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Published on: March 17, 2023
Assessing infant cognition in field settings using eye-tracking: a pilot cohort trial in Sierra Leone
Jukka M Leppänen1, Julius Walker Butcher2, Claire Godbout3
1Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland jukka.leppanen@utu.fi.
Insights
Eye-tracking successfully tested visual orienting speed in young children with moderate acute malnutrition (MAM) in Sierra Leone. This method shows promise for detecting nutritional intervention effects in resource-poor settings.
Area of Science:
- Neuroscience
- Pediatrics
- Public Health
Background:
- Malnutrition in young children can impair cognitive development and visual processing.
- Eye-tracking technology offers a potential tool for objective assessment of visual orienting speed.
- Assessing these functions in resource-limited settings is crucial for effective interventions.
Purpose of the Study:
- To evaluate the feasibility and reliability of eye-tracking for measuring saccadic reaction time (SRT) in malnourished infants.
- To compare SRT between malnourished infants and healthy controls.
- To assess the impact of supplementary feeding on SRT in malnourished infants.
Main Methods:
- A prospective dual cohort study nested within a cluster-randomized trial in Sierra Leone.
- Enrolled 138 infants (7-11 months) with moderate acute malnutrition (MAM) and 60 age-matched controls.
- Used eye-tracking to measure SRT, with feasibility assessed by successful test completion and reliability by intraclass correlation coefficients (ICCs).
Main Results:
- Eye-tracking testing was feasible in infants, with over 95% valid trials.
- Mean SRT showed moderate stability in infants (ICCs 0.53-0.69) and high stability in adults (ICC 0.92).
- MAM infants showed a trend towards slower SRT at baseline and significant improvement after 4 weeks of supplementary feeding compared to controls.
Conclusions:
- Eye-tracking-based assessment of visual orienting speed is feasible in resource-poor field settings.
- This methodology is useful for detecting group-level effects of nutritional interventions.
- Findings support the use of eye-tracking for monitoring cognitive function in vulnerable populations.
Objectives:
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.
Design:
Prospective dual cohort study nested in a cluster-randomised trial.
Setting:
8 sites participating in a cluster-randomised trial of supplementary feeding for moderate acute malnutrition (MAM).
Participants:
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.
Interventions:
Infants with MAM were provided with supplementary feeding.
Outcome Measures:
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.
Results:
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.
Conclusions:
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.
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