Table 1 Examples of specific items added or removed during the process of creating new more culturally appropriate tool

Domain of development	DDST or Denver II items removed at stage 1	New items replaced at stage 1	Denver II/Griffith’s items removed or needing modification after consensus meeting	New items removed or needing modification after consensus meeting
Gross motor	1. Head up to 45°	1. Dances to music	1. Pulls self to stand (not	1. Dances (not specific enough)
	2. Walks up steps	2. Kneels well to be respectful	understood by research	2. Carries object on head with one hand
	3. Pedals tricycle	3. Climbs and gets down	assistants)	(need to specify exact object)
		4. Carries object on head with	2. Touches toes with legs	3. Carries water on head with no hands
		one hand	straight (difficult to teach)	(need to specify size)
		5. Pushes wheel with stick
		6. Carries water on
		head– no hands

Fine motor	1. Looks for yarn	1. Bangs drum/pot	1. Draws a person with 3 parts	1. Moulds ball with clay (task not
	2. Thumb wiggle	2. Moulds ball with clay	(many not passing by age 6)	normally done by children)
	3. Thumb finger grasp	3. Makes doll of clay	2. Draws a person with 6 parts	2. Bangs drum/pot (translation “plays
		4. Sorts objects into groups	(many not passing by age 6)	drum” incorrect)
		5. Picks longest stick		3. Builds house of corn cobs (sex specific)

Language	1. Responds to bell	1. Sings	1. Knows 3 colours (colours	1. Uses respectful terms (poor reliability)
	2. Squeals	2. Knows today and tomorrow	used differently in Malawi)	2. Knows father’s name (poor reliability)
	3. Points to pictures/name	3. Knows name of own village	2. Knows opposites (not specific	3. Can count bottle tops to 10 (counting
	pictures	4. Uses respectful terms	enough–question needed	learned at school– not many children
	4. Counts 1 block	5. Knows father’s name	clarifying)	in school/nursery aged under 5)
	5. Uses plurals	6. Can count bottle tops to 10

Social	1. Plays pat-a-cake	1. Shares things	1. Helps in house	1. Spends most of time on mum’s back
	2. Plays ball with examiner	2. Plays with friends	2. Puts on clothing with help	(family dependent)
	3. Resists toy pull	3. Spends most of time on	(poor reliability)	2. Shy with strangers (poor reliability)
	4. Plays peek-a-boo	mum’s back	3. Feeds self (specify what	3. Sweeps (sex specific)
	6. Uses spoon/fork	4. Eats with family in a group	type of food)	4. Washes dishes (sex specific)
	7. Feeds doll	5. Can plant seeds by self	4. Drinks from cup by self	5. Goes to the toilet with help (not specific
	8. Brushes teeth with help	6. Washes dishes	(not specific enough	enough, eg, older children need help using
	9. Names a friend	7. Washes clothes	regarding how well or not	pit latrines)
	10. Plays board games	8. Sweeps	child needed to do this)
	12. Prepares cereal	9. Goes to the toilet with help
	13. Plays interactive games, eg, tag	10. Goes to the toilet by self
	14. Buttons up	11. Makes porridge by self
		12. Adds wood to fire
		13. Can build fire by self