Instruments to identify risk factors associated with adverse childhood experiences for vulnerable children in primary care in low- and middle-income countries: A systematic review and narrative synthesis

This systematic review followed PRISMA guidelines and used a mixed-methods narrative synthesis approach to evaluate screening instruments for ACEs in vulnerable children in LMIC primary care settings. Nine risk assessment instruments were identified: AYPA, CPDS, MDAT, CSI, IPAC, DTI, WHOQOL-BREF, HIV Adolescence Stigma Scale, and SDQ. These instruments measured indicators related to poverty-associated diseases such as HIV/AIDS, malnutrition, and factors related to violence, natural disasters, and ethnic conflict. The reviewed instruments were developed through item generation, psychometric analysis, and theoretical analysis, and were validated for use in households and school settings. None of the nine instruments in their original form could be used for rapid screening of ACEs in frontline clinical settings. Key barriers included retrospective design requiring recall, limited rater decisional capacity, inadequate institutional capacity for implementation, and poor capacity to assess individual risk factors across biopsychosocial dimensions.