Culturally appropriate measures for monitoring child development at family and community level: a WHO collaborative study

Bull World Health Organ. 1996;74(3):283-90.


Culturally appropriate techniques for monitoring child psychosocial development were prepared and tested in China, India and Thailand on a total of 28,139 children. This is the largest study of its kind ever undertaken. Representative groups aged between birth and 6 years were examined and the results were used to produce national development standards-separately for rural and urban children in China and India, and for all children combined in Thailand-which are considered to be more satisfactory than foreign-based standards. In each country, between 13 and 19 key milestones of psychosocial development were selected for a simplified developmental screening operation and these have been incorporated on a home-based record of a child's growth and development. Between 35 and 67 tests have been devised in each country to test the children at first-referral level.

PIP: Protocols of psychosocial development for children 0-6 years old, locally developed in order to be culturally appropriate, were applied to 8995 children from urban and rural areas from 6 provinces in Shanghai, China; fewer than 13,720 children in Chandigarh, Hyderabad, and Jabalpur states in India; and 5424 children from urban and rural areas in Thailand. The findings were intended to be used to develop national child development standards. This study was the largest multicultural study of its kind ever conducted. Cultural variation was the major reason accounting for the very wide range of differences in the age of attainment of a small number of items (e.g., use of cups). A wider variation between urban and rural living conditions in China and Thailand account for differences between urban and rural children in these countries. The tests did not assume that rural children might have an advantage in some areas (e.g., recognizing different types of grain or plant). Very high intertester reliability within centers existed. Lack of time and money prevented the researchers from checking reliability between centers. The researchers discarded two of the culturally appropriate tests initially selected in Thailand (walks on coconut shells and walks on sticks before 72 months of age) since few children could do them before age 6. Teams in all 3 countries selected appropriate test items (milestones) and incorporated them on the weight-for-age home-based record (19 in China, 13 in India and Thailand). The Chinese records present the milestones in pictorial form with red and yellow to represent high and moderate risks, respectively. The next phase of the study aims to determine whether developmental screening can be applied in the home, the community, and primary health care programs to identify developmental delays early enough to implement simple interventions to improve performance and prognosis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child Development*
  • Child, Preschool
  • China
  • Culture
  • Data Interpretation, Statistical
  • Humans
  • India
  • Infant
  • Infant, Newborn
  • Reference Standards
  • Reproducibility of Results
  • Sampling Studies
  • Thailand