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Usefulness of Child Development Assessments for Low-Resource Settings in Francophone Africa

Koura, Kobto G. MD, PhD; Boivin, Michael J. PhD; Davidson, Leslie L. MD, MSc; Ouédraogo, Smaïla MD, PhD; Zoumenou, Roméo MSc; Alao, Maroufou J. MD; Garcia, André MD, PhD; Massougbodji, Achille MD; Cot, Michel MD, PhD; Bodeau-Livinec, Florence MD, PhD

Journal of Developmental & Behavioral Pediatrics: September 2013 - Volume 34 - Issue 7 - p 486–493
doi: 10.1097/DBP.0b013e31829d211c
Original Articles

Objective: Few tools are available to screen or assess infant's cognitive development, especially in French-speaking Africa. This study evaluated the use of the French translation of the Mullen Scales of Early Learning (MSEL), and the “Ten Questions” questionnaire (TQ) in 1-year-old children in Benin, a francophone country.

Methods: A cross-sectional study was conducted in 3 health centers serving a semirural area in Benin. Three hundred fifty-seven children aged 12 months and their mothers were enrolled in 2011. Infant development was assessed at local health centers followed by a home visit to collect information on socioeconomic status, maternal Raven score, maternal depressive symptoms, and mother-child interactions (Home Observation for the Measurement of the Environment [HOME] Inventory), and to administer the TQ.

Results: The infant's gender (female), the HOME, and maternal education were associated with a higher Early Learning Composite score in multivariate analyses (p = .02, p = .004, p = .007, respectively). The HOME and family wealth were also associated with the Gross Motor Scale (p = .03 and p = .03, respectively). Mothers were more likely to report difficulties on the TQ when the child presented lower score on the MSEL. When considering the Gross Motor Scale as the gold standard to define moderate delays, the 2 combined motor-related questions on the TQ showed good sensitivity and specificity (76.5 and 75.7).

Conclusion: In a low-resource rural setting in Africa, the TQ effectively identified 3 quarters of 1-year-old infants with delayed development. After this screening, the MSEL may be useful for further assessment as it showed good feasibility and sensitivity to known risk factors for poor child development.

*IRD UMR216, Mère et enfant face aux infections tropicales, Paris, France;

Faculté de Pharmacie, Université Paris Descartes, Paris, France;

Université Pierre Marie Curie, Paris, France;

§International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, MI;

Department of Epidemiology, Mailman School of Public Health and the College of Physicians and Surgeons, Columbia University, New York, NY;

Laboratoire de Parasitologie, Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Bénin;

**Centre d’Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l’Enfant, Cotonou, Bénin;

††Département d’épidémiologie et biostatistiques, EHESP Rennes, Sorbonne Paris Cité, France;

‡‡Department of Microbiology, Division of Parasitology, School of Medicine, New York University, New York, NY.

Address for reprints: Florence Bodeau-Livinec, MD, PhD, Département d’épidémiologie et biostatistiques, Ecole des Hautes Etudes en Santé Publique, Avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France; e-mail:

Supported by the National Institutes of Health Grant R21-HD060524.

Disclosure: The authors declare no conflict of interest.

Received March , 2013

Accepted May , 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.