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. 2008 Jul;122(1):e92-9.
doi: 10.1542/peds.2007-3709. Epub 2008 Jun 9.

Cerebral malaria in children is associated with long-term cognitive impairment

Chandy C John  1 , Paul Bangirana, Justus Byarugaba, Robert O Opoka, Richard Idro, Anne M Jurek, Baolin Wu, Michael J Boivin
Affiliations

Cerebral malaria in children is associated with long-term cognitive impairment

Chandy C John et al. Pediatrics. 2008 Jul.

Abstract

Objective: Cerebral malaria affects >785000 African children every year. We previously documented an increased frequency of cognitive impairment in children with cerebral malaria 6 months after their initial malaria episode. This study was conducted to determine the long-term effects of cerebral malaria on the cognitive function of these children.

Methods: Children who were 5 to 12 years of age and presented to Mulago Hospital, Kampala, Uganda, with cerebral malaria (n = 44) or uncomplicated malaria (n = 54), along with healthy, asymptomatic community children (n = 89), were enrolled in a prospective cohort study of cognition. Cognitive testing was performed at enrollment and 2 years later. The primary outcome was presence of a deficit in >or=1 of 3 cognitive areas tested.

Results: At 2-year follow-up testing, 26.3% of children with cerebral malaria and 12.5% with uncomplicated malaria had cognitive deficits in >or=1 area, as compared with 7.6% of community children. Deficits in children with cerebral malaria were primarily in the area of attention (cerebral malaria, 18.4%, vs community children, 2.5%). After adjustment for age, gender, nutrition, home environment, and school level, children with cerebral malaria had a 3.67-fold increased risk for a cognitive deficit compared with community children. Cognitive impairment at 2-year follow-up was associated with hyporeflexia on admission and neurologic deficits 3 months after discharge.

Conclusions: Cerebral malaria is associated with long-term cognitive impairments in 1 of 4 child survivors. Future studies should investigate the mechanisms involved so as to develop interventions aimed at prevention and rehabilitation.

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Figures

FIGURE 1
FIGURE 1
Diagram of number of children tested at enrollment and the 6- and 24-month follow-ups. NR indicates no return (children who had CM and were enrolled at time of episode and did not return for cognitive testing); NF, not found (children who were lost to follow-up).
See this image and copyright information in PMC

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