Connecting the Dots: New AMOS Study Sheds Light on Early Childhood Development in Nejapa

By Natalie Walter, AMOS Communications Coordinator


The AMOS Urban Program

While the community of Nejapa may be located within the city limits of Nicaragua’s capitol, Managua, in many ways the lack of utilities such as steady water supply or electricity in many houses make it function more like a rural Nicaraguan community. The AMOS Urban Program exists to make sure that the members of this community do not lack the access to quality healthcare that they need and deserve like any other resident of Managua, or anyone in the world.


Watch this brand-new AMOS video to get an idea of the core tenants of the AMOS Urban Program: The Samaritan Clinic, which provides high-quality healthcare for a symbolic fee, and the consejeras, the community health workers in Nejapa who serve as a bridge between the community and the clinic, through work such as home visits to patients, and support groups for chronic patients, pregnant women, and the youth of Nejapa.




Urban Research: What Do Mosquitoes Have to do With Early Childhood Development?

The presence of the AMOS Urban Program in Nejapa allows consejeras as well as AMOS staff to be up to date on health issues facing Nejapa, so that they can plan together on how to best respond and work with the community. An example of how important it is to have this long-term partnership with and presence in the community can be seen in a recent study completed by AMOS community health workers, Global Health Internship participants, and the Drs. Denise Bothe and Joe DaPrano, experts in early childhood development who worked on the project in a volunteer capacity.*


The study arose from ongoing work related to the Zika virus. AMOS works in Nejapa and other vulnerable sectors of Manauga to educate community members on how to prevent the spread of the Zika virus. Eliminating mosquito breeding grounds in the home is one huge step to prevention, since the virus is transmitted by mosquitoes. Family planning is another, because Zika is also sexually transmitted. Of all pregnant women who are infected with Zika during their first trimester, it is estimated that 1 in 3 will give birth to babies with Congenital Zika Syndrome, an amalgamation of neurological defects, in its most severe form including microcephaly, a condition which causes babies to be born with unusually small heads. In its more nuanced forms, Congenital Zika Syndrome can cause deficits in vision, hearing, and motor function, as well as difficulties in learning and behavioral problems.


AMOS works in vulnerable communities in Managua to educate people in their own homes on how to prevent the Zika Virus.

“The purpose then of this recent study,” explains Sheila Perkins, Global Health Internship Preceptor, “was to screen children under the age of 5 for developmental delays with the ultimate goal of better programming to support not only babies and families effected by Zika, but also other children with developmental needs.” The interns and doctors worked with the consejeras to map out where all young children in the community lived. They were able to visit 86% of them, one by one, to conduct basic tests to screen their neurological development, as well as to test for microcephaly. The presence of interns and volunteer doctors to work alongside the consejeras gave us the capacity to conduct a study on early childhood development, in addition to the normal ongoing activities of the Zika project. So, what originated as a study to compliment the Zika project evolved into something much more. This level and depth of intervention is possible because of the long-term presence of AMOS in Nejapa, and the relationships the consejeras have nourished with their neighbors. To capitalize on these relationships, AMOS employs a methodology called Community-Based Participatory Research, or, CBPR.



Community-Based Participatory Research

CBPR is the process which AMOS uses to address health inequalities and social justice issues. Research generates knowledge, which is what we need to shape programs, policy, and the world around us. In order to conduct this community-based participatory research, AMOS works in the context of the community, partnering with community members in every step of the process from study design, data collection, and interventions and project implementation. The end result? Social justice outcomes!


The process of CBPR was essential for this project to work; it took input from community members, community health workers, experts in childhood development, and volunteers and interns with a desire to serve and learn.


“[The interns] are really new to this community,” said Oksana Litardo, a Global Health Intern who will be staying after the project’s completion to serve as a long-term volunteer with AMOS. “We couldn’t have done anything without the consejeras. They helped us so much with the surveys we used, telling us what was good to use in this context, because the surveys weren’t originally developed in Nejapa. And the AMOS census helped us to know all the different little alleyways in Nejapa. And on our own we wouldn’t have had the necessary confidence and trust to introduce ourselves in the houses. Because the consejeras will stay in their community, the project can continue.


These thoughts were echoed by Bertha Aragón, one of the Nejapa consjeras who worked on the study. “There’s a lot of trust between us and the mothers in the community,” she said, “so, [the interns and doctors] were able to ask the families more things, and ask for more information. And we had training [in survey methods] ourselves, too! So, people were pleased with the group of volunteers, and interested in the work they are doing and hoping that will continue. People we talked to were even giving me their phone umbers so we could stay in contact!”



Uncovering Developmental Delays in Nejapa

The findings of this study can be observed in the following infographic prepared by the interns who worked on the study.



Clear developmental delays were found in the children of Nejapa. The trend in the data seems to show an increase increase in developmental delays as children get older<. and a presence of this problem that existed before Zika had a presence in Nicaragua.


“With babies that are very young, it is still unknown if they will develop problems later,” explained Dr. Denise Bothe, one of the doctors involved in the study. “Sometimes they are born without small heads [which would indicate microcephaly], but their heads do not grow later. So at this point, it is hard to know if Zika is causing what we see in these results. It could very well be lack of stimulation that leads to these developmental delays.” So, while the study originally stemmed from the Zika project, its findings could implicate many other public health needs in Nejapa.


Says Dr. Joe DaPrano, “AMOS is uniquely situated to address childhood development because… of the consejeras, and all of the other components of AMOS that allow for direct contact in homes, such as in the Zika project. It’s not just an entre for gathering data; it’s an entre to the life in the community, for the parents to do simple, [low-cost] interventions.”


Nejapa’s community health workers, called Consejeras, serve as a bridge between AMOS and the community.

“Research does show,” Dr. Bothe adds, “that the more words a child hears in their first three years of life, the better they do academically. They have actually studied this. In order to think about why it is important to teach your child at a young age, you have to realize that the outcome is several steps away. It’s hard to actually fathom the concept that if you talk to your child more, they are more likely to get a job and come out of poverty. But once these children are educated, they can teach their children more, and it will hopefully snowball to a whole community being pulled out of poverty.”



The AMOS Urban Program Generates Knowledge & Knowledge Generates Change.

When you support the AMOS Urban Program, you are supporting a robust network of community health workers, doctors, volunteers, and community members who are all working hand in hand to ensure better urban health.

Because the Samaritan Clinic charges only a symbolic fee to its patients so that it can stay affordable in a low-income area, the high-quality healthcare provided there must be supported in other ways. “This community clinic and the urban health program can only be sustained by the generosity of individuals and partners,” says Dr. Gabriela Woo, AMOS’ Director of Programs.


Dr. Joe DaPrano has confidence in the ability of the consejeras and AMOS staff to tackle these tough issues of early childhood development in Nejapa. “In the tens years that AMOS has been in existence, the fact that they have created behavioral changes that they have reduced infant mortality and maternal mortality is a strong indicator that they could do this. We’re not talking about an easily measurable outcome. It’s not as direct. But It’s equally important.”


Consider supporting the AMOS Urban Program today – you’re supporting great research, great healthcare, and a community taking its health and hope into its own hands.




*AMOS Health & Hope would like to give special thanks to Drs. Denise Bothe,Pediatric Developmental and Behavioral dcotor and Assistant Professor in Pediatrics at Case Western Reserve University School of Medicine, and Joe DaPrano, Internal Medicine and Pediatrics doctor and Assistant Professor at Case Western Reserve University School of Medicine for their work on this study!