Characterizing developing executive functions in the first 1000 days in South Africa and Malawi: The Khula Study

Zieff, Michal R., Miles, Marlie, Mbale, Emmie, Eastman, Emma, Ginnell, Lorna, Williams, Steven C. R., Jones, Derek K. ORCID: https://orcid.org/0000-0003-4409-8049, Alexander, Daniel C., Wijeratne, Peter A., Gabard-Durnam, Laurel J., Klepac-Ceraj, Vanja, Bonham, Kevin S., Pini, Nicolò, Sania, Ayesha, Lucchini, Maristella, Deoni, Sean, Fifer, William P., Gladstone, Melissa, Amso, Dima and Donald, Kirsten A. 2026. Characterizing developing executive functions in the first 1000 days in South Africa and Malawi: The Khula Study. Wellcome Open Research 9 , 157. 10.12688/wellcomeopenres.19638.2

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Abstract

Background: The term ‘executive functions’ (EFs) refers to a set of skills that support flexible control over thought and action. Emerging EFs in early childhood are valuable for predicting school readiness and academic achievement. Understanding the developing brain and cognitive developmental dynamics that set the stage for the development of EFs in the first three years of life is crucial for developing programming that supports healthy EF development. The Khula Study is a multi-modal, multi-site, longitudinal birth cohort study designed to characterise emerging EFs in the first 1000 days of life. To date, few studies have been conducted in low- and middle-income countries, which comprise most of the world’s child population. Understanding and supporting EF development has global importance, but this must be done with the understanding that EFs are skills that develop within the context of adaptation to one’s environment. Methods: We describe the overall design of the Khula Study, methods of specific modalities of data collection, and characteristics of the sample. We enrolled 394 women (84% antenatally) from clinics in Gugulethu in Cape Town, South Africa and 507 mothers (42% antenatally) from Blantyre, Malawi. We collected baseline data, including measures of sociodemographics, mental health, substance use, and exposure to violence and social support. We contacted participants telephonically between enrolment and the first postnatal study visit to capture children’s dates of birth and biological sex. Results: Baseline data revealed the presence of different risk and protective factors that may affect EF development in South Africa and Malawi, including perinatal depression and intimate partner violence. Conclusions: The longitudinal, multidimensional design of the study will richly characterise this sample over time. Baseline data show both similarities and differences in the sociodemographic contexts in which children grow and develop across these two cultural and environmental contexts in sub-Saharan Africa.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Psychology
Publisher:	Taylor and Francis
ISSN:	2398-502X
Last Modified:	27 May 2026 11:15
URI:	https://orca.cardiff.ac.uk/id/eprint/187237

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