224 - Training transforms perceptions: Effects of MDAT training on perception of barriers to neurodevelopmental follow-up among healthcare providers in Rwanda

Publication Number: 4221.224

Jocelyne Bukeyeneza, King Faisal Hospital, Kigali, Kigali, Kigali, Rwanda; Brandon R. Hadfield, University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, Kailua, HI, United States; Gregory C. Valentine, University of Washington School of Medicine, Tacoma, WA, United States; Merhawit Abadi, Saint Paul's Hospital Millennium Medical College, ADDIS ABABA, Adis Abeba, Ethiopia

Background: The World Health Organization recommends structured neurodevelopmental follow up (NDFU) of small and/or sick newborns with timely referral. Yet, barriers exist limiting structured and culturally adapted NDFU tools within many contexts worldwide. The Malawi Development Assessment Tool (MDAT) is a culturally adapted developmental screening tool for use in many African contexts, although it has not been widely adopted within Rwandan referral hospitals or community-based NDFU organizations.

Objective: To evaluate how knowledge and perceptions of hospital- and community-based providers in Rwanda regarding barriers and facilitators to neurodevelopmental assessments for children < 2 years changed before and after MDAT training.

Design/Methods: A mixed-methods survey was conducted among healthcare providers before and after MDAT training in August 2025. Descriptive analyses (Fisher’s exact, Kruskal-Wallis, and Chi-square tests) compared pre- and post-training responses. Differences between hospital-based and community-based providers were also examined to assess setting-specific changes.

Results: 23 and 18 providers completed the pre- and post-assessments, respectively (Table 1). Before MDAT training, ≥70% providers identified key barriers to NDFU as family/maternal perceptions (70%), lack of culturally adapted tools (71.4%), and inadequate staff training (82.6%). After training, ≥70% providers cited family/maternal perceptions (83.3%), staff workload (94.4%), families lack transport (72.2%), cultural concerns (83.3%), and cost to families (88.9%) as major barriers, with a significant reduction in those believing culturally adapted tools are lacking (27.8%; Table 2 (Table 3). Pre-training, all community-based providers viewed family/maternal perceptions as a major barrier vs 46.2% of hospital-based providers (p=0.02); this difference disappeared post-training (80.0% vs 87.5%, p>0.99). Hospital-based providers showed a significant risk in perceiving phone access as a barrier (6.7% vs 37.5%, p=0.002; Table 3).

Conclusion(s): MDAT training was associated with improved awareness of culturally appropriate developmental tools and a convergence in barrier perceptions between hospital- and community-based. Although training reduced misconceptions about the lack of culturally adapted assessments, key structural and socioeconomic barriers (caregiver perceptions, staff workload, transport, and cost) remained prominent. These findings highlight the need for system-level strategies addressing logistical and family-related barriers to optimize NDFU in Rwanda.

Table 1: Demographics Based on Trainees if Hospital-Based or Community-Based and Comparing Pre- and Post-MDAT Training Assessments
MDAT Table 1.pdf

Table 2: Evaluation of Knowledge and Perceptions of Barriers Related to Neurodevelopmental Assessments and Follow Up in Rwanda Overall
MDAT Table 2.pdf

Table 3: Evaluation of Knowledge and Perceptions of Barriers Related to Neurodevelopmental Assessments and Follow Up in Rwanda Based on Hospital-Based versus Community-Based/NGO Staff
MDAT Table 3.pdf