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.
John
Chandy C
CC
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA. ccj@umn.edu
Bangirana
Paul
P
Byarugaba
Justus
J
Opoka
Robert O
RO
Idro
Richard
R
Jurek
Anne M
AM
Wu
Baolin
B
Boivin
Michael J
MJ
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