GULU UNIVERSITY MEDICAL JOURNAL

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Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. Potential factors in Neurocognitive Development in the unborn and young infants in Northern Uganda A number of potential factors together affect the neurocognitive development of the human unborn, infants and young children in rural Northern Uganda. The need to appreciate the complex interplay between these factors should be obvious in health sciences education in the hope that future health care practice will integrate and be influenced by holistic social, cultural and scientific knowledge and evidence base. This paper provides and overview of the various factors that might affect the early stages of human development from pregnancy to the first three years of life. Socio-cultural factors Members of rural communities are closely linked and interdependent. The larger rural community discourages free expression of diversity in opinion among individual members. Social cohesion between groups shapes and determines how pregnant and lactating mothers should care for their unborn, the infant and young child, and how mothers and their immediate family members must behave and relate to one another in the upbringing of their children. The fear of taboo, supernatural forces, and ancestral spirits and ostracism for non-compliance with wider rules of conduct in the community may limit free exploration required for neurocognitive development and growth of infants and young children. Cognitive development and functioning is shaped by the general expectations and environmental dictates of communities. Domestic violence Violence in homes, particularly against women and young children is common. Much of this violence is secondary to alcohol abuse or dependence. Unrecognized psychological disorder among spouses may be an additional factor. The impact of domestic violence on both the mother and her children (born or Emilio Ovuga Gulu University Faculty of Medicine emilio.ovuga@gu.ac.ug / emilio.ovuga@gmail.com unborn) can be both diverse and adverse, including the development of depressive disorder, anxiety disorders and general feelings of insecurity. Poor mental health of mothers impairs their ability to care for their young children. Childhood emotional disorders impacts negatively on school performance and personality development. The long-term results of domestic violence may include the internalization of violence by young children who may themselves become violent in their adulthood, and consequence that can only serve to propagate violence in future generations. Child rearing practices Child rearing practices in rural communities are generally harsh and children frequently receive severe beating, threats and intimidation in addition to being denied basic needs of life, such as food, health care, education and protection. In the name of disciplining young children, traumatized children continuously become re-traumatized on a regular basis. The problems arising from harsh rearing practices might result in severe but unrecognized symptoms of depression, anxiety disorders and suicidal and or behavioral problems. The role of health sciences education in this context should be community education and advocacy for improved child rearing practices and the promotion of the rights of children to health and safety and protection that are prerequisites for optimal neurocognitive development. Mass violence in Northern Uganda The more than two decades of mass violence and war in rural Northern Uganda left many children orphaned and having to become heads of their respective homes with no or limited access to the basic needs of life. The prevalence of post-traumatic stress disorder and depression among former child soldiers has been reported respectively at 87% and 58%. Neuro-imaging studies have demonstrated the long- Gulu University Medical Students’ Association (GUMSA) Passion for life 40
Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. term effects of exposure to gross violence on the brain, which in children can be expected to impair optimal brain development and growth. A recent study among children in Northern Uganda has similarly documented that at least one in every three children aged between 7 and 17 years suffers from moderate to severe social functioning, anxiety disorder, depression or suicidal behavior. These results further highlight the need to recognize that violence has negative psychological, emotional and intellectual consequences and need to be integrated in health sciences curricula. HIV/AIDS Children who live with HIV/AIDS occupy nearly 70% of paediatric beds at Gulu Regional Referral Hospital (GRRH). It has been estimated that 70% of adult patients who suffer from HIV/AIDS at GRRH also suffer from concurrent tuberculosis, and the same situation might be the case for children in Northern Uganda. The early invasion of the brain by HIV is expected to affect the optimal development of children who live with HIV/AIDS. The negative impact of HIV infection on the brain arises not only from the early invasion of the brain by the virus but also the negative nutritional consequences of the disease on the body. Malnutrition Under nutrition among children aged less than 5 years is estimated at 35% in rural Northern Uganda. This finding may be related to the effects of the recent war in Northern Uganda combined with long spells of drought and poor crop yield. A systematic degradation of arable land in Northern Uganda associated with land overuse might mean that crop yields are progressively poor in essential nutrient content. Under the circumstances neurocognitive development is also expected to be less than optimal. Sensory impairment Between 3-5% of school children suffer from learning disability; the majority of these are due to unrecognized impaired hearing or impaired vision. A small proportion of school children suffer from mild brain damage that they sustained during childbirth. While the effects of brain injury during childbirth on brain and intellectual development might be difficult to mitigate, the early recognition of visual and auditory impairment and their correction can significantly improvement academic performance and social development of school children. Efforts by the Faculty of Medicine to address modifiable sensory impairment could significantly improve academic performance on national examinations, thus improving the chances of children from Northern Uganda to compete favorably for university and other tertiary institutions admissions. Potential Roles of the Faculty of Medicine and Medical Students. The Faculty of Medicine and its students have significant roles in the following areas: a) contributing to the body of knowledge in the field of neurocognitive impairment and its associated factors including efforts to identify and mitigate the negative effects of sensory impairment, under-nutrition and early child health problems b) influencing educational policy reform and educational services provision c) impacting on best clinical practices in the field of maternal and child health d) influencing policy on environmental protection and management for optimal crop yield e) understanding the long-term effects of war and organized violence on the growth and development of infant and young children’s brains exposed to violence, trauma and loss. Gulu University Medical Students’ Association (GUMSA) Passion for life 41
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