Title:
|
Examining cognitive functions of Ugandan infants and children in relation to worm infections and anthelminthic treatment, social stimulation and the organization of executive function
|
BACKGROUND: A big proportion of populations in sub-Saharan Africa still battle with
poverty and intense exposure to infections including chronic worm infections. Studies of
cognitive effects of worms have not been consistent regarding which functions are
affected and whether deworming is beneficial. However, executive functions could be
particularly susceptible to impairment. The home environment is reported to affect child
development. However, its unique contribution in Ugandan children exposed to various
factors has not been estimated. This PhD research therefore aimed to [I] examine effects
of maternal and childhood worm infections and their treatment on executive function and
other developmental outcomes in infancy and preschool-age children; and [2] investigate
the independent effects of the home environment on child mental performance, taking
into account the confounding effects of other socio-demographic exposures. In the same
sample, [3] relationships between executive functions were examined in order to
understand how they may be disrupted by worms and other adverse factors.
METHODS: This research was conducted within the ongoing Entebbe Mother and Baby
Study (EMABS) in which 2500 pregnant women were randomised to receiving a single
dose of albendazole or placebo and praziquantel or placebo in a 2x2 design. 983 infants
born to these women were assessed at age 15 months on executive function, and other
abilities to measure the effect of maternal worm infections and their treatment on these
functions. The infants were then randomised to quarterly doses of albendazole or placebo
from age 15 months and were assessed again at age five years (N=870) on measures of
executive function, general ability and motor function to examine effects of childhood
worm infections and their treatment on performance on these functions. Relevant health
and socio-demographic date were collected and used in the analyses. 200 children were
assessed on an extended battery of executive function measures and their scores were
used to explore the structure and relationships between executive functions . Home
environments of 163 children were examined using an adapted version of the Home
Observation for Measurement of the Environment (HOME).
RESULTS: Maternal Mansonella perstans and Strongyloides stercoralis infection were
negatively associated with infants' performance on the A not B task (a measure of
executive function) and language respectively but anthelminthic treatment did not show
significant effects overall. In childhood, worms were negatively associated with
performance on measures of working memory (Verbal Fluency, Counting Span, and
Running Memory), attention (Picture Search), and general ability (Block Design).
However, treatment with quarterly albendazole did not have significant effects on
performance on measures of cognitive functioning. The home environment contributed to
cognitive performance above and beyond the effect of other factors. Low-to-moderate
inter-construct correlations were observed among executive functions and three
components were extracted from the four domains. Planning was most related to
inhibition with working memory also contributing to the best fit model.
CONCLUSION: Both infant and childhood developmental outcomes suggest that
executive functions may particularly be susceptible to impairment by worm infections but
treatment may not reverse the effects. Furthermore, the results show that the home
environment affects the child independently of SES, parental education and other global
measures. Correlations and factor loadings indicate unity among the executive functions,
particularly between planning and a combination of inhibition and working memory,
|