Audit on knowledge, attitudes and practices on developmental assessment among public health midwives in a sub-urban health area in Sri Lanka

Age-appropriate early childhood development is a key determinant of later educational attainment, social functioning, and economic productivity. In Sri Lanka, Public Health Midwives (PHMs) are frontline primary healthcare providers responsible for early childhood care and development (ECCD), including routine developmental assessment (DA). This audit aimed to assess the knowledge, attitudes, and self-reported practices related to DA among PHMs in a sub-urban Medical Officer of Health (MOH) area in Sri Lanka. The audit was conducted among PHMs attached to the Mahara MOH area in the Western Province of Sri Lanka. Audit standards were derived from the ECCD Handbook and national developmental standards for Sri Lankan infants and toddlers issued by the Ministry of Health. A structured, self-administered questionnaire assessed knowledge across multiple developmental domains, attitudes towards routine DA, and self-reported DA practices. Descriptive statistics were used to summarise findings. Of 54 eligible PHMs, 44 participated (response rate: 81.4 %). All participants agreed that DA should be routinely conducted during service encounters. However, none reported being fully confident in performing a comprehensive DA. The mean overall knowledge score was 63.7% (SD = 8.4). Knowledge was lowest for assessing primary reflexes (mean = 49.8%) and cut-off ages for milestone attainment (mean = 32.9%). While attitudes towards DA were generally favourable, reported routine practice and referral for further developmental evaluation were limited. Although PHMs demonstrated acceptable overall knowledge and favourable attitudes towards DA, important gaps were identified in critical areas such as knowledge on milestone cut-off ages, primary reflexes, confidence, and routine practice. Strengthening in-service training, supportive supervision, and referral pathways is essential. A structured capacity-building programme followed by re-audit is recommended to improve early identification and management of developmental delays.