Neuropsychological testing in a rural African school-age population: evaluating contributions to variability in test performance.

This study investigated the psychometric properties of a number of neuropsychological tests adapted for use in sub-Saharan Africa. A total of 308 school-age children in a predominantly rural community completed the tests. These tests were developed to assess skills similar to those measured by assessments of cognitive development published for use in Western contexts. Culturally appropriate adaptations were made to enhance within-population variability. Internal consistency ranged from .70 to .84. Scores on individual tests were related to various background factors at the level of the child, household, and neighborhood. School experience was the most consistent predictor of outcome, accounting for up to 22.9% of the variance observed. Significant associations were identified to determine salient background characteristics that should be taken into account when measuring the discrete effects of disease exposure in similar sociocultural and economic settings.

Determinants of variability in motor performance in middle childhood: a cross-sectional study of balance and motor co-ordination skills.

BACKGROUND: Physical activity is a key component of exploration and development. Poor motor proficiency, by limiting participation in physical and social activities, can therefore contribute to poor psychological and social development. The current study examined the correlates of motor performance in a setting where no locally validated measures of motor skills previously existed. The development of an appropriate assessment schedule is important to avoid the potential misclassification of children's motor performance. METHODS: A cross-sectional study was conducted among a predominantly rural population. Boys (N = 148) and girls (N = 160) aged between 8 and 11 years were randomly selected from five schools within Kilifi District in Kenya. Four tests of static and dynamic balance and four tests of motor coordination and manual dexterity were developed through a 4-step systematic adaptation procedure. Independent samples t-tests, correlational, univariate and regression analyses were applied to examine associations between background variables and motor scores. RESULTS: The battery of tests demonstrated acceptable reliability and validity. Variability in motor performance was significantly associated with a number of background characteristics measured at the child, (gender, nutritional status and school exposure) household (household resources) and neighbourhood levels (area of residence). The strongest effect sizes were related to nutritional status and school exposure. CONCLUSIONS: The current study provides preliminary evidence of motor performance from a typically developing rural population within an age range that has not been previously studied. As well as being culturally appropriate, the developed tests were reliable, valid and sensitive to biological and environmental correlates. Further, the use of composite scores seems to strengthen the magnitude of differences seen among groups.

Describing the burden of malaria on child development: what should we be measuring and how should we be measuring it?

There are a number of pathways, both direct and indirect, through which malaria infection could impact the course of child development, causing impairment and disability and adding to the burden of malaria. We present an overview of relevant studies that illustrate these pathways, updating the evidence previously presented. We conclude that before the mechanisms and numbers of affected children can be adequately defined, a wider range of potential pathways to impaired development need to be investigated. Only then can the calculation of the burden be evidence-based, rather than merely speculative. Priorities for future research are described. The calculation of the impact of malaria on child development also requires a degree of uniformity in the definition of outcome across studies. This is currently lacking, and suggestions are made for a common approach to the reporting of results.