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Arch Dis Child. 2019 Apr;104(Suppl 1):S22-S33. doi: 10.1136/archdischild-2018-315431.

Rating early child development outcome measurement tools for routine health programme use.

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Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK.
International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK.
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
University of Maryland School of Medicine, Baltimore, Maryland, USA.
Research Triangle Park, RIT International, Durham, USA.
Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland.
Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland.
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Institute of Child Health, Faculty of Population Health Sciences, University College London, London, UK.
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Children's Investment Fund Foundation, London, UK.
Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Department of Paediatrics and Child Health, Muhimbili University of Allied Health Sciences, Dar es Salaam, Tanzania.
Harvard Graduate School of Education, Harvard University, Massachusetts, USA.
Neonatal Medicine, University College Hospitals NHS Trust, London, UK.



Identification of children at risk of developmental delay and/or impairment requires valid measurement of early child development (ECD). We systematically assess ECD measurement tools for accuracy and feasibility for use in routine services in low-income and middle-income countries (LMIC).


Building on World Bank and peer-reviewed literature reviews, we identified available ECD measurement tools for children aged 0-3 years used in ≥1 LMIC and matrixed these according to when (child age) and what (ECD domains) they measure at population or individual level. Tools measuring <2 years and covering ≥3 developmental domains, including cognition, were rated for accuracy and feasibility criteria using a rating approach derived from Grading of Recommendations, Assessment, Development and Evaluations.


61 tools were initially identified, 8% (n=5) population-level and 92% (n=56) individual-level screening or ability tests. Of these, 27 tools covering ≥3 domains beginning <2 years of age were selected for rating accuracy and feasibility. Recently developed population-level tools (n=2) rated highly overall, particularly in reliability, cultural adaptability, administration time and geographical uptake. Individual-level tool (n=25) ratings were variable, generally highest for reliability and lowest for accessibility, training, clinical relevance and geographical uptake.


Although multiple measurement tools exist, few are designed for multidomain ECD measurement in young children, especially in LMIC. No available tools rated strongly across all accuracy and feasibility criteria with accessibility, training requirements, clinical relevance and geographical uptake being poor for most tools. Further research is recommended to explore this gap in fit-for-purpose tools to monitor ECD in routine LMIC health services.


early child development tools; health systems; low and middle income countries; maternal, newborn and child health; metrics

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Conflict of interest statement

Competing interests: The following authors on this paper have intellectual inputs and leadership roles for some of the tools reviewed: MDAT (JC), IYCD (VC, TD) and CREDI (DCM and GF). None of these authors rated any of these tools.

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