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. 2014 Aug 1;59(3):336-44.
doi: 10.1093/cid/ciu293. Epub 2014 Apr 24.

Severe malarial anemia is associated with long-term neurocognitive impairment

Paul Bangirana  1 , Robert O Opoka  2 , Michael J Boivin  3 , Richard Idro  2 , James S Hodges  4 , Regilda A Romero  5 , Elsa Shapiro  6 , Chandy C John  7
Affiliations

Severe malarial anemia is associated with long-term neurocognitive impairment

Paul Bangirana et al. Clin Infect Dis. .

Abstract

Background: Cerebral malaria (CM) is associated with long-term neurocognitive impairment in children ≥5 years of age. No prospective studies to date have assessed neurocognitive impairment in children with CM <5 years of age, or in children with severe malarial anemia (SMA), a form of severe malaria estimated to affect as many as 5 million children annually.

Methods: Children <5 years of age presenting to Mulago Hospital, Kampala, Uganda, with CM (n = 80) or SMA (n = 86) were assessed for overall cognitive ability, attention, and associative memory 1 week after discharge and 6 and 12 months later. The z scores for each domain were computed based on scores of 61 healthy community children (CC), who were also tested at enrollment and 6 and 12 months later. Groups were compared using mixed linear models, adjusted for age, weight for age, and child's education.

Results: At 12 months, children with CM had lower adjusted scores than CC in cognitive ability (P < .001), attention (P = .02), and associative memory, (P = .002). Children with SMA had lower scores than CC in cognitive ability (P = .01) but not attention or associative memory. Cognitive ability scores in children with CM and SMA did not differ significantly.

Conclusions: In children <5 years of age, SMA is associated with long-term impairment in cognitive ability, whereas CM is associated with additional impairment in the areas of attention and associative memory. SMA may be a major contributor to long-term neurocognitive impairment in children in sub-Saharan Africa.

Keywords: cerebral malaria; cognitive; impairment; severe malarial anemia.

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Figures

Figure 1.
Figure 1.
Study design and follow-up.
Figure 2.
Figure 2.
Age-adjusted neurocognitive test scores in children with cerebral malaria (CM) or severe malarial anemia (SMA) and in community children (CC) at baseline and at 6 and 12 months for cognitive ability (A), attention (B), and associative memory (C). Scores are given as means with standard errors of the mean.
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