Early clinical research in Malawi and elsewhere in Africa identified worrying developmental delays in children sick with HIV, malaria and malnutrition. Improved medical care globally meant that more children than ever were surviving but suffering developmental delay and associated disorders. The major problem often is that there are few robustly validated tools to measure early child development (ECD) in a simple, cheap, culturally specific way for young children (0-5 years). Such an assessment tool is essential for the evaluation of children and their response to interventions in an African context. Existing tools have been complex, primarily American or European (not culturally relevant), and prohibitively expensive (approximately $2,000/ kit). It has been (up to more recent times) impossible to measure ECD or quantify improvement following clinical or public health interventions.  

The MDAT (Malawi Developmental Assessment Tool) was created through a series of studies by a team at the College of Medicine in Malawi (now Kamuzu University of Health Sciences (Dr Eric Umar, Dr Maggie Nyirenda, Dr Edward Mtitimila) as well as the University of Liverpool (Professor Gladstone, Prof Lancaster, Prof Smyth Dr Ashley Jones) with support from researchers at Liverpool School of Tropical Medicine and the Malawi Liverpool Wellcome Trust (Prof Van den Broek, Ms Kayira) and originally with first studies in Lungwena, Malawi, by the team at Tampere University (Prof Ashorn).

The first preliminary studies detailed difficulties using Western tools [1]  and used qualitative studies to unravel the conceptualization of child development in African contexts [2]

We then iteratively developed the Malawi Developmental Assessment Tool (MDAT) creating a valid tool relevant to motor, language and social development of young children in Malawi and elsewhere in Africa which was then refined and robustly tested using detailed psychometric techniques creating population-based age-bands for developmental milestones for 1,446 children from 0-6 years [3].

MDAT References 

1. Gladstone, M. J., Lancaster, G. A., Jones, A. P., Maleta, K., Mtitimila, E., Ashorn, P., & Smyth, R. L. (2008). Can Western developmental screening tools be modified for use in a rural Malawian setting?. Archives of Disease in Childhood, 93(1), 23-29.

2. Gladstone, M., Lancaster, G., Umar, E., Nyirenda, M., Kayira, E., Van Den Broek, N., & Smyth, R. L. (2010). Perspectives of normal child development in rural Malawi–a qualitative analysis to create a more culturally appropriate developmental assessment tool. Child: care, health and development, 36(3), 346-353. 

3. Gladstone, M., Lancaster, G. A., Umar, E., Nyirenda, M., Kayira, E., van den Broek, N. R., & Smyth, R. L. (2010). The Malawi Developmental Assessment Tool (MDAT): the creation, validation, and reliability of a tool to assess child development in rural African settings. PLoS medicine, 7(5), e1000273.