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Facteurs de risque de mauvais développement psychomoteur de l’enfant au Benin (Risk factors for poor cognitive development of children in Benin) Michael.

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Presentation on theme: "Facteurs de risque de mauvais développement psychomoteur de l’enfant au Benin (Risk factors for poor cognitive development of children in Benin) Michael."— Presentation transcript:

1 Facteurs de risque de mauvais développement psychomoteur de l’enfant au Benin (Risk factors for poor cognitive development of children in Benin) Michael Osei MIREKU Supervisor: Michel COT Co-supervisor: Florence BODEAU-LIVINEC

2 Background and Context 2 Cognitive Development Risk factors Genetic Disorders- Sickle cell anemia (Thompson et al., 2002) Childhood under nutrition Iron deficiency/ Anemia in children Preterm births and low birth weight (LBW) Environmental factors Socio-economic factors Neurological and psychological development of a child Motor (Gross and Fine) Language (Receptive and Expressive) Visual Reception Measurement Bayley Scales of Infant Development (BSID) Mullen Scales of Early Learning (MSEL) (Hoque et al., 2012 and Akshoomoff, 2006 )

3 Background and Context cont’d 3 Anemia Etiology Genetics – Sickle cell, G6PD deficiency disease Infections – Malaria, Helminthes, HIV Nutritional – Iron, Folate, Vit. B12 deficiencies Health Consequences Increased risk of maternal morbidity and mortality (Schmiegelow et al., 2012) Infant mortality, Low birth weight, Preterm birth Control and Prevention Genetics – Antibiotherapy and analgesics Infections – Artemesin-based drugs, ITMNs, Albendazole-based drugs Nutritional – Iron, Folate, Vit. B12 supplements G6PD (Glucose-6-phosphate dehydrogenase) ITMNs-Insecticide treated mosquito nets

4 Background and Context cont’d 4 Prevalence in Africa 57.1% among pregnant women 67.6% among preschool children Source: WHO, 2008

5 Hypothesis Few studies on maternal folic acid deficiency and cognitive outcomes Few studies on lead in childhood, ID and child development 5 Maternal anemia (Maternal ID) Preterm delivery, LBW, IDA in children Poor cognitive Development ??? ID- Iron deficiency

6 Objectives 6 Main Specific To identify maternal and childhood risk factors associated with poor cognitive development of children in Benin To determine : the effect of maternal anemia and maternal iron deficiency on the cognitive development of children in Benin at age 1 year the effect of maternal folic acid deficiency on the cognitive development of children in Benin at age 1 year the impact of lead exposure on the cognitive development of children in Benin at age 1 year

7 Methods: Flow Diagram of Study inclusions 1005 women ANC1 (IPT1) 3 exclusions : - 1 HIV+ - 1 uterus malformation - 1 gestational age>28 weeks 978 women ANC2 (IPT2) 37 out: - 17 refusal - 4 lost-to-follow-up - 16 migrations 27 out of the study: - 16 refusal - 7 lost-to-follow-up - 4 migrations 941 women followed until delivery (Ouedraogo, 2012) 637 children already assessed with Mullen at one year of age (71% of follow-up) so far…..

8 8 Study Design Setting & Participants Cohort Allada, Benin (Rural community) Pregnant women and their children (1 year old) Data Collection (concluded by Jan. 2013) Infants (at birth and at 1 year) Anthropometric measurements, gender, Hb concentration, sickle cell status, cognitive function (MSEL)… Maternal Age, SES, gravidity, malaria, malnutrition, micronutrient deficiencies, complications during pregnancy, Hb concentration (3x)… Analysis Stata IC11, SAS Crude Analysis Identify confounders using DAGS Multivariate Analysis Methods (2)

9 Draft Time Table 9 Year 1 Complete data collection Primary data analysis Field trip Year 2 Data analysis Writing articles Year 3 Writing articles and PhD manuscript

10 Relevance of Study 10 Second study on the association between maternal anemia and cognitive development after only one small existing study. (Vaughn et.al, 1986) Help inform policy makers on appropriate interventions during pregnancy Contribute to the growing knowledge on risk factors of cognitive development in children

11 References 11 Hoque MM, Ahmed NU, Khan FH, Jahan R, Yasmeen HN, Chowdhury MA. (2012) Breastfeeding and cognitive development of children: assessment at one year of age. Mymensingh Med J. 21(2): Akshoomoff N. (2006) Use of the Mullen Scales of Early Learning for the Assessment of Young Children with Autism Spectrum Disorders. Child Neuropsychol. 12(4-5): Schmiegelow C, Minja D, Oesterholt M, Pehrson C, Suhrs HE, Bosteom S, Lemnge M, Magistrado P, Rasch V, Lusingu J, Theander TG, Nielsen BB. (2012).Factors associated with and causes of perinatal mortality in northeastern Tanzania. Acta Obstet Gynecol Scand. 91(9): WHO. (2008). Worldwide prevalence of anaemia 1993–2005. Pp 8-10 Thompson RJ Jr., Gustafson KE, Bonner MJ, Ware RE. (2002). Neurocognitive development of young children with sickle cell disease through three years of age. J. Pediatr. Psychol. 27 (3): Ouedraogo S. Thesis defence- UPMC in 2012 Vaughn J, Brown J, Carter JP. (1986).The effects of maternal anemia on infant behavior. Journal of the National Medical Association. 78(10) :

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13 13 Definitions Anemia Hb concentration< 110 g / L Micronutrients deficiencies Inflammation : CRP ≥ 6mg/mL Iron deficiency: ferritin < 12 µg / L ou 12 µg/L ≥ ferritin ≤ 30 µg/L et CRP+ Folate deficiency: folate < 6,6 ng / L Vitamine B12 deficiency : vitamine B12 < 150 pg / L Iron deficiency anemia: Anemia+iron deficiency Ouedraogo S. 2012

14 14 Study field Allada Source : ch.org/siteias/static/Carte-Benin.GIF Ouedraogo S. 2012

15 15 Methods: Cohort of pregnanct women MiPPAD and APEC (PI: Michel Cot) Birth cohort study in Benin 1005 pregnant women included in a trial funded by the European Commission comparing 2 IPTp: sulfadoxine–pyrimethamine and mefloquine Study of risk factors for anemia during pregnancy (malaria, helminths, iron deficiency, folate deficiency, vitamine B12 deficiency)

16 16 Variables in pregnant women At the time of recruitment: parity, gestational age, MUAC (middle upper-arm circumference), maternal weight and height and demographic and socio-economic data Malaria (parasite density and placental infection), other parasitizes (helminthes), multiple pregnancy, urinary tract infection, sickle cell disease, micronutrients deficiency, under nutrition (body mass index), poor antenatal care Anemia: – Anemia will be defined as hemoglobin <110 g/l and severe anemia as hemoglobin <80 g/l – Iron-deficiency anemia: serum ferritin C-reactive protein (CRP)

17 17 Variables in infants At 1, 9 and 12 months (within the trial): – Mortality – Anthropometric measurements – Blood assessments: malaria, other infections, nutrition, Hb, ferritin, helminthes, folic acid, vitamin B12 At 12 months (within the R21): – Development assessment MSEL: Mullen Scales of Early Learning, Ten Questions Questionnaire – Maternal depression, parent-child interaction (HOME), maternal non-verbal IQ (Raven) – Blood lead

18 18 Mothers characteristics (from Smaila Ouedraogo’s PhD) ANC1ANC2Delivery Gestational age (weeks)22,1 [21,8-22,3]**28,9 [28,6-29,1]**39,3 [39,1-39,5]** Time between visits (weeks)-6,4 [6,3-6,5]**12,1 [11,8-12,4]** Malaria (%)15,14,09,6 Helminthes (%)11,17,22,4 Hb (g / L)$ 103,2 [102,4- 103,9]** 105,1 [104,4-105,8]**111,4 [110,5-112,4]** < 11068,364,540,6 Iron deficiency (%)33,336,330,7 Iron deficiency anemia (%)24,326,513,5 Folate deficiency (%)31,316,938,7 Vitamine B12 deficiency (%)3,63,57,2 Inflammation (%)20,512,334,3

19 Anemia in pregnancy Cognitive function in childhood ? Model 1 adjusted for potential confounding factors: Total effect Causes of anemia and cognitive function: socio-economic status, mother nutrition, prenatal infections (including malaria) Infant nutrition (including breastfeeding), anemia and iron-deficiency at 12 months, malaria in infancy Common causes If question

20 Anemia in pregnancy Cognitive function in childhood ? And for or stratified by: Potential confounding and/or intermediate factors: anemia at birth, prematurity, LBW Model 2 adjusted for: Potential confounding factors (as described in model 1) Direct effect To explore mechanisms


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