ZAIRE 
Boivin, M. J., Okitundu, D., Makila-Mabe Bumoko, G., Sombo, M. T.,
Mumba, D., Tylleskar, T., Page, C. F., Tamfum Muyembe, J. J., &
Tshala-Katumbay, D. (2013). Neuropsychological effects of konzo: a
neuromotor disease associated with poorly processed cassava. Pediatrics,
131(4), e1231-e1239.
BACKGROUND: Konzo is an irreversible upper-motor neuron disorder affecting children dependent on bitter cassava for food. Although the neuroepidemiology of konzo is well characterized, we report the first neuropsychological findings.
METHOD: Children with konzo in the Democratic Republic of Congo (mean age 8.7 years) were compared with children without konzo (mean age 9.1 years) on the Kaufman Assessment Battery for Children, second edition (KABC-II), and the Bruininks-Oseretsky Test of Motor Proficiency, second edition (BOT-2). Both groups were also compared with normative KABC measures from earlier studies in a nearby nonkonzo region.
RESULTS: Using a Kruskal-Wallis test, children with konzo did worse on the KABC-II simultaneous processing (visual-spatial analysis) (K [1] = 8.78, P = .003) and mental processing index (MPI) (K [1] = 4.56, P = .03) than children without konzo. Both konzo and nonkonzo groups had poorer KABC sequential processing (memory) and MPI relative to the normative group from a nonkonzo region (K [2] = 75.55, P< .001). Children with konzo were lower on BOT-2 total (K [1] = 83.26, P < .001). KABC-II MPI and BOT-2 total were predictive of konzo status in a binary logistic regression model: odds ratio = 1.41, P < .013; 95% confidence interval 1.13-1.69.
CONCLUSIONS: Motor proficiency is dramatically affected, and both children with and without konzo have impaired neurocognition compared with control children from a nonoutbreak area. This may evidence a subclinical neurocognitive form of the disease, extending the human burden of konzo with dramatic public health implications.
Giordani, B., Boivin, M., Opel, B., Nseyila, D., & Lauer, R. (1996). Use of the
K-ABC with children in Zaire, Africa: an evaluation of the sequential-
simultaneous processing distinction within intercultural context.
International Journal of Disability, Development and Education, 43(1), 5-24.
ABSTRACT: There is a continuing need for formalised assessment procedures that can be adapted for group comparisons across diverse cultures to facilitate school and occupational placement, as well as to evaluate the effectiveness of nutritional, education, and medical intervention programs. This study used a direct translation of the Kaufman Assessment Battery for Children (K-ABC) to evaluate 130 Zairian primary school children. The distinction between Sequential Processing and Simultaneous Processing abilities on the K-ABC was generally found to be valid in this sample. The K-ABC also discriminated effectively among grade levels, differences in health and family environment indicators, and tribal membership. Reasonable test-retest correlations for the K-ABC global scales were also found with a subsample of the children. The Zairian children's K-ABC scores, particularly for the Simultaneous subtests, were markedly lower than the American normative sample. Education and experiential factors inherent in the sub-Sahara environment may put these children at a significant cultural disadvantage in terms of the skills required for successful completion of K-ABC items.
Boivin, M. J., Bornefeld, B., & Giordani, B. (1995). Use of the tactual
performance test for cognitive ability testing with African children.
Neuropsychology, 9(3), 409-417.
ABSTRACT: Researchers evaluated 195 rural Zairian children between 5 and 12 years of age with the Tactual Performance Test (TPT) used in the Reitan-Indiana Battery. For all of the TPT performance and memory measures, Zairian children with poorer anthropometric indicators of nutritional well-being were significantly below the age-matched groups of American and Canadian children. The Zairian children also did not demonstrate the typical improvements between the dominant and nondominant hand trials. Older Zairian children with such decrements tended to do more poorly on the Simultaneous Processing and Nonverbal ability portions of the Kaufman Assessment Battery for Children. Although probably not appropriate for direct intercultural comparisons, the authors concluded that neuropsychological measures derived from tasks such as the TPT may still be useful in monitoring the longitudinal brain-behavior impact of various health interventions for enhancing intellectual development for African children.
Boivin, M. J., Green, S. D. R., Davies, A. G., Giordani, B., Mokili, J. K. L.,
& Cutting, W. A. M. (1995). A preliminary evaluation of the cognitive
and motor effects of pediatric HIV infection in Zairian children. Health
Psychology, 14(1), 13-21.
ABSTRACT: Fourteen asymptomatic HIV-infected Zairian children under 2 years of age displayed social and motor developmental deficits on the Denver Developmental Screening Test when compared with 20 HIV-negative cohorts born to HIV-infected mothers and 16 control children. In a second study, 11 infected children over 2 years of age had sequential motor and visual-spatial memory deficits on the Kaufman Assessment Battery for Children and motor development deficits on the Early Childhood Screening Profiles. HIV infection affects central nervous system structures mediating motor and spatial memory development, even in seemingly asymptomatic children. Furthermore, maternal HIV infection compromises the labor-intensive provision of care in the African milieu and undermines global cognitive development in even uninfected children.
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