Person:

Jukes, Matthew

Background: The use of cognitive tests is increasing in Africa but little is known about how such tests are affected by the great ethnic and linguistic diversity on the continent.

Aim: To assess ethnic and linguistic group differences in cognitive test performance in the West African country of the Gambia and to investigate the sources of these differences.

Samples: Study 1 included 579 participants aged 14–19 years from the Wolof and Mandinka ethnic groups of the Gambia. Study 2 included 41 participants aged 12–18 years from the two ethnic groups.

Methods: Study 1 assessed performance on six cognitive tests. Participants were also asked about their history of education, residence in the city, parental education, and family socio-economic status. Study 2 assessed performance on two versions of the digit span test. Recall of the numbers 1–5 were compared with recall of numbers 1–9 for both the Wolof (who count in base 5) and the Mandinka (who count in base 10).

Results: Study 1 established that Wolof performance was lower than that of the Mandinka on five out of six cognitive tests. In four of these tests, group differences were partially mediated by participation in primary school and migration to the city. Group differences were substantial for the digit span test and were not attenuated by mediating variables. Study 2 found that digit span among the Wolof was shorter than that of the Mandinka for numbers 1–9 but not for numbers 1–5.

Conclusions: Several suggestions are made on how to consider the ethnicity, language, education, and residence (urban vs. rural) of groups when conducting comparative cognitive assessments or collecting normative data.

Background: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence on the benefits of school-based malaria prevention or how health interventions interact with other efforts to improve education quality. This study aims to evaluate the impact of school-based malaria prevention and enhanced literacy instruction on the health and educational achievement of school children in Kenya. Design: A factorial, cluster randomised trial is being implemented in 101 government primary schools on the coast of Kenya. The interventions are (i) intermittent screening and treatment of malaria in schools by public health workers and (ii) training workshops and support for teachers to promote explicit and systematic literacy instruction. Schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention is implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months. The primary outcomes are educational achievement and anaemia, the hypothesised mediating variables through which education is affected. Secondary outcomes include malaria parasitaemia, school attendance and school performance. A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions. Discussion: Across Africa, governments are committed to improve health and education of school-aged children, but seek clear policy and technical guidance as to the optimal approach to address malaria and improved literacy. This evaluation will be one of the first to simultaneously evaluate the impact of health and education interventions in the improvement of educational achievement. Reflection is made on the practical issues encountered in conducting research in schools in Africa.

Background: The control of malaria in schools is receiving increasing attention, but there remains currently no consensus as to the optimal intervention strategy. This paper analyses the costs of intermittent screening and treatment (IST) of malaria in schools, implemented as part of a cluster-randomized controlled trial on the Kenyan coast. Methods: Financial and economic costs were estimated using an ingredients approach whereby all resources required in the delivery of IST are quantified and valued. Sensitivity analysis was conducted to investigate how programme variation affects costs and to identify potential cost savings in the future implementation of IST. Results: The estimated financial cost of IST per child screened is US$ 6.61 (economic cost US$ 6.24). Key contributors to cost were salary costs (36%) and malaria rapid diagnostic tests (RDT) (22%). Almost half (47%) of the intervention cost comprises redeployment of existing resources including health worker time and use of hospital vehicles. Sensitivity analysis identified changes to intervention delivery that can reduce programme costs by 40%, including use of alternative RDTs and removal of supervised treatment. Cost-effectiveness is also likely to be highly sensitive to the proportion of children found to be RDT-positive. Conclusion: In the current context, school-based IST is a relatively expensive malaria intervention, but reducing the complexity of delivery can result in considerable savings in the cost of intervention.

Substantial resources are invested in psychological support for children orphaned or otherwise made vulnerable in the context of HIV/AIDS (OVC). However, there is still only limited scientific evidence for greater psychological distress amongst orphans and even less evidence for the effectiveness of current support strategies. Furthermore, programmes that address established mechanisms through which orphanhood can lead to greater psychological distress should be more effective. We use quantitative and qualitative data from Eastern Zimbabwe to measure the effects of orphanhood on psychological distress and to test mechanisms for greater distress amongst orphans suggested in a recently published theoretical framework. Orphans were found to suffer greater psychological distress than non-orphans (sex- and age-adjusted co-efficient: 0.15; 95% CI 0.03–0.26; P = 0.013). Effects of orphanhood contributing to their increased levels of distress included trauma, being out-of-school, being cared for by a non-parent, inadequate care, child labour, physical abuse, and stigma and discrimination. Increased mobility and separation from siblings did not contribute to greater psychological distress in this study. Over 40% of orphaned children in the sample lived in households receiving external assistance. However, receipt of assistance was not associated with reduced psychological distress. These findings and the ideas put forward by children and caregivers in the focus group discussions suggest that community-based programmes that aim to improve caregiver selection, increase support for caregivers, and provide training in parenting responsibilities and skills might help to reduce psychological distress. These programmes should be under-pinned by further efforts to reduce poverty, increase school attendance and support out-of-school youth.

Background: A strong link between phonological awareness (PA) and literacy exists, but the origins of this link are difficult to investigate, since PA skills are hard to test in young, pre-literate children, and many studies neither include such children nor report children's initial literacy levels. Aims: To examine PA and literacy in children who are attending or not attending school in rural East Africa. Sample: 108 children ages 7 to 10 years, with no education, or in grades 1 or 2, randomly selected from a community survey of all children in this age group. Methods: PA skill, reading, cognitive abilities and socio-economic status were examined. Results: Implicit and explicit PA skill with small or large units is related to letter reading ability, and this effect is independent of age, schooling, and cognitive ability. Some PA tasks are performed above chance levels by children who cannot recognise single letters. Conclusions: Basic PA develops prior to the attainment of literacy, and learning to read improves PA both quantitatively and qualitatively.