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

项目摘要 Konzo是一种神经系统疾病，与长期依赖加工不良的生氰木薯有关， 食物的主要来源。我们发现konzo地区的学龄儿童神经认知能力较差 与附近非konzo地区的患者相比，在初次发病后4年仍持续恶化， 考核我们最近的工作将这些发现扩展到了一岁的儿童， 这表明木薯氰化物神经毒性对神经发育的影响可能开始 儿童断奶后就开始喝木薯粥。“润湿法（WTM）”是一种简单且 在一项临床试验中，正在向农村妇女传授食用木薯粉前解毒的有效方法 我们在刚果民主共和国（DRC）的研究。本建议旨在将联合收割机 通过WTM培训计划，为提高护理人员的敏感性提供中介干预课程 (MISC/WTM）。MISC是一个早期儿童发展（ECD）照顾者培训计划， Boivin及其同事在临床试验中证明， 乌干达农村受艾滋病毒影响家庭的心理健康结果。培训66名随机挑选的母亲， 一个100人的MISC/WTM队列（其余34人仅接受WTM）将更好地使母亲对他们的 儿童的发展，导致更好地遵守WTM，同时提供实际的幼儿发展好处。具体 目标1.确定为母亲增加一个为期一年的双周MISC/WTM培训方案的可行性， 他们的1至4岁的孩子，由来自社区的同伴培训师领导。MISC此前曾 在乌干达，对受艾滋病毒影响的家庭实施了这一方案，但在刚果民主共和国，对konzo社区没有实施。研究目的 2.记录通过MISC更好地遵守WTM是否会导致家庭面粉木薯产量降低 母/子二联体中的生氰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（自动眼动跟踪）中的结果，马伦 学习量表（MSEL），儿童早期注意力警戒测试（ECVT;眼动追踪），以及 颜色物体联想测验（COAT）。护理人员抑郁/焦虑和相应的功能 日常生活活动也会明显改善。具体目标3。为了探索减少 在氰暴露于木薯和改善儿童的神经发育结果是介导的 MISC后立即改善护理人员的情绪健康和护理功能 干预和6个月随访。整体影响。我们的刚果民主共和国/美国伙伴关系将是第一个 为刚果民主共和国的高危儿童实施循证幼儿发展方案，加强刚果民主共和国教育部 卫生部努力防止konzo。如果MISC加强预防konzo的方案努力， 考虑到整个地区依赖有毒木薯的人群的风险范围，健康影响将是巨大的 中部/西部非洲。然后，MISC也可以用于因其他传染病而面临幼儿发展风险的儿童。

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.