The validation of the national institute of health (NIH) toolbox for the assessment of neurological and behavioral function among Zambian children and adolescents in Lusaka province, Zambia.

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Kabundula, Pelekelo
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The University of Zambia
The study set out to validate the NIHTB-CB among Zambian Children and Adolescents in Lusaka Province. The objectives of the study were to: evaluate the standardised administration of the NIHTB-CB in assessing cognitive function of children and adolescents aged 8-17 years; identify challenges encountered by children and adolescents aged 8-17 years in the administration of the NIHTB-CB in assessing cognitive function; examine the extent to which the NIHTB-CB is valid based on (face validity, content validity, constructs validity, divergent validity, convergent validity and criterion validity) in assessing cognitive function of children and adolescents aged 8-17 years; and compare results from the gold standardised of neuropsychological battery test with a threshold of 0.80-1.00 and the NIHTB-CB in children and adolescents aged 8-17 years in Lusaka Province. A total of 791 respondents consisting of professional personnel, parents, children and adolescents completed both a gold standard of full neuropsychological testing battery and the NIHTB-CB test battery and were recruited within Lusaka Province. The NIHT-CB and a gold standard of neuropsychological tool, which was already validated for use in Zambia, was also administered. An explanatory sequential research design also known as instrument validation design was utilised. Data elicited and generated was stored in RedCap. The study elicited both quantitative and qualitative data strands. Quantitative data was analysed using Stata 14.2 (Stata Corp LP, College Station, TX) to perform linear regression using generalised estimating equation, intra-class correlation coefficient (ICC), Pearson correlation for continuous variables and Spearman correlation for categorical variables, a multivariate normative comparison, Receiver Operating Characteristic Curve (ROC) and Confirmatory Factor Analysis were utilised. Qualitative data was analysed thematically. The results of the study found that the Installation Qualification (IQ) of the NIHTB-CB was done in accordance with the manufacturers‟ specifications and its Operation Qualification (OQ) operated as expected by the manufacturer as it spelt out considerable details on standardised administration conditions and instructions. The performance qualification (PQ) in terms of psychometric properties of the NIHTB CB to some extent had appropriate face and construct validity, with the exception of the Picture vocabulary test and Dimensional change card sort test which performed poorly due to requiring high levels of English language skills. Additionally, children and adolescents had limitations in comprehending task instructions, poor literacy and numeracy skills, and were unfamiliar with most of the NIHTB-CB test materials on both List sorting working memory test and Auditory verbal learning test and were later modified in the second phase of the study. In the first phase, correlations with standard neuropsychological tests were moderate (all pairwise correlations r=0.43, p<0.001) and in the second phase of the study, correlations with standard of full neuropsychological tests were strong to excellent (r=0.68; p<0.001). Based on the aforementioned findings; the study recommends that the NIHTB-CB should be utilised by the ministry of general education to assess cognitive function of children and adolescents in the Zambian schools for appropriate placement options. Keywords: Validation, Psychometric properties, Cognitive function, NIHTB-CB, HIV, HEU, Children and Adolescents.
Cognitive neuroscience. , Cognition disorders--Patients--Rehabilitation. , Language disorders in children.