Implementation of a mobile EEG system in the acquisition of resting EEG and visual evoked potentials among young children in rural Ethiopia

Theresa Inez Chin^1*Winko An^2,3Kalkidan Yibeltal⁴Firehiwot Workneh⁵Stephen Pihl³Sarah K. G. Jensen^3,6Gellila Asmamaw⁷Nebiyou Fasil⁸Atsede Teklehaimanot^10,9Krysten North^2,7Sonya V Troller-Renfree¹¹Charles A Nelson^2,3Yemane Berhane⁵Anne CC Lee^1,2,7

• ¹Warren Alpert Medical School, Brown University, Providence, United States
• ²Harvard Medical School, Boston, Massachusetts, United States
• ³Boston Children's Hospital, Boston, United States
• ⁴Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
• ⁵Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
• ⁶Harvard T.H. Chan School of Public Health, Boston, United States
• ⁷Department of Pediatrics, Brigham and Women's Hospital, Boston, United States
• ⁸Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
• ⁹College of Health Sciences, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
• ¹⁰Tikur Anbessa Hospital, Addis Ababa, Addis Ababa, Ethiopia
• ¹¹Department of Human Development, Teachers College, Columbia University, New York City, New York, United States

Children living in low-and middle-income countries (LMIC) are at disproportionately higher risk of neurodevelopmental delays due to exposure to adverse biological and environmental hazards. In infancy, global developmental assessments, such as the Bayley Scales are insensitive, do not strongly correlate with later cognitive outcomes, and require adaptation for different populations/cultural contexts. Electroencephalography (EEG) objectively measures electrical brain activity and may provide early neural markers predictive of long-term cognitive outcomes.The visual evoked potential (VEP) interrogates the efficiency of visual cortical processing and reflects neural processing speed. Mobile EEG enables the assessment of neural processing in settings where such technologies were historically inaccessible. This paper describes the experiences and lessons learned from implementing mobile EEG and VEP in rural Amhara, Ethiopia as part of the Longitudinal Infant Growth and Development (LIDG) study (NCT06296238). We describe adaptations and strategies to address and optimize data capture (e.g. dry electrode tips to improve scalp contact, tailored protocols, and adequate equipment specifications), environmental challenges (e.g. space constraints, lack of water supply, power outage) and cultural factors (e.g. hair type) unique to the study setting and population. Our formative research underscored the importance of creating awareness among community representatives (e.g. mothers, fathers, and religious leaders) and local clinicians to improve community engagement and buy-in. Culturally sensitive child behavior management techniques were also critical to ensure EEG completion and high data quality. With community sensitization, we had high consent and rates for EEG/VEP (>90%). We completed EEG recordings within an average of 20±11 minutes. Approximately 90% and 70% of participants met predefined data quality thresholds for resting EEG and VEP, respectively, after data processing. Implementing mobile EEG/VEPs was feasible and acceptable with a relatively high percentage of recordings with adequate quality in rural Ethiopia.