Published online June 9, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. e92-e99 (doi:10.1542/peds.2007-3709)
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ARTICLE

Cerebral Malaria in Children Is Associated With Long-term Cognitive Impairment

Chandy C. John, MDa, Paul Bangirana, MSb, Justus Byarugaba, MMedc, Robert O. Opoka, MMedc, Richard Idro, MMedc, Anne M. Jurek, PhDa, Baolin Wu, PhDd and Michael J. Boivin, PhD, MPHe

a Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
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 Department of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota
e International Neurologic and Psychiatric Epidemiology Program, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan

OBJECTIVE. Cerebral malaria affects >785000 African children every year. We previously documented an increased frequency of cognitive impairment in children with cerebral malaria 6 months after their initial malaria episode. This study was conducted to determine the long-term effects of cerebral malaria on the cognitive function of these children.

METHODS. Children who were 5 to 12 years of age and presented to Mulago Hospital, Kampala, Uganda, with cerebral malaria (n = 44) or uncomplicated malaria (n = 54), along with healthy, asymptomatic community children (n = 89), were enrolled in a prospective cohort study of cognition. Cognitive testing was performed at enrollment and 2 years later. The primary outcome was presence of a deficit in ≥1 of 3 cognitive areas tested.

RESULTS. At 2-year follow-up testing, 26.3% of children with cerebral malaria and 12.5% with uncomplicated malaria had cognitive deficits in ≥1 area, as compared with 7.6% of community children. Deficits in children with cerebral malaria were primarily in the area of attention (cerebral malaria, 18.4%, vs community children, 2.5%). After adjustment for age, gender, nutrition, home environment, and school level, children with cerebral malaria had a 3.67-fold increased risk for a cognitive deficit compared with community children. Cognitive impairment at 2-year follow-up was associated with hyporeflexia on admission and neurologic deficits 3 months after discharge.

CONCLUSIONS. Cerebral malaria is associated with long-term cognitive impairments in 1 of 4 child survivors. Future studies should investigate the mechanisms involved so as to develop interventions aimed at prevention and rehabilitation.

Key Words: cerebral malaria • cognitive • deficit • impairment • P falciparum

Abbreviations: CM—cerebral malaria • CC—community children • UM—uncomplicated malaria • HOME—Home Observation for Measurement of the Environment • OR—odds ratio • CI—confidence interval

Accepted Feb 15, 2008.