Effects on brain development leading to cognitive impairment: a worldwide epidemic

Optimal Method for Fetal Brain Age Prediction Using Multiplanar Slices From Structural Magnetic Resonance Imaging

The accurate prediction of fetal brain age using magnetic resonance imaging (MRI) may contribute to the identification of brain abnormalities and the risk of adverse developmental outcomes. This study aimed to propose a method for predicting fetal brain age using MRIs from 220 healthy fetuses between 15.9 and 38.7 weeks of gestational age (GA). We built a 2D single-channel convolutional neural network (CNN) with multiplanar MRI slices in different orthogonal planes without correction for interslice motion. In each fetus, multiple age predictions from different slices were generated, and the brain age was obtained using the mode that determined the most frequent value among the multiple predictions from the 2D single-channel CNN. We obtained a mean absolute error (MAE) of 0.125 weeks (0.875 days) between the GA and brain age across the fetuses. The use of multiplanar slices achieved significantly lower prediction error and its variance than the use of a single slice and a single MRI stack. Our 2D single-channel CNN with multiplanar slices yielded a significantly lower stack-wise MAE (0.304 weeks) than the 2D multi-channel (MAE = 0.979, p < 0.001) and 3D (MAE = 1.114, p < 0.001) CNNs. The saliency maps from our method indicated that the anatomical information describing the cortex and ventricles was the primary contributor to brain age prediction. With the application of the proposed method to external MRIs from 21 healthy fetuses, we obtained an MAE of 0.508 weeks. Based on the external MRIs, we found that the stack-wise MAE of the 2D single-channel CNN (0.743 weeks) was significantly lower than those of the 2D multi-channel (1.466 weeks, p < 0.001) and 3D (1.241 weeks, p < 0.001) CNNs. These results demonstrate that our method with multiplanar slices accurately predicts fetal brain age without the need for increased dimensionality or complex MRI preprocessing steps.

Spatial variations and determinants of anemia among under-five children in Ethiopia, EDHS 2005-2016

Background

Anemia has severe public health significance in sub-Saharan Africa. In Ethiopia, anemia has been increasing in the last two decades, reaching the highest national level in 2016, however, the geospatial distribution and determinants of anemia in children weren’t well explored at a national level.

Methods

We used the Ethiopian Demographic and Health Survey(EDHS) data from 2005–2016. The data consists of samples of households (HHs) obtained through a two-stage stratified sampling procedure. Our analysis included 19,699 children. Descriptive statistics, geospatial analysis, and Generalized Linear Mixed Model (GLMMs) were used.

Results

The overall prevalence of anemia was 51.5%; the spatial distribution of anemia significantly different across clusters in each survey. Children from 6 to 11 months had higher odds of anemia compared to 24–59 months (Adjusted Odds ratio (AOR) = 3.4, 95%Confidence level (CI): 2.99–3.76). Children with the first and second birth order were less likely to be anemic compared to fifth and above (AOR = 0.60, 95%CI: 0.38–0.95, and AOR = 0.83, 95%C: 0.73–0.93) respectively. Mothers’ age 15 to 24 years was associated with higher odds of anemia compared to 35 to 49 years (AOR = 1.37, 95%CI: 1.20–1.55). Children from HHs with the poorest and poorer wealth category showed a higher odds of anemia compared to the richest (AOR = 1.67, 95%CI: 1.45–1.93, and AOR = 1.25, 95%CI: 1.08–1.45) respectively. Moreover, children from HHs with one to two under-five children were less likely to be anemic compared to those three and more (AOR = 0.83, 95%CI: 0.76–0.91).

Conclusions

The geospatial distribution of anemia among children varies in Ethiopia; it was highest in the East, Northeast, and Western regions of the country. Several factors were associated with anemia; therefore, interventions targeting the hotspots areas and specific determinant factors should be implemented by the concerned bodies to reduce the consequences of anemia on the generation.

"We can't handle things we don't know about": perceived neurorehabilitation challenges for Malawian paediatric cerebral malaria survivors

BACKGROUND

We sought to identify perceptions of neurorehabilitation challenges for paediatric cerebral malaria (CM) survivors post-hospital discharge at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi.

METHODS

An exploratory approach was used to qualitatively investigate the perceived neurorehabilitation challenges for paediatric CM survivors. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs). Eighteen data-gathering sessions were conducted with 38 total participants, including 3 FGDs with 23 primary caregivers, 11 IDIs with healthcare workers at QECH, and 4 IDIs with community-based rehabilitation workers (CRWs).

RESULTS

FGDs revealed that caregivers lack important knowledge about CM and fear recurrence of CM in their children. Post-CM children and families experience substantial stigma and sociocultural barriers to integrating into their community and accessing neurorehabilitative care. At a community-level, rehabilitation infrastructure, including trained staff, equipment, and programmes, is extremely limited. Rehabilitation services are inequitably accessible, and community-based rehabilitation remains largely unavailable.

CONCLUSIONS

There is an urgent need to establish further training of rehabilitation personnel at all levels and to build accessible rehabilitation infrastructure in Malawi for post-CM patients. Additional work is required to expand this study across multiple regions for a holistic understanding of neurorehabilitation needs.

Effects of maternal stress and nutrient restriction during gestation on offspring neuroanatomy in humans

Cognitive and mental health are major determinants of quality of life, allowing integration into society at all ages. Human epidemiological and animal studies indicate that in addition to genetic factors and lifestyle, prenatal environmental influences may program neuropsychiatric disorders in later life. While several human studies have examined the effects of prenatal stress and nutrient restriction on brain function and mental health in later life, potentially mediating effects of prenatal stress and nutrient restriction on offspring neuroanatomy in humans have been studied only in recent years. Based on neuroimaging and anatomical data, we comprehensively review the studies in this emerging field. We relate prenatal environmental influences to neuroanatomical abnormalities in the offspring, measured in utero and throughout life. We also assess the relationship between neuroanatomical abnormalities and cognitive and mental disorders. Timing- and gender-specific effects are considered, if reported. Our review provides evidence for adverse effects of an unfavorable prenatal environment on structural brain development that may contribute to the risk for cognitive, behavioral and mental health problems throughout life.

Sewage Effluent Causes Metal Pollution of a Sub-tropical River System in Zimbabwe

Metal pollutants are persistent in the environment and of concern to human health. The aim of the study was to assess the distribution of metals (Cr, Fe, Pb, Mg and Cu) in Sebakwe River. Water and sediment samples were collected from upstream reference sites (4 and 5) and influenced downstream sites (1, 2 and 3) of the sewage effluent discharge point. Pb concentrations in water were significantly higher (p < 0.05) in sites 1 and 2 downstream of the sewage discharge point. In the sediments, the sites downstream of the effluent discharge point had significantly higher concentrations of Cu (p < 0.05) and Cr (p < 0.05). A comparison of metal concentration in water with World Health Organization and Standards Association of Zimbabwe standards revealed that the levels of Pb in water were above the recommended limits, posing a health risk to Pb poisoning for people living along Sebakwe River.

Prenatal depression, fetal neurobehavior, and infant temperament: Novel insights on early neurodevelopment from a socioeconomically disadvantaged Indian cohort

This article extends the research focusing on the early origins of psychopathology into the prenatal period, by exploring the association between maternal prenatal depression and offspring (fetal and infant) neurobehavior. The sample is recruited from a rural population in South India where women in the third trimester of pregnancy were assessed for depression and the heart rate responses of their fetuses to extrinsically applied vibroacoustic stimuli were studied. At 2 months postbirth, infant temperament and cortisol responsivity to immunization were assessed. The association between maternal prenatal depression and fetal responsivity to vibroacoustic stimulation, and infant responsivity to immunization, was U shaped with higher levels of responsivity noted in the offspring of mothers with very high and very low depression scores, and lower levels noted in the offspring of mothers with moderate depression scores. Maternal prenatal depression was not associated with infant temperament. The findings highlight the importance of environmental influences in the developmental origins of neurobehavior, suggesting that such differences, not evident at baseline, may emerge upon exposure to stressors. The study also emphasizes the need for further investigation in low- and middle-income contexts by providing preliminary evidence of the differing patterns of association observed between high- and low-income populations.

Traumatic Brain Injury and Infectious Encephalopathy in Children From Four Resource-Limited Settings in Africa

OBJECTIVES

To assess the frequency, interventions, and outcomes of children presenting with traumatic brain injury or infectious encephalopathy in low-resource settings.

DESIGN

Prospective study.

SETTING

Four hospitals in Sub-Saharan Africa.

PATIENTS

Children age 1 day to 17 years old evaluated at the hospital with traumatic brain injury or infectious encephalopathy.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We evaluated the frequency and outcomes of children presenting consecutively over 4 weeks to any hospital department with traumatic brain injury or infectious encephalopathy. Pediatric Cerebral Performance Category score was assessed pre morbidity and at hospital discharge. Overall, 130 children were studied (58 [45%] had traumatic brain injury) from hospitals in Ethiopia (n = 51), Kenya (n = 50), Rwanda (n = 20), and Ghana (n = 7). Forty-six percent had no prehospital care, and 64% required interhospital transport over 18 km (1-521 km). On comparing traumatic brain injury with infectious encephalopathy, there was no difference in presentation with altered mental state (80% vs 82%), but a greater proportion of traumatic brain injury cases had loss of consciousness (80% vs 53%; p = 0.004). Traumatic brain injury patients were older (median [range], 120 mo [6-204 mo] vs 13 mo [0.3-204 mo]), p value of less than 0.001, and more likely male (73% vs 51%), p value of less than 0.01. In 78% of infectious encephalopathy cases, cause was unknown. More infectious encephalopathy cases had a seizure (69% vs 12%; p < 0.001). In regard to outcome, infectious encephalopathy versus traumatic brain injury: hospital lengths of stay were longer for infectious encephalopathy (8 d [2-30 d] vs 4 d [1-36 d]; p = 0.003), discharge rate to home, or for inpatient rehabilitation, or death differed between infectious encephalopathy (85%, 1%, and 13%) and traumatic brain injury (79%, 12%, and 1%), respectively, p value equals to 0.044. There was no difference in the proportion of children surviving with normal or mild disability (73% traumatic brain injury vs 79% infectious encephalopathy; p = 0.526).

CONCLUSIONS

The epidemiology and outcomes of pediatric traumatic brain injury and infectious encephalopathy varied by center and disease. To improve outcomes of these conditions in low-resource setting, focus should be on neurocritical care protocols for pre-hospital, hospital, and rehabilitative care.

Concurrent exposure to heavy metals and cognition in school-age children in Congo-Kinshasa: A complex overdue research agenda

The impact of concurrent exposure to neurotoxic metals is a significant threat to brain function, mostly in contexts of multiple exposures as seen in the developing world. Ninety-five children (46 boys and 49 girls, 6 to 11-year old) from Congo-Kinshasa were assessed for cognition using the Kaufman Assessment Battery for Children (2nd edition) and exposure to Cr, Cu, Zn, Co, Mn, As, Cd, Se, Hg, Fe, and Pb by inductively coupled plasma mass spectrometry (ICPMS) in serum and urine collections. Concentrations of elements were all above normal ranges except for Cd, Se and Hg. General linear mixed effects models were used to predict neurocognitive outcomes with variable selection methods including backward elimination, elastic net, or subsets identified based on subject matter expertise. After adjusting for sex, age, and SES, urinary Co > 5 μg/l was associated with poor simultaneous processing (memory) (p = 0.0237). Higher excretion but normal concentration of Cd in serum was associated with better memory (p = 0.03), planning (p = 0.05), and overall performance scores (p < 0.01); thus appeared to be neuroprotective. However, higher excretion of Zn had negative influence on the overall performance scores (p = 0.02). Predictive neurotoxicology is a challenging task in contexts of multiple and concurrent exposures. Urinary Co > 5 μg/l is a risk factor for poor neurodevelopmental outcomes in such contexts. The impact of heavy metals on cognition is dependent on concentrations of and interactions between toxic and essential elements.

Elevated heavy metals levels in cognitively impaired patients from Pakistan

The deficit in the visuospatial skills, thinking, learning and memory is termed as cognitive impairment. Human exposure to heavy metals is a potential risk factor for developing cognitive impairment. This study aimed to investigate the possible association between the concentration of heavy metals and the extent of cognitive impairment. Blood samples were subjected to microwave assisted acid digestion and evaluated for metals levels using atomic absorption spectrophotometry. We measured the levels of Cu, Pb, Al, Zn, Cd and Mn in 183 patients diagnosed with cognitive impairment; mild (n = 72), moderate (n = 86) and severe (n = 25) and compared them to age-matched healthy controls (n = 90). Results showed that all the aforementioned elements were significantly higher in cognitively impaired patients and increasing concentration was strongly correlated with increase in severity of the disease. The correlation study has shown that among the studied metals, Al and Cu are strongly associated with the cognitive impairment. This suggests the need for decrease in metal exposure to humans from environment, food and industries.

Local and global challenges in pediatric traumatic brain injury outcome and rehabilitation assessment

Traumatic brain injury (TBI) is a major public health problem associated with high morbidity and mortality rates in children in both high- and low- and middle-income countries. Predicting outcome after pediatric TBI is challenging given the wide range of injury and non-injury-related factors which may have an impact. Some of these factors are relevant globally (like heterogeneity in patient and injury-related factors and research methodology) and others are more specific to local contexts (like sociodemographic and cultural factors). The assessment of rehabilitation outcomes post-TBI are similarly challenging given the various methodological limitations, disparities in access to rehabilitation, and limited awareness of deficits, which are encountered globally, as well as the lack of services in the local settings. In this article, we discuss these global and local challenges to outcome and rehabilitation assessment following pediatric TBI.

Measuring the Effect of Soil-Transmitted Helminth Infections on Cognitive Function in Children: Systematic Review and Critical Appraisal of Evidence

Recently the role of soil-transmitted helminth (STH) infections in children's cognitive developmental impairment has been under scrutiny. We conducted a systematic review of the evidence for associations between STH infections and cognitive function of children using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. We aimed to identify the domains of cognitive function in three age strata (<24months, 24-59months and ≥60months) and critically appraise the general design protocol of the studies, with a focus on the cognitive function measurement tools used. A total of 42 papers fulfilled the inclusion criteria, including 10 studies from a recent Cochrane review. Our findings demonstrate variation in tested domains, lack of consistency in the use of measurement tools and analysis of results. Cognitive function measures in children aged under 59months have been mainly limited to domains of gross motor, fine motor and language skills, whereas in children aged 60months and above most studies tested domains such as memory and processing speed. Even within the same age group the results on the association between STH infections and measures of cognitive development were often conflicting. The current study highlights the need for methodological consensus in the use of measurement tools and data analysis protocols if the effect of STH infections on cognitive function domains in children is to be correctly established. This will be an imperative next step to generate conclusive evidence of the role of STH infections in cognitive development in children.

The feasibility of an automated eye-tracking-modified Fagan test of memory for human faces in younger Ugandan HIV-exposed children

OBJECTIVE

The Fagan Test of Infant Intelligence (FTII) uses longer gaze length for unfamiliar versus familiar human faces to gauge visual-spatial encoding, attention, and working memory in infants. Our objective was to establish the feasibility of automated eye tracking with the FTII in HIV-exposed Ugandan infants.

METHOD

The FTII was administered to 31 perinatally HIV-exposed noninfected (HEU) Ugandan children 6-12 months of age (11 boys; M = 0.69 years, SD = 0.14; 19 girls; M = 0.79, SD = 0.15). A series of 10 different faces were presented (familiar face exposure for 25 s followed by a gaze preference trial of 15 s with both the familiar and unfamiliar faces). Tobii X2-30 infrared camera for pupil detection provided automated eye-tracking measures of gaze location and length during presentation of Ugandan faces selected to correspond to the gender, age (adult, child), face expression, and orientation of the original FTII. Eye-tracking gaze length for unfamiliar faces was correlated with performance on the Mullen Scales of Early Learning (MSEL).

RESULTS

Infants gazed longer at the novel picture compared to familiar across 10 novelty preference trials. Better MSEL cognitive development was correlated with proportionately longer time spent looking at the novel faces (r(30) = 0.52, p = .004); especially for the Fine Motor Cognitive Sub-scale (r(30) = 0.54, p = .002).

CONCLUSION

Automated eye tracking in a human face recognition test proved feasible and corresponded to the MSEL composite cognitive development in HEU infants in a resource-constrained clinical setting. Eye tracking may be a viable means of enhancing the validity and accuracy of other neurodevelopmental measures in at-risk children in sub-Saharan Africa.

Premature Brain Aging in Baboons Resulting from Moderate Fetal Undernutrition

Contrary to the known benefits from a moderate dietary reduction during adulthood on life span and health, maternal nutrient reduction during pregnancy is supposed to affect the developing brain, probably resulting in impaired brain structure and function throughout life. Decreased fetal nutrition delivery is widespread in both developing and developed countries, caused by poverty and natural disasters, but also due to maternal dieting, teenage pregnancy, pregnancy in women over 35 years of age, placental insufficiency, or multiples. Compromised development of fetal cerebral structures was already shown in our baboon model of moderate maternal nutrient reduction. The present study was designed to follow-up and evaluate the effects of moderate maternal nutrient reduction on individual brain aging in the baboon during young adulthood (4–7 years; human equivalent 14–24 years), applying a novel, non-invasive neuroimaging aging biomarker. The study reveals premature brain aging of +2.7 years (p < 0.01) in the female baboon exposed to fetal undernutrition. The effects of moderate maternal nutrient reduction on individual brain aging occurred in the absence of fetal growth restriction or marked maternal weight reduction at birth, which stresses the significance of early nutritional conditions in life-long developmental programming. This non-invasive MRI biomarker allows further longitudinal in vivo tracking of individual brain aging trajectories to assess the life-long effects of developmental and environmental influences in programming paradigms, aiding preventive and curative treatments on cerebral atrophy in experimental animal models and humans.

Neurodevelopment: The Impact of Nutrition and Inflammation During Infancy in Low-Resource Settings

Infancy and early childhood (ie, birth through age 24 months) represent a period of life with both exquisite opportunity and vulnerability for neurodevelopment. This is due to rapid brain development, both anatomic and functional, as well as to high nutrient requirements during a time of dependence on human milk and complementary foods. Complex interactions exist among nutrition, social, and physical environments and exposures. The newborn brain also reflects maternal exposures that occurred as the product of many interacting forces during gestation. Connections between nutrient use and acute and chronic inflammation are increasingly recognized, but the evidence base linking both nutrition and inflammation to neurodevelopment is relatively modest and quite limited for this young age group specifically. This article provides an overview of key interactions of nutritional requirements relevant to brain development and function; nutritional vulnerabilities related to maternal nutritional status and function; and the impact of environmental exposures and inflammation on nutrient homeostasis and neurodevelopment during this critical developmental window.

The Effects of a Home-based Intervention Conducted by College Students for Young Children with Developmental Delays in Vietnam

OBJECTIVES

The project assessed the efficacy of a home-based intervention program for young children (n= 64, ages ranging from 3-6 years) with developmental delays in Vietnam. It was hypothesized that the children in the intervention group would show greater progress in adaptive behavior than the children in the control group.

METHODS

Assessment of the program efficacy was carried out by comparing children who received services for 6 months and those who did not. Children who were recognized as having developmental delays by teachers in kindergarten programs, and confirmed by trained evaluators based on the Vineland Adaptive Behavior Scale-II (VABS-II), were randomly assigned to intervention and control groups. Twenty student teachers were recruited from a teaching university and were provided with pre-program training and ongoing supervision.

RESULTS

The outcomes of the program were examined at 0, 3, and 6 months using the VABS-II. The intervention group improved significantly more than the control group in overall adaptive functioning and in the areas of communication, social skills and motor skills.

CONCLUSION

The project is one of only a few early intervention projects to apply randomized control trials in a low-middle-income country. The results demonstrate the feasibility of carrying out the intervention program using teachers with no prior experience of working with children with delays/disabilities, where professional resources are scarce for this population.

Effect of enteric parasitic infection on serum trace elements and nutritional status in upper Egyptian children

Introduction:

Enteric parasitic infections still the cause of major health problems among Egyptian children as they have great morbid effect on their physical and cognitive development. Malnutrition makes children more prone to micronutrient deficiency and subsequently more vulnerable to parasitic infection. The present study aimed to identify the effect of intestinal parasitism on micronutrient serum level and children nutritional status.

Materials and Methods:

A case control study was carried out on children from 1 to 6 years old who were attending the Assiut University Children Hospital outpatient clinic, after parasitological stool examination they were divided into Group 1 (G1, n: 60) positive with enteric parasite and Group 2 (G2, n: 60) age and sex matched and free of parasites. Anthropometric measurements were expressed as weight for age (WFA), height for age (HFA), and weight for height (WFH) parameters. Serum zinc (Zn) and copper (Cu) were determined by atomic absorption spectrophotometer.

Results:

Intestinal parasitic infection rate was 55.7%; more commonly detected parasites were Giardia lamblia 28%, Cryptosporidium sp. 20%, and polyparasitism 18%. All children (G1 and G2) were underweight (WFA) while 63% of G1 were malnourished, either in the form of wasting (WFH) or stunting (HFA) or both aspects. Stunting and wasting were more dominant among children infected with G. lamblia and Cryptosporidium sp. and most of them were below 2 years old.

Conclusions:

Coincident decrease in serum Zn level and an increase of serum Cu was more prominent among G. lamblia and Cryptosporidium sp. patients. G. lamblia and Cryptosporidium sp. were found to be more associated with nonstandard children nutritional status beside to an altered micronutrient level.

The INTERGROWTH-21st Project Neurodevelopment Package: a novel method for the multi-dimensional assessment of neurodevelopment in pre-school age children

BACKGROUND

The International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Project is a population-based, longitudinal study describing early growth and development in an optimally healthy cohort of 4607 mothers and newborns. At 24 months, children are assessed for neurodevelopmental outcomes with the INTERGROWTH-21st Neurodevelopment Package. This paper describes neurodevelopment tools for preschoolers and the systematic approach leading to the development of the Package.

METHODS

An advisory panel shortlisted project-specific criteria (such as multi-dimensional assessments and suitability for international populations) to be fulfilled by a neurodevelopment instrument. A literature review of well-established tools for preschoolers revealed 47 candidates, none of which fulfilled all the project's criteria. A multi-dimensional assessment was, therefore, compiled using a package-based approach by: (i) categorizing desired outcomes into domains, (ii) devising domain-specific criteria for tool selection, and (iii) selecting the most appropriate measure for each domain.

RESULTS

The Package measures vision (Cardiff tests); cortical auditory processing (auditory evoked potentials to a novelty oddball paradigm); and cognition, language skills, behavior, motor skills and attention (the INTERGROWTH-21st Neurodevelopment Assessment) in 35-45 minutes. Sleep-wake patterns (actigraphy) are also assessed. Tablet-based applications with integrated quality checks and automated, wireless electroencephalography make the Package easy to administer in the field by non-specialist staff. The Package is in use in Brazil, India, Italy, Kenya and the United Kingdom.

CONCLUSIONS

The INTERGROWTH-21st Neurodevelopment Package is a multi-dimensional instrument measuring early child development (ECD). Its developmental approach may be useful to those involved in large-scale ECD research and surveillance efforts.

The cross-cultural utility of foreign- and locally-derived normative data for three WHO-endorsed neuropsychological tests for South African adolescents

Interpretation of neuropsychological tests may be hampered by confounding sociodemographic factors and by using inappropriate normative data. We investigated these factors in three tests endorsed by the World Health Organization: the Grooved Pegboard Test (GPT), the Children's Color Trails Test (CCTT), and the WHO/UCLA version of the Auditory Verbal Learning Test (AVLT). In a sample of 12-15-year-old, Afrikaans- and English-speaking adolescents from the Cape Town region of South Africa, analyses of covariance (ANCOVAs) demonstrated that quality of education was the sociodemographic factor with the biggest influence on test performance, and that age also significantly influenced GPT and CCTT performance. Based on those findings, we provide appropriately stratified normative data for the age group in question. Comparisons between diagnostic interpretations made using foreign normative data versus those using the current local data demonstrate that it is imperative to use appropriately stratified normative data to guard against misinterpreting performance.

The burden and predictors of cognitive impairment among 6- to 8-year-old children infected and uninfected with HIV from Harare, Zimbabwe: a cross-sectional study

With long-term survival of children infected with HIV, information on cognitive function at school age is needed. To determine cognitive function among 6- to 8 year-old children exposed to HIV and to assess factors associated with cognitive impairment, we conducted a cross-sectional study from October 2010 to December 2011 among children whose mothers participated in a national HIV prevention program in Harare. Cognitive function was assessed using the McCarthy Scales of Children's Abilities (MSCA). Of the 306 assessed children, 32 (10%) were HIV infected, 121 (40%) exposed uninfected, and 153 (50%) unexposed uninfected. The mean (SD) General Cognitive Index for the whole study group was 82 (15). An overall of 49 (16%) out of the 306 children had cognitive impairment with no difference in general cognitive function among the three groups. Children with HIV infection scored lowest in perceptual performance domain, p = .028. Unemployed caregivers, child orphanhood and undernutrition were associated with impaired cognitive performance in univariate analysis. In multivariate analysis, caregiver unemployment status remained a factor associated with cognitive impairment with an ODDS ratio of 2.1 (95% CI 1.03-3.36). In a cohort of 6- to 8-year-olds, HIV infection did not show evidence of significant difference in general cognitive function. Children infected with HIV had major deficits in perceptive performance. Lower socioeconomic status was associated with cognitive impairment. In resource-constrained settings, strategies aimed at poverty alleviation and good nutritional management should complement early infant diagnosis and treatment of HIV in order to optimize neurocognitive potential.

Survey of rehabilitation support for children 0-15 years in a rural part of Kenya

Purpose

Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0–15 years) and their families in rural Kenya.

Method

A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services.

Results

Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods.

Conclusions

The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms.

Relationship between severe acidemia, verbal abilities, and behavior in a Spanish cohort of 5-year-old children born at term

AIM

To determine whether a relationship exists between the markers of severe acidemia (SA) and the developmental, verbal, and behavioral characteristics of children with SA born at term 5 years previously, without apparent neurological impairment.

METHODS

A cohort of 76 children-38 with SA (pH < 7, base deficit ≥12 mmol/L) and 38 non-SA (pH ≥ 7.20)-were evaluated using the Battelle Developmental Inventory, McCarthy's Verbal Scale, the Token Test for Children, and the Conners 3rd Edition-Parent. The relationships between markers of SA and verbal and behavioral scores were analyzed with parametric correlations. Multiple regression analysis was used to determine the possible effect of these markers on verbal abilities, verbal memory, and attention.

RESULTS

Although none of the scores were in the "impaired" range, the SA group scored lower in verbal index (p = .000) and verbal memory (p = .004) on the McCarthy's Scales and in verbal comprehension (p = .001) on the Token Test for Children-2, and higher on the inattention (p = .003) and hyperactivity-impulsivity domains of the Conners Scales (p = .009) compared with the control group. There were no differences between the groups in the motor, personal-social, or cognitive domains on the Battelle Developmental Inventory. The SA markers were found to be predictors, accounting for 61.6% of verbal variability.

CONCLUSIONS

SA markers reflect mild long-term consequences regarding verbal abilities and inattentiveness among children born at term without apparent neurological impairment on discharge but do not suggest severe impairment to the 5-year development of children. The authors recommend that these children should be monitored to determine whether they need or might benefit from an early intervention program.

Statistical Approaches to Assess the Effects of Disease on Neurocognitive Function Over Time

INTRODUCTION

Assessment of the effects of disease on neurocognitive outcomes in children over time presents several challenges. These challenges are particularly pronounced when conducting studies in low-income countries, where standardization and validation is required for tests developed originally in high-income countries. We present a statistical methodology to assess multiple neurocognitive outcomes over time. We address the standardization and adjustment for age in neurocognitive testing, present a statistical methodology for development of a global neurocognitive score, and assess changes in individual and global neurocognitive scores over time in a cohort of children with cerebral malaria.

METHODS

Ugandan children with cerebral malaria (CM, N = 44), uncomplicated malaria (UM, N = 54) and community controls (N = 89) were assessed by cognitive tests of working memory, executive attention and tactile learning at 0, 3, 6 and 24 months after recruitment. Tests were previously developed and validated for the local area. Test scores were adjusted for age, and a global score was developed based on the controls that combined the assessments of impairment in each neurocognitive domain. Global normalized Z-scores were computed for each of the three study groups. Model-based tests compare the Z-scores between groups.

RESULTS

We found that continuous Z-scores gave more powerful conclusions than previous analyses of the dataset. For example, at all four time points, children with CM had significantly lower global Z-scores than controls and children with UM. Our methods also provide more detailed descriptions of longitudinal trends. For example, the Z-scores of children with CM improved from initial testing to 3 months, but remained at approximately the same level below those of controls or children with UM from 3 to 24 months. Our methods for combining scores are more powerful than tests of individual cognitive domains, as testing of the individual domains revealed differences at only some but not all time points.

Fetal stress and programming of hypoxic/ischemic-sensitive phenotype in the neonatal brain: mechanisms and possible interventions

Growing evidence of epidemiological, clinical and experimental studies has clearly shown a close link between adverse in utero environment and the increased risk of neurological, psychological and psychiatric disorders in later life. Fetal stresses, such as hypoxia, malnutrition, and fetal exposure to nicotine, alcohol, cocaine and glucocorticoids may directly or indirectly act at cellular and molecular levels to alter the brain development and result in programming of heightened brain vulnerability to hypoxic-ischemic encephalopathy and the development of neurological diseases in the postnatal life. The underlying mechanisms are not well understood. However, glucocorticoids may play a crucial role in epigenetic programming of neurological disorders of fetal origins. This review summarizes the recent studies about the effects of fetal stress on the abnormal brain development, focusing on the cellular, molecular and epigenetic mechanisms and highlighting the central effects of glucocorticoids on programming of hypoxic-ischemic-sensitive phenotype in the neonatal brain, which may enhance the understanding of brain pathophysiology resulting from fetal stress and help explore potential targets of timely diagnosis, prevention and intervention in neonatal hypoxic-ischemic encephalopathy and other brain disorders.

Vulnerability of the fetal primate brain to moderate reduction in maternal global nutrient availability

Moderate maternal nutrient restriction during pregnancy occurs in both developing and developed countries. In addition to poverty, maternal dieting, teenage pregnancy, and uterine vascular problems in older mothers are causes of decreased fetal nutrition. We evaluated the impact of global 30% maternal nutrient reduction (MNR) on early fetal baboon brain maturation. MNR induced major cerebral developmental disturbances without fetal growth restriction or marked maternal weight reduction. Mechanisms evaluated included neurotrophic factor suppression, cell proliferation and cell death imbalance, impaired glial maturation and neuronal process formation, down-regulation of gene ontological pathways and related gene products, and up-regulated transcription of cerebral catabolism. Contrary to the known benefits from this degree of dietary reduction on life span, MNR in pregnancy compromises structural fetal cerebral development, potentially having an impact on brain function throughout life.

Characterizing and predicting outcomes of communication delays in infants and toddlers: implications for clinical practice

PURPOSE

This article focuses on using currently available data to assist speech-language pathologists (SLPs) in making decisions regarding a child's eligibility and considerations for recommended "dosage" of early intervention (EI) services.

METHOD

Literature describing the characteristics of infants and toddlers who are likely recipients of EI services was reviewed.

RESULTS

Current literature provides information that can be used to inform clinical decisions for infants and toddlers with established medical conditions, as well as those with risk factors, for oral language, communication, and subsequent literacy disabilities. This information is summarized.

CONCLUSION

Extant literature suggests that EI makes a critical difference in the developmental course of communication as well as in other learning domains for children with a variety of established conditions. The literature also provides guidance to SLPs who must evaluate and weigh risk factors for children with less clear eligibility for services.

Children at risk for developmental delay can be recognised by stunting, being underweight, ill health, little maternal schooling or high gravidity

AIMS

To investigate markers of risk status that can be easily monitored in resource-limited settings for the identification of children in need of early developmental intervention.

METHODS

Eighty-five children in Kilifi, Kenya, aged between 2 and 10 months at recruitment, were involved in a 10-month follow-up. Data on developmental outcome were collected through parental report using a locally developed checklist. We tested for the unique and combined influence of little maternal schooling and higher gravidity, anthropometric status (being underweight and stunting) and poor health on the level of developmental achievement and the rate of acquisition of developmental milestones.

RESULTS

A model with all five predictors showed a good fit to the data (chi(2)(21, N = 85) = 23.00, p = .33). Maternal schooling and gravidity and child's stunting were found to predict the rate of developmental achievements (beta = .24, beta = .31, and beta = .41, respectively). Being underweight, ill-health, stunting and gravidity predicted initial developmental status (beta = -.26, beta = -.27, beta = -.43, and beta = -.27).

CONCLUSIONS

Slow rates of developmental achievement can be predicted using these easy-to-administer measures and the strongest relationship with risk was based on a combination of all measures.

Impaired everyday memory associated with encephalopathy of severe malaria: the role of seizures and hippocampal damage

Background

Seizures are common in children admitted with severe falciparum malaria and are associated with neuro-cognitive impairments. Prolonged febrile seizures are associated with hippocampal damage and impaired memory. It was hypothesized that severe malaria causes impaired everyday memory which may be associated with hippocampal damage.

Methods

An everyday memory battery was administered on 152 children with cerebral malaria (CM) (mean age, 7 y 4 months [SD 13 months]; 77 males) 156 children (mean age, 7 y 4 months [SD, 14 months]; 72 males) with malaria plus complex seizures (MS) and 179 children (mean age, 7 y 6 months [SD, 13 months]; 93 males) unexposed to either condition.

Results

CM was associated with poorer everyday memory [95% CI, -2.46 to -0.36, p = 0.004] but not MS [95% CI, -0.91 to 1.16, p = 1.00] compared to unexposed children. Children with exposure to CM performed more poorly in recall [95% CI, -0.79 to -0.04, p = 0.024] and recognition subtests [95% CI, -0.90 to -0.17, p = 0.001] but not in prospective memory tests compared to controls. The health factors that predicted impaired everyday memory outcome in children with exposure to CM was profound coma [95% CI, 0.02 to 0.88, p = 0.037] and multiple episodes of hypoglycaemia [95% CI, 0.05 to 0.78, p = 0.020], but not seizures.

Discussion

The findings show that exposure to CM was associated with a specific impairment of everyday memory. Seizures commonly observed in severe malaria may not have a causal relationship with poor outcome, but rather be associated with profound coma and repeated metabolic insults (multi-hypoglycaemia) that are strongly associated with impaired everyday memory.

Socioeconomic predictors of cognition in Ugandan children: implications for community interventions

Background

Several interventions to improve cognition in at risk children have been suggested. Identification of key variables predicting cognition is necessary to guide these interventions. This study was conducted to identify these variables in Ugandan children and guide such interventions.

Methods

A cohort of 89 healthy children (45 females) aged 5 to 12 years old were followed over 24 months and had cognitive tests measuring visual spatial processing, memory, attention and spatial learning administered at baseline, 6 months and 24 months. Nutritional status, child's educational level, maternal education, socioeconomic status and quality of the home environment were also measured at baseline. A multivariate, longitudinal model was then used to identify predictors of cognition over the 24 months.

Results

A higher child's education level was associated with better memory (p = 0.03), attention (p = 0.005) and spatial learning scores over the 24 months (p = 0.05); higher nutrition scores predicted better visual spatial processing (p = 0.002) and spatial learning scores (p = 0.008); and a higher home environment score predicted a better memory score (p = 0.03).

Conclusion

Cognition in Ugandan children is predicted by child's education, nutritional status and the home environment. Community interventions to improve cognition may be effective if they target multiple socioeconomic variables.

International child health: state of the art

Many published articles and policies describe what should be state of the art in global child health, and there are dozens of large initiatives aimed at implementing these policies. We have knowledge of what should work, yet struggle to effectively implement that knowledge and improve child health outcomes in resource-poor settings, even at the most basic level of ensuring sufficient food and clean water for the world's children. This article highlights many smaller programs that are operational in the field, demonstrating excellence in global child health efforts, and may approach state of the art in actual implementation. The examples include a grass roots primary health care program, a home-based neonatal care program, kangaroo mother care, ready-to-use therapeutic food (RUTF), a vitamin A program, point-of-use water purification, disasters and children, a pain management program, and a developmental disabilities program. This article also discusses the importance of strengthening human resources for health by, for example, training child health professionals in low resource countries. These programs show what can be done and could be replicated in other communities to improve child health, given a few committed individuals and modest resources. Ultimately, truly state of the art health care for children must be defined locally and championed by each state or nation. Nevertheless, there are overarching components and supports that are the responsibility of the global community, particularly those needed to assure that the basic human rights of children, including health, are met throughout the world.

Immediate neuropsychological and behavioral benefits of computerized cognitive rehabilitation in Ugandan pediatric cerebral malaria survivors

OBJECTIVE

Our earlier studies on Ugandan children surviving cerebral malaria showed cognitive deficits mainly in attention and memory. We now present the first study in sub-Saharan Africa to investigate the feasibility and potential benefits of computerized cognitive rehabilitation training on neuropsychological and behavioral functioning of children surviving cerebral malaria.

METHODS

A randomized trial in which 65 children admitted 45 months earlier with cerebral malaria were recruited at Mulago Hospital, Kampala, Uganda. For 8 weeks, 32 of the children received weekly training sessions using Captain's Log cognitive training software and the other 33 were assigned to a nontreatment condition. Pre- and postintervention assessments were completed using CogState, a computerized neuropsychological battery, measuring visuomotor processing speed, working memory, learning, attention and psychomotor speed and the Child Behavior Checklist measuring internalizing problems, externalizing problems, and total problems.

RESULTS

Preintervention scores were similar between both groups. Treatment effects were observed on visuospatial processing speed [group effect (standard error) 0.14 (0.03); p < .001], on a working memory and learning task [0.08 (0.02); p < .001], psychomotor speed [0.14 (0.07); p = .04], and on internalizing problems [-3.80 (1.56); p = .02] after controlling for age, sex, school grade, quality of the home environment, and weight for age z scores. Similar treatment effects were observed when no adjustments for the above covariates were made.

CONCLUSIONS

Computerized cognitive training long after the cerebral malaria episode has immediate benefit on some neuropsychological and behavioral functions in African children. The long-term benefit of this intervention needs to be investigated.

The effects of a home-based intervention for young children with intellectual disabilities in Vietnam

BACKGROUND

This study was conducted to examine the impact of a 1-year intervention for children with intellectual disabilities (ID) in Vietnam.

METHOD

Subjects were 30 preschool-aged children with ID (ages 3 to 6 years). Sixteen were assigned to an intervention group and 14 to a control group. Based on the Portage Curriculum (CESA 5 2003), the intervention trained parents to work with their children through modelling and coaching by teachers during weekly home visits.

RESULTS

Comparison of pre-, mid- and post-intervention assessments of the children based on the Vineland Adaptive Behavior Scales (Sparrow et al. 1984a) indicated that the intervention was promising: children in the intervention group improved significantly in most domains of adaptive behaviours, and also performed significantly better than the control group in the areas of personal care and motor skills.

CONCLUSIONS

The results from the Vietnam programme are discussed in terms of its implications and strategies for developing programmes for children with disabilities in developing countries.

Predictors of parenting stress among Vietnamese mothers of young children with and without cognitive delay

BACKGROUND

The study examined whether Vietnamese mothers of children with cognitive delay experienced more parenting stress compared to mothers of children without delay, and the factors that contribute to the parenting stress.

METHOD

The study sample included 225 mothers of children with and without cognitive delays from Hue City in Vietnam. The study protocol included mothers reporting on the scales of parenting stress and perceived social support, and on demographic questions.

RESULTS

Mothers of children with cognitive delay experienced more stress. They were poorer and less educated, and perceived less social support. More mothers of these children had health issues. Having a child with cognitive delay was the strongest predictor of stress after controlling other demographic and psychosocial variables.

CONCLUSION

Special education and early intervention services should be developed and available to educate the children with cognitive delay and support their mothers in Vietnam. Effective services also need to address their poverty and health care needs.

Monitoring psychomotor development in a resource-limited setting: an evaluation of the Kilifi Developmental Inventory

BACKGROUND

Modifications made to the Kilifi Developmental Checklist and the psychometric characteristics of the new measure (The Kilifi Developmental Inventory) which assess the psychomotor functioning of children aged 6-35 months are described.

METHODS

Two groups of community children (319 rural and 104 urban dwellers) and nine children with neurodevelopmental disorders were recruited for a cross-sectional study.

RESULTS

In both a rural and urban reference population, the inventory showed excellent internal consistency, interobserver agreement, test-retest reliability and sensitivity to maturational changes. Children with neurodevelopmental impairment and those who were underweight had significantly lower scores than the community sample, attesting to the sensitivity of the measure. Mothers found the assessment procedures acceptable and informative.

CONCLUSIONS

The Kilifi Developmental Inventory is a culturally appropriate measure that can be used to monitor and describe the development of at-risk children in resource-limited settings in Kenya.

Constructing Tests of Cognitive Abilities for Schooled and Unschooled Children

It is frequently necessary to assess children with little or no schooling to determine their level of cognitive functioning, especially in developing countries. It is not possible, however, to assume that assessments will hold equal validity for children with and without the experience of schooling. The authors, therefore, set out to create a battery of tests suitable for both schooled and unschooled children. They assessed 973 schooled and 645 unschooled children in rural coastal Kenya using culturally adapted cognitive tests. Significant effects of age and schooling were found on all tests. On some tests (verbal knowledge, speeded figure matching, and pattern copying), unschooled children did not improve as much with age as schooled children. The effects of length of exposure to schooling and of age were greater than that of initial enrollment in school. The authors conclude that it is possible to assess unschooled children, but test batteries must be carefully constructed and standardized.

Socioeconomic status, anthropometric status, and psychomotor development of Kenyan children from resource-limited settings: a path-analytic study

BACKGROUND

Sub-optimal physical growth has been suggested as a key pathway between the effect of environmental risk and developmental outcome.

AIM

To determine if anthropometric status mediates the relation between socioeconomic status and psychomotor development of young children in resource-limited settings.

STUDY DESIGN

A cross-sectional study design was used.

SUBJECTS

A total of 204 (105 girls) children from two resource-limited communities in the Coast Province, Kenya. The mean age of these children was 29 months (SD = 3.43; range: 24-35 months).

OUTCOME MEASURE

Psychomotor functioning was assessed using a locally developed and validated measure, the Kilifi Developmental Inventory.

RESULTS

A significant association was found between anthropometric status (as measured by weight-for-age, height-for-age, mid-upper arm circumference, and head circumference) and psychomotor functioning and also between socioeconomic status and anthropometric status; no direct effects were found between socioeconomic status and developmental outcome. The models showed that weight, height and to a lesser extent mid-upper arm circumference mediate the relation between socioeconomic status and developmental outcome, while head circumference did not show the same effect.

CONCLUSION

Among children under 3 years living in poverty, anthropometric status shows a clear association with psychomotor development while socioeconomic status may only have an indirect association.

The declaration of nutrition, health, and intelligence for the child-to-be

The Declaration of Nutrition, Health, and Intelligence for the Child-to-be is an urgent cry from the unborn child for a life-span of nutrients for physical and mental wellness. It is a proclamation of paramount importance for everyone involved in child development: parents, health professionals, teachers, government agencies, all producers of food--and children, so they may learn how to feed themselves well. The Declaration of Olympia on Nutrition and Fitness, 1996, came from a group pf nutritional scientists and medical doctors to commemorate the Olympic Games' 100th anniversary. They based it on the health principles of Hippocrates: genetics, the age of the individual, the powers of various foods, and exercise. Following today's vast wealth of nutritional research and expressing it with my teaching experience, I have revitalized the Declaration of Olympia by writing from the heart of the little learner and the hope of the child-to-be. The nutrients implicated in healthy reproduction and lifelong health include B vitamins, particularly B1, B6, folate, B1312 antioxidants, particularly vitamins C and E: minerals such as iron, zinc, magnesium, selenium, iodine, and copper; and essential fatty acids, particularly DHA. These nutrients also lower the risk of neural tube defects: autism, dyslexia, Down's syndrome: childhood cancers, obesity, and defective fetal cell membranes associated with maternal diabetes. Our metabolism is hugely influenced also by activity and by affection. Today's foods are often processed beyond the cells' recognition and can result in neurological and physical morbidity and mortality. A diet of unprocessed free-range animals and seafood: legumes, deep-colored vegetables and fruits: nuts, seeds, and whole grains, germ and bran, reinstates nutritional potency.

Giardia lamblia and other intestinal parasitic infections and their relationships with nutritional status in children in Brazilian Amazon

The objective of this survey was to assess the relationships between intestinal parasitism, nutritional status and hemoglobin level in children with Indian ascendancy living in an urban area in Brazilian Amazon. We carried out a cross-sectional survey obtaining anthropometric, parasitological and socioeconomic data, and hemoglobin measurements of children aged six to 84 months. Anthropometric data were expressed as z-scores for weight for age (WAZ), height for age (HAZ), weight for height (WHZ) and mid upper circumference for age (MUACZ) parameters. Parasitological examinations were performed through Ritchie (n = 307), Kato-Katz (n = 278), Baermann-Moraes (n = 238) and Safranin-methylene blue methods (n = 307). Hemoglobin measurements were obtained with a Hemocue photometer (n = 282). Socioeconomic data were used in order to classify children in three family income strata (n = 242). Multiple linear regression analysis showed independent interactions between Giardia lamblia and WAZ (beta = -0.195, SE = 0.138, p = 0.003), WHZ (beta = -0.161, SE = 0.133, p = 0.018) and MUACZ (beta = -0.197, SE = 0.143, p = 0.011), controlling for age, sex, family income, Ascaris lumbricoides, and hookworm infection. Also, the multivariate model showed that the only variable associated with hemoglobin levels was age. Intestinal parasitism control should increase children's possibilities of full development in the studied area.

The rise of non-adaptive intelligence in humans under pathogen pressure

Cleverness made our species the most successful primate on Earth, thus claiming that human intelligence is adaptive sounds to be a triviality. Not surprisingly, when establishing long-lasting pair-bonds, humans exhibit mate preferences in favour of clever partners, apparently to increase the chance that their offspring will be as clever as possible. Contrary to this well-established view, here I argue that the adaptive nature of human intelligence has never been proven in a strict evolutionary sense. Furthermore, the exceptional rise of intelligence in our species (and the lack of comparable phenomena in other apes) is best explained within the context of the Hamilton-Zuk Hypothesis. Apparently, humans have been subjected to an exceptionally strong selection pressure exerted by pathogens and parasites, and the human brain is particularly vulnerable to infections, thus cleverness is an ideal character to signal heritable genetic resistance against infections. In this scenario, human preference for intelligent mates is to increase the offspring's resistance against pathogens. Among other phenomena, this hypothesis can explain why humans enjoy wasting most of their intellectual capabilities for totally useless purposes, why prehistoric humans developed brains that made them potentially far more intelligent than required by their physical environment, and why we experience a continuous increase of human intelligence even in modern societies. Briefly, I argue that (1) human sexual selection favours intelligence as a signal of genetic resistance against pathogens, and (2) that intelligence enabled the rise of our species (in terms of population size and distribution) as an accidental side-effect.

Mass treatment for intestinal helminthiasis control in an Amazonian endemic area in Brazil

The objective of the present study was to estimate the prevalence of soil-transmitted helminthiasis and evaluate the sanitary conditions and the role of a mass treatment campaign for control of these infections in Santa Isabel do Rio Negro. A cross-sectional survey was carried out in 2002, to obtain data related to the sanitary conditions of the population and fecal samples for parasitological examination in 308 individuals, followed by a mass treatment with albendazole or mebendazole with coverage of 83% of the city population in 2003. A new survey was carried out in 2004, involving 214 individuals, for comparison of the prevalences of intestinal parasitosis before and after the mass treatment. The prevalences of ascariasis, trichuriasis and hookworm infection were 48%; 27% and 21% respectively in 2002. There was a significant decrease for the frequency of infections by Ascaris lumbricoides (p < 0.05; OR / 95% CI = 0.44 / 0.30 - 0.65), Trichuris trichiura (p < 0.05; OR / 95% CI = 0.37 / 0.22 - 0.62), hookworm (p < 0.05; OR / 95% CI = 0.03 / 0.01 - 0.15) and helminth poliparasitism (p < 0.05; OR / 95% CI = 0.16 / 0.08 - 0.32). It was also noticed a decrease of prevalence of infection by Entamoeba histolytica / dispar (p < 0.05; OR / 95% CI = 0.30 / 0.19 - 0.49) and non-pathogenic amoebas. It was inferred that a mass treatment can contribute to the control of soil-transmitted helminthiasis as a practicable short-dated measure. However, governmental plans for public health, education and urban infrastructure are essential for the sustained reduction of prevalences of those infections.

Assessing developmental outcomes in children from Kilifi, Kenya, following prophylaxis for seizures in cerebral malaria

The purpose of the study was to develop a culture-informed measure of developmental outcome and to apply it to detect differences in developmental level between children with cerebral malaria enrolled in a clinical trial to control seizures during the acute phase of the illness. The instrument was administered to a sample of 180 children, three and 12 months after discharge from hospital. The measure demonstrated high internal consistency, good inter-observer reliability, age sensitivity and strong relations with parental report of child functioning. No association was found between performance, or change in performance, with the prophylactic regime administered. The results suggested that the use of Phenobarbital in controlling provoked seizures has no observable effect on cognitive function.

Nutritional solutions to major health problems of preschool children: how to optimise growth and development

Despite major economic development in the last few decades, childhood nutrition remains a great challenge for the human species. A combination of undernutrition, overnutrition, and poor dietary quality affect to a variable extent all of the world's populations, and are often combined in the same areas and even in the same families. Malnutrition is part of the life of many individuals since conception and is transmitted by 1 generation to the next. Countries with lower income per capita and poor socioeconomic strata are mainly affected and, in turn, malnutrition hampers their development. The eradication of child malnutrition is crucial in the fight against poverty. This article examines whether this goal will be achieved within the time frame the United Nations has set.

Rehabilitation for cognitive impairments after cerebral malaria in African children: strategies and limitations

Cerebral malaria results in short- to long-term cognitive impairments in many of its child survivors. Although some of the risk factors for impairments have been identified, no attempts have been made to address the plight of those who develop cognitive impairments. This paper discusses the burden of cognitive impairment caused by cerebral malaria and suggests some rehabilitation strategies based on brain injury and cognitive rehabilitation studies. Potential cognitive rehabilitation solutions such as cognitive exercises, environmental enrichment, nutritional supplementation, physical therapy and speech therapy are highlighted. The limitations of implementing these interventions and solutions are discussed in light of the limited human resources and infrastructure of the developing countries that are malaria endemic.

Promoting child development at sick-child visits: a controlled trial

OBJECTIVE

In developing countries, the health care system often is the only existing infrastructure that can reach young children, and health care encounters may be the only opportunity for professionals to have a positive influence on child development. To address the discrepancy between Western and developing countries related to the information that is available for caregivers on how to support their child's development, the World Health Organization Department of Child and Adolescent Health and Development and United Nations International Children's Education Fund have developed the Care for Development Intervention. The Care for Development Intervention aims during acute health visits to enhance caregivers' play and communication with their children. For facilitation of its delivery worldwide, the Care for Development Intervention was developed as an additional module of the Integrated Management of Childhood Illness training course. The purpose of this study was to determine the efficacy and the safety of the Care for Development Intervention when implemented during a young child's visit for acute minor illness.

METHODS

The study design is a sequentially conducted controlled trial, with the comparison arm completed first, Care for Development Intervention training provided for the clinicians next, followed by the intervention arm. At the Pediatric Department of Ankara University School of Medicine, 2 pediatricians who were blinded to the study aims and hypotheses before Care for Development Intervention training provided standard health care to the comparison group; they then received Care for Development Intervention training and provided standard health care plus the Care for Development Intervention to the intervention group. Compliance with treatment and the outcome of illness were determined by a follow-up examination in the clinic 1 week later. One month after the clinic visits, an adapted Home Observation for Measurement of the Environment was administered in the homes by researchers who were blinded to study aims and hypotheses.

RESULTS

Children who were aged < or = 24 months and attended the clinic with minor or no illnesses were recruited for the study: 113 in the comparison group and 120 in the intervention group. At the 1-month home visit, significantly more families had optimal Home Observation for Measurement of the Environment scores (17.5% vs 6.2%), more homemade toys were observed (42.5% vs 10.6%), and more caregivers reported reading to their children (20.0% vs 3.5%) in the intervention than in the comparison group. Three independent predictors of optimal Home Observation for Measurement of the Environment score emerged from the logistic regression analysis: being in the intervention group, child ages >6 months, and maternal education greater than secondary school. Compliance with medical treatment and illness outcomes were not significantly different between the 2 groups.

CONCLUSIONS

The Care for Development Intervention is an effective method of supporting caregivers' efforts to provide a more stimulating environment for their children and can be used by health care professionals during visits for acute minor illness.