Testing the feasibility and utility of an executive function battery for use with primary school-aged students in Malawi.

There is increasing evidence that malaria impacts student educational outcomes, in part through impairments in cognitive function. Currently, there is no consensus with regards to standardized tools or approaches to assess the extent and magnitude of this association. We conducted a pilot study to assess the feasibility and utility of a well-established tablet-based battery of executive function (EF) tasks for primary school-aged children in Malawi. We collected data from 197 students in grades 1-4 in a rural primary school in Blantyre District, Malawi. The assessment battery ("EF Touch"), which consisted of seven EF tasks that measure inhibitory control, working memory, and cognitive flexibility, was administered using open-source, standardized tablet-based software (RTI International's Tangerine). Assessments were conducted in Chichewa, and task performance was analyzed for accessibility and challenge across different grade levels. High completion rates were observed for all tasks, and most students completed the entire battery within one hour. Task performance varied by grade, with older students generally performing better. Two tasks had poor performance and ceiling effects and were omitted from composite scores. A composite of EF task performance was normally distributed and increased with grade level. The study demonstrates the feasibility of using a common battery of EF tablet-based assessments with students in grades 1-4 in Malawi. Given the high burden of malaria in this region and its potential impact on cognitive development, these results help to establish the feasibility and utility of direct EF assessments in future studies that focus on the impact of malaria infection on cognitive and educational outcomes.