Caregiver Early Child Development Training for Preventing Konzo from Toxic Cassava in the DR Congo

刚果民主共和国的看护者早期儿童发展培训，以防止 Konzo 接触有毒木薯

• 批准号: 10017701
• 负责人: Michael Joseph Boivin
• 金额: $ 16.01万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-12 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017701
• 关键词: 4 year old; Adherence; Affect; Africa; Age; Age-Years; Anxiety; Area; Attention; Biological Markers; Caregivers; Central Africa; Child; Child Development; Chronic; Clinical Trials; Collaborations; Color; Communicable Diseases; Communities; Community Health Aides; Congo; Consumption; Cyanides; Democratic Republic of the Congo; Development; Developmental Delay Disorders; Developmental Disabilities; Disease; Disease Outbreaks; Eating; Economics; Educational Curriculum; Educational Intervention; Enrollment; Environment; Environment and Public Health; Exposure to; Flour; Food; Force of Gravity; Funding; HIV; Health; Household; Human; Human Milk; Infant; Intelligence; Intervention; Language; Learning; Manihot; Measures; Mediating; Medical; Mental Health; Methods; Mothers; Neurocognition; Neuropsychology; Nutritional; Outcome; Oxidants; Population; Poverty; Process; Program Development; Public Health; Randomized; Randomized Controlled Trials; Research; Research Infrastructure; Risk; Risk Factors; Rural; Sahara; School-Age Population; Serum; Severities; Social Development; Source; Specialist; Testing; Thiocyanates; Training; Training Programs; Uganda; Weaning; Well in self; Western Africa; Woman; Work; arm; base; brain behavior; burden of illness; caregiver depression; caregiver education; caregiver functioning; caregiver interventions; caregiving; cognitive development; cohort; comparison intervention; critical period; cyanogen; deprivation; disability; early childhood; emotional functioning; empowered; evidence base; follow-up; food preparation; improved; innovation; nervous system disorder; neurodevelopment; neurotoxicity; peer; prevent; programs; skills; urinary; vigilance; visual tracking

Project Summary Konzo is a neurological disease associated with chronic reliance on poorly processed cyanogenic cassava as the main source of food. We found that school-age children from konzo areas present with poor neurocognition compared to those from nearby non-konzo areas, persisting and worsening even 4 years after initial assessment. Our most recent work has extended these findings to children as young as a year in age, suggesting that the neurodevelopmental impact from cassava cyanide neurotoxicity may begin as soon as children are weaned from breast milk to cassava porridge. The “wetting method (WTM)” is a simple and effective method of detoxifying cassava flour prior to eating that is being taught to rural women in a clinical-trial study by our group in the Democratic Republic of Congo (DRC). The present proposal seeks to combine a curriculum of mediational intervention for sensitizing caregivers (MISC) with a WTM training program (MISC/WTM). MISC is an early childhood development (ECD) caregiver training program previously demonstrated in clinical trials by Boivin and colleagues to improve health, neurodevelopmental, and caregiver mental health outcomes in rural Ugandan HIV-affected households. Training 66 randomly selected moms from a cohort of 100 on MISC/WTM (while the remaining 34 get WTM only) will better sensitize mothers to their children’s development, leading to better WTM adherence while providing practical ECD benefits. Specific Aims 1. To establish the feasibility of adding a biweekly 1-year MISC/WTM training program for mothers and their 1 through 4 year-old children, led by peer trainers from the community. MISC has been previously implemented for HIV-affected households in Uganda, but not for konzo communities in the DRC. Study Aim 2. To document whether better adherence to WTM through MISC will lead to lower household flour cassava cyanogenic content and lower urinary thiocyanate (U-SCN) levels in the mother/child dyads. We will also test for improved child outcomes on the Fagan Test of Infant Intelligence (with automated eye tracking), Mullen Scales of Learning (MSEL), the Early Childhood Vigilance Test of attention (ECVT; eye tracking), and the Color-Object Association Test (COAT). Caregiver depression/anxiety and corresponding functionality for activities of daily caregiving should also significantly improve. Specific Aim 3. To explore whether reductions in cyanogenic exposure from cassava and improved child’s neurodevelopmental outcomes are mediated by improvements in caregiver emotional wellbeing and caregiving functionality immediately post MISC intervention and at 6-month follow-up. Overall Impact. Our DRC/USA partnerships will be the first to implement an evidence-based ECD program for at-risk children in the DR Congo, strengthening DRC Ministry of Health efforts to prevent konzo. If MISC strengthens the programmatic efforts to prevent konzo, the public health impact will be enormous, given the scope of risk in toxic-cassava dependent populations throughout central/western Africa. MISC could then also be used for children at ECD risk from other infectious diseases.

项目总结