668 - Early Brain Development and Its Biological and Socio-Economic Determinants in Ethiopian Children

Publication Number: 3646.668

Sarah K.G.. Jensen, Women & Infants Hospital of Rhode Island, Newton Centre, MA, United States; Firehiwot Workneh, Addis Continental Institute of Public Health, Addis Ababa, Adis Abeba, Ethiopia; Yumin Kim, The Warren Alpert Medical School of Brown University, Boston, MA, United States; Krysten North, Brigham and Women's Hospital, Boston, MA, United States; Terrie E. Inder, CHOC Children's Hospital of Orange County, Orange, CA, United States; Anne CC Lee, Warren Alpert Medical School of Brown University, Providence, RI, United States

Background: Stunted growth and socioeconomic factors can influence early cerebral development.

Objective: This study aims to characterise brain development in healthy Ethiopian children using cross-sectional data from N=149 children aged 6, 12, 18, and 24 months. We also explore whether factors related to child nutritional status (length), food insecurity, and maternal education influence early cerebral development.

Design/Methods: The Bahir Dar Child Development Study was a cross-sectional study implemented in Bahir Dar, Ethiopia. Healthy children were recruited from health centers and underwent ultra-low-field Magnetic Resonance Imaging (0.064T, Hyperfine) at a Felege Hiwot hospital. Processing and segmentation of T2 images were completed using the MiniMorph pipeline with age-specific templates to delineate the following primary outcomes: Intracranial Volume (ICV), Supratentorial Tissue, Supratentorial Cerebrospinal Fluid (CSF), Deep Gray Matter, and Corpus Callosum (CC) volumes. In exploratory analyses, we further examined volumes of key deep gray matter structures separately (thalamus, caudate, putamen, globus pallidus), as well as the anterior and posterior regions of the CC. Statistical analyses were conducted using multivariate linear regressions, and child age at the time of the scan was included as a continuous variable in all analyses.

Results: Primary structures of interest: As expected, male sex and higher child lengh was associated with larger volumes across primary structures of interest (all p< 0.05). Examining potential contributions of socioeconomic factors to brain volumes, higher maternal education was associated with larger supratentorial CSF (b= 9291.9, 95% CI = 3916.6 to 14667.3, p = 0.001), and larger total CC volumes (b= 447.7, 95% CI = 22.4 to 873.0, p =0.039). Subregion analysis: Male sex and higher child length were associated with larger volumes in all subregions (all p< 0.005 and p< 0.014, respectively). Higher maternal education was associated with larger volumes of the posterior CC (b=185.3, 95% CI = 15.8 to 354.8, p = 0.032).

Conclusion(s): These results highlight the critical and differential roles of biological factors (sex, length) and socio-economic factors related to maternal education in early cerebral development in children living in Sub-Saharan Africa. The positive association of maternal education with volume of the CC underscores the importance of early-life social determinants for pediatric neurological development in a brain region associated with better motor, language, and higher order cognitive functions.

Cerebral volume outcomes by biological and socio-economic determinants among children aged 6 to 24 months living in sub-Saharan Africa. Results from Multivariate Regression.


Figure 1: Primary outcome brain volumes across cohorts of children aged 6, 12, 18, and 24 months.


Figure 2: Volume of Posterior Corpus Callosum by Maternal education categories.
Education categories: 0 = No education [n=52]; 1= ability to read and write /or primary education [n=122]; 2 = secondary and/or vocational education [n=66]; 3= higher education [n=17].