Enfance Africaine - Mental child health in francophone Africa

In sub-Saharan Africa, few studies have looked at important determinant of early child neurodevelopment, cognitive functioning and mental health of children. Different factors, such as exposure to dietary cyanogen toxicity or chronic disease such as sickle cell anaemia, may impact child mental health. We thus propose the present collaborative project, Enfance Africaine-Mental child health in francophone Africa. The project is linked to the konzo project that focuses on toxico-nutritional and genetic determinants for neurodegeneration, and follows up a cohort of children affected by konzo (an irreversible, though preventable, upper motor neuron disease linked to the chronic consumption of cyanogenic cassava) in the Democratic Republic of Congo (DRC). Enfance Africaine does within the bigger project konzo focus on the vulnerable children exposed to cyanide through chronic consumption of poorly processed bitter cassava as a staple food, and on children affected by sickle cell anaemia. Sickle cell disease (SCD) is a neglected, chronic, multisystem genetic and hereditary disease of growing importance in the global health context. It is caused by the inheritance of a mutation in the HBB gene that results in the production of a structurally abnormal form of ?-globin leading to anaemia. SCD is the most frequent haemoglobin disorder in sub-Saharan Africa affecting 3-4% of the population, and associated with very high child mortality. The DRC is the 2nd most affected country in Africa, with approximately 12% of hospitalized children in paediatric wards having SCD. WHO estimates that 70% of deaths in SCD are avoidable by putting in place preventive measures. As a collaborative project, Enfance Africaine aims at estimating the prevalence of childhood mental health conditions and study the psychometric profile of vulnerable children exposed to dietary cyanide, and of vulnerable children affected by sickle cell anaemia in the DRC. Through a cross-sectional study, we have collected information related to medical history, family environment, maternal mental health and other related socio-demographic characteristics using a structure interview with parents/caregivers of children in konzo affected area, and of children attending the national paediatric hospital in the DRC. All children were subject to a complete clinical, including neurological examination, neurodevelopment assessment, behavior and neurocognitive evaluation using selected appropriate tools to assess early child neurodevelopment, neurocognition, motor functions, and behavior. Maternal mental health as well as home environment and parenting style were assessed. Our preliminary findings published in Plos One in 2018, suggested an association between dietary cyanogen exposure, early child neurodevelopment, cognitive abilities and motor development, even in the absence of clinically evident paralysis. We also found a significant association between child linear growth, early child neurodevelopment, cognitive ability and motor development. There is a need for community-wide interventions for better cassava detoxification processing practices, improved nutrition, and neuro-rehabilitation that are essential for optimal development of the exposed children. The second phase of the project that will study school-aged children, and children affected by sickle-cell anaemia is on-going with data collection and analysis.

In sub-Saharan Africa, only few studies have looked at the diet as an important determinant of cognitive functioning and mental health among children. Exclusive breastfeeding (EBF) and certain staple foods, such as cassava may impact child mental health. We therefore propose a collaborative project, Mental child health in francophone Africa, to (1) estimate the effect of peer counselling for EBF on the cognitive functioning and mental health among children in Burkina Faso, (2) to study the cognitive funct ioning, neuropsychological profile and mental health of children in Burkina Faso and Democratic Republic of Congo (DRC). This proposal is directly linked to the PROMISE Saving Brains (PROMISE SB) in Burkina Faso, and the KONZO project in the DRC. The PROM ISE SB follows-up children born from the EBF trial and the KONZO project follows-up children with KONZO (an irreversible upper motor neuron disease linked to the chronic consumption of cyanogenic cassava. Hypotheses: (1) Promoting peer counseling for EBF intervention in the first 6 months of life improves the cognitive functioning and mental health, (2) children affected by KONZO exhibit deficits in cognitive functioning, which will affect their attention, learning abilities, and their mental health. Met hod: children from the EBF and the KONZO cohorts will be studied using a case-control approach. The cognitive functioning and neuropsychological profile of the children will be assessed using separate clinical units. Qualitative methods (group discussions , observation and interviews) will be used to assess mental health problems. At the completion of the project, our findings will help to estimate the prevalence of mental health problems and illuminate the impact of nutrition (EBF and cyanogenic cassava) on the cognitive functioning of children in two African settings. It will also help develop a scientific rationale to address and develop strategies to improve child mental health in sub-Saharan Africa