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Although valid and reliable outcomemeasures exist for evaluating the management of children with Spina Bifida(SB), most of them were validated for American children and are not easilyapplicable in developing countries. Consequently, outcomes of interventionsgiven to children with SB in Zambia are not well known. Therefore, the currentstudy set out to develop and evaluatethe psychometric properties of a new measure titled, ‘Zambia Spina Bifida Functional Measure’ (ZSBFM) that can be usedto evaluate the impact of the interventions in children with SB.   Aretrospective study (2001-2010) was executed to identify functional domains ofcare that were considered essential in the management of children with SB andhydrocephalus. Subsequently, semi-structured interviews(n=20) and focus group discussions (n=20) of youths and parents/caregivers of children with SB were conducted foritem generation. Face and content validity (n=12),followed by item-content congruence evaluation (n=3) were carried out to validate the items. Test-retest (n=47) and inter-rater (n=40) assessments were then carried outto evaluate the stability of the measure. Consequently, exploratory factoranalysis (EFA) (n=231) was conductedto examine the construct validity.   Thefunctional domains of care identified from the records of 1,400 children withSB and hydrocephalus were self-care,mobility and social function, andthese led to the generation of 78items. Face and content validity showed excellent internal consistency(α=0.99),while the results of item-congruence exercise suggested removal of 1 item. The outcomes of the evaluations ofboth test-retest (n=47; α=0.99;Intra-class Correlation Coefficient (ICC) range: 0.74 to 1.00) and inter-rater (n=40; α=0.99; ICC range: 0.66 to 1.00) reliability showed that the developedmeasure has excellent internal consistency (p< 0.05). Considering the prioriset for analysis with 0.65 as the minimum adopted ICC, 76 items (99%) had excellent reliability, while 1 item (1%) had good reliability duringthe test-retest evaluation. For the inter-rater study, 62 items (81%) had excellent reliability, 8 items (10%) good reliability and 7 items (9%) had poor reliability, and these were recommended forremoval.Results of the EFA analyses using the PrincipleAxis Factoring on a 3-factor modelshowed that 9factors were yielded. A total of 65 items were extracted, giving a retention rate of 93% from the 70-item research version. The factor loadings ranged from 0.514 to 0.938, 0.618 to 0.889 and0.577 to 0.924 in self-care, mobility and social function respectively. The variance for each of the 3respective domains accounted for 74.11%,77.47% and 84.25%.Thechronbach’s alpha of the 3 domainsranged from 0.969 to 0.974, indicative of excellent internalconsistency. The internal consistency of the overall instrument (n=231; α=0.99)was excellent (p < 0.001).The ZSBFM demonstratedexcellent reliability and construct validity. The measure is stable and can beused to evaluate the impact of interventions in children with SB aged 6 months to 5 years in Zambia, and possibly in some other sub-Saharan Africancountries. Future studies are recommended to test the measure forresponsiveness to change and other forms of validity studies.