Validation of cognitive and psychosocial tools in Kenya: findings from the LOSHAK feasibility pilot

Sneha Sarah Mani, Roselyter Monchari Riang’a, Niranjani Nagarajan, Anthony K. Ngugi, Eunice Muthoni Mwangi, Muthoni Gichu, Patrick N. Mwangala, Edward Miguel, Michael Walker, Kenneth M. Langa, Joshua R. Ehrlich, Alden L. Gross
2025
African DevelopmentHealth
12889 2025 Article 24918.pdf

Mani SS, Riang’a RM, Nagarajan N, Ngugi AK, Mwangi EM, Gichu M, Mwangala PN, Miguel E, Walker M, Langa KM, Ehrlich JR, Gross AL. Validation of cognitive and psychosocial tools in Kenya: findings from the LOSHAK feasibility pilot. BMC Public Health. 2025 Nov 17;25(1):4008. doi: 10.1186/s12889-025-24918-z. PMID: 41249975; PMCID: PMC12625501.

Background and objectives: Adapting cognitive tests to culturally diverse and low-resource settings is essential
for expanding knowledge of cognitive health in older adults beyond high-income countries. However, contextual
differences in novel settings can affect reliability and validity. There is limited evidence on the feasibility of
implementing culturally adapted cognitive assessments in Sub-Saharan Africa, a region projected to have over
158 million adults aged 60 and older by 2050. The Longitudinal Study of Health and Ageing in Kenya (LOSHAK) is
designed to address this measurement gap by evaluating cognitive tests in this context.

Research design and methods: We analyzed data from 205 adults aged 45 years and older from the Kaloleni/
Rabai Health and Demographic Surveillance System in Coastal Kenya. Using McDonald’s omega and confirmatory
factor analysis, we evaluated the internal consistency reliability and the factor structure of four cognitive domains
(orientation, memory, executive functioning, language/fluency) and four psychosocial constructs (depressive
symptoms, loneliness, subjective well-being, and life satisfaction).

Results: McDonald’s omegas ranged from ω=0.78 to 0.95 for cognitive domains and were above 0.83 for each
psychosocial domain, suggesting high reliability. Factor analyses revealed adequate to perfect fit for most domains,
and patterns of factor loadings were mostly acceptable.

Conclusion: The successful adaptation of these assessment tools in Kenya demonstrates the feasibility of
implementing rigorous cognitive and psychosocial measurements in low-resource settings. These findings provide a
methodological framework for future aging studies in similar contexts across Sub-Saharan Africa.

Keywords: Cognition, Dementia, Successful aging, Sub-Saharan Africa, Validation

Destructive Behavior, Judgment, and Economic Decision-making under Thermal Stress

Ingvild Almås, Maximilian Auffhammer, Tessa Bold, Ian Bolliger, Aluma Dembo, Solomon M. Hsiang, Shuhei Kitamura, Edward Miguel, Robert Pickmans
2025
Environment and Climate
ueae116.pdf

Almås, I., Auffhammer, M., Bold, T., Bolliger, I., Dembo, A., Hsiang, S. M., … & Pickmans, R. (2025). Destructive Behaviour, Judgement, and Economic Decision-making under Thermal Stress. The Economic Journal, ueae116. https://doi.org/10.1093/ej/ueae116

Accumulating evidence indicates that environmental temperature substantially affects economic outcomes and violence, but the reasons for this linkage are only partially understood. We study whether temperature directly influences behaviour by evaluating the effect of thermal stress on multiple dimensions of economic decision-making, judgement and destructive behaviour with 2,000 participants in Kenya and the United States who were randomly assigned to different temperatures in a laboratory. The main finding is that most major dimensions of economic decision-making are unaffected by temperature. We also find that heat significantly increases willingness to voluntarily destroy other participants’ assets in the Kenyan sample.

Online Appendix

Ending publication bias: A values-based approach to surface null and negative results

Stephen Curry ,Eunice Mercado-Lara ,Virginia Arechavala-Gomeza,C. Glenn Begley,Christophe Bernard,René Bernard,Stefano Bertuzzi,Needhi Bhalla,Dawn Bowers,Samuel Brod,Christopher Chambers,Michael R. Dougherty,Yensi Flores Bueso,Stefânia Forner,Alexandra L. J. Freeman,Magali Haas,Darla P. Henderson,Kanika Khanna,Rebecca Lawrence,Kif Liakath-Ali,Christine Liu,Neil Malhotra,José G. Merino,Edward Miguel,Rachel Miles,Mary Munson,Shinichi Nakagawa,Robert Nobles,Joy Owango,Michel Tuan Pham,Gina Poe,Alexandra N. Ramirez,Sarvenaz Sarabipour,Jill L. Silverman,Laura N. Smith,P. Sriramarao,Paul W. Sternberg,Geeta K. Swamy,Malú Gámez Tansey,Gonzalo E. Torres,Erick H. Turner,Lauren von Klinggraeff,Frances Weis-Garcia
2025
Research Methodology
pbio.3003368.pdf

Curry S, Mercado-Lara E, Arechavala-Gomeza V, Begley CG, Bernard C, Bernard R, et al. (2025) Ending publication bias: A values-based approach to surface null and negative results. PLoS Biol 23(9): e3003368. https://doi.org/10.1371/journal.pbio.3003368

Sharing knowledge is a basic tenet of the scientific community, yet publication bias arising from the reluctance or inability to publish negative or null results remains a long-standing and deep-seated problem, albeit one that varies in severity between disciplines and study types. Recognizing that previous endeavors to address the issue have been fragmentary and largely unsuccessful, this Consensus View proposes concrete and concerted measures that major stakeholders can take to create and incentivize new pathways for publishing negative results. Funders, research institutions, publishers, learned societies, and the research community all have a role in making this an achievable norm that will buttress public trust in science.

Can Cash Transfers Save Lives? Evidence from a Large-Scale Experiment in Kenya

Michael W. Walker, Nick Shankar, Edward Miguel, Dennis Egger, Grady Killeen
2025
African DevelopmentEducation and Human CapitalHealth
w34152.pdf

Walker, M. W., Shankar, N., Miguel, E., Egger, D., & Killeen, G. (2025, August). Can cash transfers save lives? Evidence from a large-scale experiment in Kenya (NBER Working Paper No. 34152). National Bureau of Economic Research. https://www.nber.org/papers/w34152

We estimate the impacts of large-scale unconditional cash transfers on child survival. One-time transfers of USD 1000 were provided to over 10,500 poor households across 653 randomized villages in Kenya. We collected census data on over 100,000 births, including on mortality and cause of death, and detailed data on household health behaviors. Unconditional cash transfers (accounting for spillovers) lead to 48% fewer infant deaths before age one and 45% fewer child deaths before age five. Detailed data on cause of death, transfer timing relative to birth, and the location of health facilities indicate that unconditional cash transfers and access to delivery care are complements in generating mortality reductions: the largest gains are estimated in neonatal and maternal causes of death largely preventable by appropriate obstetric care and among households living close to physician-staffed facilities and those who receive the transfer around the time of birth, and treatment leads to a large increase in hospital deliveries (by 45%). The infant and child mortality declines are concentrated among poorer households with below median assets or predicted consumption. The transfers also result in a substantial decline of 51% in female labor supply in the three months before and the three months after a birth, and improved child nutrition. Infant and child mortality largely revert to pre-program levels after cash transfers end. Despite not being the main aim of the original program, we show that unconditional cash transfers in this setting may be a cost-effective way to reduce infant and child deaths.

Midlife cognitive testing in Africa: validity of the Harmonised Cognitive Assessment Protocol in the Kenya Life Panel Survey

Alden L Gross, Madeline Duhon, Eric Ochieng, Jean N Ikanga, William H Dow, Jinkook Lee, Michael W Walker, Michelle Layvant, Anthony Ngugi, Joshua R Ehrlich, Edward A Miguel
2025
African DevelopmentHealth
e096619.full .pdf

Gross, A. L., Duhon, M., Ochieng, E., Ikanga, J. N., Dow, W. H., Lee, J., … & Miguel, E. A. (2025). Midlife cognitive testing in Africa: validity of the harmonised cognitive assessment protocol in the Kenya life panel survey. BMJ open, 15(8), e096619. https://doi.org/10.1136/bmjopen-2024-096619

Cohort studies of ageing and cognitive decline typically do not begin fielding comprehensive cognitive assessments until older adulthood. However, for identifying preventable dementia risk factors, there is strong value in beginning at earlier ages. The case is especially compelling in sub-Saharan Africa, where the number of older individuals is expected to triple in the next three decades, and where risk factors may operate more intensively at earlier ages. This study reports on the adaptation and validity of the Harmonised Cognitive Assessment Protocol (HCAP) approach in the Kenya Life Panel Survey (KLPS), collected among middle-aged respondents.

Contextualization of Harmonized Cognitive Assessment Protocol (HCAP) in an aging population in rural low-resource settings in Africa: Experiences and Strategies Adopted to Optimize Effective Adaption of Cognitive Tests in Kenya

Roselyter Monchari Riang'a, Eunice Muthoni Mwangi, Niranjani Nagarajan, Felix Agoi, Patrick N Mwangala, Alden L Gross, Jean Ikanga, Kenneth M Langa, Edward Miguel, Muthoni Gichu, Joshua R Ehrlich, Anthony K Ngugi
2025
African DevelopmentHealthOther
ALZ-21-e70552.pdf

Riang’a RM, Mwangi EM, Nagarajan N, Agoi F, Mwangala PN, Gross AL, Ikanga J, Langa KM, Miguel E, Gichu M, Ehrlich JR, Ngugi AK. Contextualization of Harmonized Cognitive Assessment Protocol (HCAP) in an aging population in rural low-resource settings in Africa: Experiences and strategies adopted to optimize effective adaption of cognitive tests in Kenya. Alzheimers Dement. 2025 Aug;21(8):e70552. doi: 10.1002/alz.70552. PMID: 40835849; PMCID: PMC12367447.

Cross-cultural adaptation of cognitive assessments is crucial for detecting Alzheimer’s disease (AD) and related dementias (ADRD) in aging populations. This study documents the adaptation of the Harmonized Cognitive Assessment Protocol (HCAP) for a pilot study on the Longitudinal Study of Health and Aging in Kenya (LOSHAK) in rural Kilifi County, Kenya, highlighting challenges and strategies for optimizing outcomes. As part of the LOSHAK feasibility phase, cognitive tests including: the Swahili Mental State Examination, 10-word recall, animal naming, story recall, clock drawing, and making change, were administered to 202 participants (≥45 years) from the Kaloleni/Rabai Health and Demographic Surveillance System (KRHDSS). Measures were adapted culturally and linguistically, and trained local enumerators conducted home-based assessments. Low literacy (60.1% had no schooling), linguistic diversity, cultural norms, and infrastructure limitations influenced assessments. Key adaptations included translation, culturally relevant modifications, flexible administration, and community engagement. Contextualized cognitive assessments improve validity in rural resource-limited settings, offering insights for future research. HIGHLIGHTS: This is a narrative qualitative study documenting the experiences and Strategies Adopted to Optimize Effective Adaption of Cognitive Tests in Longitudinal Study of Health and Aging in Kenya (LOSHAK). This article documents the adaptation and contextualization of the Harmonized Cognitive Assessment Protocol (HCAP) for a pilot study on health and aging (LOSHAK) in rural Kilifi County, Kenya, focusing on the challenges and strategies employed to optimize outcome. HCAP tests were administered as part of the feasibility and pilot phase of the LOSHAK, the aim of which was to validate measures and optimize data collection procedures. The median age of the 202 study participants was 64, with 57.4% being female. A majority (62.5%) were not currently working, and nearly 70% fell within the two poorest wealth quintiles. The rural setting presented unique challenges including: low literacy rates (60.1% of participants had no schooling), diverse language use (primarily Giriama and Swahili), limited infrastructure (e.g., 44.8% of households had electricity), restrictive cultural norms that influenced data collection (e.g., in-home interviews were often conducted outdoors with destructions). Key adaptations included: translating and culturally adapting test items (e.g., using local Swahili dialects and culturally relevant examples), recruiting and training local enumerators who were familiar with the community, culture and language, iterative pre-testing and using roleplay helped to ensure that enumerator scoring was consistent, accurate, and reliable. contextualization of tool and data collection strategies included: adjusting data collection methods to accommodate cultural practices and environmental limitations, for example, allowing respondents to use their preferred language for “animal naming,” using paper and pen for some test items for which participants experienced difficulty using tablets, paying close special attention to time and season of administration, and adopting strategies to minimize background noise and other environmental distractions (e.g., due to rain, lunch hour, planting and harvesting, and school holidays). Prior to data collection, it was essential to engage local community health volunteers (CHVs), build rapport with participants, explain the study, and describe the idiosyncrasies of cognitive testing. The study emphasizes the importance of cultural sensitivity, linguistic appropriateness, and community engagement in cognitive assessment in diverse, resource-constrained settings. The findings offer practical recommendations for researchers aiming to conduct cognitive assessments in similar populations, contributing to the development of culturally sensitive and effective tools for understanding and addressing cognitive health in aging populations.

Targeting Impact versus Deprivation

Johannes Haushofer, Paul Niehaus, Carlos Paramo, Edward Miguel, and Michael Walker
2025
African Development
haushofer-et-al-2025-targeting-impact-versus-deprivation.pdf

Haushofer, Johannes, Paul Niehaus, Carlos Paramo, Edward Miguel, and Michael Walker. 2025. “Targeting Impact versus Deprivation.” American Economic Review 115 (6): 1936–74. DOI: 10.1257/aer.20221650

A large literature has examined how best to target antipoverty programs to those most deprived in some sense (e.g., consumption). We examine the potential trade-off between this objective and targeting those most impacted by such programs. We work in the context of an NGO cash transfer program in Kenya, employing recent advances in machine learning methods and dynamic outcome data to learn proxy means tests that jointly target both objectives. Targeting solely on the basis of deprivation is not attractive in this setting under standard social welfare criteria unless the planner’s preferences are extremely redistributive.

Parent psychological well-being, home learning environment, and child development among Kenyan families

Ye Rang Park, Madeline Duhon, Kyong Ah Kwon, Amber H. Beisly, Michael Walker, Edward Miguel
2025
African Development
1-s2.0-S0193397325000073-main.pdf

Park, Y. R., Duhon, M., Kwon, K. A., Beisly, A. H., Walker, M., & Miguel, E. (2025). Parent psychological well-being, home learning environment, and child development among Kenyan families. Journal of Applied Developmental Psychology, 97, 101760. https://doi.org/10.1016/j.appdev.2025.101760

While child poverty is declining globally, many children in Sub-Saharan Africa still live in poverty and face obstacles that hinder them from achieving their full developmental potential. Parents’ psychological well-being has important influences on child development directly or indirectly through the home learning environment (HLE). Still, there is a lack of research on this topic from Sub-Saharan Africa. To fill this gap, the present study examined associations among parents’ psychological well-being, HLE, and children’s socioemotional and cognitive development, using a large sample of 1633 parents (73 % mothers, 88 % married; 38 % completed some secondary school) and their children (M age = 7.7 years) from Kenya. There were unique processes between different aspects of parents’ psychological well-being and child development: Parent depressive symptoms were directly associated with child development, whereas parent self-efficacy was directly and indirectly associated through HLE. The findings provide implications for developing family-focused preventive interventions in Sub-Saharan Africa.

Data Availability