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Clin Infect Dis. 2014 Aug 1;59(3):336-44. doi: 10.1093/cid/ciu293. Epub 2014 Apr 24.

Severe malarial anemia is associated with long-term neurocognitive impairment.

Author information

1
Department of Psychiatry, and.
2
Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
3
Department of Psychiatry, Michigan State University School of Human Medicine, East Lansing.
4
Department of Biostatistics, and.
5
Department of Pediatrics, University of Minnesota Medical School, Minneapolis.
6
Department of Epidemiology, University of Minnesota School of Public Health, and.
7
Department of Biostatistics, and Department of Epidemiology, University of Minnesota School of Public Health, and.

Abstract

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.

KEYWORDS:

cerebral malaria; cognitive; impairment; severe malarial anemia

PMID:
24771329
PMCID:
PMC4155441
DOI:
10.1093/cid/ciu293
[Indexed for MEDLINE]
Free PMC Article

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