Empowering moms can lead to better outcomes for families and communities. Taking what was learned in a 10-year National Institutes of Health (NIH)-sponsored research program in rural areas of Uganda that helped moms living with HIV in bonding with their children is now being applied in the Democratic Republic of the Congo (DRC), Africa, so moms there can help to prevent a permanent paralytic neurological disease in their children caused from toxic cassava.
Michael Boivin, Ph.D., MPH, faculty member of the Departments of Psychiatry and Neurology & Ophthalmology with the Michigan State University College of Osteopathic Medicine, and his Congolese colleagues, are using the Mediational Intervention for Sensitizing Caregivers (MISC) – a maternal training program originally developed by early child development experts at Bar Ilan University in Israel, to enhance development of very young children infected and affected by HIV exposure, in a new way in the DRC. In this new NIH-sponsored research program, Dr. Boivin’s team is combining MISC with a detoxification program called the wetting method – a soaking method that removes cyanide through evaporation as cassava paste is dried in the open air and by sun light, if available. Detoxifying cassava will lower the risk of contracting konzo, a neurological disease caused by exposure to the high levels of exposure to cyanide found in this root vegetable, the main source of food for families in the region without other sources of protein during time of extreme food and water insecurity.
Dr. Boivin’s team has been gauging the emotional health of moms throughout their MISC work, studying such things as maternal depression, anxiety and other factors, because when moms are debilitated by a disease they or their children have, it limits their ability to do daily activities and compounds poor emotional well-being, Dr. Boivin said. “Teaching moms practical skills that they can use to help them with younger children, including those who may have disease, is vital,” he explained.
Dr. Boivin’s Work
Dr. Boivin, a 2023 University Distinguished Professor, a 2021 MSU Beal Award Outstanding Faculty, and a 2018 MSU Community Engaged Scholar Award (CESA) winner for his konzo prevention collaborations, is an internationally recognized expert in neurodevelopmental evaluation of African children. He is also a two-time Fulbright research fellow (DRC, 1990-91; Uganda 2003-04) and West African Research Association fellow (Senegal, 1997) whose research has assessed the neurodevelopmental impact of interventions for konzo disease, pediatric HIV, cerebral malaria, intestinal parasite and anemia treatment and malnutrition in children, and other significant public health risk factors in sub-Sahara Africa. His current work in using MISC to help prevent konzo in Congolese children and families was initially supported by a grant from the Alliance for African Partnership (AAP) to develop “A Partnership for Training Caregivers to Prevent Konzo Disease from Toxic Cassava and Enhance Neurodevelopment in Very Young Congolese Children.”
This initial grant was then followed by a grant from the Canadian Grand Challenges Saving Brains program, as well as a grant from the NIH Fogarty Program. Working with his colleagues in the MSU College of Osteopathic Medicine Global Neuropsychiatry Research Center, Itziar Familiar-Lopez, M.D., MPH., Ph.D., and Alla Sikorskii, Ph.D., M.S., the team recently applied to the National Institutes of Mental Health to evaluate the mental health benefits of MISC and konzo prevention for mothers and their children as the children reach school age. This work will involve eye tracking measures of konzo vulnerable brain/behavior processes, involving innovative assessments, supervised by Barbara Thompson, Ph.D., in the MSU College of Human Medicine.
Today’s Focus
The MISC work in the DRC provides those in the region the opportunity to continue to use the food staple cassava while enhancing mother/child bonding to ensure moms will more reliably perform the labor-intensive wetting method processes that need to occur daily to remove the cyanides from household cassava flour. Doing so, Dr. Boivin said, will help to prevent neurological disease that can lead to partial or full paralysis when the liver lacks sufficient protein to detoxify high levels of cyanamide.
“The long-term benefit for children is reducing psycho-social risks as they grow and age in highly impoverished settings where many health, nutritional, social and educational adverse risk factors must be overcome,” Dr. Boivin said. The Ministry of Health in the DRC is also working with Oregon Health and Sciences University (OHSU) Professor Desire Tshala-Katumbay, M.D., M.S., Ph.D. (principal investigator of the konzo prevention research program), Dr. Boivin and their colleagues at the University of Kinshasa medical school as well as at the National Institute for Biomedical Research (INRB). Boivin and Tshala-Katumbay have been invited to share their findings at international meetings and at the NIH and will do so again in July at the 2023 annual meeting for the American Society for Nutrition (ASN) in Boston, MA.
The MSU/DRC collaborative team has been documenting the neurodevelopmental effects of konzo and long-term exposure to toxic cassava and has explored new ways to prevent the disease by detecting blood and urine-based biomarkers for high-risk exposure levels in mothers and children. Their most recent findings continue to support the wetting method as the best way to prevent konzo if it can be reliably implemented through strategies such as MISC training for moms.
“We need to provide the Congolese mothers with practical caregiving skills and empowerment, and that is at the core of MISC. These moms can be empowered to make a difference in their families and communities, passing on what they’ve learned to their children and beyond in a manner that is culturally and socially transformative” Dr. Boivin said. “Our mission is about caring for those most affected by extreme poverty and the trauma it can cause, in practical, effective and sustainable ways.”
By Terri Hughes-Lazzell