title: Long-term Behavioral Problems in Children With Severe Malaria.
abstract: Severe malaria in children is associated with long-term neurocognitive impairment, but it is unclear whether it is associated with long-term behavioral problems.
  
  
  
  Children <5 years old with cerebral malaria (CM) or severe malarial anemia (SMA) treated at Mulago Hospital, Kampala, Uganda were assessed for behavioral outcomes at 0, 6, 12, and 24 months using the Child Behavior Checklist. Sample sizes at 0, 12, and 24 months were 122, 100, and 80 in the CM group, 130, 98, and 81 in the SMA group, and 149, 123, and 90 in healthy community control (CC) children, respectively. Age adjusted z-scores for behavioral outcomes were computed using scores for the CC group. Study groups were compared using regression models adjusted for age, nutritional status, preschool education, and socioeconomic status.
  
  
  
  At 12 months, children with SMA had higher z-scores than CC children for internalizing (mean difference, 0.49; SE, 0.14; P = .001), externalizing (mean difference, 0.49; SE, 0.15; P = .001), and total problems (mean difference, 0.51; SE, 0.15; P < .001). Children with CM had higher adjusted z-scores than CC children for externalizing problems (mean difference, 0.39; SE, 0.15; P = .009) but not internalizing or total problems. At 24 months, children with CM or SMA both had increased internalizing and externalizing behavioral problems compared with CC children (P ≤ .05 for all).
  
  
  
  CM and SMA are associated with long-term internalizing and externalizing behavioral problems in children. They may contribute substantially to mental health morbidity in children <5 years old in malaria endemic areas.
authors.affiliation: Division of Biostatistics, School of Public Health, and ssenk001@umn.edu.
authors.forename: John Mbaziira
authors.initials: JM
authors.lastname: Ssenkusu
authors.affiliation: Division of Biostatistics, School of Public Health, and.
authors.forename: James Steven
authors.initials: JS
authors.lastname: Hodges
authors.affiliation: Departments of Pediatrics and Child Health, and.
authors.forename: Robert Opika
authors.initials: RO
authors.lastname: Opoka
authors.affiliation: Departments of Pediatrics and Child Health, and.
authors.forename: Richard
authors.initials: R
authors.lastname: Idro
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Elsa
authors.initials: E
authors.lastname: Shapiro
authors.affiliation: Department of Pediatrics, Indiana University, Indianapolis, Indiana ssenk001@umn.edu.
authors.forename: Chandy Chiramukhathu
authors.initials: CC
authors.lastname: John
authors.affiliation: Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda; and.
authors.forename: Paul
authors.initials: P
authors.lastname: Bangirana
mesh_terms: D017677:Age Distribution; D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D016014:Linear Models; D016779:Malaria, Cerebral / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D009483:Neuropsychological Tests; D015995:Prevalence; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D014454:Uganda / Q000453:epidemiology