Table 5 Data collection tools

The Bayley Scales of Infant Development-Third Edition (BSID-III) [62]

A comprehensive objective assessment administered face-to-face by a qualified independent assessor to assess child development. Only the cognition and language subscales are administered.

Child cognitive and language development

Validated in South Africa [63, 64] with reported values similar to the reference population in the USA [62].

Edinburgh Postnatal Depression Scale (EPDS) [65]

10-item questionnaire of perinatal depressive symptoms over the last 7 days assessed on a scale of 0 to 3.

Maternal depressive symptoms

Widely used and validated in Africa and South Africa, including use amongst antenatal populations [66]. Has been validated in the study population against a structured clinical interview for depression (DSM-IV) showing good specificity (93%) and sensitivity (68%) for detecting clinical depression [67, 68]

Child Behaviour Checklist (1.5-5-year-old) [69]

Externalising subscale (attention problems and aggressive behaviour syndrome scales) of the CBCL. 24 items, assessed on a scale of 0 to 2. Parental self-report.

Child externalising behaviour

Has been shown to be reliable in Africa [70], and to have high (> 90%) sensitivity and specificity for identifying behavioural emotional problems compared to a clinical diagnosis by a psychiatrist in other LMICs [71] Widely used and well-validated in South Africa [72, 73].

Parenting Stress Index Short Form [74, 75]

Measure of parenting stress related to three domains: the parental role, the parent-child relationship, and the degree to which the parent finds the child difficult. The scale comprises 36 statements, which are scored 1 (strongly disagree) to 5 (strongly agree) and can be summed to reflect the total score for each domain.

Maternal perception of child behaviour (Dysfunctional Interaction and Difficult Child subscales)

Has been shown to be reliable in South Africa [76]

Brief Rumination Response Scale

A 5-item questionnaire assessing depressive rumination assessed on a scale of 0 (never) to 4 (always).

Maternal rumination

A validated and reliable measure of depressive rumination [61, 77]

The Generalized Anxiety Disorder Scale (GAD-7)

7-item questionnaire assessing symptoms of generalised anxiety disorder over the previous 2 weeks. Scores

Maternal anxiety

Has been widely used in the study setting and has shown good reliability [76, 78].

Multiple Indicator Cluster Survey (MICS)

Specific questions from the Early Child Development module of the UNICEF ‘Multiple Indicator Cluster Surveys’ (MICS) under five are used to assess cognitive and emotional stimulation at home. Items are mostly scored on a dichotomous scale of 0 and 1 except for the question about how many children’s books or picture books a mother has for her child (0 = none, 1 = a number of books and 2 = ten or more books).

Cognitive and emotional stimulation.

Validated survey used in over 100 countries over the past two decades, also used in large scale surveys in 27 African countries [79, 80].