Cerebral malaria is associated with long-term mental health disorders: A cross sectional survey of a long-term cohort

Richard Idro, Angelina Kakooza-Mwesige, Benjamin Asea, Keron Ssebyala, Paul Bangirana, Robert O. Opoka, Samson K. Lubowa, Margaret Semrud-Clikeman, Chandy John, Joyce Nalugya

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Cerebral malaria (CM) and severe malarial anaemia (SMA) are associated with neuro-developmental impairment in African children, but long-term mental health disorders in these children are not well defined. Methods: A cohort of children previously exposed to CM (n = 173) or SMA (n = 99) had neurologic assessments performed and screening for behaviour difficulties using the Strengths and Difficulties Questionnaire (SDQ) a median of 21 months after the disease episode. These findings were compared to concurrently recruited community children (CC, n = 108). Participants with SDQ total difficulties score ≥17 had a mental health interview with the child and adolescent version of the Mini-International Neuropsychiatric Interview (MINI-KID) and a sample had brain magnetic resonance imaging (MRI). Results: Fifty-five children had SDQ score ≥17. On the MINI-KID, these children were classified as having no difficulties (n = 18), behaviour difficulties only (n = 13) or a mental health disorder (n = 24). Behaviour difficulties were seen in similar frequencies in CM (3.5 %), SMA (4.0 %) and CC (2.8 %). In contrast, mental health disorders were most frequent in CM (10.4 %), followed by SMA (4.0 %) and CC (1.8 %). Externalizing disorders (conduct, oppositional defiance and attention deficit hyperactivity) were the most common mental health disorders. The median total coma duration was 72 (IQR 36.0-115.0) h in patients with mental health disorders compared to 48 (IQR 28.5-78.7) h in those without, p = 0.039. Independent risk factors for mental health disorder included neurologic deficit at discharge (OR 4.09 (95 % CI 1.60, 10.5) and seizure recurrences during hospitalization, (OR 2.80, 95 % CI 1.13, 6.97). Brain MRI findings consistent with small vessel ischaemic neural injury was seen in over half of these children. Conclusions: Cerebral malaria may predispose children to mental health disorders, possibly as a consequence of ischaemic neural injury. There is urgent need for programmes of follow-up, diagnosis and interventions for these children.

Original languageEnglish (US)
Article number184
JournalMalaria Journal
Volume15
Issue number1
DOIs
StatePublished - Mar 31 2016

Fingerprint

Cerebral Malaria
Mental Disorders
Mental Health
Cross-Sectional Studies
Anemia
Magnetic Resonance Imaging
Interviews
Conduct Disorder
Wounds and Injuries
Brain
Coma
Neurologic Manifestations
Nervous System
Seizures
Hospitalization

Keywords

  • Behaviour
  • Cerebral malaria
  • Children
  • Disorder
  • Mental health
  • Psychiatric

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases

Cite this

Idro, R., Kakooza-Mwesige, A., Asea, B., Ssebyala, K., Bangirana, P., Opoka, R. O., ... Nalugya, J. (2016). Cerebral malaria is associated with long-term mental health disorders: A cross sectional survey of a long-term cohort. Malaria Journal, 15(1), [184]. https://doi.org/10.1186/s12936-016-1233-6

Cerebral malaria is associated with long-term mental health disorders : A cross sectional survey of a long-term cohort. / Idro, Richard; Kakooza-Mwesige, Angelina; Asea, Benjamin; Ssebyala, Keron; Bangirana, Paul; Opoka, Robert O.; Lubowa, Samson K.; Semrud-Clikeman, Margaret; John, Chandy; Nalugya, Joyce.

In: Malaria Journal, Vol. 15, No. 1, 184, 31.03.2016.

Research output: Contribution to journalArticle

Idro, R, Kakooza-Mwesige, A, Asea, B, Ssebyala, K, Bangirana, P, Opoka, RO, Lubowa, SK, Semrud-Clikeman, M, John, C & Nalugya, J 2016, 'Cerebral malaria is associated with long-term mental health disorders: A cross sectional survey of a long-term cohort', Malaria Journal, vol. 15, no. 1, 184. https://doi.org/10.1186/s12936-016-1233-6
Idro, Richard ; Kakooza-Mwesige, Angelina ; Asea, Benjamin ; Ssebyala, Keron ; Bangirana, Paul ; Opoka, Robert O. ; Lubowa, Samson K. ; Semrud-Clikeman, Margaret ; John, Chandy ; Nalugya, Joyce. / Cerebral malaria is associated with long-term mental health disorders : A cross sectional survey of a long-term cohort. In: Malaria Journal. 2016 ; Vol. 15, No. 1.
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AU - Opoka, Robert O.

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N2 - Background: Cerebral malaria (CM) and severe malarial anaemia (SMA) are associated with neuro-developmental impairment in African children, but long-term mental health disorders in these children are not well defined. Methods: A cohort of children previously exposed to CM (n = 173) or SMA (n = 99) had neurologic assessments performed and screening for behaviour difficulties using the Strengths and Difficulties Questionnaire (SDQ) a median of 21 months after the disease episode. These findings were compared to concurrently recruited community children (CC, n = 108). Participants with SDQ total difficulties score ≥17 had a mental health interview with the child and adolescent version of the Mini-International Neuropsychiatric Interview (MINI-KID) and a sample had brain magnetic resonance imaging (MRI). Results: Fifty-five children had SDQ score ≥17. On the MINI-KID, these children were classified as having no difficulties (n = 18), behaviour difficulties only (n = 13) or a mental health disorder (n = 24). Behaviour difficulties were seen in similar frequencies in CM (3.5 %), SMA (4.0 %) and CC (2.8 %). In contrast, mental health disorders were most frequent in CM (10.4 %), followed by SMA (4.0 %) and CC (1.8 %). Externalizing disorders (conduct, oppositional defiance and attention deficit hyperactivity) were the most common mental health disorders. The median total coma duration was 72 (IQR 36.0-115.0) h in patients with mental health disorders compared to 48 (IQR 28.5-78.7) h in those without, p = 0.039. Independent risk factors for mental health disorder included neurologic deficit at discharge (OR 4.09 (95 % CI 1.60, 10.5) and seizure recurrences during hospitalization, (OR 2.80, 95 % CI 1.13, 6.97). Brain MRI findings consistent with small vessel ischaemic neural injury was seen in over half of these children. Conclusions: Cerebral malaria may predispose children to mental health disorders, possibly as a consequence of ischaemic neural injury. There is urgent need for programmes of follow-up, diagnosis and interventions for these children.

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