Neurodevelopment from infancy to early childhood in West Africa: the contribution of early markers and psychosocial factors to developmental outcomes

Lead Research Organisation: UNIVERSITY OF CAMBRIDGE
Department Name: Psychology

Abstract

Over 200 million children under the age of 5 years in low-resource settings are exposed to adverse environmental factors, such as inadequate nutrition, physical illness and a lack of stimulation. This can have consequences for their ability to achieve important developmental milestones and, as a result, for subsequent school performance. While this is recognised as an important issue, there is very little research that aims to identify the earliest signs of risk and how it shapes development. Identifying early signs of risk in infancy is crucial for developing interventions to help children achieve optimal outcomes. It is also important to better understanding how specific aspects of a child's environment, such as nutrition and caregiving practices, contribute to their development. With this work, we will be better able to understand how certain risk factors impact on development and also how to best promote enriching elements within the family and broader community that can offset the impact of risk.

The aim of this research is to investigate the development of cognitive skills from infancy to preschool age among a group of children from a rural region of The Gambia, West Africa. The data for this project comes from the Brain Imaging for Global Health project (BRIGHT; globalfnirs.org), a study that has been following a group of children in The Gambia from the prenatal period to preschool age to measure their brain and cognitive development during early childhood.

The specific aims of this study are to:
(1) Examine cognitive development from infancy to preschool age among this group of children in the rural Gambian setting. Our goal is to study individual differences in development, which may help to identify children who show delayed development compared with the rest of the group.

(2) Investigate whether the ability to regulate attention and respond to social input during infancy predicts cognitive development during preschool age. We will use assessments of behavioural and neural responses to measure these skills in infancy and explore how they relate to outcomes during preschool age.

(3) To understand how both adverse and enriching elements of a child's environment contribute to their cognitive development. In particular we are interested in examining how exposure to adversity early in life impacts on development. The adverse factors that we will investigate are poverty, poorer physical growth and maternal mental health difficulties. We are also interested whether enriching factors, including maternal engagement and broader caregiver support, can promote healthy cognitive development and offset some of the impacts of risk.

(4) In addition to our research aims, we will also engage members of the Gambian community (parents, healthcare professionals) to ask for their input in our work. Moreover, we will establish a network of researchers from African institutions and across the globe, who study early childhood development in Africa, to share our findings and form collaborations.

Our work has the potential to have important impacts for research, as well as the development of interventions. Firstly, this study can help us better understand the general development of children in The Gambia. It can also help identify early signs and risk factors for developmental difficulties. Finally, our findings will help to identify and promote elements of the family and broader community that provide enrichment. With this work, we aim to make a lasting contribution to the research community and society in The Gambia and broader global health settings.
 
Description This grant aims to realise key research, engagement and capacity building aims. The primary aim of this work has been to use data from the Brain Imaging for Global Health (BRIGHT) project to characterise and map trajectories of cognitive development from infancy to preschool age among children in a rural area of The Gambia. Substantial steps have been made in achieving this research goal. In particular, we have focussed on characterising cognitive outcomes at preschool age in this sample, using a battery of measures that examine global cognitive development, executive functions (EFs) and adaptive skills. Analyses of this data have revealed distinct patterns of skill, depending on the domain measured. On average, children in this setting performed within expected ranges (or better) on the EF measures and showed generally good adaptive skills.

However, while children did well on EF tasks, there was substantial variation in domains related to literacy, numeracy, and working memory. We also examined longitudinal trajectories of cognitive development. We have demonstrated significant associations between cognitive skills measured at 5-months of age with the cognitive outcomes measured at preschool age. This work has been presented at the International Congress of Infant Studies (ICIS) meeting in July 2022. We also successfully created growth curve models to map developmental trajectories of cognitive skills.

We have also capitalised on our collaboration with project partners from the University of the Witwatersrand (South Africa) and Oxford (UK) to combine data collected from their study in South Africa with equivalent data that we have from the BRIGHT project. In particular, both studies have used the same EF assessments among age-matched pre-school age children. We examined the contribution of socioeconomic factors and interactions with caregivers to EFs, within each setting. We found that children in both settings performed within age-expectation on these tasks, challenging the widely held notion that growing in low-income settings predisposes children to having poorer EFs. Furthermore, we did not find associations with socioeconomic factors, but a relationship between EFs and engagement in enriching activities with caregivers emerged in the Gambian sample. This work is one of the few studies that examined EF skills and their shared and distinct predictors in two majority world settings. A manuscript describing these findings is currently under review in the Developmental Science special issue "Towards a Globalized Developmental Science".

We also explored environmental risk and protective factors of child cognitive outcomes. We were interested in examining the role of maternal mental health difficulties in cognitive development. Part of this work also involved exploring why some mothers may be at heightened risk for poor mental health, focussing on environmental factors related to poverty. These factors are important because they are shared between the mother and child. We found that poverty related factors, such as lower income, greater household size (i.e., overcrowding) and work in agriculture predicted poorer maternal mental health. This work was submitted to the Journal of Affective Disorders and presented at the International Society of Developmental Psychobiology conference in 2023.

We also examined whether maternal mental health interacted with caregiving practices, such as sensitivity and responsiveness in interactions with their child, and whether this contributed to child cognitive development. Indeed, we found that mothers who reported higher depression showed lower mood and engagement during interactions with their infants. Maternal sensitivity, engagement, and mood were related to infant EF skills at preschool age, as well as their gross motor skills. This work was presented at the Lancaster Conference on Infant and Child Development, and the European Conference on Developmental Psychology in 2023.

Finally, we have established a network (the African Brain and Cognitive Development Network [AfriBCD]) aimed at bringing together researchers who conduct child development research in Africa, with a strong focus on inviting researchers based at African institutions. AfriBCD currently has over 60 members in sixteen countries in Africa, Europe, and North America. We have held two virtual meetings, which had approximately 30-40 attendees each and an in-person meeting in September 2023. Through this network, we have formed a collaboration with researchers who have established a community of practice aimed at developing cognitive tools that are culturally and contextually appropriate for use in the African context. We are also in the process of writing a manuscript that describes this network, as well as challenges faced by African researchers and their proposed solutions.

We have also carried out stakeholder engagement events with professionals who work in the clinical field in The Gambia, where the data collection for this study was conducted. We were able to share our findings with them and to invite them to ask questions and provide feedback. We also had wider discussions about caregiving practices in their community and challenges faced by both families and medical professionals. It was a highly fruitful discussion that enriched our understanding of the context and provided an opportunity to share our findings with people who work directly in the care of the community that we study.
Exploitation Route The research findings to date are an important contribution to the field, as we are one of the few studies that have examined cognitive development over such an extensive developmental time frame and across distinct cognitive domains, in a low-resource community in the Global South. As such, we expect that this work will help guide future researchers in characterising cognitive outcomes and identifying domains that are critical to focus on in the context of poverty. The work demonstrating good EF skills in The Gambia and South Africa also opens avenues for looking at areas where children in these contexts show strength. This is important as most prior work in majority world settings is heavily focussed on risk and deficit models. Furthermore, understanding the contextual factors that contribute to cognitive development (such as maternal mental health and caregiving practices) can help in the formation of interventions to support both mothers and infants to achieve the best possible outcome.

The engagement work that has been undertaken has shown that there is growing interest in assessing neurocognitive development in Africa. Future funds could be used to additional host in-person meetings, particularly in African based academic institutions. Funds are needed to support the creation of platforms to support researchers from Africa, the Global South and the Global North to form collaborations and to network.
Sectors Education

Healthcare
 
Description The engagement work done by this grant has extended beyond working with academic stakeholders and we have started to engage with non-academic partners as well. We currently have a number of members of the AfriBCD network who work in education and healthcare in African settings. Furthermore, within The Gambia specifically, we have established contact with representatives from educational and healthcare facilities in the area where the community is based. We are in the process of organising a stakeholder engagement event in The Gambia. At the present time, the extent of our impact has been to engage these distinct stakeholders in research. This is particularly important as it gives us an opportunity to disseminate research findings to stakeholders who work directly with the community in question. It also gives us an opportunity to learn from them about how to contextualise and implement our research findings further. We held a stakeholder engagement event to speak to local healthcare providers (doctors, nurses, midwives) at the Medical Research Council Unit The Gambia (MRCG), where our study was conducted. Clinicians at the MRCG are aware of our work but we have never previously discussed our findings with them. Therefore, it was a useful opportunity to share our findings with professionals who are directly responsible for the care of our participants and the community. It was also very beneficial to hear their views on our work and about caregiving practices and the challenges faced more generally. Finally, the work on this grant led to an invitation to present at the Learning Sciences Meeting at UNESCO. Here, I spoke about the findings from the work done on this grant, particularly highlighting findings of the associations between cognitive ability and exposures in early infancy to preschool age cognitive outcomes. The message of my talk was that investments need to be made into infant and early child development to support later educational outcomes. This meeting was attended by policy makers, politicians, educators, researchers, and members of non-governmental organisations. Therefore, it was an excellent opportunity to share our findings with professionals who have a role in implementing these findings into practice.
First Year Of Impact 2022
Sector Education,Healthcare
Impact Types Policy & public services
 
Description African Brain and Cognitive Development (AfriBCD) Network 
Organisation University of Cambridge
Department Department of Psychology
Country United Kingdom 
Sector Academic/University 
PI Contribution The AfriBCD network was established as a part of this grant. The network is aimed at bringing together researchers, clinicians, educators and other stakeholders who do child development research in Africa. As part of this grant, I established the network, recruited over 140 members, began hosting regular virtual meetings, and hosted an in-person meeting in Cambridge to showcase the work done by our members and think about ways to support African based researchers.
Collaborator Contribution Dr Sarah Lloyd-Fox, which was the PI on this grant, established this network with me as a joint effort. Dr Catherine Draper and Professor Gaia Scerif (who are both project partners) were very involved in the establishment of this network. Dr Draper is South African and was able to provide invaluable guidance, they both opened up avenues for recruiting members. Dr Draper spoke at the meeting in Cambridge and Professor Scerif also attended. Their support has been vital in understanding the contextual factors necessary for establishing a network of this kind.
Impact - We have hosted 4 virtual meetings, where speakers who do research in Africa came to present their research. We wanted to prioritise and give a platform to researchers based in African institutions. The meetings have typically been attended by 30-40 people and generate lively discussion, this has been a positive way to promote African psychological research. - We hosted 1 in-person meeting in Cambridge. There were 8 speakers doing research talks (5 of these were invited speakers from Africa, the grant covered their travel expenses to attend). There were also speakers from 3 relevant organisations (Cambridge-Africa, Young Scientists for Africa, and Cambridge Global solutions). In addition to research talks, we asked members to compile a list of their biggest challenges in doing research in Africa and potential solutions. A publication describing these outcomes is under preparation.
Start Year 2022
 
Description African Brain and Cognitive Development (AfriBCD) Network 
Organisation University of Oxford
Country United Kingdom 
Sector Academic/University 
PI Contribution The AfriBCD network was established as a part of this grant. The network is aimed at bringing together researchers, clinicians, educators and other stakeholders who do child development research in Africa. As part of this grant, I established the network, recruited over 140 members, began hosting regular virtual meetings, and hosted an in-person meeting in Cambridge to showcase the work done by our members and think about ways to support African based researchers.
Collaborator Contribution Dr Sarah Lloyd-Fox, which was the PI on this grant, established this network with me as a joint effort. Dr Catherine Draper and Professor Gaia Scerif (who are both project partners) were very involved in the establishment of this network. Dr Draper is South African and was able to provide invaluable guidance, they both opened up avenues for recruiting members. Dr Draper spoke at the meeting in Cambridge and Professor Scerif also attended. Their support has been vital in understanding the contextual factors necessary for establishing a network of this kind.
Impact - We have hosted 4 virtual meetings, where speakers who do research in Africa came to present their research. We wanted to prioritise and give a platform to researchers based in African institutions. The meetings have typically been attended by 30-40 people and generate lively discussion, this has been a positive way to promote African psychological research. - We hosted 1 in-person meeting in Cambridge. There were 8 speakers doing research talks (5 of these were invited speakers from Africa, the grant covered their travel expenses to attend). There were also speakers from 3 relevant organisations (Cambridge-Africa, Young Scientists for Africa, and Cambridge Global solutions). In addition to research talks, we asked members to compile a list of their biggest challenges in doing research in Africa and potential solutions. A publication describing these outcomes is under preparation.
Start Year 2022
 
Description African Brain and Cognitive Development (AfriBCD) Network 
Organisation University of the Witwatersrand
Country South Africa 
Sector Academic/University 
PI Contribution The AfriBCD network was established as a part of this grant. The network is aimed at bringing together researchers, clinicians, educators and other stakeholders who do child development research in Africa. As part of this grant, I established the network, recruited over 140 members, began hosting regular virtual meetings, and hosted an in-person meeting in Cambridge to showcase the work done by our members and think about ways to support African based researchers.
Collaborator Contribution Dr Sarah Lloyd-Fox, which was the PI on this grant, established this network with me as a joint effort. Dr Catherine Draper and Professor Gaia Scerif (who are both project partners) were very involved in the establishment of this network. Dr Draper is South African and was able to provide invaluable guidance, they both opened up avenues for recruiting members. Dr Draper spoke at the meeting in Cambridge and Professor Scerif also attended. Their support has been vital in understanding the contextual factors necessary for establishing a network of this kind.
Impact - We have hosted 4 virtual meetings, where speakers who do research in Africa came to present their research. We wanted to prioritise and give a platform to researchers based in African institutions. The meetings have typically been attended by 30-40 people and generate lively discussion, this has been a positive way to promote African psychological research. - We hosted 1 in-person meeting in Cambridge. There were 8 speakers doing research talks (5 of these were invited speakers from Africa, the grant covered their travel expenses to attend). There were also speakers from 3 relevant organisations (Cambridge-Africa, Young Scientists for Africa, and Cambridge Global solutions). In addition to research talks, we asked members to compile a list of their biggest challenges in doing research in Africa and potential solutions. A publication describing these outcomes is under preparation.
Start Year 2022
 
Description Catalyzing Cognition Research in Africa Community of Practice 
Organisation University of Laval
Country Canada 
Sector Academic/University 
PI Contribution I have teamed up with a group of researchers who are creating a community of practice to develop measures of cognitive assessment that are suitable for use with African populations. I have recently set up my own research network and have invited the researchers from this community of practice to present their work, thus attracting potential members for their community or practice. I have also shared information about this community of practice via the mailing list of my network to help them attract members.
Collaborator Contribution These partners have presented at my African research network virtual meeting. We are currently discussing setting up a joint website.
Impact There are currently no outputs.
Start Year 2022
 
Description Catalyzing Cognition Research in Africa Community of Practice 
Organisation University of the Witwatersrand
Country South Africa 
Sector Academic/University 
PI Contribution I have teamed up with a group of researchers who are creating a community of practice to develop measures of cognitive assessment that are suitable for use with African populations. I have recently set up my own research network and have invited the researchers from this community of practice to present their work, thus attracting potential members for their community or practice. I have also shared information about this community of practice via the mailing list of my network to help them attract members.
Collaborator Contribution These partners have presented at my African research network virtual meeting. We are currently discussing setting up a joint website.
Impact There are currently no outputs.
Start Year 2022
 
Description Collaboration with Rogier Kievit at Donder's Institute in The Netherlands 
Organisation Radboud University Nijmegen
Department Donders Institute for Brain, Cognition and Behaviour
Country Netherlands 
Sector Academic/University 
PI Contribution The primary goal of my work with Professor Kievit is to learn statistical modelling methods from him. However, during my visit to his research group, I did several presentations for his lab group and department, telling them about the BRIGHT project and my work. We hope to extend our collaboration and share data with this team in the future.
Collaborator Contribution Professor Rogier Kievit is a project partner on this grant. I visited him and his research group for two weeks. During this time, we worked on data analyses. In particular, we worked on creating longitudinal models of cognitive development in the sample of children from The Gambia, who were participants in the BRIGHT project. He has also supported my analyses of perinatal mental health data from the same study. Professor Kievit taught me several key analytical methods and oversaw my work on these analyses. This work is ongoing and we hope to submit a manuscript with the results later this year.
Impact There are currently no outputs but we are in the process of preparing two manuscripts, which we hope to submit in the coming months.
Start Year 2022
 
Description Collaboration with South African research team 
Organisation University of Oxford
Country United Kingdom 
Sector Academic/University 
PI Contribution I received data collected from a study in South Africa. I combined this with data from the Brain Imaging for Global Health (BRIGHT) project, which is the data collected from The Gambia being used in this grant. I conducted data analyses on the data sets from these two studies and combined them for a joint publication, on which I am listed as first author and both of these partners are included as authors. This is currently under review in the journal "Developmental Science".
Collaborator Contribution Dr Catherine Draper (University of the Witwatersrand) and Professor Gaia Scerif (University of Oxford) are two project partners on this grant. They ran a study that collected data on executive functioning among low-income preschool aged children in South Africa. The measures used and age of participants in the study were the same as those in the Brain Imaging for Global Health (BRIGHT) project, which is the data being used in this grant. Therefore, they shared data collected from their study with me for a joint publication for a special issue on "Child Development in a Global Context" in Developmental Science.
Impact A manuscript that arose from this collaboration is currently under review in Developmental Science. Milosavljevic, B., Cook, C., Fadera, T., Ghillia, G., Howard, S.J., Makaula., H., Mbye, E., McCann, S., Merkley, R., Mshudulu, M., Saidykhan, M., Touray, E., Tshetu, N., Elwell, C., Moore, S.E., Scerif, G., Draper, C.E., & Lloyd-Fox, S. (Under review). Executive functioning skills and their environmental predictors among pre-school aged children in South Africa and The Gambia. Developmental Science.
Start Year 2022
 
Description Collaboration with South African research team 
Organisation University of the Witwatersrand
Country South Africa 
Sector Academic/University 
PI Contribution I received data collected from a study in South Africa. I combined this with data from the Brain Imaging for Global Health (BRIGHT) project, which is the data collected from The Gambia being used in this grant. I conducted data analyses on the data sets from these two studies and combined them for a joint publication, on which I am listed as first author and both of these partners are included as authors. This is currently under review in the journal "Developmental Science".
Collaborator Contribution Dr Catherine Draper (University of the Witwatersrand) and Professor Gaia Scerif (University of Oxford) are two project partners on this grant. They ran a study that collected data on executive functioning among low-income preschool aged children in South Africa. The measures used and age of participants in the study were the same as those in the Brain Imaging for Global Health (BRIGHT) project, which is the data being used in this grant. Therefore, they shared data collected from their study with me for a joint publication for a special issue on "Child Development in a Global Context" in Developmental Science.
Impact A manuscript that arose from this collaboration is currently under review in Developmental Science. Milosavljevic, B., Cook, C., Fadera, T., Ghillia, G., Howard, S.J., Makaula., H., Mbye, E., McCann, S., Merkley, R., Mshudulu, M., Saidykhan, M., Touray, E., Tshetu, N., Elwell, C., Moore, S.E., Scerif, G., Draper, C.E., & Lloyd-Fox, S. (Under review). Executive functioning skills and their environmental predictors among pre-school aged children in South Africa and The Gambia. Developmental Science.
Start Year 2022
 
Description AfriBCD network knowledge exchange meeting in Cambridge 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact This was an in-person meeting for the African Brain and Cognitive Development (AfriBCD) network. The aim was to showcase developmental psychology research being conducted in Africa and, in particular, being done at African institutions. We invited 5 researchers from Africa (Nigeria, Tanzania, Uganda, and South Africa) to present their work, there were also 4 UK based researchers, and 3 speakers representing organisations that support researchers in Africa (Cambridge Africa, Young Scientists for Africa, and Cambridge Global Challenges). The idea was for people to share their work, form connections and learn from each other. There were 40 attendees in total. We asked speakers and attendees to form discussion groups where they discussed challenges of doing psychological research in Africa and potential solutions. We collected this information and a manuscript describing this network, meeting, challenges and solutions, is currently in preparation.
Year(s) Of Engagement Activity 2023
URL https://www.afribcd.org/kem2023
 
Description African Brain and Cognitive Development (AfriBCD) Network virtual meetings 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact We have established a network for stakeholders involved in child development research in Africa. We have currently hosted two virtual meetings, which has approximately 30-40 attendees each. Attendees included researchers, as well as postgraduate students, educators and healthcare staff. Both meeting sparked discussion about important matters such as how to better support African based researchers and the types of resources needed. There was also discussion about the use of cognitive assessment tools in Africa and this network led to a collaboration with researchers who have established a community or practice to create culturally and contextually sensitive cognitive assessment tools.
Year(s) Of Engagement Activity 2022,2023
 
Description Cambridge Festival 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact We took part in the annual Cambridge Festival, where members of the local community are invited to the university for a series of talks and events. We organised a stand for children, where they engaged in a series of arts and crafts activities that were meant to teach them how infant sensory processing develops and about brain activity/anatomy. We also put up posters showcasing research from the Brain Imaging for Global Health (BRIGHT) project in The Gambia, as well as research being done with infants in other labs. We discussed our research with visitors.
Year(s) Of Engagement Activity 2023
URL https://www.festival.cam.ac.uk
 
Description Capacity Building Workshop, Regensburg Germany 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact I was invited to present a talk at a capacity building workshop hosted by the University of Regensburg in Germany. The aim of this workshop was to bring together researchers and stakeholders who conduct their research in the Global South, with the idea of supporting capacity development. Here, I spoke about the Brain Imaging for Global Health (BRIGHT) project and the findings from this grant award. I also spoke about the African Brain and Cognitive Development (AfriBCD) network, which was set up as part of this grant, and the work we have been doing to promote the work of African based researchers.
Year(s) Of Engagement Activity 2023
 
Description Stakeholder engagement event in The Gambia 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact A knowledge exchange meeting was held at the Medical Research Council Unit, The Gambia (MRCG). We invited medical professionals (doctors, nurses, midwives) to discuss their views on early childhood development, how to foster enriching caregiving practices, challenges faced in their profession and by families, and to present to them information at the Brain Imaging for Global Health (BRIGHT) project and preliminary results from this study. BRIGHT was carried out at the MRC and the clinical staff there are very familiar with it, but we have never previously shared study findings with them or sought their opinion on our work and the questions we are asking, so this was an opportunity to speak with medical staff and invite them to share their views. We conducted two focus groups with the health professionals to broadly speak to them about caregiving practices in their community, challenges faced by parents and ways to promote caregiving practices that would support healthy neural and cognitive development. We then spoke to them about our research examining infant neural and cognitive development and how environmental factors play a role, and invited them to ask questions and share their views.
Year(s) Of Engagement Activity 2023
 
Description UNESCO Learning Sciences Expert Meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact I was invited to present the work sponsored by this grant on the Brain Imaging for Global Health (BRIGHT) project for a Learning Sciences Expert Meeting hosted by UNESCO at their headquarters in Paris, France. I presented to a group of approximately 50 people who were representing different academic institutions, government organisations and non-profit organisations. My presentation showcased the work from BRIGHT, which shows strong evidence that environmental and health factors very early in infancy have an impact on later cognitive outcomes. Therefore, the message of my talk was that infant and early childhood development need to be crucial areas of focus for education policy.
Year(s) Of Engagement Activity 2023
URL https://glhconnect.unesco.org/unesco-expert-meeting-learning-sciences