By Abhipreet Kaur

The Detection workstream under NAMASTE focuses on strengthening early identification of neurodevelopmental conditions, with a particular emphasis on autism, among children aged 1.5 to 9 years. Across sites, capacity building efforts target nonspecialist frontline workers in Delhi and Nepal, and specialist providers in Goa and Sri Lanka. Screening is conducted using the Social Attention and Communication Surveillance tool (SACS), alongside locally embedded mechanisms such as RBSK in India and Nepal and CHDR pathways in Sri Lanka. Data are captured through REDCap to enable systematic triaging and follow up.

SACS, developed by Dr Josephine Barbaro at La Trobe University, has demonstrated strong sensitivity and specificity across global settings. Master trainers from all four sites were trained on the tool, followed by cultural adaptation of training materials to ensure relevance and feasibility within each country context.

At the annual meeting, country teams presented their implementation experiences within diverse health systems. They described preparatory phases that included adapting training content, identifying appropriate cadres, and integrating screening within existing service structures. Differences across sites were evident. In Goa and Sri Lanka, developmental screening aligns with the mandated responsibilities of RBSK doctors and Public Health Midwives. In Delhi and Nepal, frontline workers such as Anganwadi Workers and Female Community Health Volunteers serve as the first point of community contact, though screening is not embedded within their routine roles.

Teams shared insights on training duration, supervised practice, and digital integration of REDCap. Pre and post training assessments reflected improvements in knowledge, attitudes, and confidence. However, challenges emerged, particularly among non-specialist workers who sometimes interpreted autism related behaviours through everyday cultural frameworks. Ongoing supervision and inter-rater reliability exercises were critical in maintaining fidelity to the screening protocol.

From a data perspective, over 16,000 children have been screened across sites, with 288 children with autism and 509 with broader neurodevelopmental delays triaged into NAMASTE pathways. While the REDCap platform enabled real time tracking, technical barriers such as login issues, syncing errors, and duplicate screenings required continued data support, particularly in Delhi.

Each site highlighted a key learning. Delhi demonstrated the importance of incentivising frontline workers to sustain screening coverage. Goa pivoted from training Anganwadi Workers to engaging RBSK doctors to improve accountability and uptake. Nepal underscored the role of digital literacy, noting that while most volunteers owned smartphones, structured training and hands on supervision were essential for effective digital data collection. Sri Lanka identified three years of age as the most feasible point for systematic mass screening within its public health midwife network.

The meeting reinforced that early detection is both a technical and systems level effort. Successful implementation depends on contextual adaptation, workforce alignment, supportive supervision, and digital capacity. Across settings, the shared commitment to strengthening early identification continues to anchor the Detection workstream within NAMASTE.

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