowledge as group quiz

• To explain about informed consent

• To do group work practicing informed consent

• To acquaint about the personal and health questionnaire

• To do interview practice session in groups using personal and health questionnaire

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Activity IE: Group Quiz After brief review of the previous day, the trainees participated in group quiz comprising of the questions of the introductory sessions.

Introduction to Initial FormsMrs Rejina Gurung

This session consisted of describing some of the specific formatting present in the tool and instructions associated with it. Some of the examples of the interview questionnaire formatting includes Uppercase text, lowercase text, GO TO/skip functions etc. Then, the red, amber flags and their referral pathways was also discussed.

Informed ConsentMrs. Ashmita Poudel

The sample of informed consent was first distributed to every participant. Then, Mrs Poudel led the session about when the informed consent is to be implemented with explanation on how and who can give informed consent. Further, she demonstrated how written informed consent can be taken at clinic visit.

Activity IIA: Practice Informed Consent The participants then practiced taking informed consent in pairs. After their practice, one of the pair was asked to demonstrate after which constructive feedback were given.

Personal and Health QuestionnaireMrs. Ashmita Poudel Ms. Elisha Joshi

The next session was led by Mrs Poudel whereby she oriented the trainees with the section 1 and section 2 of the questionnaire including the information about the interviewer and personal information about the caregiver/mother.

The section 3 was led by Ms Joshi which consisted of the Health details and various danger signs which required urgent referral. The session included detailed description about the different danger signs (convulsions, fever, pneumonia, dehydration etc.) that might be present in the child and its subsequent actions to be followed.

Short overview of importance of vision and hearing to early childhood development was also provided and the various examination tips and steps were discussed as well.

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Group Activity II D: Practice Session The personal and health questionnaires were then distributed to the trainees and practice session was carried out by giving them different scenarios. The queries (like when to refer the children to the facility) that arose during the practice session were duly addressed.

DAY 3 (22nd May)

The objectives of third day were:

• To orient the trainees about modified Family care Indicator (mFCI)

• To conduct practice session using mFCI

• To introduce IYCD tool

• To describe motor and language domain of IYCD tool

• To conduct practice session for motor and language domain of IYCD tool


Modified Family Care IndicatorMrs. Ashmita Poudel

The third day of the training started with presentation on modified family care indicators. She emphasized on the quality of child’s home environment and the psychosocial stimulation the children require. A group quiz was carried out. Initially a role play using FCI questionnaires was displayed by trainers. Similarly, all the participants in a pair were engaged in role play followed by feedbacks from the observant participants and trainers.

Ms. Gurung and team shared their pilot testing experiences regarding responses from mothers to FCI questionnaires especially caregiver’s mental health state. She focused interviewer to be good listener and gain the confidence of caregivers to retrieve their personal feelings.

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Introduction to IYCD toolMrs Rejina Gurung

Based on their personal and professional backgrounds, the trainees were encouraged to brainstorm and share about the different developmental milestones of children and their importance.

Then, Mrs Gurung started the session clarifying about how IYCD developed, its structure and how to administer it in EN-SMILING.

Group Activity IIIA The IYCD tool was the distributed to each of the participants and then group work was carried out to allow the assessors to identify age of child and which questions to be asked in different domains.

Motor ComponentMs Elisha Joshi

Ms Joshi then elucidated each question in motor component with explanation of the description as well. She emphasized that one has to show the picture or play video/audio before reading out the questions and ask the questions as they are written.

Group Activity IIIB The trainers initially demonstrated on how to assess motor domain using IYCD tool for 2-year-old child. Then the trainees were asked to work in pairs to practice assessing motor domain of IYCD tool for different age group.

The participants exclaimed the too was easy to administer and with translation seemed to be appropriate.

Language and CognitiveAsmita Poudel

Mrs Poudel oriented the group about the 30 items in Language and Cognitive domain. She stressed on the description of each item and clarified all the queries.

Practice Session The trainees were then divided into groups and practice assessing the language and cognitive domain using IYCD tool for different age band child.

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DAY 4 (23rd May)


The objectives of forth day were:• To orient the trainees socio emotional and general behaviour domain of IYCD tool

• To conduct practice session using IYCD

• To introduce MDAT tool

• To demonstrate using MDAT tool

IYCD- Socio emotional Ms. Elisha Joshi

After the recap of the previous day, the session then included detailed explanation on socio emotional domain of IYCD tool. She stressed that the responses are different than that of motor and language domain and the mother/caregiver should know about answering the question with ‘Almost always’, ‘Always’, ‘Almost never’, ‘never’ and ‘Sometimes’.

General BehaviorMrs Rejina Gurung

Mrs Gurung started the session by giving examples of general behavior of her daughter. Then she gave detailed explanation of each item.

Activity IIIC: Trainee’s Role Playing

The participants were then divided into six pairs and asked to role play assessing all the domains for children of different age. The trainers then supervised the group work and provided feedback to each of them.

Activity IIID: Test your Knowledge

The questions were distributed to the participants so as to test their knowledge and understanding regarding IYCD.

Introduction to MDATMrs Rejina Gurung

Mrs. Gurung headed the session with brief introduction about how the tool developed and its structure and MDAT kit. She also described about the normal reference ranges and using it for start rule for MDAT. She encouraged participants to be tactful and attentive during observation so that the child would not be over or underrated.

Demonstration of MDAT and Discussion

Ms. Joshi showed some videos displaying the developmental milestones of children of different age band. Ms. Joshi demonstrated MDAT to participants by assessing a 24 months’ child. Later, detailed discussion of each item was done considering the activities carried out by Ms. Joshi with the child and mother during demonstration. Ms. Gurung then presented the way of indicating responses in MDAT which is different than other tools.

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DAY 5 (24th May)


The objectives of fifth day were:

• To orient the trainees fine motor and gross motor domain of MDAT tool

• To conduct practice session using MDAT

MDAT-Gross MotorMs. Elisha Joshi

After the recap of the previous day, Ms Joshi explained each of the question for MDAT. For each question, she also described the instruction and the criteria of ‘pass’ and ‘fail’ for the child. While describing the questions, she stressed on the co-administered and automatically pass items as well.

MDAT- Fine MotorMrs Asmita Poudel

Just like Ms Joshi, Mrs Poudel also elucidated all the items of fine motor. The participants felt easy to relate with the tool after the demonstration of the previous day. Mrs Poudel also suggested the trainees to make a master copy of the tool so as to indicate the parent reported questions, or the time limit questions etc.

Activity V: Trainee’s Practical session A 12-month-old child was assessed by the participants on motor domains only and after the assessment group discussion done and feedback provided.

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DAY 6 (25th May)


The objectives of sixth day were:

• To orient the trainees about language, hearing and social domain of MDAT tool


MDAT-Language and HearingMrs Rejina Gurung

After the recap of the previous day, Mrs Gurung explained about the items in language and hearing. She differentiated between the parent reported and observation questions. She also indicated the co-administered questions and automatically pass items.

MDAT- SocialMrs Asmita Poudel

Mrs Poudel also elaborated all the questions of social domain of MDAT. She used the description used in the item guide for further clarification.

Scoring of MDAT Ms. Elisha Joshi

Ms Joshi then gave detailed presentation on scoring of MDAT using the normal reference range and how to identify if the child has passed or need follow up or referral. After the presentation, the participants were given different scenarios and asked what advice they would give. The session was session and all the facilitators guided the trainees with scoring of MDAT.

Activity V: Trainee’s Practical session Just like the previous day, a 7 month and 23 old children was assessed by the participants but on all domains and scoring was also done. After the assessment group discussion was carried out regarding the positive and corrective actions to be taken.

Activity VC: Test your Knowledge The questions were distributed to the participants so as to test their knowledge and understanding regarding MDAT.

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DAY 7 (26th May)


The objectives of seventh day were:


MDAT- Practical session Practical session with 9 months baby was done by the trainees and all the other participants quietly observed and scored the assessment. Later, after the assessment the scoring sheet were collected to check for inter rater reliability.

MDAT- Practical session Practical session with 12 month child was carried out by one of the trainee while other observed and scored on the MDAT sheet. Following the assessment, discussion was then carried out to clarify any queries.

Presentation: CREDIMs. Elisha Joshi

Ms Joshi explained how the CREDI was developed, its domains and how to administer it (start and stop rules). She also highlighted the interview tips and how CREDI was different from IYCD in terms of showing the pictures only after reading out the question.

Activity IV: Age of Child Group activity was then carried out to assess which set of questions will the assessor start for the children with different age bands.

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Presentation: The tool Motor, language and Social EmotionalMs. Elisha JoshiMrs Asmita Poudel

Both Ms Joshi and Mrs Poudel facilitated all the questions along with description of the item guide. Ms Joshi explained about the minute details like child laughing sometimes meaning once a day or more and she also focused on the what the item is supposed to assess (like early gross motor, fine motor).

Mrs Poudel stressed that the questions should be asked in same order as they are given and not suggesting answers to one’s question.

DAY 8 (27th May)


The objectives of eight day were:

• To conduct practice session using CREDI

CREDI- Mental health Mrs Gurung led the session describing about the mental health questions of CREDI. She focused that these questions need to be asked to all the children irrespective of their age group.

CREDI- Role Play Role play was carried out in pairs and assessment for children of 6,9,12,18 and 24 months were carried out. The trainees expressed being comfortable using CREDI.

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CREDI and IYCD- Role Play All the participants were then asked to demonstrate assessing the developmental outcome of children using IYCD and CREDI in-front of other participants. After each demonstration, constructive feedback was given to the assessors.

Interview tips and Discussion After the practical demonstration, the discussion session was led by Mrs Gurung and team regarding the interview tips while using CREDI. She asked the assessors not to interpret ambiguous responses but rather request them to respond using one of three responses. If response is unclear, one has to repeat him/herself.

Activity IV: test your Knowledge Set of questions to assess knowledge and understanding was distributed to the participants and later collected.

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DAY 9 (28th May)


The objectives of ninth day were:

• To orient about the anthropometry and haemoglobin measurement

• To describe about the use and interpretation of Z-score

• To explain about discharge summary

• To discuss and practice full EN-SMILING assessment

• To explain of the main roles of telephone interviewer and operator

Introduction and AnthropometryMs. Elisha Joshi

Ms. Joshi explained about the components of anthropometry tool i.e. height, weight and head circumference including how to measure each of them. The trainers demonstrated the procedure of measuring height, weight and head circumference.

Presentation: Z-scoreMrs. Rejina Gurung

Following the introduction of the anthropometric tools, Mrs. Gurung explained what is Z-score and how the score can be calculated and interpreted. She highlighted that the scores are different for males and females. Then the trainees were assigned to work in groups measuring the anthropometry and calculating the Z-score along with its interpretations.

Presentation: HaemoglobinMrs Asmita Poudel

Along with assessing neurodevelopmental outcomes, the assessors need to take blood sample from the children for measuring hemoglobin. Mrs. Poudel explained the procedure fir using Hemcue microuvette. Mrs. Poudel also discussed about the hemoglobin result interpretations and conditions for referral.

Discharge SummaryMs. Elisha Joshi Mrs Asmita Poudel

Ms Joshi led the session about how the discharge card will be auto filled in the app. She also made the assessor cautious for any kind of child abuses (neglect, physical injury, emotional abuse and sexual abuse) and the next subsequent actions to be taken. Then Mrs. Poudel explained about the discharge card which needs to be filled at every discharge and the information to be filled. She also discussed the feedback to be given to the caregiver based on if any flags were identified or not.

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Discussion: Full EN-SMILING- Flow Chart Mrs. Gurung then reviewed the complete EN-SMILING flow chart that the assessors will follow and implement.

Practical: Full EN-SMILING face to face clinical appointment

Group work was conducted to practice all the EN-SMILING tools during face to face clinical appointment. The participants were enthusiastic about using the complete EN-SMILING tools.

Presentation: Main Roles Mrs Poudel explained the main roles of the telephone interviewer and operator in EN-SMILING study like making initial contact with mother, administering the phone questionnaires, fixing clinical appointments and making reminder calls for appointments.

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DAY 10 (29th May)


The objectives of tenth day were:

• To describe the EN-SMILING call centre

• To explain about the 6 weeks and 3 month phone follow up

EN-SMILING Call Centre Mrs. Gurung stressed about the guideline of EN-SMILING Call Centre and the telephone operator needs to follow the guideline at every phone call. She also explained how the initial contact with the caregivers/mothers can happen at multiple stages during the study.

Interviewer skills Mrs Poudel underpinned about the crucial role of establishing rapport with the caregivers/mothers and administering EN-SMILING phone questionnaires. She also reinforced with tips for conducting interview.

Telephone Interviewer Ms Joshi explained the flow chart of interview set up developed by Bangladesh team. She explained that it is crucial for EN-SMILING team to be familiar with the flow chart. She clarified about the auto call rescheduling and call rescheduling which later will be prompted in customized app. As per the flow chart, she explained actions to be done at different possible conditions like assessment not completed, unsuccessful call etc. Further, she updated on the interview questionnaire formatting.

6 weeks and 3 month phone follow up Mrs Poudel headed the session elaborating each question of 6 weeks and 3 months including the skip questions. Further she explained about some social and motor questions included from IYCD.

Practice session The trainees were given two different case scenarios and assigned to complete the 6 weeks and 3 month questionnaire.

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EN-SMILING Phone Follow up questionnaire Mrs Gurung led the session where she explained the EN-SMILING phone follow up questionnaire and after which practice session was carried out in pairs with two different case scenarios.

Telephone Operator Mrs Poudel gave explanation about call in centre steps to fix and remind facility visit appointments according the flow chart.

Supervisors roles and data quality monitoring

This session focused on the role of supervisors and the actions to be followed in any incidents, red flags. Mrs Gurung also described about the various ways of maintaining the data quality and supervision

Closing Session On the last day of the training, certificates were distributed to the trainees for successful completion of the training. The certificates were awarded by Dr. Shree Krishna Shrestha, HOD, Pediatrics, PAHS and Dr.Amrita Ghimire. Dr. Shrestha was very enthusiastic regarding the program and encouraged the assessors to come up to him if any help is needed.

Hence, the 10 days training of data collectors ended congratulating them and wishing them luck for their tenure.

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7.0 tRaining outComeThe outcome of the training was in line with the training objectives. The outcome consisted the following:

1. Capacity building of data collectors

2. Orientation on all the EN-SMILING study tools

3. Performance evaluation of data collectors

4. Training evaluation by data collectors

8.0 leaRning RefleCtionSThe following were valuable learning reflections from this training:

• Knowledge and skills on EN-SMILING study tools enhances.

• More practice session for MDAT required.

• The training in the customized application would have helped in gaining deeper insights.

THANK YOU !

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anneXeSDay 1 Introduction Facilitator

10:00- 10:1515mins Registration+ Tea

10:15- 11:0045mins

Presentation: Welcome, Introduction and Objectives

Rejina Gurung

11:00-11:3030mins

Presentation:Roles and Responsibilities

Elisha Joshi

11:30 –12:0030mins

Presentation: Data Flow

Asmita Poudel

12:00-13:0060mins

Activity IB:Understanding the Study and Different Roles Participants

13:00-14:0060mins LUNCH

14:00-15:0060mins

Presentation:Introduction to Early Childhood Development

Rejina Gurung

15:00-15:4545mins

Activity IC:Understanding ECD and ECD tools Participants

15:45-16:1530mins

Presentation:Introduction to EN-SMILING interview skills

Elisha Joshi

16:15-16:3015mins

Activity ID:Mock Practice interviews Participants

16:30-17:0030mins

Presentation:Why are high quality data important?

Asmita Poudel

Day 2: Initial forms

8:00- 8:1515mins Recap of Previous Day Participants

8:15-8:3015mins

Activity IE:Group Quiz Elisha, Asmita

8:30-8:4515mins

Presentation:Introduction to initial forms

Rejina Gurung

10:15-10:4530 mins

Presentation:Introducing the Study and Informed Consent

Asmita Poudel

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10:45-11:1530mins

Activity IIA:Informed Consent Participants

11:15-12:0045mins LUNCH

1200-13:0060mins

Presentation:Personal and Health Questionnaire

Rejina Gurung

13:00-14:3060mins

Presentation:Personal and Health Questionnaire

Elisha Joshi

14:30-15:0030mins

Activity IIB:Trainees Role Playing Participants

Day 3: IYCD

8:00-8:1515mins Recap of Previous Day Participants

8:15-9:1560mins

Presentation:Modified FCI

Asmita Poudel

9:15- 9:4530mins

Activity IIC:Trainees Role Playing Participants

9:45-10:4560mins

Presentation:Introduction to the IYCD tool

Rejina Gurung

10:45-11:0015mins

Activity IIIA:ID Age of Child and Questions in Four Domains Participants

11:00-12:0060mins LUNCH

12:00- 13:0060mins

Presentation:IYCD tool- MOTOR COMPONENT

Elisha Joshi

13:00-14:3030mins

Activity IIIB:Trainer’s Role Playing Participants

14:30-15:0030mins

Presentation:IYCD tool- LANGUAGE and COGNITIVE

Asmita Poudel

15:00-15:3030mins Practice session using IYCD

Day 4: IYCD and MDAT

8:00-8:15 Recap of Previous Day Participants

15:00-15:3030mins

Presentation:IYCD tool-SOCIO-EMOTIONAL

Elisha Joshi

29


14:00-14:3030mins

Presentation:IYCD tool-GENERAL BEHAVIOURAL

Rejina Gurung

8:15-10:30135mins

Activity IIIC:Trainee’s Role Playing

Participants

10:30-11:0030mins

Activity IIID:Test Your Knowledge Elisha Joshi

11:00-12:0060mins LUNCH

12:00-12:4545mins

Presentation:Introduction to MDAT

Rejina Gurung

12:45- 14:45120mins Demonstration using MDAT Elisha, Asmita

14:45- 15:3045mins Discussion Rejina Gurung,

Elisha, Asmita

Day 5: MDAT

8:00-8:1515mins

Recap of Previous Day Participants

8:15- 9:1560mins

Presentation: The tool- GROSS MOTOR, Elisha Joshi

9:15-11:0090mins

Presentation: The tool- FINE MOTOR Asmita Poudel

LUNCH

12:00- 14:002 hours Practice session in 18 months child Participants

14:00- 15:3090mins Discussion and Feedback

Day 6: MDAT Practical


8:15-9:1560mins

Presentation: MDAT- Language and Hearing

Rejina Gurung

9:15-11:0060mins

Presentation: MDAT- Social

Asmita Poudel

30

11:00-12:0060mins LUNCH

12:00 -12:3030mins

Presentation: MDAT- Scoring

Elisha Joshi

12:30-15:00150mins

Practical sessionMDAT – 7months and 23months

Participants

15:00-15:3030mins Test your knowledge Participants

Day 7: MDAT and CREDI


8:15-11:00165mins

Practical sessionMDAT – 7months and 23months

Participants

11:00-12:0060mins LUNCH

12:00-13:0060mins

Presentation: Introduction to CREDI

Elisha Joshi

13:00- 13:3030mins Activity IV: Age of child

13:30-15:30120mins

Presentation: CREDI: Motor, language and social emotional

Asmita PoudelElisha Joshi

Day 8: CREDI


8:15-9:0045mins

Presentation: CREDI: Mental health

Rejina Gurung

9:00-11:00120mins Practical Session using CREDI Participants

11:00-12:0060mins LUNCH

12:00-14:00120mins

Practical sessionIYVD and CREDI

Participants

14:00-15:0060mins Interview tips and Discussion Rejina Gurung

Elisha Joshi

13:00- 13:3030mins Test your knowledge Participants

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Day 9: Anthropometry and Summary


8:15- 9:1560mins

PresentationIntroduction, Anthropometry

Elisha Joshi

9:15-10:0045mins

Group Activity VIAZ-score

Rejina Gurung

10:00-11:00 Presentation: Hemoglobin Asmita Poudel

11:00-12:0060mins LUNCH

12:00-13:0060mins

Practical Discussion:Feedback and Discharge Summary

Elisha JoshiAsmita Poudel

13:00-13:3030mins Discussion: Full EN-SMILING Flow Chart Rejina Gurung

13:30-14:3060mins Practical: Full EN-SMILING face to face clinical appointment

14:30- 15:3060mins

PresentationMain roles of Telephone Interviewer

Asmita Poudel

Day 10: Telephone Interviewer and Opeartor

8:00- 8:3030 mins

PresentationEN-SMILING call centre

Rejina Gurung

8:30-9:0030mins

PresentationInterviewer skills

Asmita Poudel

9:00-9:3030mins

PresentationInitial follow up and Telephone Interviews

Elisha Joshi

9:30-10:3060mins

Presentation6 weeks and 3 month phone follow up

Asmita Poudel

10:30-11:0030mins Practical: 6 weeks and 3 month follow up

11:00-12:0060mins LUNCH

12:00-13:0060mins Presentation : Phone Follow up questionnaire Rejina Gurung

13:00-14:0060mins

PresentationTelephone Operator

Asmita Poudel

14:00-15:0030mins

PresentationSupervisors role and data quality monitoring

Elisha Joshi

15:00-15:3030mins Summary and Feedback Rejina, Elisha and

Asmita

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