1921
Volume 97, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Cerebral malaria (CM) is a common cause of death and disability among children in sub-Saharan Africa. Many prior studies of neuropsychiatric morbidity have been limited by a cross-sectional design or a short duration of follow-up. Most have included subjects who may have presented with coma due to a disease process other than CM. No studies have assessed the relationship between magnetic resonance imaging (MRI) findings and long-term outcomes. The Cognitive Outcomes and Psychiatric symptoms of retinopathy-positive CM (COPS) cohort is the first large ( = 221) prospectively recruited cohort of stringently defined cases of CM and hospital-based, age-matched, non-CM controls in whom cognitive and psychiatric outcomes are assessed with standardized measures semi-annually for up to 5 years. We report baseline characteristics of the cohort and outcomes at 1 month. At enrollment, CM cases were more likely to come from families with fewer socioeconomic resources and to have health characteristics that increase risk for malaria. In children younger than 5 years, cases were delayed in motor, language, and social development by approximately 6 months, compared with controls. More significant delays occurred in those with MRI abnormalities at the 1-month follow-up visit. There were no differences between cases and controls in inhibitory self-control, nor in cognitive function in children ≥ 5 years of age. The latter finding may be related to the smaller sample size, case-control imbalance in socioeconomic status, or the use of cognitive and behavioral assessments that are less culturally appropriate to this population. Continued follow-up will help determine predictors of long-term outcomes.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.17-0020
2017-04-24
2020-09-24
Loading full text...

Full text loading...

/deliver/fulltext/14761645/97/1/tpmd170020.html?itemId=/content/journals/10.4269/ajtmh.17-0020&mimeType=html&fmt=ahah

References

  1. World Health Organization, 2016. World Malaria Report 2016. Geneva, Switzerland: World Health Organization.
    [Google Scholar]
  2. Idro R, Marsh K, John CC, Newton CR, 2010. Cerebral malaria: mechanisms of brain injury and strategies for improved neurocognitive outcome. Pediatr Res 68: 267274.[Crossref]
    [Google Scholar]
  3. Birbeck GL, Molyneux ME, Kaplan PW, Seydel KB, Chimalizeni YF, Kawaza K, Taylor TE, 2010. Blantyre malaria project epilepsy study (BMPES) of neurological outcomes in retinopathy-positive paediatric cerebral malaria survivors: a prospective cohort study. Lancet Neurol 9: 11731181.[Crossref]
    [Google Scholar]
  4. Idro R, Ndiritu M, Ogutu B, Mithwani S, Maitland K, Berkley J, Crawley J, Fegan G, Bauni E, Peshu N, 2007. Burden, features, and outcome of neurological involvement in acute falciparum malaria in Kenyan children. JAMA 297: 22322240.[Crossref]
    [Google Scholar]
  5. World Health Organization, 2014. Severe malaria. Trop Med Int Health 19: 7131.[Crossref]
    [Google Scholar]
  6. Boivin MJ, Bangirana P, Byarugaba J, Opoka RO, Idro R, Jurek AM, John CC, 2007. Cognitive impairment after cerebral malaria in children: a prospective study. Pediatrics 119: e360e366.[Crossref]
    [Google Scholar]
  7. John CC, Bangirana P, Byarugaba J, Opoka RO, Idro R, Jurek AM, Wu B, Boivin MJ, 2008. Cerebral malaria in children is associated with long-term cognitive impairment. Pediatrics 122: e92e99.[Crossref]
    [Google Scholar]
  8. Holding PA, Stevenson J, Peshu N, Marsh K, 1999. Cognitive sequelae of severe malaria with impaired consciousness. Trans R Soc Trop Med Hyg 93: 529534.[Crossref]
    [Google Scholar]
  9. Kihara M, Carter JA, Holding PA, Vargha-Khadem F, Scott RC, Idro R, Fegan GW, de Haan M, Neville BG, Newton CR, 2009. Impaired everyday memory associated with encephalopathy of severe malaria: the role of seizures and hippocampal damage. Malar J 8: 273.[Crossref]
    [Google Scholar]
  10. Boivin MJ, Vokhiwa M, Sikorskii A, Magen JG, Beare NA, 2014. Cerebral malaria retinopathy predictors of persisting neurocognitive outcomes in Malawian children. Pediatr Infect Dis J 33: 821824.[Crossref]
    [Google Scholar]
  11. Idro R, Kakooza-Mwesige A, Balyejjussa S, Mirembe G, Mugasha C, Tugumisirize J, Byarugaba J, 2010. Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan children. BMC Res Notes 3: 104.[Crossref]
    [Google Scholar]
  12. Idro R, Carter JA, Fegan G, Neville BG, Newton CR, 2006. Risk factors for persisting neurological and cognitive impairments following cerebral malaria. Arch Dis Child 91: 142148.[Crossref]
    [Google Scholar]
  13. Bangirana P, Opoka RO, Boivin MJ, Idro R, Hodges JS, Romero RA, Shapiro E, John CC, 2014. Severe malarial anemia is associated with long-term neurocognitive impairment. Clin Infect Dis 59: 336344.[Crossref]
    [Google Scholar]
  14. Bangirana P, Opoka RO, Boivin MJ, Idro R, Hodges JS, John CC, 2016. Neurocognitive domains affected by cerebral malaria and severe malarial anemia in children. Learn Individ Differ 46: 3844.[Crossref]
    [Google Scholar]
  15. Taylor TE, Fu WJ, Carr RA, Whitten RO, Mueller JS, Fosiko NG, Lewallen S, Liomba NG, Molyneux ME, 2004. Differentiating the pathologies of cerebral malaria by postmortem parasite counts. Nat Med 10: 143145.[Crossref]
    [Google Scholar]
  16. Postels DG, Taylor TE, Molyneux M, Mannor K, Kaplan PW, Seydel KB, Chimalizeni YF, Kawaza K, Birbeck GL, 2012. Neurologic outcomes in retinopathy-negative cerebral malaria survivors. Neurology 79: 12681272.[Crossref]
    [Google Scholar]
  17. Seydel KB, Kampondeni SD, Valim C, Potchen MJ, Milner DA, Muwalo FW, Birbeck GL, Bradley WG, Fox LL, Glover SJ, Hammond CA, Heyderman RS, Chilingulo CA, Molyneux ME, Taylor TE, 2015. Brain swelling and death in children with cerebral malaria. N Engl J Med 372: 11261137.[Crossref]
    [Google Scholar]
  18. Gladstone M, Lancaster GA, Umar E, Nyirenda M, Kayira E, van den Broek NR, Smyth RL, 2010. The Malawi developmental assessment tool (MDAT): the creation, validation, and reliability of a tool to assess child development in rural African settings. PLoS Med 7: e1000273.[Crossref]
    [Google Scholar]
  19. Bangirana P, Seggane-Musisi Allebeck P, Giordani B, John CC, Opoka OR, Byarugaba J, Ehnvall A, Boivin MJ, 2009. A preliminary examination of the construct validity of the KABC-II in Ugandan children with a history of cerebral malaria. Afr Health Sci 9: 186192.
    [Google Scholar]
  20. Kaufman AS, 2004. KABC-II: Kaufman Assessment Battery for Children. Bloomington, MN: NCS Pearson.
    [Google Scholar]
  21. Boivin MJ, Gladstone MJ, Vokhiwa M, Birbeck GL, Magen JG, Page C, Semrud-Clikeman M, Kauye F, Taylor TE, 2011. Developmental outcomes in Malawian children with retinopathy-positive cerebral malaria. Trop Med Int Health 16: 263271.[Crossref]
    [Google Scholar]
  22. Gioia GA, Isquith PK, Guy SC, Kenworthy L, 2000. Behavior Rating Inventory of Executive Function: BRIEF. Odessa, FL: Psychological Assessment Resources.
    [Google Scholar]
  23. Familiar I, Ruisenor-Escudero H, Giordani B, Bangirana P, Nakasujja N, Opoka R, Boivin M, 2015. Use of the behavior rating inventory of executive function and child behavior checklist in Ugandan children with HIV or a history of severe malaria. J Dev Behav Pediatr 36: 277284.[Crossref]
    [Google Scholar]
  24. Bangirana P, Musisi S, Boivin MJ, Ehnvall A, John CC, Bergemann TL, Allebeck P, 2011. Malaria with neurological involvement in Ugandan children: effect on cognitive ability, academic achievement and behaviour. Malar J 10: 334.[Crossref]
    [Google Scholar]
  25. Bangirana P, John CC, Idro R, Opoka RO, Byarugaba J, Jurek AM, Boivin MJ, 2009. Socioeconomic predictors of cognition in Ugandan children: implications for community interventions. PLoS One 4: e7898.[Crossref]
    [Google Scholar]
  26. Bergemann TL, Bangirana P, Boivin MJ, Connett JE, Giordani BJ, John CC, 2012. Statistical approaches to assess the effects of disease on neurocognitive function over time. J Biom Biostat (Suppl 7): 7310.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.17-0020
Loading
/content/journals/10.4269/ajtmh.17-0020
Loading

Data & Media loading...

Supplemental Figure

  • Received : 10 Jan 2017
  • Accepted : 28 Feb 2017
  • Published online : 24 Apr 2017
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error