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Table 1 Clinical assessment method and definitions of impairment

From: Childhood disability in Malawi: a population based assessment using the key informant method

Impairment/health condition Screen/Exam Ages (year) Assessment Case definition
Moderate/severe vision impairment SCREEN 0–2 Fix and follow Unable to fix and follow
3–4 Counting fingers (child copies number of fingers shown at 6 m both eyes together) Unable to count finger at 6 m (approx. Equivalent to Visual Acuity (VA) < 6/60).
≥ 5 Visual acuity test using tumbling E-chart Presenting VA <6/60 in better eye.
EXAM   Eye exam with direct ophthalmoscope and retinoscope by ophthalmic clinical officer  
Moderate/severe hearing impairment SCREEN 6 m-4 Otoacoustic Emissions (OAE) tests. Fails OAE both ears.
≥ 5 Ages ≥ 5 years: Pure Tone Audiometry (PTA)a > 35 dBHL in both earsa
EXAM   Ear exam by ENT clinical officer using an otoscope  
Moderate/severe physical impairment    Standardised observation of activities (ability to hold and change position, mobility, and hand function) and physical examination by orthopaedic clinical officer to determine severity and cause Moderate/severe physical impairment lasting more than one month/from birth) affecting functioning based on observation of activities and physical examination.
Epilepsy    Eight screening questions about type and frequency of epilepsy episodes in the past year Paediatric clinical officer/nurse confirmed epilepsy based on responses to screening questions.
  SCREEN 0–2   Paediatric clinical officer/Nurse judgement
Intellectual impairment   ≥ 5 12 age-relevant questions on behaviour, communication, comprehension, concentration, relationships and learning b Scores positive on at least 3 questions and/or presence of Down’s Syndrome, microcephaly or hydrocephaly.
  1. aIt was not possible to undertake Pure Tone Audiometry 40% children aged ≥ 5 years due to noisy environments or communication difficulties. Children who could not undergo PTA were classified according to the Ottaoacoustic Emmissions test results. bThese questions were developed in consultation with local occupational therapist