Published online January 15, 2007
PEDIATRICS Vol. 119 No. 2 February 2007, pp. e360-e366 (doi:10.1542/peds.2006-2027)
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ARTICLE

Cognitive Impairment After Cerebral Malaria in Children: A Prospective Study

Michael J. Boivin, PhD, MPHa, Paul Bangirana, MSb, Justus Byarugaba, MBChB, MMedc, Robert O. Opoka, MBChB, MMedc, Richard Idro, MBChB, MMedc, Anne M. Jurek, PhDd and Chandy C. John, MD, MSd

a International Neurologic and Psychiatric Epidemiology Program, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
b Department of Mental Health and Community Psychology, Makerere University Institute of Psychology, Kampala, Uganda
c Department of Paediatrics and Child Health, Makerere University Medical School and Mulago Hospital, Kampala, Uganda
d Global Pediatrics Program, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota

OBJECTIVE. This study was conducted to assess prospectively the frequency of cognitive deficits in children with cerebral malaria.

METHODS. Cognitive testing in the areas of working memory, attention, and learning was performed for Ugandan children 5 to 12 years of age with cerebral malaria (n = 44), children with uncomplicated malaria (n = 54), and healthy community children (n = 89) at admission and 3 and 6 months later.

RESULTS. Six months after discharge, 21.4% of children with cerebral malaria had cognitive deficits, compared with 5.8% of community children. Deficits were seen in the areas of working memory (11.9% vs 2.3%) and attention (16.7% vs 2.3%). Children with cerebral malaria had a 3.7-fold increased risk of a cognitive deficit, compared with community children, after adjustment for age, gender, nutritional status, school level, and home environment. Among children with cerebral malaria, those with a cognitive deficit had more seizures before admission (mean: 4.1 vs 2.2) and a longer duration of coma (43.6 vs 30.5 hours), compared with those without a deficit. Children with uncomplicated malaria did not have an increased frequency of cognitive deficits.

CONCLUSIONS. Cerebral malaria may be a major cause of cognitive impairment in children in sub-Saharan Africa. Cognitive deficits in children with cerebral malaria are more likely for those who have multiple seizures before effective treatment for cerebral malaria.

Key Words: cerebral malaria • cognitive • deficit • impairment • sequelae

Abbreviations: CM—cerebral malaria • UM—uncomplicated malaria • CC—community children • K-ABC—Kaufman assessment battery for children • TOVA—tests of variables of attention • TPT—tactual performance test • OR—odds ratio • CI—confidence interval

Accepted Aug 21, 2006.


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