title: Long-term impact of childhood malaria infection on school performance among school children in a malaria endemic area along the Thai-Myanmar border.
abstract: BACKGROUND
  Children represent a high-risk group for malaria worldwide. Among people in Thailand who have malaria during childhood, some may have multiple malaria attacks during their lifetime. Malaria may affect neurological cognition in children, resulting in short-term impairment of memory and language functions. However, little is known regarding the long-term effects of malaria infection on cognitive function. This study examines the long-term impact of malaria infection on school performance among school children living in a malaria-endemic area along the Thai-Myanmar border.
  
  
  METHODS
  A retrospective cohort study was conducted among school children aged 6-17 years in a primary-secondary school of a sub-district of Ratchaburi Province, Thailand. History of childhood malaria infection was obtained from the medical records of the sole malaria clinic in the area. School performance was assessed by using scores for the subjects Thai Language and Mathematics in 2014. Other variables, such as demographic characteristics, perinatal history, nutritional status, and emotional intelligence, were also documented.
  
  
  RESULTS
  A total of 457 students were included, 135 (30 %) of whom had a history of uncomplicated malaria infection. About half of the malaria-infected children had suffered infection before the age of four years. The mean scores for both Mathematics and Thai Language decreased in relation to the increasing number of malaria attacks. Most students had their last malaria episode more than two years previously. The mean scores were not associated with duration since the last malaria attack. The association between malaria infection and school performance was not significant after adjusting for potential confounders, including gender, school absenteeism over a semester term, and emotional intelligence.
  
  
  CONCLUSIONS
  This study characterizes the long-term consequences of uncomplicated malaria disease during childhood. School performance was not associated with a history of malaria infection, considering that most students had their last malaria infection more than two years previously. These findings indicate that the impact of uncomplicated malaria infection on school performance may not be prolonged.
authors.affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. nutchavadee.voa@student.mahidol.ac.th.
authors.forename: Nutchavadee
authors.initials: N
authors.lastname: Vorasan
authors.affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. wirichada.pan@mahidol.ac.th.
authors.forename: Wirichada
authors.initials: W
authors.lastname: Pan-Ngum
authors.affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Podjanee@tropmedres.ac.
authors.forename: Podjanee
authors.initials: P
authors.lastname: Jittamala
authors.affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. wanchai.man@mahidol.ac.th.
authors.forename: Wanchai
authors.initials: W
authors.lastname: Maneeboonyang
authors.affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. prasert.ruk@mahidol.ac.th.
authors.forename: Prasert
authors.initials: P
authors.lastname: Rukmanee
authors.affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. saranath.law@mahidol.ac.th.
authors.forename: Saranath
authors.initials: S
authors.lastname: Lawpoolsri
mesh_terms: D000293:Adolescent; D002648:Child; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000453:epidemiology* / Q000209:etiology*; D008288:Malaria / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D002052:Myanmar; D012189:Retrospective Studies; D012574:Schools; D013334:Students; D013785:Thailand