Assessing infant cognition in field settings using eye-tracking: A pilot cohort trial in Sierra Leone

Authors: LEPPANEN, JUKKA - University Of Turku; BUTCHER, JULIUS - The Republic Of Sierra Leone; GODBOUT, CLAIRE - Washington University School Of Medicine; STEPHENSON, KEVIN - Washington University School Of Medicine; HENDRIXSON, D TAYLOR - Washington University School Of Medicine; GRISWOLD, STACY - Tufts University; ROGERS, BEATRICE - Tufts University; WEBB, PATRICK - Tufts University; KOROMA, AMINATA - Ministry Of Health & Sanitation; MANARY, MARK - Children'S Nutrition Research Center (CNRC)

Submitted to: BMJ Open
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/14/2022
Publication Date: 2/17/2022
Citation: Leppanen, J.M., Butcher, J.W., Godbout, C., Stephenson, K., Hendrixson, D., Griswold, S., Rogers, B.L., Webb, P., Koroma, A.S., Manary, M.J. 2022. Assessing infant cognition in field settings using eye-tracking: A pilot cohort trial in Sierra Leone. BMJ Open. 12. Article e049783. https://doi.org/10.1136/bmjopen-2021-049783.
DOI: https://doi.org/10.1136/bmjopen-2021-049783

Interpretive Summary: There are very few ways to measure brain function quickly in malnourished children. The feasibility of measuring repeatedly how quickly eyes move back and forth was tested in malnourished children with laptop images before and after recovery in Sierra Leone. The results demonstrated that the speed of eye movement is slower in malnourished children and this could be a method used routinely in clinics to assess how brain function is affected by malnutrition.

Technical Abstract: To investigate the feasibility of eye-tracking-based testing of the speed of visual orienting in malnourished young children at rural clinics in Sierra Leone.Prospective dual cohort study nested in a cluster-randomised trial. 8 sites participating in a cluster-randomised trial of supplementary feeding for moderate acute malnutrition (MAM). For the MAM cohort, all infants aged 7–11 months at the eight sites were enrolled, 138 altogether. For controls, a convenience sample of all non-malnourished infants aged 7–11 months at the same sites were eligible, 60 altogether. A sample of 30 adults at the sites also underwent eye-tracking tests as a further control. Infants with MAM were provided with supplementary feeding. The primary outcomes were feasibility and reliability of eye-tracking-based testing of saccadic reaction time (SRT). Feasibility was assessed by the percent of successful tests in the infants. Reliability was measured with intraclass correlation coefficients (ICCs). Secondary outcomes were mean SRT based on nutritional state as well as and changes in mean SRT after supplementary feeding of MAM children. Infants exhibited consistent orienting to targets on a computer screen (>95% of valid trials). Mean SRTs had moderate stability within visits (ICCs 0.60–0.69) and across the 4-week test–retest interval (0.53) in infants; the adult control group had greater SRT stability (within visit ICC=0.92). MAM infants had a trend toward higher adjusted SRT at baseline (difference=12.4 ms, 95% CI-2 to 26.9, p=0.09) and improvement in SRT 4 weeks thereafter (difference=-14 ms, 95% CI -26.2 to -1.7, p=0.025) compared with age-matched controls. The results demonstrate the feasibility of eye-tracking-based testing in a resource-poor field setting and suggest eye-tracking measures have utility in the detection of group level effects of supplementary feeding.