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Arán Filippetti V, Gutierrez M, Krumm G. Norms, convergent validity, test-retest reliability, and practice effects for verbal fluency overall performance, clustering, and switching in Spanish-speaking children. Clin Neuropsychol 2024:1-30. [PMID: 38360587 DOI: 10.1080/13854046.2024.2315729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/08/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE We conducted two empirical studies (in a cross-sectional and a longitudinal design) with the aim at establishing normative data (including norms for strategy use [i.e., clustering and switching strategies] and performance over time), and examining the convergent validity, the test-retest reliability (3-4 wks interval) and the changes in performance with practice (1 year interval) of the different verbal fluency (VF) quantitative and qualitative scores in Spanish-speaking children and adolescents. METHOD In S1 (n = 620 6- to 15-year-old Spanish-speaking children and adolescents), MANCOVA and Pearson's correlations were employed. In S2 (n = 148 6- to 12-year-old Spanish-speaking children), intraclass correlation coefficient (ICC), paired t-tests, and Confirmatory Factor Analysis (CFA) were used. RESULTS S1 results showed an age effect on all VF measures (quantitative and qualitative). The number of switches/clusters was more related to total word productivity and to executive functions (EF) than the mean cluster size. In S2, a significant increase in phonological VF performance was observed on number of switches and word productivity scores from baseline (Time 1) to repeat testing at Time 2. Practice effects were observed at Time 3 on all measures except for semantic and phonological mean cluster size. Test-retest reliability coefficients at Time 2 for number of clusters and switches, but not for mean cluster size, fell in the moderate range, ranging from ICCs .61 to ICCs .81. Test-retest reliability coefficients for total word productivity were higher (ICCs above .80) and stronger when testing as a unity with CFA methods (ϕ=.94, p < .001). CONCLUSIONS These data may be relevant for informing the neuropsychological assessment of spontaneous cognitive flexibility in children with typical development (TD) and those with developmental or acquired disorders.
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Affiliation(s)
- Vanessa Arán Filippetti
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Centro Interdisciplinario de Investigaciones en Ciencias de la Salud y del Comportamiento (CIICSAC) - Universidad Adventista del Plata, Argentina
- Facultad de Humanidades, Educación y Ciencias Sociales, Universidad Adventista del Plata, Entre Ríos, Argentina
| | - Marisel Gutierrez
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Centro Interdisciplinario de Investigaciones en Ciencias de la Salud y del Comportamiento (CIICSAC) - Universidad Adventista del Plata, Argentina
- Facultad de Humanidades, Educación y Ciencias Sociales, Universidad Adventista del Plata, Entre Ríos, Argentina
| | - Gabriela Krumm
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Centro Interdisciplinario de Investigaciones en Ciencias de la Salud y del Comportamiento (CIICSAC) - Universidad Adventista del Plata, Argentina
- Facultad de Humanidades, Educación y Ciencias Sociales, Universidad Adventista del Plata, Entre Ríos, Argentina
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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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Chongwo EJ, Wedderburn CJ, Nyongesa MK, Sigilai A, Mwangi P, Thoya J, Odhiambo R, Ngombo K, Kabunda B, Newton CR, Abubakar A. Neurocognitive outcomes of children exposed to and living with HIV aged 3-5 years in Kilifi, Kenya. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1193183. [PMID: 37732169 PMCID: PMC10508958 DOI: 10.3389/frph.2023.1193183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Globally, 1.7 million children are living with HIV, with the majority of them residing in sub-Saharan Africa. Due to reduced rates of vertical transmission of HIV, there is an increasing population of children born to HIV-infected mothers who remain uninfected. There is a growing concern around the development of these children in the antiretroviral therapy era. This study examined the neurocognitive outcomes of children who are HIV-exposed infected (CHEI), HIV-exposed uninfected (CHEU) and HIV-unexposed uninfected (CHUU) and explored the relationship between child neurocognitive outcomes and child's biomedical and caregivers' psychosocial factors. Methods CHEI, CHUU and CHEU aged 3-5 years and their caregivers were recruited into the study. Neurocognitive outcomes were assessed using a validated battery of assessments. One-way analysis of variance and covariance (ANOVA and ANCOVA) were used to evaluate differences among the three groups by neurocognitive outcomes. Linear regression models were used to investigate the association between child neurocognitive outcomes and biomedical factors (nutritional status, HIV disease staging) and caregivers' psychosocial factors [symptoms of common mental disorders (CMDs) and parenting behaviour]. Results The study included 153 children and their caregivers: 43 (28.1%) CHEI, 52 (34.0%) CHEU and 58 (39.9%) CHUU. ANOVA and ANCOVA revealed a significant difference in cognitive ability mean scores across the child groups. Post hoc analysis indicated that CHEU children had higher cognitive ability mean scores than the CHUU group. Better nutritional status was significantly associated with higher cognitive ability scores (β = 0.68, 95% CI [0.18-1.18], p = 0.008). Higher scores of CMDs were negatively associated with inhibitory control (β = -0.28, 95% CI [-0.53 to 0.02], p = 0.036). While comparing HIV stages 2 and 3, large effect sizes were seen in working memory (0.96, CI [0.08-1.80]) and cognitive ability scores (0.83 CI [0.01-1.63]), indicating those in stage 3 had poor performance. Conclusions Neurocognitive outcomes were similar across CHEI, CHEU and CHUU, although subtle differences were seen in cognitive ability scores where CHEU had significantly higher cognitive mean scores than the CHUU. Well-designed longitudinal studies are needed to ascertain these findings. Nonetheless, study findings underscore the need for strategies to promote better child nutrition, mental health, and early antiretroviral therapy initiation.
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Affiliation(s)
| | - Catherine J. Wedderburn
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Paediatrics and Child Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | | | - Antipa Sigilai
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Paul Mwangi
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Janet Thoya
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Rachel Odhiambo
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Katana Ngombo
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Beatrice Kabunda
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Charles R. Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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McHenry MS, Mukherjee D, Bhavnani S, Kirolos A, Piper JD, Crespo-Llado MM, Gladstone MJ. The current landscape and future of tablet-based cognitive assessments for children in low-resourced settings. PLOS DIGITAL HEALTH 2023; 2:e0000196. [PMID: 36821551 PMCID: PMC9949664 DOI: 10.1371/journal.pdig.0000196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Interest in measuring cognition in children in low-resourced settings has increased in recent years, but options for cognitive assessments are limited. Researchers are faced with challenges when using existing assessments in these settings, such as trained workforce shortages, less relevant testing stimuli, limitations of proprietary assessments, and inadequate parental knowledge of cognitive milestones. Tablet-based direct child assessments are emerging as a practical solution to these challenges, but evidence of their validity and utility in cross-cultural settings is limited. In this overview, we introduce key concepts of this field while exploring the current landscape of tablet-based assessments for low-resourced settings. We also make recommendations for future directions of this relatively novel field. We conclude that tablet-based assessments are an emerging and promising method of assessing cognition in young children. Further awareness and dissemination of validated tablet-based assessments may increase capacity for child development research and clinical practice in low-resourced settings.
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Affiliation(s)
- Megan S. McHenry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, United States of America
- * E-mail:
| | - Debarati Mukherjee
- Indian Institute of Public Health—Bengaluru, Life Course Epidemiology, Bengaluru, Karnataka, India
| | | | - Amir Kirolos
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Joe D. Piper
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Maria M. Crespo-Llado
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Melissa J. Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Kusi-Mensah K, Nuamah ND, Wemakor S, Agorinya J, Seidu R, Martyn-Dickens C, Bateman A. Assessment Tools for Executive Function and Adaptive Function Following Brain Pathology Among Children in Developing Country Contexts: a Scoping Review of Current Tools. Neuropsychol Rev 2022; 32:459-482. [PMID: 34870774 PMCID: PMC9381467 DOI: 10.1007/s11065-021-09529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022]
Abstract
Several tools have been developed to assess executive function (EFs) and adaptive functioning, although in mainly Western populations. Information on tools for low-and-middle-income country children is scanty. A scoping review of such instruments was therefore undertaken.We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis- Scoping Review extension (PRISMA-ScR) checklist (Tricco et al., in Annals of Internal Medicine 169(7), 467-473, 2018). A search was made for primary research papers of all study designs that focused on development or adaptation of EF or adaptive function tools in low-and-middle-income countries, published between 1st January 1894 to 15th September 2020. 14 bibliographic databases were searched, including several non-English databases and the data were independently charted by at least 2 reviewers.The search strategy identified 5675 eligible abstracts, which was pruned down to 570 full text articles. These full-text articles were then manually screened for eligibility with 51 being eligible. 41 unique tools coming in 49 versions were reviewed. Of these, the Behaviour Rating Inventory of Executive Functioning (BRIEF- multiple versions), Wisconsin Card Sorting Test (WCST), Go/No-go and the Rey-Osterrieth complex figure (ROCF) had the most validations undertaken for EF tests. For adaptive functions, the tools with the most validation studies were the Vineland Adaptive Behaviour Scales (VABS- multiple versions) and the Child Function Impairment Rating Scale (CFIRS- first edition).There is a fair assortment of tests available that have either been developed or adapted for use among children in developing countries but with limited range of validation studies. However, their psychometric adequacy for this population was beyond the scope of this paper.
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Affiliation(s)
- Kwabena Kusi-Mensah
- Department of Psychiatry, University of Cambridge, Clifford Allbutt Building Cambridge Biomedical Campus CB2 OAH, Cambridge, UK.
- Komfo Anokye Teaching Hospital, P. O. Box 1934, Kumasi, Ghana.
| | | | - Stephen Wemakor
- Department of Psychiatry, University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, 48109, MI, USA
| | | | | | | | - Andrew Bateman
- Department of Psychiatry, University of Cambridge, Clifford Allbutt Building Cambridge Biomedical Campus CB2 OAH, Cambridge, UK
- School of Health and Social Care, University of Essex, Colchester, UK
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Nampijja M, Mutua AM, Elliott AM, Muriuki JM, Abubakar A, Webb EL, Atkinson SH. Low Hemoglobin Levels Are Associated with Reduced Psychomotor and Language Abilities in Young Ugandan Children. Nutrients 2022; 14:nu14071452. [PMID: 35406065 PMCID: PMC9002834 DOI: 10.3390/nu14071452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022] Open
Abstract
Children living in Sub-Saharan Africa are vulnerable to developmental delay, particularly in the critical first five years due to various adverse exposures including disease and nutritional deficiencies. Anemia and iron deficiency (ID) are highly prevalent in pregnant mothers and young children and are implicated in abnormal brain development. However, available evidence on the association between anemia, ID and neurodevelopment in sub-Saharan Africa is limited. Using data from the Entebbe Mother and Baby Study prospective birth cohort, we examined the effect of maternal and child hemoglobin (Hb) levels and child iron status on developmental scores in 933 and 530 pre-school Ugandan children respectively. Associations between Hb levels, iron status and developmental scores were assessed using regression analyses adjusting for potential confounders. Lower maternal and child Hb levels were associated with reduced psychomotor scores at 15 months, while only lower Hb levels in infancy were associated with reduced language scores. We found no evidence that anemia or ID was associated with cognitive or motor scores at five years. This study emphasizes the importance of managing anemia in pregnancy and infancy and highlights the need for further studies on the effects of anemia and ID in children living in Sub-Saharan Africa.
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Affiliation(s)
- Margaret Nampijja
- Maternal and Child Wellbeing (MCW) Unit, African Population and Health Research Center, Nairobi 00100, Kenya;
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
| | - Agnes M. Mutua
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Correspondence: (A.M.M.); (S.H.A.); Tel.: +254-709983677-76 (A.M.M. & S.H.A.)
| | - Alison M. Elliott
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - John Muthii Muriuki
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi 195-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Institute for Human Development, Aga Khan University, Nairobi 30270-00100, Kenya
| | - Emily L. Webb
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (J.M.M.); (A.A.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
- Correspondence: (A.M.M.); (S.H.A.); Tel.: +254-709983677-76 (A.M.M. & S.H.A.)
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A Systematic Review of the Validity and Realiability of Assessment Tools for Executive Function and Adaptive Function Following Brain Pathology among Children and Adolescents in Low- and Middle-Income Countries. Neuropsychol Rev 2022; 32:974-1016. [PMID: 35349054 PMCID: PMC9630223 DOI: 10.1007/s11065-022-09538-3] [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: 06/08/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022]
Abstract
Minimal but increasing number of assessment instruments for Executive functions (EFs) and adaptive functioning (AF) have either been developed for or adapted and validated for use among children in low and middle income countries (LAMICs). However, the suitability of these tools for this context is unclear. A systematic review of such instruments was thus undertaken. The Systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist (Liberati et al., in BMJ (Clinical Research Ed.), 339, 2009). A search was made for primary research papers reporting psychometric properties for development or adaptation of either EF or AF tools among children in LAMICs, with no date or language restrictions. 14 bibliographic databases were searched, including grey literature. Risk of bias assessment was done following the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) guidelines (Mokkink et al., in Quality of Life Research,63, 32, 2014). For EF, the Behaviour Rating Inventory of Executive Functioning (BRIEF- multiple versions), Wisconsin Card Sorting Test (WCST), Go/No-go and the Rey-Osterrieth complex figure (ROCF) were the most rigorously validated. For AFs, the Vineland Adaptive Behaviour Scales (VABS- multiple versions) and the Child Function Impairment Rating Scale (CFIRS- first edition) were most validated. Most of these tools showed adequate internal consistency and structural validity. However, none of these tools showed acceptable quality of evidence for sufficient psychometric properties across all the measured domains, particularly so for content validity and cross-cultural validity in LAMICs. There is a great need for adequate adaptation of the most popular EF and AF instruments, or alternatively the development of purpose-made instruments for assessing children in LAMICs. Systematic Review Registration numbers: CRD42020202190 (EF tools systematic review) and CRD42020203968 (AF tools systematic review) registered on PROSPERO website (https://www.crd.york.ac.uk/prospero/).
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Pozuelo JR, Kilford EJ. Adolescent health series: Adolescent neurocognitive development in Western and Sub-Saharan African contexts. Trop Med Int Health 2021; 26:1333-1344. [PMID: 34270856 DOI: 10.1111/tmi.13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The transitional period of adolescence has long been associated with physical, social and behavioural change. During this time, adolescents start to develop their own self-identity, make important life decisions and acquire the necessary skills to successfully transition to adulthood. More recently, advances in brain imaging technology have enabled increased understanding of structural and functional changes in the human brain during this developmental period, and how they relate to social, emotional, motivational and cognitive development. The ability to integrate these developing cognitive processes in increasingly complex social contexts is a key aspect of mature decision-making, which has implications for adolescent health, educational, economic and social outcomes. Insights from the field of developmental cognitive neuroscience could increase our understanding of this influential stage of life and thus inform potential interventions to promote adolescent health, a critical goal for global health research. Many social changes occur during adolescence and the social environment shapes both brain and cognitive development and the decisions adolescents make. Thus, it is important to study adolescent neurocognitive development in socio-cultural context. Yet, despite evidence from Western studies that socio-cultural and economic factors impact on adolescent neurocognitive development, existing studies of adolescent neurocognitive development in sub-Saharan Africa are relatively scarce. We summarise research findings from Western and sub-Saharan African contexts and highlight areas where research is lacking. Longitudinal studies from more diverse global samples will be needed to build a comprehensive model of adolescent development, that characterises both commonalities in developmental trajectories, as well as the way these can meaningfully differ between both individuals and contexts.
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Affiliation(s)
- Julia R Pozuelo
- Department of Psychiatry, University of Oxford, Oxford, UK.,Centre for the Study of African Economies, Blavatnik School of Government and Economics Department, University of Oxford, Oxford, UK
| | - Emma J Kilford
- Institute of Cognitive Neuroscience, University College London, London, UK.,Department of Clinical, Educational & Health Psychology, University College London, London, UK
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9
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Nampijja M, Lubyayi L, Tumusiime J, Nabulime J, Kizindo R, Kabuubi P, Sanya RE, Kabagenyi J, Akurut H, Muhangi L, Webb EL, Alcock K, Elliott AM. Effect of intensive versus standard anthelminthic treatment on growth and cognition among children living in a high Schistosoma mansoni transmission setting: a study nested within a cluster-randomised trial. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.16092.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Schistosomiasis and other worm infections have been associated with growth and cognitive impairments; however, whether treatment reverses these effects is uncertain. Moreover, mechanisms linking these infections to cognition are not clear. We aimed to compare growth and cognitive benefits of intensive versus standard anthelminthic treatment in school-aged-children and explore processes that might be involved. We hypothesised that intensive treatment would have greater benefits than standard treatment. Methods: The study was nested within a cluster-randomised trial of either quarterly single-dose praziquantel of 40mg/kg to treat Schistosoma mansoni plus triple dose albendazole of 400mg (intensive treatment) to treat soil-transmitted worms including Ascaris lumbricoides, hookworm and Trichuris trichiura, or annual single-dose praziquantel 40mg/kg plus six-monthly single-dose albendazole 400mg (standard treatment) conducted in the Koome islands in Lake Victoria, Uganda (ISRCTN47196031). Children aged 5-9 years (N=384) were assessed on primary outcomes (height, weight and eight measures of cognitive ability), worm infection, and proposed mediators of worm effects (cytokines, iron status, physical activity) at one year (intensive n=85; standard n=64) and at two years (intensive n=158; standard n=128) of the intervention. Linear regression was used to examine intervention effects on height, weight and cognitive performance. Linear mixed effects models were used to study changes in growth and cognitive performance between the two arms across the two time-points. Results: Intensive treatment resulted in lower Schistosoma mansoni prevalence than standard treatment (at one year, 41% versus 70%; adjusted odds ratio (aOR)=0.24, 95% CI: 0.12, 0.49; at two years, 39% versus 69%; aOR=0.27; 95% CI: 0.16, 0.43) but there were no significant differences in growth and cognitive outcomes at either time-point. Worms and treatment showed no consistent association with the proposed mediators of worm effects. Conclusion: Reduction in worm burden may not improve growth and cognitive outcomes in high S. mansoni transmission settings. Possible implications are discussed.
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Mutua AM, Nampijja M, Elliott AM, Pettifor JM, Williams TN, Abubakar A, Webb EL, Atkinson SH. Vitamin D Status Is Not Associated with Cognitive or Motor Function in Pre-School Ugandan Children. Nutrients 2020; 12:nu12061662. [PMID: 32503251 PMCID: PMC7352320 DOI: 10.3390/nu12061662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022] Open
Abstract
Vitamin D deficiency is common worldwide and young children are among the most affected groups. Animal studies suggest a key role for vitamin D in brain development. However, studies investigating the effects of vitamin D on neurobehavioural outcomes in children are inconclusive and evidence is limited in sub-Saharan Africa. We evaluated the effect of vitamin D status on cognitive and motor outcomes using prospective data from the Entebbe Mother and Baby Study birth cohort. We analysed data from 302 Ugandan children with 25-hydroxyvitamin D (25(OH)D) measurements below five years and developmental measures at five years of age. We used multivariable linear regression, adjusted for potential confounders, to estimate the effect of 25(OH)D on cognitive and motor outcomes. Of 302 children, eight (2.7%) had 25(OH)D levels <50 nmol/L, 105 (35.8%) had levels 50-75 nmol/L and 189 (62.6%) had levels >75 nmol/L. There was no evidence that earlier vitamin D status was associated with cognitive and motor outcomes in five-year-old Ugandan children. This study adds to the sparse literature and highlights the need for further longitudinal studies on vitamin D and neurobehavioural outcomes in children living in sub-Saharan Africa.
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Affiliation(s)
- Agnes M. Mutua
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, P.O. BOX 230-80108 Kilifi, Kenya; (T.N.W.); (A.A.)
- Correspondence: (A.M.M.); (S.H.A.); Tel.: +254-709983677/76 (A.M.M.)
| | - Margaret Nampijja
- Maternal and Child Wellbeing (MCW) Unit, African Population and Health Research Center, P.O. Box 10787-00100 Nairobi, Kenya;
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda;
| | - Alison M. Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda;
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - John M. Pettifor
- South African Medical Research Council and Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, 26 Chris Hani Road, Soweto 6201, Johannesburg, South Africa;
| | - Thomas N. Williams
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, P.O. BOX 230-80108 Kilifi, Kenya; (T.N.W.); (A.A.)
- Department of Medicine, Imperial College of Science Technology and Medicine, St Mary’s Hospital, London W2 1NY, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Amina Abubakar
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, P.O. BOX 230-80108 Kilifi, Kenya; (T.N.W.); (A.A.)
- Department of Public Health, School of Human and Health Sciences, Pwani University, P.O. BOX 195-80108 Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- Institute for Human Development, Aga Khan University, 2nd Parklands Avenue, P.O. BOX 30270-00100 Nairobi, Kenya
| | - Emily L. Webb
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research-Coast, KEMRI Wellcome Trust Research Programme, P.O. BOX 230-80108 Kilifi, Kenya; (T.N.W.); (A.A.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
- Correspondence: (A.M.M.); (S.H.A.); Tel.: +254-709983677/76 (A.M.M.)
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Mazibuko X, Flack P, Kvalsvig J. Towards a South African model of language-based learning disability. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2019; 66:e1-e8. [PMID: 31793312 PMCID: PMC6890563 DOI: 10.4102/sajcd.v66i1.634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/13/2019] [Accepted: 10/08/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This conceptual article is inspired by the first phase of a doctoral research project that aimed to develop and validate a bilingual language assessment test for IsiZulu-English-speaking children in grades 1, 2 and 3 with language-based learning disabilities (L-b LDs) in South Africa. OBJECTIVES Phase 1, systematic literature review, pretesting and formulating of a theoretical framework, with the aim to determine early indicators of L-b LDs; this is important for developing a clinical language test as it determines its constructs. METHOD Thematic analysis was used to develop the models. RESULTS This article reviews the literature on indicators and definitions of L-b LD, introduces models that were developed in the study to conceptualise L-b LD and discusses implications for language test development. CONCLUSION The models provided in this article conceptualise L-b LD and identify its early indicators. The application of these models in both educational and clinical settings is proposed for differentiation of L-b LD.
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Affiliation(s)
- Xoli Mazibuko
- Discipline of Speech Language Pathology, University of KwaZulu-Natal, Durban.
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Qi H, Roberts KP. Cultural Influences on the Development of Children's Memory and Cognition. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2019; 56:183-225. [PMID: 30846047 DOI: 10.1016/bs.acdb.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Memory is socially constructed. The types of information that children pay attention to and remember, as well as how children organize and recall their memories can differ as a function of sociocultural background. This chapter presents an overview of cultural variations on children's memory and cognition. We draw attention to the necessity of conducting controlled experiments to examine cultural differences in the specific processes involved in episodic memory (e.g., encoding, retention, discrimination skills). We highlight potential challenges (e.g., language, measurement equivalence) that researchers need to overcome to conduct valid cross-cultural research. In light of cultural transformations in recent decades, we outline promising avenues for future research as well as the applications of this research to important issues for forensics and immigrants and asylum-seekers.
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Affiliation(s)
- Hongyuan Qi
- Wilfrid Laurier University, Waterloo, ON, Canada
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Willoughby MT, Piper B, Oyanga A, Merseth King K. Measuring executive function skills in young children in Kenya: Associations with school readiness. Dev Sci 2019; 22:e12818. [PMID: 30779264 DOI: 10.1111/desc.12818] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 01/28/2019] [Accepted: 02/08/2019] [Indexed: 11/28/2022]
Abstract
Most of what is known about the association between children's executive function (EF) and school readiness skills is derived from research conducted in Western countries. We tested whether these associations were evident in a middle-income country context. Participants were 1,480 children, aged 4-7 years old, who participated in an endline assessment of the Tayari program, an early childhood education (ECE) model that is being delivered by the Kenyan education system. High rates of task completion, low rates of floor effects, and high rates of assessor quality ratings supported the feasibility of large-scale direct assessments of EF with young children. Assessor ratings of children's attention-related behaviors during testing were positively associated with their performance on EF tasks (rs = 0.12-0.27). An EF composite score was not related to demographic factors or to children's exposure to the Tayari program. However, the EF composite score was uniquely associated with performance-based measures of early literacy (β = 0.18, 95% confidence interval [CI] = 0.05, 0.31), early numeracy (β = 0.16, 95% CI = 0.07, 26), and social-emotional competencies (β = 0.12, 95% CI = 0.03, 0.20), even after adjustment for multiple covariates. These results are discussed with respect to the ways in which EF skills inform ongoing efforts to invest in ECE in low- and middle-income countries.
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Affiliation(s)
- Michael T Willoughby
- Education and Workforce Development, RTI International, Research Triangle Park, North Carolina
| | - Benjamin Piper
- International Education, RTI International, Nairobi, Kenya
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Nampijja M, Kizindo R, Apule B, Lule S, Muhangi L, Titman A, Elliott A, Alcock K, Lewis C. The role of the home environment in neurocognitive development of children living in extreme poverty and with frequent illnesses: a cross-sectional study. Wellcome Open Res 2018; 3:152. [PMID: 30687794 PMCID: PMC6338129 DOI: 10.12688/wellcomeopenres.14702.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 11/20/2022] Open
Abstract
Background: The home environment is reported to contribute significantly to children’s developing cognitive skills. However, it is not yet evident whether this role prevails in the context of extreme poverty and frequent ill-health. We therefore investigated the role of the home environment in Ugandan children taking into account the frequent infections and extreme poverty in which they lived. Methods: Cognitive abilities of 163 5-year-old children were assessed. Home environments of these children, their health status and family socioeconomic status (SES) were assessed respectively using the EC-HOME, anthropometry and illnesses, and traditional SES measures. Structural equation analyses compared five models on the influence of the home environment, SES, and child health on the cognitive scores. Results: The model in which the home environment mediates the combined influence of SES and child health on cognitive performance showed a particularly good fit to the data compared with the four alternative models, i.e. those in which the HOME, SES and health independently influence cognitive performance. Conclusions: Home environments providing cognitive stimulation can enable children to overcome effects of major adverse life experiences on cognitive development.
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Affiliation(s)
- Margaret Nampijja
- Coinfections Programme, MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road Entebbe. P.O. Box 49, Entebbe, Uganda
| | - Robert Kizindo
- Coinfections Programme, MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road Entebbe. P.O. Box 49, Entebbe, Uganda
| | - Barbara Apule
- Coinfections Programme, MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road Entebbe. P.O. Box 49, Entebbe, Uganda
| | - Swaib Lule
- Coinfections Programme, MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road Entebbe. P.O. Box 49, Entebbe, Uganda
| | - Lawrence Muhangi
- Coinfections Programme, MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road Entebbe. P.O. Box 49, Entebbe, Uganda
| | - Andrew Titman
- Department of Psychology, Lancaster University, Fylde College LA1 4YF, Lancaster, LA1 4YF, UK
| | - Alison Elliott
- Coinfections Programme, MRC/UVRI and LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road Entebbe. P.O. Box 49, Entebbe, Uganda
| | - Katie Alcock
- Department of Psychology, Lancaster University, Fylde College LA1 4YF, Lancaster, LA1 4YF, UK
| | - Charlie Lewis
- Department of Psychology, Lancaster University, Fylde College LA1 4YF, Lancaster, LA1 4YF, UK
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Nguyen R, Brooks M, Bruno R, Peacock A. Behavioral measures of state impulsivity and their psychometric properties: A systematic review. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2018.06.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Finn K, Lori J, Lee M, Giordani B. Interdisciplinary Ugandan perspectives on computerized intervention implementation for child survivors of severe malaria: A qualitative analysis. Appl Nurs Res 2018; 39:154-159. [PMID: 29422151 DOI: 10.1016/j.apnr.2017.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Severe malaria (SM) is the leading cause of pediatric cognitive impairment in sub-Saharan Africa. Computerized Cognitive Rehabilitation Therapy (CCRT), a promising intervention for children suffering from SM related cognitive delay, targets areas impacted by the disease (memory, attention, and executive function), but has yet to be implemented for daily use. This paper explores the perspectives of Ugandan professionals regarding CCRT implementation in the academic setting of Uganda. METHODS A qualitative descriptive approach was taken to conduct interviews with Ugandan professionals directly or indirectly aware of an ongoing CCRT intervention trial. Eight individuals were consented and interviewed. Responses were analyzed thematically. Question topics included knowledge of malaria and CCRT, perspectives on implementation feasibility, and experience engaging in a global collaborative research endeavor. RESULTS Facilitators included perceived value and environment. Potential barriers were geography and resource availability. Perceived value is seen, expected, and/or hoped for outcomes by adults involved in the child's development. Environment speaks to the internal environment of the CCRT program as well as the external environment of the school setting. Geography presents as a barrier due to the difficulty of accessing CCRT in rural settings. Resource availability was a consistently identified barrier to implementation including aspects of technological, financial, and understanding deficits leading to difficulties in CCRT dissemination. CONCLUSION Results demonstrate optimism and hope of Ugandan professionals for CCRT in children who have survived SM. Professionals identify and prioritize needs for implementation uniquely, pointing to the value in interdisciplinary collaboration to ensure effective implementation of CCRT.
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Affiliation(s)
| | - Jody Lori
- University of Michigan, United States
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Abessa TG, Bruckers L, Kolsteren P, Granitzer M. Developmental performance of hospitalized severely acutely malnourished under-six children in low- income setting. BMC Pediatr 2017; 17:197. [PMID: 29179758 PMCID: PMC5704634 DOI: 10.1186/s12887-017-0950-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/15/2017] [Indexed: 11/21/2022] Open
Abstract
Background Retrospective studies show that severe acute malnutrition (SAM) affects child development. However, to what extent SAM affects children of different ages at its acute stage is not well documented. This study was aimed at comparing the developmental performance of severely acutely malnourished children under six with that of age and gender-matched non-malnourished healthy children. Methods The developmental performances of 310 children with SAM (male = 155, female = 155); mean age = 30.7 mo; SD = 15.2 mo) admitted to the nutritional rehabilitation unit (NRU) at Jimma University’s Hospital was compared with that of 310 age and gender-matched, non-malnourished healthy children (male = 155, female = 155; mean age = 29.6 mo; SD = 15.4 mo) living in Jimma Town in Ethiopia. Two culturally adapted tools were used: (1) the Denver II-Jimma, to assess the children’s performance on personal social (PS), fine motor (FM) language (LA), gross motor (GM) skills, and (2) the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), to assess social-emotional (SE) skills. Multivariable Poisson regression analysis was conducted to compare the developmental performance scores of SAM and non-malnourished children. Results For one-year-old children, SAM delays their developmental performance on GM, FM, PS and LA by 300%, 200%, 140% and 71.4% respectively. For three-years-old children, SAM delays their developmental performance on GM by 80%, on FM and LA by 50% each, and on PS by 28.6%. Of the skills assessed on Denver II-Jimma, GM is the most, and PS is the least affected. Younger SAM children are more affected than older ones on all the domains of development. The delay in FM, GM, LA and PS generally decreases with an increase in age. Social-emotional behavior problems seem to be most pronounced in the very young and older age ranges. Conclusions SAM has a differential age effect on the different dimensions of development in children under 6 years of age. Electronic supplementary material The online version of this article (10.1186/s12887-017-0950-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Teklu Gemechu Abessa
- Department of Special Needs and Inclusive Education, College of Behavioral Sciences and Education, Jimma University, Jimma, Ethiopia. .,REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium.
| | | | - Patrick Kolsteren
- Department of Food Safety and Food Quality, University of Gent, Ghent, Belgium
| | - Marita Granitzer
- REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
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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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Siqueira LDS, Gonçalves HA, Hübner LC, Fonseca RP. Development of the Brazilian version of the Child Hayling Test. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2016; 38:164-174. [DOI: 10.1590/2237-6089-2016-0019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/09/2016] [Indexed: 11/21/2022]
Abstract
Abstract Introduction: The Hayling Test assesses the components of initiation, inhibition, cognitive flexibility and verbal speed by means of a sentence completion task. This study presents the process of developing the Brazilian version of the Child Hayling Test (CHT) and reports evidence of its content validity. Methods: 139 people took part in the study. The adaptation was performed by seven translators and 12 specialist judges. An initial sample of 92 healthy children was recruited to test a selection of sentences adapted from previous adult and pediatric versions of the instrument, and a sample of 28 healthy children was recruited for pilot testing of the final version. The instrument was developed in seven stages: 1) translation, 2) back-translation, 3) comparison of translated versions, 4) preparation of new stimuli, 5) data collection with healthy children to analyze comprehension of the stimuli and analyses by the authors against the psycholinguistic criteria adopted, 6) analyses conducted by judges who are specialists in neuropsychology or linguistics, and 7) the pilot study. Results: Twenty-four of the 72 sentences constructed were selected on the basis of 70-100% agreement between judges evaluating what they assessed and level of comprehensibility. The pilot study revealed better performance by older children, providing evidence of the instrument's sensitivity to developmental factors. Conclusions: Future studies employing this version of CHT with clinical pediatric populations who have frontal lesions and dysfunctions and in related areas are needed to test functional and differential diagnoses of preserved or impaired executive functions.
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Abessa TG, Worku BN, Kibebew MW, Valy J, Lemmens J, Thijs H, Yimer WK, Kolsteren P, Granitzer M. Adaptation and standardization of a Western tool for assessing child development in non-Western low-income context. BMC Public Health 2016; 16:652. [PMID: 27465679 PMCID: PMC4964036 DOI: 10.1186/s12889-016-3288-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/09/2016] [Indexed: 11/24/2022] Open
Abstract
Background Due to lack of culturally relevant assessment tools, little is known about children’s developmental profiles in low income settings such as Ethiopia. The objective of this study was to adapt and standardize the Denver II for assessing child development in Jimma Zone, South West Ethiopia. Methods Culture-specific test items in Denver II were modified. After translation into two local languages, all test items were piloted and fine-tuned. Using 1597 healthy children 4 days to 70.6 months of age, the 25, 50, 75 and 90 % passing ages were determined for each test item as milestones. Milestones attainment on the adapted version and the Denver II were compared on the 90 % passing age. Reliability of the adapted tool was examined. Results A total of 36 (28.8 %) test items, mostly from personal social domain, were adapted. Milestones attainment ages on the two versions differed significantly on 42 (34 %) test items. The adapted tool has an excellent inter-rater on 123 (98 %) items and substantial to excellent test-retest reliability on 119 (91 %) items. Conclusions A Western developmental assessment tool can be adapted reliably for use in low-income settings. Age differences in attaining milestones indicate a correct estimation of child development requires a population-specific standard.
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Affiliation(s)
- Teklu Gemechu Abessa
- Department of Psychology, College of Behavioral Sciences and Education, Jimma University, Jimma, Oromia, Ethiopia. .,REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium.
| | - Berhanu Nigussie Worku
- Department of Psychology, College of Behavioral Sciences and Education, Jimma University, Jimma, Oromia, Ethiopia.,REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
| | - Mekitie Wondafrash Kibebew
- Department of Population and Family Health, Jimma University, Jimma, Oromia, Ethiopia.,Department of Food Safety and Food Quality, University of Ghent, Ghent, Belgium
| | - Jan Valy
- Department of Healthcare, PXL University College, Hasselt, Belgium
| | - Johan Lemmens
- Department of Healthcare, PXL University College, Hasselt, Belgium
| | | | | | - Patrick Kolsteren
- Department of Food Safety and Food Quality, University of Ghent, Ghent, Belgium
| | - Marita Granitzer
- REVAL Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, University of Hasselt, Hasselt, Belgium
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Petersen IT, Hoyniak CP, McQuillan ME, Bates JE, Staples AD. Measuring the development of inhibitory control: The challenge of heterotypic continuity. DEVELOPMENTAL REVIEW 2016; 40:25-71. [PMID: 27346906 PMCID: PMC4917209 DOI: 10.1016/j.dr.2016.02.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Inhibitory control is thought to demonstrate heterotypic continuity, in other words, continuity in its purpose or function but changes in its behavioral manifestation over time. This creates major methodological challenges for studying the development of inhibitory control in childhood including construct validity, developmental appropriateness and sensitivity of measures, and longitudinal factorial invariance. We meta-analyzed 198 studies using measures of inhibitory control, a key aspect of self-regulation, to estimate age ranges of usefulness for each measure. The inhibitory control measures showed limited age ranges of usefulness owing to ceiling/floor effects. Tasks were useful, on average, for a developmental span of less than 3 years. This suggests that measuring inhibitory control over longer spans of development may require use of different measures at different time points, seeking to measure heterotypic continuity. We suggest ways to study the development of inhibitory control, with overlapping measurement in a structural equation modeling framework and tests of longitudinal factorial or measurement invariance. However, as valuable as this would be for the area, we also point out that establishing longitudinal factorial invariance is neither sufficient nor necessary for examining developmental change. Any study of developmental change should be guided by theory and construct validity, aiming toward a better empirical and theoretical approach to the selection and combination of measures.
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Matafwali B, Serpell R. Design and validation of assessment tests for young children in Zambia. New Dir Child Adolesc Dev 2014; 2014:77-96. [PMID: 25512047 DOI: 10.1002/cad.20074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Early childhood education has received unprecedented attention among African policymakers in recent years, recognizing that the early years form an important foundation upon which later development is anchored and noting evidence that various Early Childhood Development (ECD) indicators are predictive of future academic success. Central to the provision of quality early childhood education is assessment of developmental outcomes. But currently there is little systematic documentation of culturally appropriate child assessment instruments in Africa. We briefly review the literature on cross-cultural issues in child assessment and identify a variety of approaches to test design and adaptation. We then describe the process through which two child assessment instruments were developed in the Zambian context and empirical evidence was collected of their ecocultural and psychometric validity: the Panga Munthu Test and the Zambia Child Assessment Tool (ZamCAT). Implications are derived from these examples for future development of culturally responsive child assessment instruments in Africa.
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Affiliation(s)
- Beatrice Matafwali
- Department of Educational Psychology, Sociology, and Special Education, School of Education, University of Zambia
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Harrison AJ, Zimak EH, Sheinkopf SJ, Manji KP, Morrow EM. Observation-centered approach to ASD assessment in Tanzania. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:330-347. [PMID: 25247726 DOI: 10.1352/1934-9556-52.5.330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Abstract In many lower-income countries, there is a paucity of assessment services for autism spectrum disorders (ASD)., Guidelines will be provided for conducting cross-cultural assessments in the context of limited validated resources in Tanzania. By examining behavioral, social, and adaptive differences we were able to provide differential diagnostic evaluations aligning with best practice standards for 41 children in Tanzania age 2-21 years. We describe the utility of a flexible, behavioral observation instrument, the Childhood Autism Rating Scales, Second Edition (CARS2), to gather diagnostic information in a culturally sensitive manner. We observed that the ASD group was characterized by significantly higher scores on the CARS2, F = 21.09, p < .001, η(2) = .37, than the general delay comparison group. Additional recommendations are provided for making cultural adaptations to current assessment instruments for use in a country without normed instruments, such as Tanzania.
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Cromwell EA, Dube Q, Cole SR, Chirambo C, Dow AE, Heyderman RS, Van Rie A. Validity of US norms for the Bayley Scales of Infant Development-III in Malawian children. Eur J Paediatr Neurol 2014; 18:223-30. [PMID: 24423629 PMCID: PMC4019333 DOI: 10.1016/j.ejpn.2013.11.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/21/2013] [Accepted: 11/24/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Most psychometric tests originate from Europe and North America and have not been validated in other populations. We assessed the validity of United States (US)-based norms for the Bayley Scales of Infant and Toddler Development-III (BSID-III), a neurodevelopmental tool developed for and commonly used in the US, in Malawian children. METHODS We constructed BSID-III norms for cognitive, fine motor (FM), gross motor (GM), expressive communication (EC) and receptive communication (RC) subtests using 5173 tests scores in 167 healthy Malawian children. Norms were generated using Generalized Additive Models for location, scale and shape, with age modeled continuously. Standard z-scores were used to classify neurodevelopmental delay. Weighted kappa statistics were used to compare the classification of neurological development using US-based and Malawian norms. RESULTS For all subtests, the mean raw scores in Malawian children were higher than the US normative scores at younger ages (approximately <6 months) after which the mean curves crossed and the US normative mean exceeded that of the Malawian sample and the age at which the curves crossed differed by subtest. Weighted kappa statistics for agreement between US and Malawian norms were 0.45 for cognitive, 0.48 for FM, 0.57 for GM, 0.50 for EC, and 0.44 for RC. CONCLUSION We demonstrate that population reference curves for the BSID-III differ depending on the origin of the population. Reliance on US norm-based standardized scores resulted in misclassification of the neurological development of Malawian children, with the greatest potential for bias in the measurement of cognitive and language skills.
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Affiliation(s)
- Elizabeth A Cromwell
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
| | - Queen Dube
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; Department of Pediatrics & Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi.
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
| | - Chawanangwa Chirambo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
| | - Anna E Dow
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
| | - Annelies Van Rie
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
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Abstract
Neurodevelopmental delay, neurodisability, and malnutrition interact to contribute a significant burden of disease in global settings. Assessments which are well integrated with plans of management or advice are most likely to improve outcomes. Assessment tools used in clinical research and programming to evaluate outcomes include developmental and cognitive tools that vary in complexity, sensitivity, and validity as well as the target age of assessment. Few tools have been used to measure socioemotional outcomes and fewer to assess the disabled child with malnutrition. There is a paucity of tools used clinically which actually provide families and professionals with advice to improve outcomes. Brain imaging, electroencephalography, audiology, and visual assessment can also be used to assess the effect of malnutrition on brain structure and function. The interaction of neurodisability and malnutrition is powerful, and both need to be considered when assessing children. Without an integrated approach to assessment and management, we will not support children and families to reach their best potential outcomes.
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Gonzalez JM, Rubin M, Fredrick MM, Velligan DI. A qualitative assessment of cross-cultural adaptation of intermediate measures for schizophrenia in multisite international studies. Psychiatry Res 2013; 206:166-72. [PMID: 23167987 PMCID: PMC3615112 DOI: 10.1016/j.psychres.2012.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 10/23/2012] [Accepted: 10/25/2012] [Indexed: 11/29/2022]
Abstract
In this substudy of the Measurement and Treatment Research to Improve Cognition in Schizophrenia we examined qualitative feedback on the cross-cultural adaptability of four intermediate measures of functional outcome (Independent Living Scales, UCSD Performance-Based Skills Assessment, Test of Adaptive Behavior in Schizophrenia, and Cognitive Assessment Interview). Feedback was provided by experienced English-fluent clinical researchers at 31 sites in eight countries familiar with medication trials. Researchers provided feedback on test subscales and items which were rated as having adaptation challenges. They noted the specific concern and made suggestions for adaptation to their culture. We analyzed the qualitative data using a modified Grounded Theory approach guided by the International Testing Commission Guidelines model for test adaptation. For each measure except the Cognitive Assessment Interview (CAI), the majority of subscales were reported to require major adaptations in terms of content and concepts contained in the subscale. In particular, social, financial, transportation and health care systems varied widely across countries-systems which are often used to assess performance capacity in the U.S. We provide suggestions for how to address future international test development and adaptation.
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Affiliation(s)
- Jodi M Gonzalez
- Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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Impact of anthelminthic treatment in pregnancy and childhood on immunisations, infections and eczema in childhood: a randomised controlled trial. PLoS One 2012; 7:e50325. [PMID: 23236367 PMCID: PMC3517620 DOI: 10.1371/journal.pone.0050325] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 10/17/2012] [Indexed: 12/14/2022] Open
Abstract
Background Helminth infections may modulate immune responses to unrelated pathogens and allergens; these effects may commence prenatally. We addressed the hypothesis that anthelminthic treatment in pregnancy and early childhood would improve responses to immunisation and modulate disease incidence in early childhood with both beneficial and detrimental effects. Methods and Findings A randomised, double-blind, placebo-controlled trial was conducted in Entebbe, Uganda [ISRCTN32849447]. In three independent randomisations, 2507 pregnant women were allocated to receive single-dose albendazole or placebo, and praziquantel or placebo; 2016 of their offspring were randomised to receive quarterly single-dose albendazole or placebo from age 15 months to 5 years. Primary outcomes were post-immunisation recall responses to BCG and tetanus antigens, and incidence of malaria, diarrhoea, and pneumonia; incidence of eczema was an important secondary outcome. Analysis was by intention-to-treat. Of 2345 live births, 1622 (69%) children remained in follow-up at age 5 years. 68% of mothers at enrolment, and 11% of five-year-olds, had helminth infections. Maternal hookworm and Schistosoma mansoni were effectively treated by albendazole and praziquantel, respectively; and childhood hookworm and Ascaris by quarterly albendazole. Incidence rates of malaria, diarrhoea, pneumonia, and eczema were 34, 65, 10 and 5 per 100 py, respectively. Albendazole during pregnancy caused an increased rate of eczema in the children (HR 1.58 (95% CI 1.15–2.17), p = 0.005). Quarterly albendazole during childhood was associated with reduced incidence of clinical malaria (HR 0.85 (95% CI 0.73–0.98), p = 0.03). There were no consistent effects of the interventions on any other outcome. Conclusions Routine use of albendazole in pregnancy may not always be beneficial, even in tropical developing countries. By contrast, regular albendazole treatment in preschool children may have an additional benefit for malaria control where helminths and malaria are co-endemic. Given the low helminth prevalence in our children, the effect of albendazole on malaria is likely to be direct. Trial registration Current Controlled Trials ISRCTN32849447
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Kitsao-Wekulo PK, Holding PA, Taylor HG, Abubakar A, Connolly K. Neuropsychological testing in a rural African school-age population: evaluating contributions to variability in test performance. Assessment 2012; 20:776-84. [PMID: 22936783 DOI: 10.1177/1073191112457408] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Patricia K. Kitsao-Wekulo
- International Centre for Behavioural Studies, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Penny A. Holding
- International Centre for Behavioural Studies, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Amina Abubakar
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Tilburg University, Tilburg, The Netherlands
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Brunswick N, Neil Martin G, Rippon G. Early cognitive profiles of emergent readers: A longitudinal study. J Exp Child Psychol 2012; 111:268-85. [DOI: 10.1016/j.jecp.2011.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 08/02/2011] [Accepted: 08/02/2011] [Indexed: 11/26/2022]
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Müller U, Kerns KA, Konkin K. Test–Retest Reliability and Practice Effects of Executive Function Tasks in Preschool Children. Clin Neuropsychol 2012; 26:271-87. [DOI: 10.1080/13854046.2011.645558] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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