Where it has been used

“The Sustainable Development Goals recognize that early childhood development can help drive the transformation we hope to achieve over the next 15 years”

UN Secretary-General Ban Ki-moon, UN Headquarters, 22 September 2015

The global reach of MDAT

The Global Strategy for Women’s, Children’s and Adolescent’s Health (2016-2030) outlines a number of strategies that need to be put in place in order to help these young children not just survive, but thrive. 

One of which is ‘ensuring that all children have access to good quality early-childhood development’. And that’s where the MDAT comes in.

The MDAT enables teams in low and middle income settings around the world to measure the impact of interventions which may affect early child development in the first few years of life.

How the MDAT can help children

The MDAT can be used to evaluate how child development is affected by different interventions or events, which could lead to new standards of practice being developed. 

Red flags for use within the MDAT can help to identify those children whose development is very delayed and where there may be concerns that the child has a disability.  Although we would not recommend the tool for screening on its own, it can be helpful in providing guidance as to what children in low and middle income settings can do at different ages and what questions you can ask and use to assess children in these settings.

Studies from Malawi and other countries have shown good validity (sensitivity to change) of the tool in identifying children with neurodisabilities and developmental delay in a wide variety of research studies including; Children born prematurely, children with infections such as HIV (both infected and exposed), children affected by cerebral malaria, and children who have had malnutrition.  Additionally, the MDAT has also been shown to have good predictive validity for school attainment with children who scored better on the MDAT doing better in maths in secondary school in Malawi. 

Why the MDAT is unique

As this tool has been specifically developed for those in sub-saharan Africa, it’s unique in the sense that it’s culturally relevant, accurate and accessible in both low income settings and/or rural Africa. It has now been used in many low and middle-income countries, including those in South East Asia and South America.

Recent studies have also demonstrated its use as one of only three tools which report adequate psychometric properties and feasibility for identifying and monitoring young children with disabilities at primary health care level in low and middle income settings.


The MDAT has been used in over 20 countries on more than 8000 children and endorsed by Governments, Researchers, and NGOs such as the Gates Foundation, Save the Children, Medicins Sans Frontieres and World Bank.

How it was developed

MDAT was developed by a team of researchers at the University of Liverpool and the College of Medicine in Malawi. 

It was created after a series of detailed studies in Lungwena (the Mangochi region of Malawi) as well as in a number of different areas of Southern Malawi (Nguludi, Namitambo, Bangwe and Mikolongwe). 

The MDAT has undergone rigorous research and testing. The first version was created in 2008 and the second in 2010.

Selection of studies using the MDAT (ongoing and completed)

The tool has been well adopted. To date the 2010 publication has achieved 80 citations (Scopus) and 45,306 full text view (PlumX Metrics).

PBI, Kenya (2018)

Pre-term birth initiative investigating developmental outcomes of pre-term babies (6,12,18 months) born in neonatal units in Kenya. 

EN-SMILING, Bangladesh, Nepal & Tanzania (2017)

Long term follow up of 20,000 children to promote early identification of adverse developmental outcomes. This will compare the use of the MDAT, IYCD (parent report questionnaire) and the CREDI along with the Bayley III. 

SHINE, Zimbabwe (2016)

Trial investigating single and combined effects of WASH and Nutrition on early child development at 2 years of age in 1,600 children. This trial finished in 2016. The MDAT identified differences between children with and without HIV exposure in utero but only identified very small differences between children with and without the WASH and nutrition interventions. 

Sugira Muryango, Rwanda (2017)

Evaluating effects of home-based parenting intervention on child development. This trial is still underway.

CHAIN, Pakistan, Uganda, Malawi (2016-2018)

Investigating developmental outcomes of children with severe acute malnutrition vs those with moderate malnutrition and community cohorts. This trial is still underway but some results have been presented at the Paediatric Academy of Science. 

Blantyre Malaria Project, Malawi (2010)

The MDAT has been used for many years in assessing children with retinopathy‐positive cerebral malaria (CM) for neurocognitive sequelae, as well as for those children with encephalitis and has demonstrated significant developmental delay in children with these conditions.