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.
Early childhood (1 through 4 yrs) is a period of dramatic developmental change that can be seriously compromised by exposure to toxic cyanogenic cassava (konzo disease), with potentially great impact throughout central and western sub-Sahara Africa in regions dependent on this food staple. In the face of ongoing economic instability and nutritional, medical and educational deprivation affecting communities at risk for konzo in the Democratic Republic of Congo, no programs exist for sustaining a favorable developmental milieu for young children. By establishing the viability of caregiver training intervention to enhance functionality among caregivers and improve caregiving quality while preventing konzo, this project can benefit neurodevelopment for tens of millions of at-risk children.
