The challenge of creating culturally appropriate assessment tools for child development

Of the approximately 200million children under 5 years old who are thought to be at risk of not fulfilling their developmental potential, the majority live in south Asia and sub-Saharan Africa. However, little work has been done to establish, and evaluate, the reliability of tools for assessing developmental progress of young children in such settings.

In a new study published in PLoS Medicine, Melissa Gladstone and colleagues from the University of Liverpool, University of Lancaster, the College of Medicine at the University of Malawi and the Wellcome Trust Research Labs, Blantyre, Malawi, develop and evaluate a new tool, the Malawi Developmental Assessment Tool, for assessing developmental progress of young children in rural African settings.

A consensus process was used to identify items for inclusion in the tool, and the researchers aimed to ensure these were culturally appropriate. In the study, candidate items for rating a child's progress were refined in a number of stages, involving evaluation by a language expert, a group of nurse-midwives, a psychologist, paediatricians and medical students (all Malawian).

The draft instrument was then piloted on 80 children, and finally tested in a group of 1,513 children from rural and semi-urban sites in southern Malawi. The final version of the tool contained 136 items (relating to domains such as fine and gross motor skills, language and social development), requires a small set of props, and takes about 30 minutes to administer per child. In a test phase, the tool correctly identified almost all children with neurodisability.

The researchers comment that the tool may be broadly applicable in rural African settings, although a limitation is that given the shortage of services to support these populations, the tool is more likely to be used in a research context.