DEVELOPMENT AND VALIDATION OF AN INTEGRATED RISK-BASED ENVIRONMENTAL HEALTH ASSESSMENT FRAMEWORK FOR CHILDCARE FACILITIES IN NIGERIA

Background: Children in childcare settings may be exposed to multiple environmental health hazards, yet these risks are often assessed separately. This study developed and validated an integrated, multidomain, risk-based environmental health assessment framework for childcare facilities in Nigeria. 
Methods: An initial set of 91 indicators was refined through a three-round modified Delphi process with a 16-member multidisciplinary expert panel. The final 72-item instrument covered six domains. Domain weights were derived using the Analytic Hierarchy Process. Content validity was assessed using item-level and scale-level content validity indices. Internal consistency was evaluated using Cronbach's alpha, and inter-rater and test-retest reliability were assessed using intraclass correlation coefficients. The framework was piloted in 30 childcare facilities across six states or regions and urban, peri-urban, and rural settings. 
Results: The final framework included Water, Sanitation and Hygiene, Food Safety, Structural and Physical Safety, Indoor and Outdoor Air Quality, Chemical and Toxicant Exposure, and Biological and Vector Hazards. Scale-level content validity was 0.94. Overall internal consistency was high (alpha = 0.91), while inter-rater and test-retest reliability were good (ICC = 0.89 and 0.86). Composite risk scores ranged from 20.4 to 66.7; 20.0% of facilities were Low risk, 36.7% Moderate, 30.0% High, and 13.3% Critical. 
Conclusion: The framework demonstrated strong content validity and reliability and provides a structured approach for integrated environmental health risk assessment in childcare facilities.