Severe malarial anemia is associated with long-term neurocognitive impairment.
BACKGROUND
Cerebral malaria (CM) is associated with long-term neurocognitive impairment in children ≥5 years of age. No prospective studies to date have assessed neurocognitive impairment in children with CM <5 years of age, or in children with severe malarial anemia (SMA), a form of severe malaria estimated to affect as many as 5 million children annually.


METHODS
Children <5 years of age presenting to Mulago Hospital, Kampala, Uganda, with CM (n = 80) or SMA (n = 86) were assessed for overall cognitive ability, attention, and associative memory 1 week after discharge and 6 and 12 months later. The z scores for each domain were computed based on scores of 61 healthy community children (CC), who were also tested at enrollment and 6 and 12 months later. Groups were compared using mixed linear models, adjusted for age, weight for age, and child's education.


RESULTS
At 12 months, children with CM had lower adjusted scores than CC in cognitive ability (P < .001), attention (P = .02), and associative memory, (P = .002). Children with SMA had lower scores than CC in cognitive ability (P = .01) but not attention or associative memory. Cognitive ability scores in children with CM and SMA did not differ significantly.


CONCLUSIONS
In children <5 years of age, SMA is associated with long-term impairment in cognitive ability, whereas CM is associated with additional impairment in the areas of attention and associative memory. SMA may be a major contributor to long-term neurocognitive impairment in children in sub-Saharan Africa.
Department of Psychiatry, and.
Paul
P
Bangirana
Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
Robert O
RO
Opoka
Department of Psychiatry, Michigan State University School of Human Medicine, East Lansing.
Michael J
MJ
Boivin
Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
Richard
R
Idro
Department of Biostatistics, and.
James S
JS
Hodges
Department of Pediatrics, University of Minnesota Medical School, Minneapolis.
Regilda A
RA
Romero
Department of Epidemiology, University of Minnesota School of Public Health, and.
Elsa
E
Shapiro
Department of Biostatistics, and Department of Epidemiology, University of Minnesota School of Public Health, and.
Chandy C
CC
John
D000740:Anemia / Q000150:complications*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000150:complications*; D008297:Male; D010351:Patient Discharge; D011446:Prospective Studies; D014454:Uganda / Q000453:epidemiology
cerebral malaria; cognitive; impairment; severe malarial anemia