About

Peter C. Rockers is an Associate Professor in the Department of Global Health at the Boston University School of Public Health. He is also the Director of the Global Health Program Design, Monitoring, and Evaluation certificate program. His research primarily focuses on evaluating the impacts of health system strengthening interventions and policies in low- and middle-income countries using experimental methods. He has a particular interest in interventions aimed at improving early childhood development outcomes in high poverty settings. Dr. Rockers is involved in efforts to enhance how the biopharmaceutical industry measures and reports on issues related to access.

Research topics

• Sociology
• Environmental health
• Social Science
• Medicine
• Biology
• Geography
• Microbiology
• Agricultural economics
• Business
• Economic growth
• Family medicine
• Nursing
• Economics

Selected publications

• Predictors of saccadic reaction time among young children in Lusaka, Zambia

  PLoS ONE · 2026-03-26

  articleOpen accessSenior author

  Saccadic reaction time (SRT), an assessment of visual processing speed, may afford an accurate and unbiased measure of early childhood development (ECD). Few studies have examined SRT in low- and middle-income countries (LMICs), including its drivers. We sought to identify predictors of SRT as well as to assess the correlation between SRT and concurrent measures of ECD [Global Scales of Early Development (GSED) development-for-age Z-score (DAZ), height-for-age Z-score (HAZ), and head circumference-for-age Z-score (HCZ)], among young children in Lusaka, Zambia. We conducted a sub-study among 299 Lusakan children participating in a 2x2 cluster-randomized trial. SRT was assessed at ~31 months using a screen-based setup with a Tobii Pro Fusion tracker. Associations with household, caregiver, and child characteristics were assessed using univariable regression models; predictors significant at the p < 0.20 level were retained in a multivariable model. Pearson correlation coefficients were calculated to assess associations between SRT and other concurrent measures of ECD. In the multivariable model, characteristics found to be significant predictors of SRT included: being the only child <5 in the household at baseline (β: -10.02, 95% CI: -19.71, -0.33, p = 0.04), length-for-age Z-score (LAZ) at baseline (β: -3.17, 95% CI: -6.31, -0.04, p = 0.047), consuming ≥4 food groups in the past day (β: -10.42, 95% CI: -19.98, -0.86, p = 0.03), and having diarrhea in the past 2 weeks (β: 12.38, 95% CI: 0.71, 24.06, p = 0.04). SRT was significantly negatively correlated with HAZ (-0.176, p < 0.01) and HCZ (-0.132, p < 0.05), but not GSED DAZ. Overall, we identified several significant predictors of SRT among young children in Lusaka, Zambia, including birth spacing, baseline LAZ, dietary diversity, and diarrheal disease. Further research is needed, including in different age groups and geographic locations, to better understand the drivers of slow SRT, and poor ECD generally, in LMICs.

  PublisherDOI

• Breastfeeding, the Gut Microbiome, and Growth among Infants in Lusaka, Zambia

  Journal of Nutrition · 2025-10-23

  article
  PublisherDOI

• Infant EEG power predicts early childhood language and motor skills in a rural South African cohort

  Global Pediatrics · 2025-10-05

  articleOpen access

  • Children in LMIC contexts are at high risk for not meeting developmental milestones. • We assessed infant EEG power and later development in a rural South Africa. • Infant EEG power was linked with language and motor skills at 17 and 36 months. • EEG power may predict individual differences in language and motor development in LMIC settings. Early neural development underlies fundamental behavioral outcomes. In low- and middle-income countries (LMICs), healthy development is often perturbed by compounded adversities, yet little is known about the neural mechanisms driving these trajectories. The current study explores the relationship between infant EEG power and early childhood developmental outcomes at two timepoints in the Greater Tzaneen subdistrict, Mopani district, Limpopo Province, South Africa. In a sample of 242 children, we assessed how EEG relative power at seven months related to development at 17 and 36 months. Increased left hemisphere theta band activity (4–6 Hz) predicted lower caregiver-reported language and motor skills, and increased left hemisphere beta activity (13–30 Hz) predicted reported motor skills at 17 months. Increased infant gamma power (30–48 Hz) in the left hemisphere was associated with higher observed language and gross motor skills at 36 months. Results suggest that early neural oscillations have small but consistent associations with later language and motor skills in a LMIC context.

  PublisherDOI

• Qualitative application of the diffusion of innovation theory to maternity waiting homes in rural Zambia

  Implementation Science Communications · 2025-02-04 · 1 citations

  articleOpen access

  BACKGROUND: Understanding factors affecting adoption of an innovation is critical to its long-term success. Maternity waiting homes (MWHs) increase access to facility-based delivery in low-resourced settings; yet, quality issues deter utilization of this innovative approach. We sought to understand how attributes that are thought to promote diffusion of innovations (e.g., relative advantage, compatibility, observability, complexity, etc.) affected MWH use after implementation of an improved quality MWH model in rural Zambia compared to standard of care. METHODS: We conducted 158 in-depth interviews (IDIs) with randomly selected rural-living women who had delivered a baby in the prior 12 months. Half lived in catchment areas where new quality MWHs were constructed, half in catchment areas with standard of care (ranging from low quality community structures to no MWH). We applied content analysis to identify themes. RESULTS: Utilization of MWHs was higher among intervention (65.4%) than control women (42.5%). Respondents in both study arms perceived relative advantages to pregnant women staying at MWHs compared to going directly to health facilities when labor begins. MWH stays allowed for clinical staff to routinely check on and educate women, and address complications immediately. Compatibility of the homes with cultural values and needs depended on implementation. While some women from intervention sites complained about overcrowding, women in control sites more often perceived the lack of cleanliness, amenities, and safety as deterrents to utilization. Women at intervention sites received sensitization about MWHs from a wider range of sources, including traditional leaders. Required preparations needed to stay at MWHs (e.g. delivery supplies, food, and childcare) made adoption complex and may have deterred utilization. CONCLUSIONS: The improved MWH model addressed most community concerns around quality. Having opinion leaders who communicate the relative advantage of MWHs to pregnant women and their social networks may facilitate MWH utilization. The complexity of decisions and resources needed to stay at MWHs remains a critical barrier to use. To facilitate equitable adoption of MWHs among the most vulnerable women, planners should explore how to support women during their delivery preparations and MWH stays, particularly regarding food security and lack of social support for childcare. TRIAL REGISTRATION: clinicaltrials.gov, NCT02620436, Registered 02 December 2015, https://clinicaltrials.gov/study/NCT02620436?term=NCT02620436&rank=1.

  PublisherOA PDFDOI

• Traditional beliefs and practices surrounding pregnancy loss in Limpopo Province, South Africa

  Social Science & Medicine · 2025-08-21 · 1 citations

  articleOpen access

  South Africa has a diversity of traditional beliefs and practices within its existing sub-cultures which include complex belief patterns around women’s sexual and reproductive health, including pregnancy loss (i.e. abortion or miscarriage). Causes of pregnancy loss among the different cultures can be attributed broadly to ancestors, bewitchment, and ritual pollution. However, of these factors, ritual pollution has not been adequately researched. This study sought to examine current beliefs and practices surrounding a traditional illness called Go wela in Limpopo, South Africa. A total of 95 participants were recruited and interviewed. Audio-recordings were transcribed verbatim, translated into English, and then thematically analysed. Go wela is an illness that men receive from sexual intercourse with a woman who is “unclean” after a pregnancy loss. It was recommended that treatment of Go wela must happen with the aid of a traditional healer relatively quickly after the man is impacted, otherwise the condition could be fatal. Traditional illnesses are perceived as spiritual or cultural afflictions requiring interventions beyond biomedical care, emphasizing the interplay between cultural practices, spirituality, and maternal health. Illnesses such as Go wela have a significant impact on individuals in the way they conceive disease and health and consequently seek care. As very little research has examined these questions, more studies are needed to examine how ritual pollution-related illnesses impact public health for individuals and their communities. • Pregnancy loss can be attributed to “ritual pollution” • This is when women are ritually “unclean” and can transmit illness via sex • These traditions involve complex belief patterns around women’s reproductive health • Traditional illnesses are spiritual afflictions outside of biomedical care • They emphasize the interplay between cultural practices, spirituality, and health

  PublisherDOI

• Physiological Markers of Early Social Skills in Rural South Africa: The Role of Frontal Alpha Asymmetry and Heart Rate Variability

  Developmental Psychobiology · 2025-12-29

  article

  Early social skills underlie the development of crucial regulatory and behavioral processes across childhood. EEG frontal alpha asymmetry and heart rate variability are two physiological markers that have been extensively studied in relation to social skills in high-income country (HIC) samples. The prevalence of adversities in low- and middle-income countries (LMICs) is linked to pervasive deficits in early social skills, yet little is known about the role of physiology in contributing to these processes. The current study explores two physiological measures across two timepoints in relation to social skills in a rural, low-resourced context. In a sample of 229 young children from Greater Tzaneen, South Africa, we assessed how both frontal alpha asymmetry and change in heart rate variability from 17 to 36 months related to 36-month social skills. Left frontal asymmetry predicted poorer social skills, while greater increase in heart rate variability across timepoints predicted higher social skills, especially in children displaying right-lateralized asymmetry. Findings extend work from HICs to a LMIC context, suggesting potential implications for later mental health challenges, while identifying autonomic maturation as a possible protective factor in low-resource settings for specific neurophysiological profiles.

  PublisherDOI

• Early Emerging Gradients in Children's Eye Movement Times Across Levels of Household Resources

  Developmental Science · 2025-08-12

  articleOpen accessSenior author

  Studies in low-resource settings suggest that multiple aspects of early childhood development are sensitive to the relative poverty of a child's environment. We examined whether direct, quantitative measures of early developing cognitive functions show a similar association with relative poverty. Eye movement latencies were recorded in children at 7, 17, and 36 months in rural South Africa (N = 374). The latency to respond to the appearance of visual objects was inversely associated with a proxy measure of the child's socioeconomic environment (household asset ownership), with longer latencies observed in children from households with less asset-based resources. This gradient was detectable at 7 months, increased between 7 and 36 months, was not explained by differences in prior exposure to screens, and generalized to the latency of eye movements towards socially cued objects (i.e., pointing gestures that directed the child's attention to a specific object). Physical growth (height-for-age) and developmental milestone scores were lower in children from households with less resources. The results were replicated in an analysis of independent data from 31-month-old children collected in Zambia (N = 270). The results provide novel evidence for early emerging gradients in behaviors that are universal and mechanistically involved in learning and skill formation. SUMMARY: Eye tracking was used to assess whether the early development of elementary visual behaviors is associated with the relative poverty of the environment in low-resource settings. Eye movement latencies to the onset of visual stimuli were longer in children from relatively poorer environments, with suggestive evidence for a steepening of this gradient over early childhood. A similar gradient across poverty levels was seen in eye movement latencies to dynamic social spatial cues (gaze and hand gestures) This study provides novel, quantitative evidence for very early-emerging gradients in behaviors that are essential for adaptive functioning and learning across all environments.

  PublisherOA PDFDOI

• Bantu on the brain: Community-informed adaptations of the Macarthur-Bates Communication Development Index to contemporary Zambian languages using item response theory

  medRxiv · 2025-06-05

  preprintOpen access

  Abstract The MacArthur-Bates Communication Development Inventories (MB-CDI) are a widely used set of tools to assess language acquisition in early childhood. Although it has been adapted in 120 languages, there is not a linguistic nor culturally congruent tool for any of the 72 Zambian Bantu languages. This manuscript describes the process to adapt the MB-CDI for two of the most spoken languages in Zambia: Nyanja and Bemba. Using mixed-methods with caregivers of children aged 16 to 30 months in Lusaka, Zambia, we have constructed two Bantu-language adaptations of the MD-CDI: Words and Sentences short form. Two focus group discussions of caregivers were conducted, one in Nyanja (n=10) and one in Bemba (n=10). The goal of the focus groups was to generate a list of commonly heard words in early childhood. Facilitators then administered individual assessment surveys to Bemba (n=77) and Nyanja (n=109) caregivers to determine which words from the generated lists their child (aged 16-30 months) had acquired in productive speech. We then fitted a 2-parameter item response theory model to our data to reflect 100 words, characterized by a range of difficulty and highest ability to effectively distinguish between different levels of language proficiency. Our adapted MB-CDI for Bemba and Nyanja is a language acquisition assessment tool for ages 16-30 months to measure language development in the two most spoken Bantu languages in Zambia.

  PublisherOA PDFDOI

• Working across religions, cultures, settings, and development: Protocol for wave 2 data collection with children and parents by the developing belief network

  PLoS ONE · 2025-09-05 · 2 citations

  articleOpen accessCorresponding

  The Developing Belief Network is a global research collaborative studying religious development in diverse social-cultural settings, with a focus on the intersection of cognitive mechanisms and cultural beliefs and practices in early and middle childhood. The current manuscript describes the study protocol for the network's second wave of data collection, which aims to further explore the development and diversity of religious cognition and behavior using a multi-time point approach. This protocol is designed to investigate three key research questions-how children represent and reason about religious and supernatural agents, how children represent and reason about religion as an aspect of social identity, and how religious and supernatural beliefs are transmitted within and between generations-via a set of eight tasks for children between the ages of 5 and 13 years and a survey completed by their parents/caregivers. This study is being conducted in 41 distinct cultural-religious settings, spanning 16 countries and 12 written languages. In this manuscript, we provide detailed descriptions of all elements of this study protocol, and give a brief overview of the ways in which this protocol has been adapted for use in diverse religious communities. As one example of how this protocol has been implemented outside of the United States, we present Arabic- and English-language study materials for children being raised in one of the following religious traditions in Lebanon: the Druze faith, Maronite Christianity, Orthodox Christianity, Shia Islam, or Sunni Islam. We end with reflections on the challenges of developing and implementing large-scale, multi-site, multi-time point studies of child development; our approach to navigating these challenges; and our suggestions for how future researchers might learn from our experiences and build on the work presented here.

  PublisherOA PDFDOI

• Implementation fidelity of a multisite maternity waiting homes programme in rural Zambia: application of the conceptual framework for implementation fidelity to a complex, hybrid-design study

  BMJ Public Health · 2025-01-01 · 2 citations

  articleOpen access

  Background: Implementation fidelity measures are critical for understanding complex interventions. Though maternity waiting homes (MWHs) are recommended by the WHO and have been used to help pregnant women access health facilities for decades, a gap exists regarding fidelity studies on MWHs. To better understand intervention outcomes results, we assessed the fidelity of implementation of an improved Core MWH Model in 10 facilities in rural Zambia. Methods: We analysed indicators for fidelity employing a widely used conceptual framework. We compared performance from October 2016 to July 2018 to goals set out during intervention design. The Core MWH Model consists of three pillars-infrastructure, policies and linkages to care-each designed to be culturally appropriate and responsive to community standards for safety and comfort. Results: 70% of sites exhibited high adherence to the Core MWH Model components. User experience corroborated poorer performing elements: insufficient lighting, small cooking spaces, non-locking cabinets and few educational classes. Mission statements and governing documents were not always visible or available. The proportion of 3206 users who came from>10 km away was higher than the proportion of the surrounding population living at that distance except in two sites with low populations of remote-living women. Women stayed for just below the target of 14 nights. MWH occupancy rate overall was lower (52%) than the target (80%). MWH users reported high quality and satisfaction. Only three MWHs reached 50% female membership on their governance committees but met other key indicators for community ownership and engagement. Conclusions: This fidelity evaluation of an MWH model in rural Zambia helps bridge the evidence-practice gap for the WHO's recommendation on implementing MWHs and adds to the expanding body of literature on implementation fidelity studies in global health. Trial registration number: NCT02620436.

  PublisherOA PDFDOI

Frequent coauthors

• Günther Fink

  Swiss Tropical and Public Health Institute

  69 shared

• Davidson H. Hamer

  Boston University

  36 shared

• Richard Laing

  35 shared

• Margaret E. Kruk

  Harvard Global Health Institute

  35 shared

• Till Bärnighausen

  University Hospital Heidelberg

  33 shared

• Veronika J. Wirtz

  Boston University

  27 shared

• Sandro Galea

  Boston University

  24 shared

• Nancy A. Scott

  Boston University

  18 shared