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Kipkemoi P, Savage JE, Gona J, Rimba K, Kombe M, Mwangi P, Kipkoech C, Posthuma D, Newton CRJC, Abubakar A. Evaluation of the Psychometric Properties of the Social Communication Questionnaire in Rural Kenya. J Autism Dev Disord 2024:10.1007/s10803-024-06380-9. [PMID: 38816602 DOI: 10.1007/s10803-024-06380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 06/01/2024]
Abstract
Children can be reliably diagnosed with autism as early as 3 years of age, and early interventions are initiated. There is often a significant gap between the age of onset of symptoms (2-3 years) and diagnosis (8-10 years) in Africa. We conducted a study to validate the Social Communication Questionnaire (SCQ) as a screening instrument in a rural setting in Kenya. The study was conducted along the Kenyan Coast. Study participants included 172 children with a neurodevelopmental disorder (NDD) diagnosis (84 of which were autism) and 112 controls. Internal consistency was evaluated through the use of Cronbach's alpha, confirmatory factor analysis (CFA) with maximum likelihood procedure to assess the conceptual model for the SCQ. Additionally, the sensitivity and specificity of cut-off scores using ROC analysis and item difficulties and discrimination quality using an IRT framework were also assessed. Factor analysis revealed an adequate fitting model for the three-factor DSM-IV-TR (root mean squared error of approximation (RMSEA) = 0.050; Comparative Fit Index (CFI) = 0.974; Tucker-Lewis Index (TLI) = 0.973) and two-factor DSM-5 factor structure (RMSEA = 0.050; CFI = 0.972; TLI = 0.974). The reliability coefficient alphas for the whole group for all items (Cronbach's α = 0.90) and all three domains (Cronbach's α = 0.68-0.84) were acceptable to excellent. The recommended cut-off score of 15 yielded 72% sensitivity and 100% specificity in the ASD group compared to the typically developing group. We provide early evidence of the adequate factor structure and good internal consistency of the SCQ. We also note that the recommended cut-off yielded sufficient predictive validity.
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Affiliation(s)
- Patricia Kipkemoi
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya.
- Complex Trait Genetics Department, Center for Neurogenomics and Cognitive Research (CNCR), Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Jeanne E Savage
- Complex Trait Genetics Department, Center for Neurogenomics and Cognitive Research (CNCR), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Joseph Gona
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
| | - Kenneth Rimba
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
| | - Martha Kombe
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
| | - Paul Mwangi
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
| | - Collins Kipkoech
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
| | - Danielle Posthuma
- Complex Trait Genetics Department, Center for Neurogenomics and Cognitive Research (CNCR), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Child and Adolescent Psychology and Psychiatry, Complex Trait Genetics, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Charles R J C Newton
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Oxford, OX3 7JX, UK
- Department of Public Health, Pwani University, P.O. BOX, Kilifi, 195-80108, Kenya
- Institute for Human Development, Aga Khan University, P.O. BOX, Nairobi, 30270-00100, Kenya
| | - Amina Abubakar
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, P.O Box 230-80108, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Oxford, OX3 7JX, UK
- Department of Public Health, Pwani University, P.O. BOX, Kilifi, 195-80108, Kenya
- Institute for Human Development, Aga Khan University, P.O. BOX, Nairobi, 30270-00100, Kenya
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Otieno B, Elson L, Matharu AK, Riithi N, Chongwo E, Katana K, Nasambu C, Mutebi F, Feldmeier H, Krücken J, Fillinger U, Abubakar A. Neurocognitive and mental health outcomes in children with tungiasis: a cross-sectional study in rural Kenya and Uganda. Infect Dis Poverty 2023; 12:100. [PMID: 37964353 PMCID: PMC10644620 DOI: 10.1186/s40249-023-01154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Tungiasis, a neglected tropical parasitosis, disproportionately affects children. Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like tungiasis. Pathophysiology of tungiasis suggests it could detrimentally affect cognition and behaviour. This study pioneered the investigation of neurocognitive and mental health outcomes in children with tungiasis. METHODS This was a multi-site cross-sectional study including 454 quasi-randomly sampled school-children aged 8-14 from 48 randomly selected schools in two counties in Kenya and a district in Uganda. The participants were stratified into infected and uninfected based on the presence of tungiasis. The infected were further classified into mild and severe infection groups based on the intensity of the infection. Adapted, validated, and standardized measures of cognition and mental health such as Raven Matrices and Child Behaviour Checklist were used to collect data. Statistical tests including a multilevel, generalized mixed-effects linear models with family link set to identity were used to compare the scores of uninfected and infected children and to identify other potential risk factors for neurocognitive and behavioural outcomes. RESULTS When adjusted for covariates, mild infection was associated with lower scores in literacy [adjusted β(aβ) = - 8.9; 95% confidence interval (CI) - 17.2, - 0.6], language (aβ = - 1.7; 95% CI - 3.2, - 0.3), cognitive flexibility (aβ = - 6.1; 95% CI - 10.4, - 1.7) and working memory (aβ = - 0.3; 95% CI - 0.6, - 0.1). Severe infection was associated with lower scores in literacy (aβ = - 11.0; 95% CI - 19.3, - 2.8), response inhibition, (aβ = - 2.2; 95% CI - 4.2, - 0.2), fine motor control (aβ = - 0.7; 95% CI - 1.1, - 0.4) and numeracy (aβ = - 3; 95% CI - 5.5, - 0.4). CONCLUSIONS This study provides first evidence that tungiasis is associated with poor neurocognitive functioning in children. Since tungiasis is a chronic disease with frequent reinfections, such negative effects may potentially impair their development and life achievements.
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Affiliation(s)
- Berrick Otieno
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Hospital Road, Kilifi, Kenya.
| | - Lynne Elson
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Hospital Road, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Abneel K Matharu
- International Centre of Insect Physiology and Ecology (ICIE), Human Health Theme, Nairobi, Kenya
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Naomi Riithi
- International Centre of Insect Physiology and Ecology (ICIE), Human Health Theme, Nairobi, Kenya
| | - Esther Chongwo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Khamis Katana
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Hospital Road, Kilifi, Kenya
| | - Carophine Nasambu
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Hospital Road, Kilifi, Kenya
| | - Francis Mutebi
- School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala , Uganda
| | | | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Ulrike Fillinger
- International Centre of Insect Physiology and Ecology (ICIE), Human Health Theme, Nairobi, Kenya
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Programme, Hospital Road, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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Becker D, Meisenberg G, Dutton E, Bakhiet SFA, Alfayez FA, Essa YAS. International differences in the speed of cognitive development: A systematic examination of the existence of the Simber Effect. Acta Psychol (Amst) 2023; 240:104015. [PMID: 37708722 DOI: 10.1016/j.actpsy.2023.104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/13/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
The Simber Effect refers to the phenomenon whereby, in Arabic countries, young children have an IQ that is little different from that of Western children but that these differences increase throughout childhood culminating in a difference of around 20 points by adulthood. The true nature of this phenomenon is revealed by an examination of 125 samples from all around the globe measured with Raven's Progressive Matrices. We show that in many cases different speeds of cognitive development increase the IQ score differences between countries mostly between 4 and 9 years of age, and that these increases can in part be explained by poor environmental conditions. However, the patterns are not completely clear, either in terms of regularity or strengths. Methodological problems, in particular the cross-sectional designs of the included samples, as well as the significance of the Simber Effect for country comparisons in intelligence are discussed.
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Affiliation(s)
- David Becker
- Department of Psychology, Chemnitz University of Technology, Germany.
| | | | | | | | - Fayez Abdulaziz Alfayez
- King Saud University, Educational Administration Department, College of Education, Riyadh, Saudi Arabia.
| | - Yossry A S Essa
- Arish University, Department of Special Education, College of Education, Egypt
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Rachel M, Jia H, Amina A, Perez-Garcia M, Kumar M, Wicherts JM. Psychometric evaluation of the computerized battery for neuropsychological evaluation of children (BENCI) among school aged children in the context of HIV in an urban Kenyan setting. BMC Psychiatry 2023; 23:373. [PMID: 37248481 DOI: 10.1186/s12888-023-04880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Culturally validated neurocognitive measures for children in Low- and Middle-Income Countries are important in the timely and correct identification of neurocognitive impairments. Such measures can inform development of interventions for children exposed to additional vulnerabilities like HIV infection. The Battery for Neuropsychological Evaluation of Children (BENCI) is an openly available, computerized neuropsychological battery specifically developed to evaluate neurocognitive impairment. This study adapted the BENCI and evaluated its reliability and validity in Kenya. METHODOLOGY The BENCI was adapted using translation and back-translation from Spanish to English. The psychometric properties were evaluated in a case-control study of 328 children (aged 6 - 14 years) living with HIV and 260 children not living with HIV in Kenya. We assessed reliability, factor structure, and measurement invariance with respect to HIV. Additionally, we examined convergent validity of the BENCI using tests from the Kilifi Toolkit. RESULTS Internal consistencies (0.49 < α < 0.97) and test-retest reliabilities (-.34 to .81) were sufficient-to-good for most of the subtests. Convergent validity was supported by significant correlations between the BENCI's Verbal memory and Kilifi's Verbal List Learning (r = .41), the BENCI's Visual memory and Kilifi's Verbal List Learning (r = .32) and the BENCI's Planning total time test and Kilifi's Tower Test (r = -.21) and the BENCI's Abstract Reasoning test and Kilifi's Raven's Progressive Matrix (r = .21). The BENCI subtests highlighted meaningful differences between children living with HIV and those not living with HIV. After some minor adaptions, a confirmatory four-factor model consisting of flexibility, fluency, reasoning and working memory fitted well (χ2 = 135.57, DF = 51, N = 604, p < .001, RMSEA = .052, CFI = .944, TLI = .914) and was partially scalar invariant between HIV positive and negative groups. CONCLUSION The English version of the BENCI formally translated for use in Kenya can be further adapted and integrated in clinical and research settings as a valid and reliable cognitive test battery.
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Affiliation(s)
- Maina Rachel
- Department of Methodology and Statistics, Tilburg University, Tilburg, Netherlands.
- Brain and Mind Institute, Aga Khan University, Nairobi, 10834-00400, Kenya.
| | - He Jia
- Department of Methodology and Statistics, Tilburg University, Tilburg, Netherlands
| | - Abubakar Amina
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Miguel Perez-Garcia
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Manasi Kumar
- Brain and Mind Institute, Aga Khan University, Nairobi, 10834-00400, Kenya
| | - Jelte M Wicherts
- Department of Methodology and Statistics, Tilburg University, Tilburg, Netherlands
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Toor HK, Hanif R. Executive Function Touch battery: Translation and preliminary measure validation for Pakistani preschoolers. PLoS One 2022; 17:e0274431. [PMID: 36107940 PMCID: PMC9477268 DOI: 10.1371/journal.pone.0274431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/28/2022] [Indexed: 11/19/2022] Open
Abstract
Keeping in mind the importance of measuring early executive function (EF) skills in low and middle-income countries, the present study examined the feasibility and preliminary psychometric properties of a performance-based computerized EF measure; EF Touch, to be used with Pakistani preschoolers. Review of the content and Urdu translation of verbal instruction EF Touch battery was carried out by subject matter experts before data collection from the 120 preschoolers aged between 3.1 to 5.9 years. The feasibility report indicated that between 79.2% -100% of the preschoolers completed each executive function task. Confirmatory factor analysis revealed the unidimensionality of the EF battery. Item response theory models were used for the initial assessment of tasks and item parameters. Results demonstrated that each task worked invariantly across subgroups of preschoolers residing in low and middle-income households. Moreover, preschoolers showed differences on each task, and task scores reflect their latent EF skills in the low to moderate range. The battery was demonstrated as a feasible and reliable measure for use with low and middle-income countries specifically in Pakistan.
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Affiliation(s)
- Hafsa Khalil Toor
- Department of Psychology, Foundation University Islamabad, Islamabad, Pakistan
| | - Rubina Hanif
- National Institute of Psychology, Quaid-i-Azam University Islamabad, Islamabad, Pakistan
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Boivin MJ, Zoumenou R, Sikorskii A, Fievet N, Alao J, Davidson L, Cot M, Massougbodji A, Bodeau-Livinec F. [Formula: see text]Neurodevelopmental assessment at one year of age predicts neuropsychological performance at six years in a cohort of West African Children. Child Neuropsychol 2021; 27:548-571. [PMID: 33525970 PMCID: PMC8035243 DOI: 10.1080/09297049.2021.1876012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
Rural children from Benin, west Africa were evaluated with the Mullen Scales of Early Learning (MSEL) at one year of age and then at six years with the Kaufman Assessment Battery for Children (KABC-II), the visual computerized Tests of Variables of Attention (TOVA), and the Bruininks-Oseretsky Test (BOT-2) of motor proficiency (N = 568). Although both the MSEL and KABC-II were available to the assessors in French, instructions to the mother/child were in local language of Fon. Mothers were evaluated with the Edinburgh Postpartum Depression Scale (EPDS), Caldwell HOME Scale, educational level and literacy, and a Socio-Economic Scale - also in their local language (Fon). After adjusting for maternal factors, MSEL cognitive composite was correlated with KABC-II with moderate effect sizes, but not with TOVA scores. Overall eta-squared effect for the multivariate models were moderately to strongly correlated (.07 to .37). Neurodevelopmental assessments in early childhood adapted cross-culturally are predictive of school-age neuropsychological cognitive ability.
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Affiliation(s)
- Michael J Boivin
- Michigan State University Departments of Psychiatry and of Neurology & Ophthalmology, University of Michigan Department of Psychiatry
| | | | | | - Nadine Fievet
- Mère et Enfant Face aux Infections Tropicales, Université Paris Descartes, Paris, France
| | - Jules Alao
- Mère et Enfant Face aux Infections Tropicales, Université Paris Descartes, Paris, France
| | - Leslie Davidson
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Michel Cot
- Université Paris Descartes, Paris, France
| | - Achille Massougbodji
- Centre d'Etude et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfance (CERPAGE), Université d'Abomey-Calavi, Cotonou, Benin
| | - Florence Bodeau-Livinec
- École des hautes études en santé publique (EHESP), EPOPé team, UMR1153, F-35000 Rennes, France
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Denckla CA, Lee SY, Kim R, Spies G, Vasterling JJ, Subramanian SV, Seedat S. Patterning of individual variability in neurocognitive health among South African women exposed to childhood maltreatment. Sci Rep 2021; 11:6669. [PMID: 33758246 PMCID: PMC7988062 DOI: 10.1038/s41598-021-85979-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/09/2021] [Indexed: 11/08/2022] Open
Abstract
There are individual differences in health outcomes following exposure to childhood maltreatment, yet constant individual variance is often assumed in analyses. Among 286 Black, South African women, the association between childhood maltreatment and neurocognitive health, defined here as neurocognitive performance (NP), was first estimated assuming constant variance. Then, without assuming constant variance, we applied Goldstein's method (Encyclopedia of statistics in behavioral science, Wiley, 2005) to model "complex level-1 variation" in NP as a function of childhood maltreatment. Mean performance in some tests of information processing speed (Digit-symbol, Stroop Word, and Stroop Color) lowered with increasing severity of childhood maltreatment, without evidence of significant individual variation. Conversely, we found significant individual variation by severity of childhood maltreatment in tests of information processing speed (Trail Making Test) and executive function (Color Trails 2 and Stroop Color-Word), in the absence of mean differences. Exploratory results suggest that the presence of individual-level heterogeneity in neurocognitive performance among women exposed to childhood maltreatment warrants further exploration. The methods presented here may be used in a person-centered framework to better understand vulnerability to the toxic neurocognitive effects of childhood maltreatment at the individual level, ultimately informing personalized prevention and treatment.
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Affiliation(s)
- Christy A Denckla
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Sun Yeop Lee
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Georgina Spies
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
| | | | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Cambridge, MA, 02138, USA
| | - Soraya Seedat
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
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Rachel M, Fons VDVJR, Amina A, Perez-Garcia M, Manasi K. Assessing Neuropsychological Functions in Middle Childhood: a Narrative Review of Measures and Their Psychometric Properties Across Context. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2021. [DOI: 10.1007/s40817-021-00096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Background
There is a significant number of neuropsychological measures for use among children aged 6–12 years. However, most of these tests have been developed in high-income contexts (HICs). To avoid or to at least to minimize bias in assessment, most researchers carry out cultural adaptations of these tools. In selecting sub-tests to adapt before using the entire test battery, researchers would benefit from having a reference source summarizing available tools and how easily they can be used in different context. This is where the paper makes a contribution. This narrative review has a twofold aim: first, to identify tools commonly used among 6–12-year-olds; second, to summarize the psychometric properties of these tools especially emphasizing their usage across different cultural contexts.
Methods
We searched the literature from 1 January 1987 to 31 December 2017 for tools used among children aged 6 to 12 years. An extensive search of PubMed, Psych Info and Web of Science using the keywords (i) neuropsychological or neurocognitive with (ii) assessment or test was done.
Results
A hundred and forty-five papers out of 306 reported on psychometric properties of different tools including Behavior Rating Inventory of Executive Functioning—BRIEF (count = 6), Visual-Motor Integration—VMI (count = 6), the Test of Memory Malingering—TOMM (count = 6), MSVT (count = 6) and Continuous Performance Tests—CPT (count = 6). Forty-six percent of the papers reported studies conducted in the USA. Most of these studies were based in high-income countries, which further highlights the need to validate these measures for use in lower- and middle-income countries. Psychometric check was adequate in most tests for measuring executive functioning such as BRIEF, although tests such as CPT that measure complex attention had mixed findings. Moreover, we found that these studies addressed certain aspects of validity and or reliability while leaving out others; thus, a comprehensive picture is lacking.
Conclusion
We propose further studies to thoroughly investigate and report the psychometric properties of these measures, especially in lower- and middle-income countries.
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Magai DN, Koot HM, Mwangi P, Chongwo E, Newton CR, Abubakar A. Long-term neurocognitive and educational outcomes of neonatal insults in Kilifi, Kenya. BMC Psychiatry 2020; 20:578. [PMID: 33267843 PMCID: PMC7709237 DOI: 10.1186/s12888-020-02939-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/28/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is little data on the long-term neurocognitive and educational outcomes among school-aged survivors of neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) in Africa. This study investigates the long-term neurocognitive and educational outcomes and the correlates of these outcomes in school-aged survivors of NNJ or HIE in Kilifi, Kenya. METHODS We conducted a cross-sectional study on neurocognitive and educational outcomes among school-aged survivors (6-12 years) of NNJ (n = 134) and HIE (n = 107) and compared them to a community comparison group (n = 134). We assessed nonverbal intelligence, planning, working memory, attention, syntax, pragmatics, word-finding, memory, perceptual-motor, mathematical, and reading abilities. We also collected information on medical history, caregivers' mental health, and family environment. RESULTS The survivors of NNJ had lower mean total scores in word-finding [F (1, 250) = 3.89, p = 0.050] and memory [F (1, 248) = 6.74, p = 0.010] than the comparison group. The survivors of HIE had lower mean scores in pragmatics [F (1, 230) = 6.61, p = 0.011] and higher scores higher scores in non-verbal reasoning [F (1, 225) =4.10, p = 0.044] than the comparison group. Stunted growth was associated with almost all the outcomes in HIE. CONCLUSION Survivors of NNJ and HIE present with impairment in the multiple domains, which need to be taken into consideration in the planning of educational and rehabilitative services.
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Affiliation(s)
- Dorcas N. Magai
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, P.O Box 230, Kilifi, Kenya ,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Hans M. Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Paul Mwangi
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, P.O Box 230, Kilifi, Kenya
| | - Esther Chongwo
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, P.O Box 230, Kilifi, Kenya
| | - Charles R. Newton
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, P.O Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, P.O. Box 195-80108, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, OX3 7JX UK
| | - Amina Abubakar
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, P.O Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, P.O. Box 195-80108, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, OX3 7JX UK ,grid.470490.eInstitute for Human Development, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
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Magai DN, Newton CR, Mwangi P, Koot HM, Abubakar A. Patterns of neurobehavioral functioning in school-aged survivors of neonatal jaundice and hypoxic-ischemic encephalopathy in Kilifi, Kenya: A cross-sectional study. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.15200.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Studies in high-income countries have reported that school-aged children who survive neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) develop long-term neurocognitive problems. However, less is known about the patterns of functioning in school-aged survivors of NNJ and HIE in sub-Saharan Africa. This study examined patterns of functioning in school-aged children who survived NNJ and HIE in Kilifi, Kenya. Methods: This is a cross-sectional study that included 107 survivors of NNJ/HIE (64 with NNJ, 43 with HIE), aged 6-12 years, admitted to Kilifi County Hospital on the Kenyan Coast. The Gross Motor Function Classification System (GMFCS), Adapted Communication Profile, Raven’s Coloured Progressive Matrices (RCPM) and an epilepsy screening tool were used to assess gross motor function, communication function, intellectual functioning, and epilepsy, respectively. Results: Most of the survivors of NNJ (95.2%) and HIE (95.3%) had no impairments in gross motor functioning. A small percentage of the children in the NNJ and HIE groups had profound problems in their communication (4.7% and 4.7%); expressive communication function (4.7% and 4.7%); social functions (3.1% and 2.3%); receptive communication (4.7% and 2.3%); and communicative effectiveness (4.7% and 2.3%). Cognitive impairment was reported in 10.9% and 11.9% for NNJ and HIE survivors, respectively. Active epilepsy was detected in 1.6% of survivors of NNJ and 2.3% of survivors of HIE. All children had normal hearing and visual functioning except one participant who presented with mild visual acuity problems. Conclusions: Most school-aged children who survive with NNJ and HIE have normal motor and communication function; however, one in ten are likely to present with lowered intellectual functioning compared to the normative sample.
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Maina RW, Abubakar A, Miguel PG, Van De Vijver FJR, Kumar M. Standardization of the Computerized Battery for Neuropsychological Evaluation of Children (BENCI) in an urban setting, in Kenya: a study protocol. BMC Res Notes 2019; 12:799. [PMID: 31818323 PMCID: PMC6902457 DOI: 10.1186/s13104-019-4830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/27/2019] [Indexed: 11/12/2022] Open
Abstract
Objective In sub Saharan Africa one of the key challenges in assessment using neuropsychological tools has been the lack of adequately validated and easily implementable measures. This study will translate into English, adapt and standardize the Computerized Battery for Neuropsychological Evaluation of Children (BENCI). The BENCI battery will be adapted using back-translation design, comprehensive cultural adaptation and standardized in a case–control study involving two groups of children: HIV infected and HIV unexposed, uninfected children. The content adaptation will be iteratively carried out using knowledge of English and feedback from pilot testing with children. The proposed study will first involve the cultural adaptation of the BENCI. It will then recruit 544 children aged 8–11 years with half of them being HIV+, while the other half will be HIV unexposed-uninfected. Test–retest reliability will be analyzed using Pearson’s correlation while ANOVA and correlational analyses will be used to calculate discriminant, convergent and construct validity. Results This study will result in an open access adequately adapted and standardized measure of neuropsychological functioning for use with children in East Africa. The protocol paper provides an opportunity to share the planned methods and approaches.
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Affiliation(s)
- Rachel Wanjiru Maina
- Department of Clinical Medicine and Therapuetics, University of Nairobi, Nairobi, 10834-00400, Kenya. .,Department of Culture Studies, Tilburg University, Tilburg, The Netherlands.
| | - Amina Abubakar
- Neurosciences Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Perez-Garcia Miguel
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Fons J R Van De Vijver
- Department of Culture Studies, Tilburg University, Tilburg, The Netherlands.,Department of Psychology, Higher School of Economics, Ulitsa, Russia
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Plattner IE, Mbakile-Mahlanza L, Marobela S, Kgolo TJF, Monyane-Pheko MMB, Patel V, Feinstein A. Developing a Computerized Brief Cognitive Screening Battery for Botswana: A Feasibility Study. Arch Clin Neuropsychol 2019; 34:682-689. [PMID: 30165575 DOI: 10.1093/arclin/acy071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/26/2018] [Accepted: 08/07/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To determine the feasibility of using a brief computerized battery for assessing cognition in citizens of Botswana. METHOD A group of 134 healthy subjects were administered a brief computerized battery of tests (Stroop, Symbol Digit Modalities Test (c-SDMT), and 2 and 4 second versions of the Paced Visual Serial Addition Test (PVSAT)). Half the subjects were tested in English and the other half in Setswana. RESULTS All subjects completed the 20 min battery. Participants administered the tests in English had more years of education (p < .001) and were more likely to be male (p = .024) than those administered the tests in Setswana. There were no significant cognitive differences between the English and Setswana groups. Predictors of cognition were education (c-SDMT, PVSAT 4 and 2 second versions), age (Stroop, c-SDMT), and sex (c-SDMT), with females performing better than males on the latter. Language was not associated with performance on any of the cognitive tests and there were no significant interactions between language and any of the demographic predictors of cognition. CONCLUSIONS The results demonstrate that our brief computerized approach is feasible with similar findings obtained for both language groups. Two further phases to the development of the Botswana version of the brief computerized battery can now proceed. The first is to obtain normative data from a larger sample representative of Botswana society in general. The second will be to validate the cognitive measures in a sample of people with acquired brain injury using the normative data to determine thresholds for impairment.
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Affiliation(s)
| | | | - Shathani Marobela
- University of Botswana, Department of Psychology, Private Bag, Gaborone, Botswana
| | | | | | - Viral Patel
- Sunnybrook Health Sciences Center, Department of Psychiatry, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Anthony Feinstein
- Sunnybrook Health Sciences Center, Department of Psychiatry, 2075 Bayview Avenue, Toronto, ON, Canada.,University of Toronto, Department of Psychiatry, 27 King's College Circle, Toronto, ON, Canada
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Magai DN, Newton CR, Mwangi P, Koot HM, Abubakar A. Patterns of neurobehavioral functioning in school-aged survivors of neonatal jaundice and hypoxic-ischemic encephalopathy in Kilifi, Kenya: A cross-sectional study. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15200.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Studies in high-income countries have reported that school-aged children who survive neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) develop long-term neurocognitive problems. However, less is known about the patterns of functioning in school-aged survivors of NNJ and HIE in sub-Saharan Africa. This study examined patterns of functioning in school-aged children who survived NNJ and HIE in Kilifi, Kenya. Methods: This is a cross-sectional study that included 107 survivors of NNJ/HIE (64 with NNJ, 43 with HIE), aged 6-12 years, admitted to Kilifi County Hospital on the Kenyan Coast. The Gross Motor Function Classification System (GMFCS), Adapted Communication Profile, Raven’s Coloured Progressive Matrices (RCPM) and an epilepsy screening tool were used to assess gross motor function, communication function, intellectual functioning, and epilepsy, respectively. Results: Most of the survivors of NNJ (95.2%) and HIE (95.3%) had no impairments in gross motor functioning. A small percentage of the children in the NNJ and HIE groups had profound problems in their communication (4.7% and 4.7%); expressive communication function (4.7% and 4.7%); social functions (3.1% and 2.3%); receptive communication (4.7% and 2.3%); and communicative effectiveness (4.7% and 2.3%). Cognitive impairment was reported in 10.9% and 11.9% for NNJ and HIE survivors, respectively. Active epilepsy was detected in 1.6% of survivors of NNJ and 2.3% of survivors of HIE. All children had normal hearing and visual functioning except one participant who presented with mild visual acuity problems. Conclusions: Most school-aged children who survive with NNJ and HIE have normal motor and communication function; however, one in ten are likely to present with lowered intellectual functioning compared to the normative sample.
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Denckla CA, Spies G, Heaton R, Vasterling J, Franklin D, Korte KJ, Colgan C, Henderson DC, Koenen KC, Seedat S. Generalizability of demographically corrected Zambian neuropsychological norms to South African women. Clin Neuropsychol 2019; 33:40-57. [PMID: 30950749 PMCID: PMC6778499 DOI: 10.1080/13854046.2019.1588995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 01/27/2023]
Abstract
Objective: Demographically corrected norms typically account for the effects of age, education, and in some cases, sex and other factors (e.g. race/ethnicity). However, generalizability of normative standards to different countries and ethnic groups is not universal. This study sought to determine whether demographically specific Zambian neuropsychological norms would generalize to a group of South African women.Method: 212 English-Xhosa bilingual, South African (SA) women were administered a comprehensive neuropsychological (NP) test battery in either English or Xhosa. We examined rates of "impairment" using Global Deficit Scores (GDS) based upon published, demographically corrected norms from a nearby African country (Zambia). Using multiple regression, we examined the extent to which Zambian norms "corrected" for the effects of age and education in this SA sample.Results: Compared to the normative standards from Zambia, the South African women performed somewhat worse than expected on a few test measures and better than expected on others, but their GDS and associated "impairment" rates were close to what was seen in Zambia. Demographically corrected Zambian norms adequately adjusted for the effects of age and years of education in this sample of SA women, with the exception that Zambian norms appeared to "under correct" for the positive effects of years of education on tests of information processing speed.Conclusions: Demographically corrected norms developed for Zambia may adequately adjust for the effects of age in SA women. Further research is needed to determine whether additional corrections for education are needed in SA, especially for tests of information processing speed.
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Affiliation(s)
| | - Georgina Spies
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
| | - Robert Heaton
- HIV Neurobehavioral Research Center at the University of California, La Jolla, CA, USA
| | - Jennifer Vasterling
- VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, USA
| | - Donald Franklin
- HIV Neurobehavioral Research Center at the University of California, La Jolla, CA, USA
| | - Kristina J. Korte
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Courtney Colgan
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Soraya Seedat
- NRF/DST South African Research Chairs Initiative, PTSD Program, Stellenbosch University, Cape Town, South Africa
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15
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Sanou AS, Diallo AH, Holding P, Nankabirwa V, Engebretsen IMS, Ndeezi G, Tumwine JK, Meda N, Tylleskar T, Kashala-Abotnes E. Effects of schooling on aspects of attention in rural Burkina Faso, West Africa. PLoS One 2018; 13:e0203436. [PMID: 30183764 PMCID: PMC6124811 DOI: 10.1371/journal.pone.0203436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/21/2018] [Indexed: 11/25/2022] Open
Abstract
Background We aimed to study the effects of schooling on aspects of attention using the Test of Variables of Attention (TOVA) among children in rural Burkina Faso. Methods We re-enrolled children of a previously community-based cluster randomized exclusive breastfeeding trial in rural Burkina Faso. A total of 534 children (280 boys and 254 girls) aged 6 to 8 years were assessed using the TOVA. We examined the effect size difference using Cohen’s d, ANOVA and conducted regression analyses. Results Forty nine percent of the children were in school. Children not in school performed poorly with a small effect size difference for ‘Response Time’, ‘Errors of omission’, and ‘Errors of commission’ compared to children in school. The effect size difference was moderate for ‘Response Time Variability’, and ‘D prime score’. Conclusion Schooling affects different aspects of attention in rural Burkina Faso. In settings where literacy and schooling rate is low, public sensitizations of the benefits of schooling need to be reinforced and advice on sending children to school need to be provided continuously.
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Affiliation(s)
- Anselme Simeon Sanou
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Public Health, Centre MURAZ Research Institute, Bobo-Dioulasso, Burkina Faso
- * E-mail:
| | - Abdoulaye Hama Diallo
- Department of Public Health, Centre MURAZ Research Institute, Bobo-Dioulasso, Burkina Faso
- Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Victoria Nankabirwa
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
- Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ingunn Marie S. Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - James K. Tumwine
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Nicolas Meda
- Department of Public Health, Centre MURAZ Research Institute, Bobo-Dioulasso, Burkina Faso
- Department of Public Health, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Thorkild Tylleskar
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Esperance Kashala-Abotnes
- Centre for International Health, Department of Global Public Health and Primary Health Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Willoughby MT, Piper B, Kwayumba D, McCune M. Measuring executive function skills in young children in Kenya. Child Neuropsychol 2018; 25:425-444. [DOI: 10.1080/09297049.2018.1486395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Michael T. Willoughby
- Education & Workforce Development, RTI International, Research Triangle Park, North Carolina, USA
| | - Benjamin Piper
- International Education, RTI International, Nairobi, Kenya
| | | | - Megan McCune
- International Education, RTI International, Washington, DC, USA
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17
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Bodeau-Livinec F, Davidson LL, Zoumenou R, Massougbodji A, Cot M, Boivin MJ. Neurocognitive testing in West African children 3-6 years of age: Challenges and implications for data analyses. Brain Res Bull 2018; 145:129-135. [PMID: 29630997 DOI: 10.1016/j.brainresbull.2018.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE When testing African children with developmental and cognitive standardized tests from high-income countries (HIC), investigators are uncertain as to whether to apply the HIC norms for these tests when standardizing a child's raw-score performance on the basis of age. The present study compared the construct validity of both raw and HIC-based standardized scores for the Mullen Scales of Early Learning (MSEL) and the Kaufman Assessment Battery in Children - 2nd edition (KABC-II) for Beninese children in a rural setting from three to six years of age. METHODS Seventy-four children 3-4 yrs of age were assessed with the MSEL, and 61 eligible older children (5-6 yrs of age) were assessed with the KABC-II. Assessors spoke the instructions to the children and caregivers for the assessment items in the local language. The developmental quality of the home environment was evaluated with the Caldwell Home Observation for Measurement of the Environment (HOME) inventory, and a material possessions and housing quality checklist was used as a measure of socio-economic status (SES). Children's mothers were given the Raven's Progressive Matrices test (nonverbal cognitive ability), and the Edinburgh Postpartum Depression Scale (EPDS) (emotional wellbeing). RESULTS For the MSEL, the 4-yr old group performed significantly better than the 3-yr old group on both the raw and standardized score comparisons for all scales. These differences were attenuated when using standardized scores, although the MSEL standardized cognitive composite score was still highly significant between years of age. When comparing 5- to 6-yr olds on KABC-II subtest and global scale performance, comparisons between the raw and standardized mean score performances were much less consistent. Generally, 6-yr olds performed significantly better than 5-yr olds on the raw score comparisons on the KABC-II subtests, but not so for standardized scores. Parent-child interactions assessed through the HOME measure was associated with both raw and standardized MSEL cognitive composite score outcomes on a multiple regression analysis. SES was the only significant predictor for KABC-II raw and standardized outcomes. CONCLUSION Standardization using HIC norms was not optimal, resulting in minimal impact to account for age when using the MSEL, and lower scores for oldest children compared with youngest children when using the KABC2. This is likely due to children in Benin drifting away from HIC-based norms with each passing year of age, systematically lowering standardized performance measures. These findings support the importance of having a local comparison group of reference or control children to allow for adjusted (for age, HOME, and SES) raw score comparisons when using western-based tests for developmental and neuropsychological evaluation.
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Affiliation(s)
- Florence Bodeau-Livinec
- EHESP, F-35000 Rennes, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
| | - Leslie L Davidson
- Columbia University, Mailman School of Public Health and the College of Physicians and Surgeons, NY, USA.
| | - Roméo Zoumenou
- Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales, Faculté de Pharmacie de Paris, Université Paris Descartes, Paris, France; The Centre Biomédical des Cordeliers, Université Pierre et Marie Curie, Paris, France; PRES Paris Sorbonne Cité, Université Paris Descartes, Paris, France.
| | | | - Michel Cot
- Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales, Faculté de Pharmacie de Paris, Université Paris Descartes, Paris, France; The Centre Biomédical des Cordeliers, Université Pierre et Marie Curie, Paris, France; PRES Paris Sorbonne Cité, Université Paris Descartes, Paris, France.
| | - Michael J Boivin
- Departments of Psychiatry and Neurology & Ophthalmology, Michigan State University, 909 fee Road, Rm 321, West Fee Hall, East Lansing, MI, 48824, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
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18
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Kitsao-Wekulo P, Holding PA, Kvalsvig JD, Alcock KJ, Taylor HG. Measurement of expressive vocabulary in school-age children: Development and application of the Kilifi Naming Test (KNT). APPLIED NEUROPSYCHOLOGY-CHILD 2017; 8:24-39. [PMID: 29023138 DOI: 10.1080/21622965.2017.1378579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The dearth of locally developed measures of language makes it difficult to detect language and communication problems among school-age children in sub-Saharan African settings. We sought to describe variability in vocabulary acquisition as an important element of global cognitive functioning. Our primary aims were to establish the psychometric properties of an expressive vocabulary measure, examine sources of variability, and investigate the measure's associations with non-verbal reasoning and educational achievement. The study included 308 boys and girls living in a predominantly rural district in Kenya. The developed measure, the Kilifi Naming Test (KNT), had excellent reliability and acceptable convergent validity. However, concurrent validity was not adequately demonstrated. In the final regression model, significant effects of schooling and area of residence were recorded. Contextual factors should be taken into account in the interpretation of test scores. There is need for future studies to explore the concurrent validity of the KNT further.
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Affiliation(s)
- Patricia Kitsao-Wekulo
- a African Population and Health Research Center , Nairobi , Kenya.,b School of Applied Human Sciences, University of KwaZulu-Natal , Durban , South Africa.,c KEMRI-Wellcome Trust Research Programme , Kilifi , Kenya
| | | | - Jane D Kvalsvig
- f School of Public Health Medicine , University of KwaZulu-Natal , Durban , South Africa
| | - Katherine J Alcock
- d Department of Psychology , Lancaster University , Lancaster , United Kingdom
| | - H Gerry Taylor
- e Department of Pediatrics, School of Medicine , Case Western Reserve University , Cleveland , OH , USA
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Semrud-Clikeman M, Romero RAA, Prado EL, Shapiro EG, Bangirana P, John CC. [Formula: see text]Selecting measures for the neurodevelopmental assessment of children in low- and middle-income countries. Child Neuropsychol 2017; 23:761-802. [PMID: 27609060 PMCID: PMC5690490 DOI: 10.1080/09297049.2016.1216536] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Diseases affecting millions of children in low- and middle-income countries (LMICs), such as malnutrition, micronutrient deficiency, malaria, and HIV, can lead to adverse neurodevelopmental outcomes. Thus, a key health outcome in children is neurodevelopmental status. In this paper, the neurodevelopmental screening and testing measures most commonly utilized in LMICs are reviewed, and a matrix is presented to help researchers and clinicians determine which measures may be most useful for various LMIC inquiries. The matrix is based on an Internet literature review of 114 publications for the period January 1998 to February 2016, reporting the psychometric properties of instruments tested in LMIC children. The measures are classified as screening tests or more detailed tests that include both comprehensive batteries of general development and tests of specific domains. For completeness, two experts have reviewed this paper, as well as the authors. An overview of the tests used to date is presented, including the benefits and drawbacks of each test, in order to provide researchers and developmental clinicians with a way to decide which tests may be best suited to their developmental assessment goals. Remarkable progress has been made in neurodevelopmental testing in children in LMICs over the past two decades but there remains a need for additional research in this area to develop new tests, better evaluate and adapt current tests, and assess test validity and reliability across cultures.
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Affiliation(s)
| | | | | | - Elsa G Shapiro
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Paul Bangirana
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
- Department of Pediatrics, Indiana University, Indianapolis, IN
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Pitchford NJ, Outhwaite LA. Can Touch Screen Tablets be Used to Assess Cognitive and Motor Skills in Early Years Primary School Children? A Cross-Cultural Study. Front Psychol 2016; 7:1666. [PMID: 27826281 PMCID: PMC5078468 DOI: 10.3389/fpsyg.2016.01666] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/11/2016] [Indexed: 11/21/2022] Open
Abstract
Assessment of cognitive and motor functions is fundamental for developmental and neuropsychological profiling. Assessments are usually conducted on an individual basis, with a trained examiner, using standardized paper and pencil tests, and can take up to an hour or more to complete, depending on the nature of the test. This makes traditional standardized assessments of child development largely unsuitable for use in low-income countries. Touch screen tablets afford the opportunity to assess cognitive functions in groups of participants, with untrained administrators, with precision recording of responses, thus automating the assessment process. In turn, this enables cognitive profiling to be conducted in contexts where access to qualified examiners and standardized assessments are rarely available. As such, touch screen assessments could provide a means of assessing child development in both low- and high-income countries, which would afford cross-cultural comparisons to be made with the same assessment tool. However, before touch screen tablet assessments can be used for cognitive profiling in low-to-high-income countries they need to be shown to provide reliable and valid measures of performance. We report the development of a new touch screen tablet assessment of basic cognitive and motor functions for use with early years primary school children in low- and high-income countries. Measures of spatial intelligence, visual attention, short-term memory, working memory, manual processing speed, and manual coordination are included as well as mathematical knowledge. To investigate if this new touch screen assessment tool can be used for cross-cultural comparisons we administered it to a sample of children (N = 283) spanning standards 1–3 in a low-income country, Malawi, and a smaller sample of children (N = 70) from first year of formal schooling from a high-income country, the UK. Split-half reliability, test-retest reliability, face validity, convergent construct validity, predictive criterion validity, and concurrent criterion validity were investigated. Results demonstrate “proof of concept” that touch screen tablet technology can provide reliable and valid psychometric measures of performance in the early years, highlighting its potential to be used in cross-cultural comparisons and research.
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21
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Knox PC, MacCormick IJC, Mbale E, Malewa M, Czanner G, Harding SP. Longitudinal Visuomotor Development in a Malaria Endemic Area: Cerebral Malaria and Beyond. PLoS One 2016; 11:e0164885. [PMID: 27764173 PMCID: PMC5072745 DOI: 10.1371/journal.pone.0164885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/03/2016] [Indexed: 01/17/2023] Open
Abstract
Paediatric cerebral malaria is the most serious complication of Plasmodium falciparum infection. While the majority recover, long-term cognitive impairment has been highlighted as a significant and neglected problem. Persistent or serious deficits in processes such as attention or behavioural inhibition should be manifest in changes to performance on oculomotor tasks. Therefore we investigated the impact of cerebral malaria on the development of reflexive pro-saccades and antisaccades. In a longitudinal study, 47 children previously admitted with retinopathy-confirmed cerebral malaria (mean age at admission 54 months), were compared with 37 local healthy controls (mean ages at first study visit 117 and 110 months respectively). In each of three or four test sessions, over a period of up to 32 months, participants completed 100 prosaccade tasks and 100 antisaccade tasks. Eye movements were recorded using infrared reflectance oculography; prosaccade, correct antisaccade and error prosaccade latency, and antisaccade directional error rate were calculated. Hierarchical linear modelling was used to investigate the effect of age and the influence of cerebral malaria on these parameters. Data were also collected from an independent, older group (mean age 183 months) of 37 local healthy participants in a separate cross-sectional study. Longitudinal data exhibited the expected decrease in latency with age for all saccade types, and a decrease in the antisaccade directional error rate. Hierarchical linear modelling confirmed that age had a statistically significant effect on all parameters (p< = 0.001). However, there were no statistically significant differences between the cerebral malaria and control groups. Combining groups, comparison with the literature demonstrated that antisaccade directional error rate for the Malawi sample was significantly higher than expected, while latencies for all saccade types were indistinguishable from published. The high directional error rate was also confirmed in the older, healthy Malawian participants from the cross sectional study. Our observation of similar oculomotor performance in cerebral malaria and control groups at long follow-up periods suggests that cerebral malaria survivors are not at a generally increased risk of persistent cognitive deficits. Our data raise questions about the prevailing hypothesis that cerebral malaria has gross impacts on the development of processes such as attention and behavioural inhibition. More importantly, our novel finding of a clear difference in antisaccade performance between all of the Malawi participants and published data suggests that the Malawian paediatric population as a whole faces serious challenges to cognitive development beyond cerebral malaria.
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Affiliation(s)
- Paul C. Knox
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Duncan Building, Liverpool, L7 ATX, United Kingdom
- * E-mail:
| | - Ian J. C. MacCormick
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Duncan Building, Liverpool, L7 ATX, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Blantyre, Malawi
| | - Emme Mbale
- University of Malawi College of Medicine, College of Medicine, P/Bag 360 Chichiri, Blantyre, Malawi
| | - Macpherson Malewa
- University of Malawi College of Medicine, College of Medicine, P/Bag 360 Chichiri, Blantyre, Malawi
| | - Gabriela Czanner
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Duncan Building, Liverpool, L7 ATX, United Kingdom
- Department of Biostatistics, University of Liverpool, Waterhouse Building, Liverpool, L69 3GL, United Kingdom
| | - Simon P. Harding
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Duncan Building, Liverpool, L7 ATX, United Kingdom
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Holding P, Anum A, van de Vijver FJR, Vokhiwa M, Bugase N, Hossen T, Makasi C, Baiden F, Kimbute O, Bangre O, Hasan R, Nanga K, Sefenu RPS, A-Hayat N, Khan N, Oduro A, Rashid R, Samad R, Singlovic J, Faiz A, Gomes M. Can we measure cognitive constructs consistently within and across cultures? Evidence from a test battery in Bangladesh, Ghana, and Tanzania. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 7:1-13. [PMID: 27463827 DOI: 10.1080/21622965.2016.1206823] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We developed a test battery for use among children in Bangladesh, Ghana, and Tanzania, assessing general intelligence, executive functioning, and school achievement. The instruments were drawn from previously published materials and tests. The instruments were adapted and translated in a systematic way to meet the needs of the three assessment contexts. The instruments were administered by a total of 43 trained assessors to 786 children in Bangladesh, Ghana, and Tanzania with a mean age of about 13 years (range: 7-18 years). The battery provides a psychometrically solid basis for evaluating intervention studies in multiple settings. Within-group variation was adequate in each group. The expected positive correlations between test performance and age were found and reliability indices yielded adequate values. A confirmatory factor analysis (not including the literacy and numeracy tests) showed a good fit for a model, merging the intelligence and executive tests in a single factor labeled general intelligence. Measurement weights invariance was found, supporting conceptual equivalence across the three country groups, but not supporting full score comparability across the three countries.
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Affiliation(s)
- Penny Holding
- a United Nations Children's Fund (UNICEF) , KMTECH , Nairobi , Kenya
| | - Adote Anum
- b Department of Psychology , University of Ghana , Legon , Ghana
| | | | - Maclean Vokhiwa
- d Blantyre Malaria Project, College of Medicine, University of Malawi , Malawi
| | - Nancy Bugase
- e Navrongo Health Research Centre, Ghana Health Service , Navrongo , Ghana
| | - Toffajjal Hossen
- f Research Physician, Malaria Research Group , Chittagong , Bangladesh
| | - Charles Makasi
- g National Institute of Medical Research, Muhimbili Medical Research Centre , Dar-es-Salaam , Tanzania
| | - Frank Baiden
- h Epidemiology, Ensign College of Public Health , Kpong , Eastern Region , Ghana
| | - Omari Kimbute
- i National Institute of Medical Research, Muhimbili Medical Research Centre , Dar-es-Salaam , Tanzania
| | - Oscar Bangre
- h Epidemiology, Ensign College of Public Health , Kpong , Eastern Region , Ghana
| | - Rafiqul Hasan
- f Research Physician, Malaria Research Group , Chittagong , Bangladesh
| | - Khadija Nanga
- j Department of Epidemiology and Disease Control , School of Public Health, University of Ghana , Accra , Ghana
| | | | - Nasmin A-Hayat
- k Child Development Centre, Chittagong Maa- Shishoo O General Hospital , Chittagong , Bangladesh
| | - Naila Khan
- l Department of Pediatric Neurosciences , Bangladesh Institute of Child Health, Dhaka Shishu (Children's) Hospital , Dhaka , Bangladesh
| | - Abraham Oduro
- m Epidemiology & Community Medicine, Bangladesh Institute of Tropical and Infectious Disease (BITID) , Chittagong , Bangladesh
| | - Rumana Rashid
- f Research Physician, Malaria Research Group , Chittagong , Bangladesh
| | - Rasheda Samad
- n Associate Professor of Pediatrics, Chittagong Medical College , Chittagong , Bangladesh
| | | | - Abul Faiz
- p Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University , Bangkok , Thailand.,q Dev Care Foundation , Dhaka , Bangladesh
| | - Melba Gomes
- r The UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases , Geneva , Switzerland
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Alcock KJ, Rimba K, Holding P, Kitsao-Wekulo P, Abubakar A, Newton CRJC. Developmental inventories using illiterate parents as informants: Communicative Development Inventory (CDI) adaptation for two Kenyan languages. JOURNAL OF CHILD LANGUAGE 2015; 42:763-785. [PMID: 25158859 PMCID: PMC5496672 DOI: 10.1017/s0305000914000403] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Communicative Development Inventories (CDIs, parent-completed language development checklists) are a helpful tool to assess language in children who are unused to interaction with unfamiliar adults. Generally, CDIs are completed in written form, but in developing country settings parents may have insufficient literacy to complete them alone. We designed CDIs to assess language development in children aged 0;8 to 2;4 in two languages used in Coastal communities in Kenya. Measures of vocabulary, gestures, and grammatical constructions were developed using both interviews with parents from varying backgrounds, and vocabulary as well as grammatical constructions from recordings of children's spontaneous speech. The CDIs were then administered in interview format to over 300 families. Reliability and validity ranged from acceptable to excellent, supporting the use of CDIs when direct language testing is impractical, even when children have multiple caregivers and where respondents have low literacy levels.
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Affiliation(s)
| | - K Rimba
- Centre for Geographic Medicine-Coast,Kenya Medical Research Institute,Kilifi,Kenya
| | - P Holding
- Centre for Geographic Medicine-Coast,Kenya Medical Research Institute,Kilifi,Kenya, andInternational Centre for Behavioural Studies,Kenya
| | - P Kitsao-Wekulo
- International Centre for Behavioural Studies,Kenya and University of KwaZulu-Natal,South Africa
| | - A Abubakar
- Centre for Geographic Medicine-Coast,Kenya Medical Research Institute,Kilifi,Kenya and University of Tilburg,the Netherlands
| | - C R J C Newton
- Centre for Geographic Medicine-Coast,Kenya Medical Research Institute,Kilifi,KenyaandInstitute of Child Health,London,UK
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Kariuki SM, Abubakar A, Newton CRJC, Kihara M. Impairment of executive function in Kenyan children exposed to severe falciparum malaria with neurological involvement. Malar J 2014; 13:365. [PMID: 25224247 PMCID: PMC4171581 DOI: 10.1186/1475-2875-13-365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 09/14/2014] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Persistent neurocognitive impairments occur in a fifth of children hospitalized with severe falciparum malaria. There is little data on the association between different neurological phenotypes of severe malaria (seizures, impaired consciousness and prostration) and impairments in executive function. METHODS Executive functioning of children exposed to severe malaria with different neurological phenotypes (N = 58) and in those unexposed (N = 56) was examined using neuropsychological tests such as vigilance test, test for everyday attention test for children (TEA-Ch), contingency naming test (CNT) and self-ordered pointing test (SOPT). Linear regression was used to determine the association between neurological phenotypes of severe malaria and executive function performance scores, accounting for potential confounders. RESULTS Children with complex seizures in severe malaria performed more poorly than unexposed controls in the vigilance (median efficiency scores (interquartile range) = 4.84 (1.28-5.68) vs. 5.84 (4.71-6.42), P = 0.030) and SOPT (mean errors (standard deviation) = 29.50 (8.82) vs. 24.80 (6.50), P = 0.029) tests, but no differences were observed in TEA-Ch and CNT tests. Performance scores for other neurological phenotypes of severe malaria were similar with those of unexposed controls. After accounting for potential confounders, such as child's age, sex, schooling; maternal age, schooling and economic activity; perinatal factors and history of seizures, complex seizures remained associated with efficiency scores in the vigilance test (beta coefficient (β) (95% confidence interval (CI)) = -0.40 (-0.67, -0.13), P = 0.006) and everyday attention scores of the TEA-Ch test (β (95% CI) = -0.57 (-1.04, -0.10), P = 0.019); the association with SOPT error scores was weak (β (95% CI) = 4.57 (-0.73-9.89), P = 0.089). Combined neurological phenotypes were not significantly associated with executive function performance scores. CONCLUSION Executive function impairment in children with severe malaria is associated with specific neurological phenotypes, particularly complex seizures. Effective prophylaxis and management of malaria-associated acute seizures may improve executive functioning performance scores of children.
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Affiliation(s)
- Symon M Kariuki
- KEMRI/Wellcome Trust Collaborative Research Programme, P,O, Box 230, 80108 Kilifi, Kenya.
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25
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Kitsao-Wekulo PK, Holding PA, Taylor HG, Kvalsvig JD, Connolly KJ. Determinants of variability in motor performance in middle childhood: a cross-sectional study of balance and motor co-ordination skills. BMC Psychol 2013; 1:29. [PMID: 25566377 PMCID: PMC4270021 DOI: 10.1186/2050-7283-1-29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 12/02/2013] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Patricia K Kitsao-Wekulo
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research -Coast, Kilifi, Kenya ; International Centre for Behavioural Studies, Nairobi, Kenya ; University of KwaZulu-Natal, Durban, South Africa
| | - Penny A Holding
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research -Coast, Kilifi, Kenya ; International Centre for Behavioural Studies, Nairobi, Kenya ; Case Western Reserve University, Cleveland, OH USA
| | | | | | - Kevin J Connolly
- Department of Psychology, The University of Sheffield, Sheffield, UK
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