Perspectives of normal child development in rural Malawi - a qualitative analysis to create a more culturally appropriate developmental assessment tool

Background Child development in developing countries is often evaluated using assessment tools created for 'Western' settings. Recent work has demonstrated that, for certain developmental milestones, 'Western' tools may be inaccurate as they include items unfamiliar to children of different cultural settings. Methods We used qualitative methods to gather information about normal development in an African setting. Ten village and two professional focus group discussions (FGDs) were conducted. We used purposive sampling methods to recruit groups of mothers, grandmothers and men in four areas of Southern Malawi for village FGDs. Separate FGDs were carried out with professionals working in areas relating to child development. A thematic content analysis established main patterns and themes and dissemination of results and continued feedback allowed for respondent validation and reflection of results. The information then gathered was used to create questions for a revised Malawian developmental assessment tool. Results Social and gross motor milestones were the main focus of interest for village and professional FGDs with the latter creating new language and fine motor concepts. Social milestones highlighted included 'duties and chores', 'sharing' and 'taking up leadership roles'. Language milestones included 'reporting events' and 'shrugging to indicate no' and fine motor milestones included 'peeling bananas', 'sorting maize' and 'making patterns with bottle tops'. Intelligence was described in relation to social and community integrity rather than 'Western' concepts of numeracy and literacy. Conclusions Concepts, ideas and language relating to normal development in a sub-Saharan African setting have been gathered in this study. These have been used to create items for a more culturally appropriate developmental assessment tool.