title: Developmental outcomes in Malawian children with retinopathy-positive cerebral malaria.
abstract: OBJECTIVE
  To assess children with retinopathy-positive cerebral malaria (CM) for neurocognitive sequelae.
  
  
  METHODS
  Participants were selected from an ongoing exposure-control study. Eighty-three Malawian children averaging 4.4 years of age and diagnosed with retinopathy-positive CM were compared to 95 controls. Each child was classified as delayed or not using age-based norms for the Malawi Developmental Assessment Tool (MDAT) for developmental delay on the total scale and for the domains of gross motor, fine motor, language and social skills. Groups were also compared on the Achenbach Child Behaviour Checklist (CBCL) (1.5-5 years).
  
  
  RESULTS
  Children with retinopathy-positive CM were delayed, relative to the comparison group, on MDAT total development (P = 0.028; odds ratio or OR = 2.13), with the greatest effects on language development (P = 0.003; OR = 4.93). The two groups did not differ significantly on the Achenbach CBCL internalizing and externalizing symptoms total scores. Stepwise regression demonstrated that coma duration, seizures while in hospital, platelet count and lactate level on admission were predictive of assessment outcomes for the children with retinopathy-positive CM.
  
  
  CONCLUSIONS
  Children who suffer retinopathy-positive CM at preschool age are at greater risk of developmental delay, particularly with respect to language development. This confirms previous retrospective study findings with school-age children evaluated years after acute illness. The MDAT and the Achenbach CBCL proved sensitive to clinical indicators of severity of malarial illness.
authors.affiliation: International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, MI, USA. boivin@msu.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Boivin
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Gladstone
authors.forename: Maclean
authors.initials: M
authors.lastname: Vokhiwa
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Birbeck
authors.forename: Jed G
authors.initials: JG
authors.lastname: Magen
authors.forename: Connie
authors.initials: C
authors.lastname: Page
authors.forename: Margaret
authors.initials: M
authors.lastname: Semrud-Clikeman
authors.forename: Felix
authors.initials: F
authors.lastname: Kauye
authors.forename: Terrie E
authors.initials: TE
authors.lastname: Taylor
mesh_terms: D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000469:parasitology*; D015822:Eye Infections, Parasitic / Q000469:parasitology*; D005260:Female; D006801:Humans; D007223:Infant; D007805:Language Development Disorders / Q000469:parasitology; D016779:Malaria, Cerebral / Q000150:complications*; D008295:Malawi; D008297:Male; D011379:Prognosis; D011594:Psychometrics; D012164:Retinal Diseases / Q000469:parasitology*; D012923:Social Class