{"doi":"10.1371/journal.pone.0274664","title":"Performance of the UNICEF/UN Washington Group tool for identifying functional difficulty in rural Zimbabwean children","abstract":"INTRODUCTION: Over one billion people live with disability worldwide, of whom 80% are in developing countries. Robust childhood disability data are limited, particularly as tools for identifying disability function poorly at young ages. METHODS: A subgroup of children enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (a cluster-randomised, community-based, 2x2 factorial trial in two rural districts in Zimbabwe) had neurodevelopmental assessments at 2 years of age. We evaluated functional difficulty prevalence in HIV-exposed and HIV-unexposed children using the Washington Group Child Functioning Module (WGCFM), comparing absolute difference using chi-squared or Fisher's exact tests. Concurrent validity with the Malawi Developmental Assessment Tool (MDAT) was assessed using logistic regression with cohort MDAT score quartiles, linear regression for unit-increase in raw scores and a Generalised Estimating Equation approach (to adjust for clusters) to compare MDAT scores of those with and without functional difficulty. A 3-step, cluster-adjusted multivariable regression model was then carried out to examine risk factors for functional difficulty. FINDINGS: Functional Difficulty prevalence was 4.2% (95%CI: 3.2%, 5.2%) in HIV-unexposed children (n = 1606) versus 6.1% (95%CI: 3.5%, 8.9%) in HIV-exposed children (n = 314) (absolute difference 1.9%, 95%CI: -0.93%, 4.69%; p = 0.14). Functional difficulty score correlated negatively with MDAT: for each unit increase in WGCFM score, children completed 2.6 (95%CI: 2.2, 3.1) fewer MDAT items (p = 0.001). Children from families with food insecurity and poorer housing were more at risk of functional difficulty. INTERPRETATION: Functional difficulty was identified in approximately 1-in-20 children in rural Zimbabwe, which is comparable to prevalence in previous studies. WGCFM showed concurrent validity with the MDAT, supporting its use in early childhood.","journal":"PLoS ONE","year":2022,"id":290408,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7114,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":345425,"name":"Jaya Chandna","orcid":"0000-0001-9836-0554","position":1,"is_corresponding":false},{"id":345428,"name":"Florence D. Majo","orcid":"0009-0006-1282-0462","position":2,"is_corresponding":false},{"id":346613,"name":"Naume V. Tavengwa","orcid":null,"position":3,"is_corresponding":false},{"id":346614,"name":"Batsirai Mutasa","orcid":null,"position":4,"is_corresponding":false},{"id":345427,"name":"Bernard Chasekwa","orcid":"0000-0001-8080-7573","position":5,"is_corresponding":false},{"id":345424,"name":"Robert Ntozini","orcid":"0000-0002-8543-2835","position":6,"is_corresponding":false},{"id":345432,"name":"Andrew J. Prendergast","orcid":"0000-0001-7904-7992","position":7,"is_corresponding":false},{"id":345430,"name":"Jean H. Humphrey","orcid":"0000-0001-6974-2975","position":8,"is_corresponding":false},{"id":345431,"name":"Melissa Gladstone","orcid":"0000-0002-2579-9301","position":9,"is_corresponding":false},{"id":972802,"name":"Thomas Frederick Dunne","orcid":"0000-0003-3385-3360","position":0,"is_corresponding":true}],"reference_count":25,"raw_metadata":null,"created_at":"2026-07-19T00:30:30.639224Z","pmid":"36112574","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}