Feasibility and Acceptability of Magnetic Resonance Imaging and Electroencephalography for Child Neurodevelopmental Research in Rural Ethiopia

Firehiwot Workneh^1*Theresa Inez Chin²Kalkidan Yibeltal³Krysten North^4,5Nebiyou Fasil⁶Workagegnhu Tarekegn⁷Betelhem Haimanot Abate⁸Sarem Mulugeta⁹Gellila Asmamaw⁴Atsede Teklehaimanot¹⁰Sonya V Troller-Renfree¹¹Sarah K G Jensen^12,5Moriah E Thomason¹³Terrie Inder¹⁴Charles A Nelson^12,5Alemayehu Worku¹Anne Cc Lee^2,4Yemane Berhane¹

• ¹Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Addis Ababa, Ethiopia
• ²Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States
• ³Department of Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
• ⁴Department of Pediatrics, Global Advancement of Infants and Mothers (AIM) Lab, Brigham and Women’s Hospital, Boston, Massachusetts, United States
• ⁵Harvard Medical School, Boston, Massachusetts, United States
• ⁶Department of Global Health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
• ⁷Department of Nutrition and Behavioural Science, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
• ⁸Addis Continental Institute of Public Health, Bahir Dar, Ethiopia
• ⁹Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
• ¹⁰Addis Ababa University College of Health Science, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
• ¹¹Department of Human Development, Teachers College, Columbia University, New York City, New York, United States
• ¹²Boston Children’s Hospital, Boston, Massachusetts, United States
• ¹³Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, United States
• ¹⁴Center for Neonatal Research, Children’s Hospital of Orange County, California, United States

Background: Magnetic resonance imaging (MRI) and electroencephalography (EEG) are valuable tools for studying neuroanatomical and electrophysiological features of early brain development. Studies implementing neuroimaging tools in low-and middle-income countries are still rare, and there is limited data on the acceptability of such tools among rural communities.The present study explores the perceptions, feasibility, and acceptability of introducing MRI and EEG for child development research in the rural Amhara region of Ethiopia.Methods: A total of 40 in-depth interviews were conducted among community members (n=24) and clinicians (n=16). A semi-structured interview included four themes: 1) Baseline knowledge about neuroimaging procedures, 2) perceptions after watching explanatory videos, 3) facilitators and barriers to the uptake of the technologies, and 4) recommendations to increase uptake.Interviews were conducted in Amharic, the local language. All interviews were transcribed verbatim to Amharic, translated into English, and double-coded. We used thematic analysis to organize data according to predefined and emerging themes.Result: Knowledge of MRI and EEG was limited, and none of the community members had previous experiences with either technology. Broadly, participants responded positively to our introductory videos showing MRI and EEG acquisition and expressed high levels of acceptability. However, participants reported concerns about possible harms related to radiation, electrical shock, and injury from MRI/EEG procedures. Those with lesser education were identified to be less accepting of MRI/EEG. In addition, several mothers expressed that consent from their husbands was necessary for their child's participation in neurodevelopmental research.Potential logistical barriers identified included transportation challenges to the neuroimaging study sites, especially for rural-dwelling families. Creating awareness, using explanatory videos, and engaging community members and clinicians were recommended to facilitate acceptance of EEG and MRI.In this formative study, MRI and EEG were viewed as acceptable methods for assessing child neurodevelopment in rural areas of Ethiopia. Community members' and clinicians' views were impacted largely by social, religious, educational, and logistical aspects.Concerns related to MRI radiation, electrical shock, and injuries from EEG can be addressed through awareness creation and education. Engaging community leaders and healthcare providers is key to improving acceptability.