Cerebral malaria in children is associated with long-term cognitive impairment.
OBJECTIVE
Cerebral malaria affects >785000 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 >or=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 >or=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.
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA. ccj@umn.edu
Chandy C
CC
John
Paul
P
Bangirana
Justus
J
Byarugaba
Robert O
RO
Opoka
Richard
R
Idro
Anne M
AM
Jurek
Baolin
B
Wu
Michael J
MJ
Boivin
D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D016779:Malaria, Cerebral / Q000150:complications*; D008297:Male; D011446:Prospective Studies; D012021:Reflex, Abnormal; D013997:Time Factors