Lessons learned from a door-to-door screening program for developmental delay and motor impairment in children in Cuenca, Ecuador

Background: Children with neurodevelopmental conditions in low-resource urban settings often remain undiagnosed and excluded from care. Reliable epidemiological data is crucial for addressing this issue, but in Ecuador, official data are limited. To address this, an door-to-door screening survey was carried out in an urban area of Cuenca, Ecuador. This paper reviews the lessons learned when implementing epidemiological research in a mobile and economically vulnerable population.
Methods: The original project was a cross-sectional, door-to-door survey conducted across 134 city blocks to screen children aged 2 to 59 months for developmental delay and those aged 5 to 12 years for motor impairment. Following project completion, a structured reflective evaluation was undertaken to analyze the encountered challenges. This review drew on meeting records, follow-up data, and a targeted literature review to identify implementation barriers and develop recommendations for future community-based screening initiatives.
Results: The analysis revealed a critical weakness in the original study’s design. A six-month delay between screening and diagnoses combined with high population mobility drove a 31–65% loss to follow-up between stages. Additional challenges included a lack of treatment pathways for participants, limited institutional support, and undeveloped soft skills of the student researchers. Strengths included reaching many unregistered children with disabilities, effective household mapping, and valuable experiential learning for medical students.
Conclusions: This study underscores the importance of aligning methodological design with sociocultural realities. Programs should ensure robust institutional commitments, implement study stages concurrently, and integrate treatment into the research protocol to improve participant retention. Community-based screening initiatives can serve as meaningful training experiences for health science students.