Long-term behavioral problems in children with severe malaria

John Mbaziira Ssenkusu, James Steven Hodges, Robert Opika Opoka, Richard Idro, Elsa Shapiro, Chandy John, Paul Bangirana

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Severe malaria in children is associated with long-term neurocognitive a impairment, but it is unclear whether it is associated with long-term behavioral problems. METHODS: Children <5 years old with cerebral malaria (CM) or severe malarial anemia (SMA) treated at Mulago Hospital, Kampala, Uganda were assessed for behavioral outcomes at 0, 6, 12, and 24 months using the Child Behavior Checklist. Sample sizes at 0, 12, and 24 months were 122, 100, and 80 in the CM group, 130, 98, and 81 in the SMA group, and 149, 123, and 90 in healthy community control (CC) children, respectively. Age adjusted z-scores for behavioral outcomes were computed using scores for the CC group. Study groups were compared using regression models adjusted for age, nutritional status, preschool education, and socioeconomic status. RESULTS: At 12 months, children with SMA had higher z-scores than CC children for internalizing (mean difference, 0.49; SE, 0.14; P = .001), externalizing (mean difference, 0.49; SE, 0.15; P = .001), and total problems (mean difference, 0.51; SE, 0.15; P < .001). Children with CM had higher adjusted z-scores than CC children for externalizing problems (mean difference, 0.39; SE, 0.15; P = .009) but not internalizing or total problems. At 24 months, children with CM or SMA both had increased internalizing and externalizing behavioral problems compared with CC children (P ≤ .05 for all). CONCLUSIONS: CM and SMA are associated with long-term internalizing and externalizing behavioral problems in children. They may contribute substantially to mental health morbidity in children <5 years old in malaria endemic areas.

Original languageEnglish (US)
Article numbere20161965
JournalPediatrics
Volume138
Issue number5
DOIs
StatePublished - Nov 1 2016

Fingerprint

Malaria
Cerebral Malaria
Anemia
Problem Behavior
Uganda
Child Behavior
Nutritional Status
Checklist
Social Class
Sample Size
Mental Health
Morbidity
Education
Control Groups

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Ssenkusu, J. M., Hodges, J. S., Opoka, R. O., Idro, R., Shapiro, E., John, C., & Bangirana, P. (2016). Long-term behavioral problems in children with severe malaria. Pediatrics, 138(5), [e20161965]. https://doi.org/10.1542/peds.2016-1965

Long-term behavioral problems in children with severe malaria. / Ssenkusu, John Mbaziira; Hodges, James Steven; Opoka, Robert Opika; Idro, Richard; Shapiro, Elsa; John, Chandy; Bangirana, Paul.

In: Pediatrics, Vol. 138, No. 5, e20161965, 01.11.2016.

Research output: Contribution to journalArticle

Ssenkusu, JM, Hodges, JS, Opoka, RO, Idro, R, Shapiro, E, John, C & Bangirana, P 2016, 'Long-term behavioral problems in children with severe malaria', Pediatrics, vol. 138, no. 5, e20161965. https://doi.org/10.1542/peds.2016-1965
Ssenkusu JM, Hodges JS, Opoka RO, Idro R, Shapiro E, John C et al. Long-term behavioral problems in children with severe malaria. Pediatrics. 2016 Nov 1;138(5). e20161965. https://doi.org/10.1542/peds.2016-1965
Ssenkusu, John Mbaziira ; Hodges, James Steven ; Opoka, Robert Opika ; Idro, Richard ; Shapiro, Elsa ; John, Chandy ; Bangirana, Paul. / Long-term behavioral problems in children with severe malaria. In: Pediatrics. 2016 ; Vol. 138, No. 5.
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N2 - BACKGROUND: Severe malaria in children is associated with long-term neurocognitive a impairment, but it is unclear whether it is associated with long-term behavioral problems. METHODS: Children <5 years old with cerebral malaria (CM) or severe malarial anemia (SMA) treated at Mulago Hospital, Kampala, Uganda were assessed for behavioral outcomes at 0, 6, 12, and 24 months using the Child Behavior Checklist. Sample sizes at 0, 12, and 24 months were 122, 100, and 80 in the CM group, 130, 98, and 81 in the SMA group, and 149, 123, and 90 in healthy community control (CC) children, respectively. Age adjusted z-scores for behavioral outcomes were computed using scores for the CC group. Study groups were compared using regression models adjusted for age, nutritional status, preschool education, and socioeconomic status. RESULTS: At 12 months, children with SMA had higher z-scores than CC children for internalizing (mean difference, 0.49; SE, 0.14; P = .001), externalizing (mean difference, 0.49; SE, 0.15; P = .001), and total problems (mean difference, 0.51; SE, 0.15; P < .001). Children with CM had higher adjusted z-scores than CC children for externalizing problems (mean difference, 0.39; SE, 0.15; P = .009) but not internalizing or total problems. At 24 months, children with CM or SMA both had increased internalizing and externalizing behavioral problems compared with CC children (P ≤ .05 for all). CONCLUSIONS: CM and SMA are associated with long-term internalizing and externalizing behavioral problems in children. They may contribute substantially to mental health morbidity in children <5 years old in malaria endemic areas.

AB - BACKGROUND: Severe malaria in children is associated with long-term neurocognitive a impairment, but it is unclear whether it is associated with long-term behavioral problems. METHODS: Children <5 years old with cerebral malaria (CM) or severe malarial anemia (SMA) treated at Mulago Hospital, Kampala, Uganda were assessed for behavioral outcomes at 0, 6, 12, and 24 months using the Child Behavior Checklist. Sample sizes at 0, 12, and 24 months were 122, 100, and 80 in the CM group, 130, 98, and 81 in the SMA group, and 149, 123, and 90 in healthy community control (CC) children, respectively. Age adjusted z-scores for behavioral outcomes were computed using scores for the CC group. Study groups were compared using regression models adjusted for age, nutritional status, preschool education, and socioeconomic status. RESULTS: At 12 months, children with SMA had higher z-scores than CC children for internalizing (mean difference, 0.49; SE, 0.14; P = .001), externalizing (mean difference, 0.49; SE, 0.15; P = .001), and total problems (mean difference, 0.51; SE, 0.15; P < .001). Children with CM had higher adjusted z-scores than CC children for externalizing problems (mean difference, 0.39; SE, 0.15; P = .009) but not internalizing or total problems. At 24 months, children with CM or SMA both had increased internalizing and externalizing behavioral problems compared with CC children (P ≤ .05 for all). CONCLUSIONS: CM and SMA are associated with long-term internalizing and externalizing behavioral problems in children. They may contribute substantially to mental health morbidity in children <5 years old in malaria endemic areas.

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