title: Eye-tracking-based assessment of cognitive function in low-resource settings.
abstract: BACKGROUND
  Early development of neurocognitive functions in infants can be compromised by poverty, malnutrition and lack of adequate stimulation. Optimal management of neurodevelopmental problems in infants requires assessment tools that can be used early in life, and are objective and applicable across economic, cultural and educational settings.
  
  
  OBJECTIVE
  The present study examined the feasibility of infrared eye tracking as a novel and highly automated technique for assessing visual-orienting and sequence-learning abilities as well as attention to facial expressions in young (9-month-old) infants. Techniques piloted in a high-resource laboratory setting in Finland (N=39) were subsequently field-tested in a community health centre in rural Malawi (N=40).
  
  
  RESULTS
  Parents' perception of the acceptability of the method (Finland 95%, Malawi 92%) and percentages of infants completing the whole eye-tracking test (Finland 95%, Malawi 90%) were high, and percentages of valid test trials (Finland 69-85%, Malawi 68-73%) satisfactory at both sites. Test completion rates were slightly higher for eye tracking (90%) than traditional observational tests (87%) in Malawi. The predicted response pattern indicative of specific cognitive function was replicated in Malawi, but Malawian infants exhibited lower response rates and slower processing speed across tasks.
  
  
  CONCLUSIONS
  High test completion rates and the replication of the predicted test patterns in a novel environment in Malawi support the feasibility of eye tracking as a technique for assessing infant development in low-resource setting. Further research is needed to the test-retest stability and predictive validity of the eye-tracking scores in low-income settings.
authors.affiliation: Tampere Center for Child Health Research, School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Linda
authors.initials: L
authors.lastname: Forssman
authors.affiliation: Tampere Center for Child Health Research, School of Medicine, University of Tampere, Tampere, Finland.|Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
authors.affiliation: Tampere Center for Child Health Research, School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Ulla
authors.initials: U
authors.lastname: Ashorn
authors.affiliation: School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maleta
authors.affiliation: School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Andrew
authors.initials: A
authors.lastname: Matchado
authors.affiliation: Tampere Center for Child Health Research, School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Emma
authors.initials: E
authors.lastname: Kortekangas
authors.affiliation: Tampere Center for Child Health Research, School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Jukka M
authors.initials: JM
authors.lastname: Leppänen
mesh_terms: D000886:Anthropometry; D001294:Attitude to Health; D003071:Cognition / Q000502:physiology*; D053483:Eye Movement Measurements; D005133:Eye Movements / Q000502:physiology*; D005240:Feasibility Studies; D005260:Female; D005387:Finland; D006801:Humans; D007223:Infant; D007398:Interpersonal Relations; D008295:Malawi; D008297:Male; D008507:Medically Underserved Area; D009035:Mothers / Q000523:psychology; D010465:Perception; D012959:Socioeconomic Factors
keywords: Neurodevelopment; cognition; infant