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

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

Research output: Contribution to journalArticle

164 Citations (Scopus)

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)
JournalPediatrics
Volume122
Issue number1
DOIs
StatePublished - Jul 2008
Externally publishedYes

Fingerprint

Cerebral Malaria
Malaria
Cognition
Cognitive Dysfunction
Abnormal Reflexes
Uganda
Neurologic Manifestations
Survivors

Keywords

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

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

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

Cerebral malaria in children is associated with long-term cognitive impairment. / John, Chandy; Bangirana, Paul; Byarugaba, Justus; Opoka, Robert O.; Idro, Richard; Jurek, Anne M.; Wu, Baolin; Boivin, Michael J.

In: Pediatrics, Vol. 122, No. 1, 07.2008.

Research output: Contribution to journalArticle

John, C, Bangirana, P, Byarugaba, J, Opoka, RO, Idro, R, Jurek, AM, Wu, B & Boivin, MJ 2008, 'Cerebral malaria in children is associated with long-term cognitive impairment', Pediatrics, vol. 122, no. 1. https://doi.org/10.1542/peds.2007-3709
John, Chandy ; Bangirana, Paul ; Byarugaba, Justus ; Opoka, Robert O. ; Idro, Richard ; Jurek, Anne M. ; Wu, Baolin ; Boivin, Michael J. / Cerebral malaria in children is associated with long-term cognitive impairment. In: Pediatrics. 2008 ; Vol. 122, No. 1.
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AB - 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.

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