Developmental Neuroscience and Stunting Conference
US Science Envoy Program
March 16-18, 2016
Luang Prabang, Laos
Research Group Summary & Goals
Group Member (Organization, Country Representation)
- Nguyen Quang Dung (National Institute of Nutrition, Vietnam)
- Sengchanh Kounnavong (Ministry of Health, Laos)
- Le Thi Quynh Nhi (Ho Chi Mihn University of Medicine, Vietnam)
- Min Kyaw Htet (Trisakti University, Myanmar)
- Michael Toole (Burnet Institute, Australia)
- Le Thi Huong (Hanoi Medical University, Vietnam)
- Theingi Thwin (Ministry of Health, Myanmar)
- Cheri Nijssen-Jordan (Loa Friends Hospital for Children, Laos)
- Dare Baldwin (University of Oregon, US)
- Jackie Shannon (Oregon Health Sciences University, US)
- Khamseng Philavong, (Ministry of Health, Laos)
- Kyaw Linn (Yangon Chldren’s Hospital, Myanmmar)
Day 1 Research Group Notes:
The first breakout session was oriented toward identifying research initiatives that those in attendance might be interested in initiating, especially collaboratively across nations. Given the neuroscience focus of the conference, we began with consideration of the extent to which we might be able to agree on tools for measuring neuro-cognitive development, with an eye toward indices that would be sensitive to effects of malnutrition.
- How do we currently measure brain development?
- One concern raised and about which there was considerable consensus is that existing behavioral testing tools are expensive and lengthy to administer (and require extensive training). This poses serious obstacles to large-scale neuro-behavioral assessment at present. The group as a whole endorsed the goal of identifying updated tools that are more amenable to use across multiple contexts and settings that are relatively easy to administer.
- Along these lines, Katherine Krasovec pointed to a new tool validated in Cambodia, which is open source, and group members discussed a possible opportunity here to participate in further validation of this new neuro-developmental tool across nations, and across communities and contexts within nations.
- A related point was the opportunity to undertake cross-validation of the new tool under development in Cambodia with the neuro-cognitive battery that Dr. Jeffrey Measelle has been developing for use in Laos, and regarding which he has some partial, preliminary pilot data.
- Concern was raised that some of the behavioral measures currently under development seem to have subjective components that pose challenges to standardization, analysis, and reproducibility. The group questioned the extent to which it may be possible to move away from subjective measures to increasingly include more objective measures. Examples proposed included EEG, fNIRS, and biomarkers (e.g., blood draw which could provide information about children’s developmental progress in relation to myelination). The group expressed great interest in the introduction of neuroimaging methods to supplement behavioral assessments of neuro-cognitive development.
- Questions were raised about how much we currently know regarding behavior and attitudes within and across nations regarding brain development and cognitive development. Obtaining information – via large survey studies, for example – may be crucial for assessing the extent to which different communities/groups/stakeholders will be receptive to information about the brain and neuro-cognitive development. It was agreed that formative research within each country that addressed receptivity to neuroscience would be important.
- Assessing knowledge that adults across the South-east Asia region possess regarding a variety of fundamental health-related topics was also raised as an important and still necessary research focus.
- The group acknowledged that we are still very much in the midst of determining what diet children actually are receiving across the region. A need was noted for assembling what information we have in data repositories, and to summarize these data in review articles.
- It was suggested that we do not yet know what adults’ current knowledge is, across the region, regarding what constitutes a healthy diet for children. Information-gathering is seen as needed on this front.
- Furthermore, we currently know little about the kinds of knowledge and/or attitudes adults/parents across the region possess regarding relations between children’s diet – both prenatally and postnatally — and brain development (cause-and-effect knowledge). Information-gathering on this front will be needed.
- The same set of questions raised in Sections 3a-3c hold for the issue of water/sanitation, as well.
- The group acknowledged that an important goal for research in the region is to develop, test, and validate interventions that support children’s healthy brain development, and more generally, their long-term health and well-being; such interventions are distinct from interventions that target specific health concerns (nutrition, sanitation/hygiene, health) vs. targeting the child’s overall wellbeing and development.
- With this goal in mind, we noted that we will need to gather qualitative information regarding what interventions people in the region would be open to, and what attitudes currently are regarding existing interventions that either have been, or at present are being, undertaken across the region.
- Families willingness/openness to participate in scientific research was discussed. Specifically, the group discussed factors that make families across different national and community settings more or less responsive to requests to participate in studies of children’s development.
- The group agreed that it should share information and work together to figure out how best to frame information to enhance widespread engagement with, and adoption of, research as well as interventions and educational programs. For example, some group members noted that use of the word “science” tends to elicit disinterest, whereas use of the term “survey” more effectively elicits interest; as well, framing interventions as helping to support children’s “success at school” tends to elicit interest.
Day 2 Research Group Notes:
The second research breakout session was held after participants heard talks on the relationship between nutrition and brain development and ongoing work in Bangladesh and Laos to implement interventions in nutrition and cognitive stimulation. With this background the research group came together a second time to discuss opportunities for international collaboration on research interventions to impact nutrition and cognitive development. While the stated ultimate hope and goal of the participants is to develop:
- Multinational cohort study to track relations between nutritional status and neuro-cognitive development in the region;
- Intervention to improve outcomes where relevant;
there was the recognition that these efforts can be extremely costly. The group outlined a series of activities that they could begin to move on that would both demonstrate meaningful collaboration as well as lay the groundwork for future intervention development.
- First, it was determined that to date, there is no comprehensive review of existing cohort studies/intervention studies across the region. Thus, a first activity will be to develop a literature review (including grey literature) of existing cohort and intervention studies in Myanmar, Vietnam, Cambodia and Laos. The review will also include information about what measures are being used, specifics of interventions, demographics of participants, project goals, etc., all with an eye to developing a standardized approach for ultimate goal of designing a multi-national cohort study.Identified leads: Jackie Shannon, Le Thi Quynh Nhi (Vietnam), Min Kyaw Htet (Myanmar), Dare Baldwin
- A second interest was in conducting a review of available tools for measuring neuro-cognitive development and of interventions thought to benefit neuro-cognitive development. While some of this work has been done, it was thought that this type of review had not been conducted from the lens of implementation in SE Asian countries.Identified leads: Michael Toole, Sengchanh Kounnavong (Laos), Dare Baldwin, Cheri Nijssen-Jordan (Laos) Nguyen Quang Dung (Vietnam)
- Finally, it was proposed that a small scale validation study be conducted to pilot test the tools and intervention approaches identified via the prior literature reviews as being most promising for use in the region.
Identified leads: Le Thi Huong (Vietnam), Theingi Thwin (Myanmar) Lao Friends Hospital for Children (pilot site)