Creating a New Measure of Child Development

As a health economist, Günther Fink had never focused on early childhood development issues. That all changed when a research project of his in Zambia turned out to have an important early childhood dimension.
Fink, who is an assistant professor of international health economics at the Harvard School of Public Health and an affiliated faculty member of the Center on the Developing Child, has been studying a major, ongoing anti-malaria initiative in Zambia. His initial research questions centered on figuring out how much, or whether, this comprehensive, country-wide effort to limit the spread of the deadly mosquito-borne disease could—beyond the obvious effects on health—benefit the long-term development or growth potential of an impoverished country like Zambia.
In thinking about the development of human capital in Zambia, an African nation of 13.2 million people, Fink started to consider the effects of the campaign on child development and how to measure that across time. Malaria is a scourge in Zambia—it is the leading cause of morbidity and mortality there, with nearly 4.3 million cases and 50,000 deaths per year. Malaria is responsible for one quarter of childhood deaths, according to the U.S. Agency for International Development (USAID). Among children under age 5 in Zambia, the principal causes of death are malaria and HIV. There is no malaria vaccine.
Beginning in about 2004, an internationally supported and locally coordinated campaign against malaria started attacking the disease in several ways, including through the distribution of insecticide-treated bed nets, indoor spraying for mosquitoes, the distribution of anti-malarial medication to health facilities, and improved diagnosis and treatment.
The anti-malaria initiative has already had significant positive effects on children’s health. According to internationally standardized demography and health surveys, the mortality rate for children under age 5 declined from 168 per 1,000 in 2001 to 119 per 1,000 in 2007—a 30 percent drop in just six years. Among survivors, the percentage of children under age 5 with fever (likely caused by malaria) in the two weeks preceding the survey dropped a dramatic 60 percent in those same six years—from 44.6 percent to 17.9 percent.
Fink and his colleagues realized that, in order to assess the true impact of the initiative on the country’s human capital development, they needed to assess the physical, socio-emotional, and cognitive development of children at age 6—right before they enter primary school—and to follow these cohorts throughout their school careers. The Center provided seed funding for the development of the assessment and a first round of use, but Fink still found that it was a task easier said than done.
fink-quote.gifCurrently, the main internationally collected measure of child development is one that struck Fink as frustratingly narrow and sad: stunting. In other words, the standard for determining healthy child development at the country level is how stunted—or not—children’s height-for-age growth is. In Zambia, in 2002, among children under 5 years of age, that figure stood at a staggering 52.5 percent. Fortunately, since the anti-malaria effort began, the percentage of children found to be stunted has already decreased in Zambia—to 45 percent in 2007, or a 15 percent decline.
With his co-principal investigator at the University of Zambia, Beatrice Matafwali, Fink wrestled with the question of how to measure more aspects of children’s development in sub-Saharan Africa against an international standard. How do you do that without using one of the established, but culturally inappropriate, tests that are available off-the-shelf from the United States or Europe?
Fink determined that the answer is that you simply have to create a new instrument of measurement. “Where you are at age 6, before you enter school, predicts so many things in your life, and yet we have no way of comparing one country to another,” Fink says. Country comparisons are important for talking to policymakers, Fink says, because “improvement is good, but it’s easier to push governments if they’re underperforming.”
Making the new assessment culturally appropriate has been a big hurdle, however. A Zambian child may never have seen the kind of toys or household items (such as scissors) that are commonly used in such tests in the West. Language and vocabulary are challenges, too, given that, across Zambia, more than 70 different languages are spoken.
So, in compiling items for the test, the researchers have had to drop items or replace them with others. (Items requiring memorization might be used over items employing scissors, for instance.) Alternatively, the researchers have changed the scoring. The heart of the matter, Fink says, is, “What kind of question can I ask that allows me to say whether the child is below benchmark?”
In 2010, Fink and colleagues completed the new instrument and began using it to survey the first cohort of about 2,000 children nationwide. The hope, Fink says, is that some sections of the instrument will be useful for comparisons within Zambia, others for comparisons within sub-Saharan Africa, and still other sections of the survey will permit broader global comparisons. (The project has been carried out in partnership with the Zambian government and UNICEF Zambia.)
Back at Harvard, Fink is a member of the Center’s Global Early Childhood Development Research Group, an interdisciplinary, cross-School group of faculty members who have formally affiliated with the Center. The intellectual back-and-forth with his early childhood development colleagues, Fink says, proved critical to this project, as he pushed for generating hard figures and they urged caution about measurement and comparison. “I sometimes remind people that we need some kind of agreement,” Fink says goodnaturedly, “because you need numbers for policy.”
While he says economists can be guilty of oversimplification, Fink argues, “How can somebody sitting in the Ministry of Finance in a place like Zambia decide whether or not they should invest more in early childhood if they have no information?”

—Millicent Lawton
Photo by Fred Field

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