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. 2023 Apr 1;151(4):e2022058310.
doi: 10.1542/peds.2022-058310.

Severe Malaria and Academic Achievement

Ann Jacquelline Nakitende  1   2 , Paul Bangirana  1   2 , Noeline Nakasujja  1 , John M Ssenkusu  3 , Caitlin Bond  4 , Richard Idro  5   6 , Yi Zhao  7 , Margaret Semrud-Clikeman  8 , Chandy C John  4
Affiliations

Severe Malaria and Academic Achievement

Ann Jacquelline Nakitende et al. Pediatrics. .

Abstract

Background: Cerebral malaria (CM) and severe malarial anemia (SMA) are associated with neurocognitive impairment in childhood but their effects on long-term academic achievement are not known.

Methods: Ugandan children 5 to 12 years old who participated in a previous study evaluating cognitive outcomes after CM (n = 73) or SMA (n = 56), along with community children (CC, n = 100) from the same household or neighborhood, were on average enrolled 67.1 months (range, 19-101 months) after the severe malaria episode or previous study enrollment. Academic achievement in word reading, sentence comprehension, spelling, and math computation was evaluated using the Wide Range Achievement Test, Fourth Edition. Age-adjusted z-scores for academic achievement outcomes were calculated from CC scores.

Results: After adjustment for age and time from enrollment, reading scores were lower (mean difference from CC [95% confidence interval]) in children with CM (-0.15 [-0.27 to -0.03], P = .02) or SMA (-0.15 [-0.28 to -0.02], P = .02) than CC. Postdischarge malaria episodes were associated with worse spelling and reading scores in CM and worse spelling scores only in SMA. Pathway analysis showed that incidence of postdischarge uncomplicated malaria contributed significantly to the association of CM or SMA with poorer reading scores.

Conclusion: Children with CM or SMA have poorer long-term reading skills. Postdischarge malaria episodes contribute significantly to this association. Postdischarge malaria chemoprevention should be assessed as an intervention to improve long-term academic achievement in children with severe malaria.

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Conflict of interest statement

Declaration of conflicting interests: The authors declared no potential conflict of interest.

Figures

Figure 1.
Figure 1.. Flow chart of study population.
Children ≥ 5 years of age were tested using the Wide Range Achievement Test, 4th Edition (WRAT - 4).
Figure 2.
Figure 2.. Academic achievement in children with cerebral malaria (CM) or severe malarial anemia (SMA) compared to community controls (CC).
Mean differences evaluated by linear regression, adjusted for age and time from enrollment in parent study. Reported P-values significant based on Dunnett’s post-hoc test for multiple comparisons. Total numbers for sentence comprehension domain: CM, n=54; SMA, n=42; CC, n=81.
Figure 3.
Figure 3.. Pathway diagram of association of post-discharge malaria incidence on reading for children with cerebral malaria (CM), severe malarial anemia (SMA) compared to community controls (CC).
See this image and copyright information in PMC

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