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

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

Research output: Contribution to journalArticle

170 Scopus citations

Abstract

OBJECTIVE. Cerebral malaria affects >785 000 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 ≥ 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 ≥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.

Original languageEnglish (US)
Pages (from-to)e92-e99
JournalPediatrics
Volume122
Issue number1
DOIs
StatePublished - Jul 1 2008
Externally publishedYes

Keywords

  • Cerebral malaria
  • Cognitive
  • Deficit
  • Impairment
  • P falciparum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    John, C. C., Bangirana, P., Byarugaba, J., Opoka, R. O., Idro, R., Jurek, A. M., Wu, B., & Boivin, M. J. (2008). Cerebral malaria in children is associated with long-term cognitive impairment. Pediatrics, 122(1), e92-e99. https://doi.org/10.1542/peds.2007-3709