Over the past decade, researchers have shown increased interest in examining the cognitive development of children in non-Western countries, often in connection with evaluations of health and educational interventions. However, many studies have used Western-developed measures without proper consideration of contextual validity. Across domains—from language to cognition to non-cognitive skills—this results in varying degrees of bias that call into question the findings of these studies. In this article, we focus in particular on the problem of differences in dimensionality perception between children in sub-Saharan Africa and those in Western countries. Although most Western children are exposed to extensive two-dimensional materials during early childhood, such as picture books and photographs, most rural African children are not. We therefore argue that assessments using two-dimensional stimuli, such as line drawings or patterns, may be inappropriate for capturing cognitive development in settings where such formats are unfamiliar to young children. We also discuss a modified assessment of non-verbal reasoning designed to be contextually appropriate for children in rural Africa—the Object-based Pattern Reasoning Assessment (OPRA). Created during a national study of pre-school child development in Zambia, this new assessment uses local materials such as beans and stones, requires little training to administer, and avoids potential instrument bias related to two-dimensionality among young children living in developing countries.

BackgroundDespite major progress made over the past 10 years, malaria remains one of the primary causes of ill health in developing countries in general, and in sub-Saharan Africa in particular. Whilst a large literature has documented the frequency and severity of malaria infections for children under-five years, relatively little evidence is available regarding the impact of early childhood malaria exposure on subsequent child development.MethodsThe objective of the study was to assess the associations between early childhood exposure to malaria and pre-school development. Child assessment data for 1,410 children in 70 clusters collected through the 2010 Zambian Early Childhood Development Project was linked with malaria parasite prevalence data from the 2006 Zambia Malaria Indicator Survey. Linear and logistic models were used to estimate the effect of early childhood exposure to malaria on anthropometric outcomes as well as on a range of cognitive and behavioural development measures.ResultsNo statistically significant associations were found between parasite exposure and children’s height and weight. Exposure to the malaria parasite was, however, associated with lower ability to cope with cognitive tasks administered by interviewers (z-score difference −1.11, 95% CI −2.43–0.20), as well as decreased overall socio-emotional development as assessed by parents (z-score difference −1.55, 95% CI −3.13–0.02). No associations were found between malaria exposure and receptive vocabulary or fine-motor skills.ConclusionsThe results presented in this paper suggest potentially large developmental consequences of early childhood exposure to malaria. Continued efforts to lower the burden of malaria will not only reduce under-five mortality, but may also have positive returns in terms of the long-term well-being of exposed cohorts.

Findings provide evidence to support the psychometric properties and feasibility of using the ASQ-3 in both South Africa and Zambia through a combination of caregiver-report and direct observations.

BackgroundThere is a growing global acknowledgement that improving child survival rates is no longer sufficient. Emphasis is shifting to the improvement of health and developmental trajectories in early childhood. Screening and measurement of these trajectories in low and middle income countries is difficult, however, as they currently rely on developmental tests standardised among populations of children growing up in resource rich environments.MethodsThis paper presents a comparison of one such tool adapted for use with children living in Southern Africa to children from the United States, Norway, Korea and Spain. The Ages and Stages Questionnaire version 3 (ASQ-3) was adapted and administered to 853 children living in South Africa and Zambia.ResultsChildren in southern Africa were found to perform significantly better than children from other countries early in life, especially in the domains of communication, gross motor and fine motor skills. By the age of five, children in southern Africa were performing significantly worse than their peers in the domains of fine motor and problem-solving.ConclusionThe results indicate the applicability of the ASQ-3 in southern Africa and point to the importance of early interventions to protect the early good development of African children in order to promote positive life trajectories.

While early childhood education has received increasing attention in the developing world in recent years, relatively little evidence is available from sub-Saharan Africa on its effects on child development and subsequent school enrolment. We use a prospective case-control design to evaluate the developmental impact of a community-based early childhood center in an urban area in Zambia. Comparing 40 children attending the center to 40 children not attending the center from the same community, we find that center attendance was associated with significantly better performance in an assessment of task orientation, and was also weakly associated with increased letter familiarity. We also observed higher performance among center students on tests of receptive language and pencil-related fine motor skills. These associations were, however, smaller and not statistically significant. We conducted a follow-up one year after the initial assessment, when children were seven years old and should have been in first grade. At follow-up, 27% of non-attendees were not yet enrolled in primary school, compared to just 11% of center students, suggesting that participation in early education encourages a timely transition into first grade.