title: Long-term impact of malaria chemoprophylaxis on cognitive abilities and educational attainment: follow-up of a controlled trial.
abstract: OBJECTIVE
  We investigated the long-term impact of early childhood malaria prophylaxis on cognitive and educational outcomes.
  
  
  METHODS
  This was a household-based cluster-controlled intervention trial.
  
  
  METHODS
  The study was conducted in 15 villages situated between 32 km to the east and 22 km to the west of the town of Farafenni, the Gambia, on the north bank of the River Gambia.
  
  
  METHODS
  A total of 1,190 children aged 3-59 mo took part in the trial. We traced 579 trial participants (291 in the prophylaxis group and 288 in the placebo group) in 2001, when their median age was 17 y 1 mo (range 14 y 9 mo to 19 y 6 mo).
  
  
  METHODS
  Participants received malaria chemoprophylaxis (dapsone/pyrimethamine) or placebo for between one and three malaria transmission seasons from 1985 to 1987 during the controlled trial. At the end of the trial, prophylaxis was provided for all children under 5 y of age living in the study villages.
  
  
  METHODS
  The outcome measures were cognitive abilities, school enrolment, and educational attainment (highest grade reached at school).
  
  
  RESULTS
  There was no significant overall intervention effect on cognitive abilities, but there was a significant interaction between intervention group and the duration of post-trial prophylaxis (p = 0.034), with cognitive ability somewhat higher in the intervention group among children who received no post-trial prophylaxis (treatment effect = 0.2 standard deviations [SD], 95% confidence interval [CI] -0.03 to 0.5) and among children who received less than 1 y of post-trial prophylaxis (treatment effect = 0.4 SD, 95% CI 0.1 to 0.8). The intervention group had higher educational attainment by 0.52 grades (95% CI = -0.041 to 1.089; p = 0.069). School enrolment was similar in the two groups.
  
  
  CONCLUSIONS
  The results are suggestive of a long-term effect of malaria prophylaxis on cognitive function and educational attainment, but confirmatory studies are needed.
authors.affiliation: Partnership for Child Development, Department for Infectious Disease Epidemiology, Imperial College School of Medicine, London, United Kingdom. jukesma@gse.harvard.edu
authors.forename: Matthew C H
authors.initials: MC
authors.lastname: Jukes
authors.forename: Margaret
authors.initials: M
authors.lastname: Pinder
authors.forename: Elena L
authors.initials: EL
authors.lastname: Grigorenko
authors.forename: Helen Baños
authors.initials: HB
authors.lastname: Smith
authors.forename: Gijs
authors.initials: G
authors.lastname: Walraven
authors.forename: Elisa Meier
authors.initials: EM
authors.lastname: Bariau
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sternberg
authors.forename: Lesley J
authors.initials: LJ
authors.lastname: Drake
authors.forename: Paul
authors.initials: P
authors.lastname: Milligan
authors.forename: Yin Bun
authors.initials: YB
authors.lastname: Cheung
authors.forename: Brian M
authors.initials: BM
authors.lastname: Greenwood
authors.forename: Donald A P
authors.initials: DA
authors.lastname: Bundy