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

项目摘要 Konzo是一种神经疾病，与长期依赖加工不良的生氰木薯作为 它是食物的主要来源。我们发现，来自康佐地区的学龄儿童神经认知能力较差。 与来自附近非Konzo地区的人相比，即使在最初的4年后，他们的病情仍在持续和恶化 评估。我们最新的工作将这些发现扩展到一岁以下的儿童， 提示木薯氰化物神经毒性对神经发育的影响可能最早开始于 孩子们从母乳到木薯粥断奶。湿润法(WTM)是一种简单的 在临床试验中向农村妇女传授的食用前木薯面粉解毒的有效方法 我们小组在刚果民主共和国(刚果民主共和国)进行的研究。目前的提案试图将一个 通过WTM培训计划为照顾者提供敏感的调解干预课程(MISC (MISC/WTM)MISC是以前的儿童早期发展(ECD)照顾者培训计划 Boivin和他的同事在临床试验中展示了改善健康、神经发育和照顾者的能力 乌干达受艾滋病毒影响的农村家庭的心理健康状况。培训66名随机挑选的母亲 接受MISC/WTM治疗的100人(其余34人只接受WTM治疗)将更好地让母亲意识到他们的 儿童发展，导致更好地遵守WTM，同时提供实际的幼儿发展惠益。特定的 目标1.确定为母亲和妇女增加为期一年的MISC/WTM培训方案的可行性 他们1到4岁的孩子，由社区的同龄人培训师带领。MISC在此之前 在乌干达受艾滋病毒影响的家庭中实施，但不在刚果民主共和国的Konzo社区实施。研究目的 2.记录通过MISC更好地遵守WTM是否会降低家用面粉木薯 母亲/孩子二人组中的氰化物含量和较低的尿硫氰酸盐(U-SCN)水平。我们还将测试 为了改善儿童在费根婴儿智力测试(带有自动眼球跟踪)中的成绩，马伦 学习量表(MSEL)、早期儿童注意力警觉性测试(ECVT；眼球跟踪)和 颜色-对象关联性测试(外套)。照顾者抑郁/焦虑和相应的功能 日常照料活动也应显著改善。具体目标3.探讨减排是否 木薯中的氰化物暴露和改善儿童的神经发育结果是通过 MISC后立即改善照顾者的情绪幸福感和照看功能 并进行干预和6个月的随访。整体影响。我们的刚果民主共和国/美国合作伙伴关系将是第一个 为刚果(金)高危儿童实施循证幼儿发展计划，加强刚果部 预防康佐的卫生努力的一部分。如果MISC加强方案努力，防止Konzo，公众 考虑到有毒木薯依赖人群的风险范围，对健康的影响将是巨大的 非洲中部/西部。然后，MISC也可以用于患有其他传染病的ECD风险儿童。

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.