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Engeda EH, Aldersey HM, Davison CM, Gelaye KA, Fayed N. Severe malaria-related disability in Ethiopian children from the perspectives of caregivers: an interpretive description study. Disabil Rehabil 2024; 46:2327-2337. [PMID: 37303154 DOI: 10.1080/09638288.2023.2221457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE This study explored severe malaria-related disability in children from the perspectives of their caregivers. MATERIALS AND METHODS The interpretive description qualitative approach was employed. The participants were selected using the purposive sampling technique considering the child's history of severe malaria, age (0-10 years), and location (urban/rural). Data were collected through face-to-face interviews with sixteen caregivers. Reflexive thematic data analysis was utilized. Through prolonged engagement, reflective journaling, an audit trail, and co-authors' review, trustworthiness was enhanced. RESULTS The study generated five themes from the interviews: mitigators of disability, contributors of disability, impact on body function, impact on activities and participation, and uncertainties about future well-being. The findings revealed previously unstudied social components of disability and environmental factors. Furthermore, the research uncovered health-related quality of life aspects that are out of the scope of the current comprehensive disability framework. CONCLUSIONS The study contributes to a deeper understanding of severe malaria-related disability in children from the biopsychosocial perspective. The findings could help policymakers, researchers, and clinicians who want to design rehabilitation interventions for the affected children or examine the components of disability on a large scale using quantitative methods.IMPLICATIONS FOR REHABILITATIONVarious contextual factors interacted with severe malaria and influenced functioning either as facilitators or barriers, implying disability related to malaria can be prevented or created.The long-term impacts of severe malaria are not limited to functioning and disability but also affect the health-related quality of life of children who survive severe malaria.Rehabilitation professionals should consider applying comprehensive functioning and disability frameworks such as the ICF when designing (or applying) screening tools, planning interventions, and evaluating the outcomes of intervention for children with severe malaria-related disability.Rehabilitation interventions for children with severe malaria-related disability should consider patient- or caregiver-reported outcomes (components of disability).
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Affiliation(s)
- Eshetu Haileselassie Engeda
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Queen's University School of Rehabilitation Therapy, Kingston, Canada
| | | | - Colleen M Davison
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nora Fayed
- Queen's University School of Rehabilitation Therapy, Kingston, Canada
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Engeda EH, Aldersey HM, Davison CM, Gelaye KA, Fayed N. Perceptions and behaviors of healthcare providers towards rehabilitation support to children with severe malaria-related disability in Ethiopia: A qualitative descriptive study using the Theoretical Domains Framework. PLoS One 2024; 19:e0298769. [PMID: 38696368 PMCID: PMC11065226 DOI: 10.1371/journal.pone.0298769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/31/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Severe malaria often results in childhood disability. The prevalence of disability related to severe malaria is significant and is estimated to affect up to 53% of severe malaria survivors. In contrast, information is sparse about how healthcare providers in Africa think about or provide rehabilitation support in acute and post-acute phases respectively. Understanding the perceptions and behaviors of healthcare providers treating malaria could help inform malaria-related disability research, policy, and practice, aimed at the providers themselves. This study explored the perceptions and behaviors of healthcare providers towards rehabilitation for children with severe malaria-related disability. The Theoretical Domains Framework was used to describe the findings relative to wider literature on health provider behavior change. METHODS A qualitative descriptive approach was used to interview thirteen healthcare providers recruited purposively based on their clinical professions, roles, and settings. Data were analyzed using directed content analysis. We decided on the most prominent theoretical domains considering the frequency of specific perceptions and behaviors across the participants, the frequency of perceptions and behaviors in each domain, and evidence of strong perceptions and behaviors. RESULTS Nine out of fourteen theoretical domains were identified. These domains were: Beliefs about consequences, environmental context and resources, goals, knowledge, skills, optimism, reinforcement, social influences, and social or professional role and identity. Healthcare providers' beliefs about their roles in screening for disability or referring to rehabilitation were less positive. CONCLUSIONS The findings of this study suggest the need for interventions to support healthcare providers in acute phases (prevention and control of severe malaria) and post-acute phases (disability screening, referral, and rehabilitation care). Recommended interventions should focus on developing clinical guidelines, training clinicians, addressing institutional factors, and modifying external social influences such as socio-cultural factors.
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Affiliation(s)
- Eshetu Haileselassie Engeda
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Heather M. Aldersey
- Queen’s University School of Rehabilitation Therapy, Kingston, Ontario, Canada
| | - Colleen M. Davison
- Department of Public Health Sciences, Queen’s University Kingston, Kingston, Ontario, Canada
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nora Fayed
- Queen’s University School of Rehabilitation Therapy, Kingston, Ontario, Canada
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Zoumenou R, Bodeau-Livinec F, Chausseboeuf L, Boivin MJ, Wendland J. Is Neurodevelopmental Assessment in Early Childhood Predictive of Performance Assessed Later in Childhood and Adolescence in Sub-Saharan Africa? A Systematic Review of the Literature. Arch Clin Neuropsychol 2024; 39:98-116. [PMID: 37470401 PMCID: PMC10802230 DOI: 10.1093/arclin/acad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Most neurodevelopmental tests used to assess child development in sub-Saharan Africa were developed in western or high-income countries, raising the question of their usefulness with African children. OBJECTIVE This systematic review identified and synthesized key findings from studies measuring development in children in Sub-Saharan Africa in early childhood and again at school age, to assess neurocognitive associations longitudinally from infancy through middle childhood. METHODS The study was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, selecting articles referenced in the PubMed, PsycInfo, and Embase databases using the following inclusion criteria: published between 2000 and 2022, written in French or English, and presenting results dealing with the objective assessment of child's neurodevelopment. All articles were registered in the Zotero reference manager and analyzed by title, abstract, and full text. RESULTS Several of the seven selected studies confirmed that attention and working memory in infancy can predict children's neurocognitive performance, including mathematical ability, at school age. In two of the studies, children with poor mental development at 1 year of age are more likely to present with poorer behavioral development at school age, including learning difficulties in school and risk for grade repetition. CONCLUSION Cognitive ability assessed in early childhood is strongly associated with performance at school age in cohorts of African children followed longitudinally. Even with assessments adapted cross-culturally, infants and preschoolers at risk for poor developmental outcomes can be identified to better receive strategic early interventions to enhance their development.
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Affiliation(s)
- Roméo Zoumenou
- Institut de Recherche pour le Developpement, Mère et enfant face aux infections tropicales, 75006 Paris, France
- Laboratoire psychopathologie et processus en santé, Institute de psychologie, 92774 Boulogne, France
| | - Florence Bodeau-Livinec
- Institut de recherche en santé, environnement et travail (IRSET), Ecole des hautes etudes en santé (EHESP), 93210 Saint-Denis, France
| | - Léa Chausseboeuf
- Laboratoire psychopathologie et processus en santé, Institute de psychologie, 92774 Boulogne, France
| | - Michael J Boivin
- Department of Psychiatry and Department of Neurology & Ophthalmology, Michigan State University, East Lansing, MI 48824 USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA
| | - Jaqueline Wendland
- Laboratoire psychopathologie et processus en santé, Institute de psychologie, 92774 Boulogne, France
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Engeda EH, Aldersey HM, Davison CM, Gelaye KA, Abebe AB, Chala MB, Fayed N. Severe malaria-related disability in African children: a scoping review. Disabil Rehabil 2024; 46:31-39. [PMID: 36533299 DOI: 10.1080/09638288.2022.2157053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Disability is a consequence of severe malaria for a significant proportion of African children. This scoping review aims to describe the impact of severe malaria on African children according to current literature using an international biopsychical classification and framework of disability and functioning. MATERIALS AND METHODS MEDLINE, EMBASE, Global Health, and CINHAL databases were searched for original research conducted on African children aged 0-18 using terms related to severe malaria and components of disability. Independent and dependent variables were extracted and classified using the World Health Organization's International Classification of Functioning, Disability, and Health-Children and Youth version (ICF-CY) using standardized coding methods. RESULTS Seventy-two percent of the measured variables in the 34 included studies were coded as "body functions," (i.e., impairments), such as mental, neuromusculoskeletal, movement, and sensory functions, and 23.3% of variables were coded as "activities and participation" (i.e., activity limitations/participation restrictions), such as difficulties with general tasks and demands, communication, mobility, interpersonal interactions, and relationships. "Environment" variables such as family support, health access, education, or societal attitudes were not found in the included studies. CONCLUSIONS Existing peer-reviewed quantitative research of severe malaria-related disability is focused on neurological sequelae, with less research about activity limitations and participation restrictions.
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Affiliation(s)
- Eshetu Haileselassie Engeda
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Heather M Aldersey
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Colleen M Davison
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abey Bekele Abebe
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
- Department of Physiotherapy, School of Medicine, Gondar University Specialized Comprehensive Hospital, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Bayisa Chala
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
- Department of Physiotherapy, School of Medicine, Gondar University Specialized Comprehensive Hospital, University of Gondar, Gondar, Ethiopia
| | - Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Ssemata AS, Nakitende AJ, Kizito S, Thomas MR, Islam S, Bangirana P, Nakasujja N, Yang Z, Yu Y, Tran TM, John CC, McHenry MS. Association of severe malaria with cognitive and behavioural outcomes in low- and middle-income countries: a meta-analysis and systematic review. Malar J 2023; 22:227. [PMID: 37537555 PMCID: PMC10401769 DOI: 10.1186/s12936-023-04653-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Malaria affects 24 million children globally, resulting in nearly 500,000 child deaths annually in low- and middle-income countries (LMICs). Recent studies have provided evidence that severe malaria infection results in sustained impairment in cognition and behaviour among young children; however, a formal meta-analysis has not been published. The objective was to assess the association between severe malaria infection with cognitive and behavioural outcomes among children living in LMICs. METHODS Six online bibliographic databases were searched and reviewed in November 2022. Studies included involved children < 18 years of age living in LMICs with active or past severe malaria infection and measured cognitive and/or behaviour outcomes. The quality of studies was assessed. Definitions of severe malaria included cerebral malaria, severe malarial anaemia, and author-defined severe malaria. Results from all studies were qualitatively summarized. For studies with relevant data on attention, learning, memory, language, internalizing behaviour and externalizing behaviour, results were pooled and a meta-analysis was performed. A random-effects model was used across included cohorts, yielding a standardized mean difference between the severe malaria group and control group. RESULTS Out of 3,803 initial records meeting the search criteria, 24 studies were included in the review, with data from 14 studies eligible for meta-analysis inclusion. Studies across sub-Saharan Africa assessed 11 cohorts of children from pre-school to school age. Of all the studies, composite measures of cognition were the most affected areas of development. Overall, attention, memory, and behavioural problems were domains most commonly found to have lower scores in children with severe malaria. Meta-analysis revealed that children with severe malaria had worse scores compared to children without malaria in attention (standardized mean difference (SMD) -0.68, 95% CI -1.26 to -0.10), memory (SMD -0.52, 95% CI -0.99 to -0.06), and externalizing behavioural problems (SMD 0.45, 95% CI 0.13-0.78). CONCLUSION Severe malaria is associated with worse neuropsychological outcomes for children living in LMICs, specifically in attention, memory, and externalizing behaviours. More research is needed to identify the long-term implications of these findings. Further interventions are needed to prevent cognitive and behavioural problems after severe malaria infection. TRIAL REGISTRATION This systematic review was registered under PROSPERO: CRD42020154777.
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Affiliation(s)
- Andrew Sentoogo Ssemata
- Department of Psychiatry, School of Medicine, Makerere University, P. O. Box 7072, Kampala, Uganda.
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Simon Kizito
- Department of Mental Health and Community Psychology, School of Psychology, Makerere University, Kampala, Uganda
| | - Melissa R Thomas
- Richard M. Fairbanks School of Public Health, Indiana University-Purdue University, Indianapolis, USA
| | - Sumaiya Islam
- School of Medicine, City University of New York (CUNY), New York City, USA
- Mailman School of Public Health, Columbia University, New York City, USA
| | - Paul Bangirana
- Department of Psychiatry, School of Medicine, Makerere University, P. O. Box 7072, Kampala, Uganda
- Global Health Uganda, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Ziyi Yang
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, USA
| | - Yunpeng Yu
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, USA
| | - Tuan M Tran
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Megan S McHenry
- Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Magai DN, Koot HM, Mwangi P, Chongwo E, Newton CR, Abubakar A. Long-term neurocognitive and educational outcomes of neonatal insults in Kilifi, Kenya. BMC Psychiatry 2020; 20:578. [PMID: 33267843 PMCID: PMC7709237 DOI: 10.1186/s12888-020-02939-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/28/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There is little data on the long-term neurocognitive and educational outcomes among school-aged survivors of neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) in Africa. This study investigates the long-term neurocognitive and educational outcomes and the correlates of these outcomes in school-aged survivors of NNJ or HIE in Kilifi, Kenya. METHODS We conducted a cross-sectional study on neurocognitive and educational outcomes among school-aged survivors (6-12 years) of NNJ (n = 134) and HIE (n = 107) and compared them to a community comparison group (n = 134). We assessed nonverbal intelligence, planning, working memory, attention, syntax, pragmatics, word-finding, memory, perceptual-motor, mathematical, and reading abilities. We also collected information on medical history, caregivers' mental health, and family environment. RESULTS The survivors of NNJ had lower mean total scores in word-finding [F (1, 250) = 3.89, p = 0.050] and memory [F (1, 248) = 6.74, p = 0.010] than the comparison group. The survivors of HIE had lower mean scores in pragmatics [F (1, 230) = 6.61, p = 0.011] and higher scores higher scores in non-verbal reasoning [F (1, 225) =4.10, p = 0.044] than the comparison group. Stunted growth was associated with almost all the outcomes in HIE. CONCLUSION Survivors of NNJ and HIE present with impairment in the multiple domains, which need to be taken into consideration in the planning of educational and rehabilitative services.
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Affiliation(s)
- Dorcas N. Magai
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, P.O Box 230, Kilifi, Kenya ,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Hans M. Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Paul Mwangi
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, P.O Box 230, Kilifi, Kenya
| | - Esther Chongwo
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, P.O Box 230, Kilifi, Kenya
| | - Charles R. Newton
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, P.O Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, P.O. Box 195-80108, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, OX3 7JX UK
| | - Amina Abubakar
- grid.33058.3d0000 0001 0155 5938Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, P.O Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, P.O. Box 195-80108, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, OX3 7JX UK ,grid.470490.eInstitute for Human Development, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya
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Association between Malaria Infection and Early Childhood Development Mediated by Anemia in Rural Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030902. [PMID: 32024214 PMCID: PMC7037381 DOI: 10.3390/ijerph17030902] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 02/08/2023]
Abstract
Malaria is a leading cause of morbidity and mortality among children under five years of age, with most cases occurring in Sub-Saharan Africa. Children in this age group in Africa are at greatest risk worldwide for developmental deficits. There are research gaps in quantifying the risks of mild malaria cases, understanding the pathways linking malaria infection and poor child development, and evaluating the impact of malaria on the development of children under five years. We analyzed the association between malaria infection and gross motor, communication, and personal social development in 592 children age 24 months in rural, western Kenya as part of the WASH Benefits environmental enteric dysfunction sub-study. Eighteen percent of children had malaria, 20% were at risk for gross motor delay, 21% were at risk for communication delay, and 23% were at risk for personal social delay. Having a positive malaria test was associated with increased risk for gross motor, communication, and personal social delay while adjusting for child characteristics, household demographics, study cluster, and intervention treatment arm. Mediation analyses suggested that anemia was a significant mediator in the pathway between malaria infection and risk for gross motor, communication, and personal social development delays. The proportion of the total effect of malaria on the risk of developmental delay that is mediated by anemia across the subscales was small (ranging from 9% of the effect on gross motor development to 16% of the effect on communication development mediated by anemia). Overall, malaria may be associated with short-term developmental delays during a vulnerable period of early life. Therefore, preventative malaria measures and immediate treatment are imperative for children’s optimal development, particularly in light of projections of continued high malaria transmission in Kenya and Africa.
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Abstract
Falciparum malaria is the most common cause of convulsions in children admitted to hospital in malaria endemic areas. Detection of convulsions requires close monitoring and one should be on the look out for signs of subtle convulsions. About a third of acute seizures in children with cerebral malaria, do not manifest as convulsions, but as changes in eye deviation, salivation and/or eye deviation. It is important to terminate convulsions lasting more than 5 min, since prolonged convulsions are associated with neurological deficits in survivors of children with severe malaria. Initial management should include putting the child into the left lateral position, checking the blood glucose and administering oxygen if hypoxic. The benzodiazepines, particularly diazepam, are used as the initial anticonvulsants. Phénobarbital and Phenytoin are used as second-line treatments. Prompt and effective management of falciparum malaria associated convulsions may contribute to a better outcome in children with severe malaria.
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Affiliation(s)
- B R Ogutu
- Walter Reed Project-Centre for Clinical Research, Kenya Medical Research Institute [KEMRI], PO Box 54, Kisumu.
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Hora R, Kapoor P, Thind KK, Mishra PC. Cerebral malaria--clinical manifestations and pathogenesis. Metab Brain Dis 2016; 31:225-37. [PMID: 26746434 DOI: 10.1007/s11011-015-9787-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/22/2015] [Indexed: 01/28/2023]
Abstract
One of the most common central nervous system diseases in tropical countries is cerebral malaria (CM). Malaria is a common protozoan infection that is responsible for enormous worldwide mortality and economic burden on the society. Episodes of Plasmodium falciparum (Pf) caused CM may be lethal, while survivors are likely to suffer from persistent debilitating neurological deficits, especially common in children. In this review article, we have summarized the various symptoms and manifestations of CM in children and adults, and entailed the molecular basis of the disease. We have also emphasized how pathogenesis of the disease is effected by the parasite and host responses including blood brain barrier (BBB) disruption, endothelial cell activation and apoptosis, nitric oxide bioavailability, platelet activation and apoptosis, and neuroinflammation. Based on a few recent studies carried out in experimental mouse malaria models, we propose a basis for the neurological deficits and sequelae observed in human cerebral malaria, and summarize how existing drugs may improve prognosis in affected individuals.
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Affiliation(s)
- Rachna Hora
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, 143005, India.
| | - Payal Kapoor
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, 143005, India
| | - Kirandeep Kaur Thind
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, 143005, India
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Carter JA, Murira G, Gona J, Tumaini J, Lees J, Neville BG, Newton CR. Speech and Language Disorders in Kenyan Children: Adapting Tools for Regions with Few Assessment Resources. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2012.10820514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Julie Anne Carter
- The Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute Centre for International Health and Development, Institute of Child Health
| | - Grace Murira
- The Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute
| | - Joseph Gona
- The Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute
| | - Judy Tumaini
- The Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute
| | - Janet Lees
- Neurosciences Unit, Institute of Child Health
| | | | - Charles Richard Newton
- The Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute Neurosciences Unit, Institute of Child Health, University of Oxford
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Affiliation(s)
- Charles R Newton
- ICNA Executive Board Member; KEMRI-Wellcome Collaborative Programme; Kilifi; Kenya
| | - Diane C Chugani
- Children's Hospital of Michigan Autism Center; Wayne State University School of Medicine; Detroit; MI; USA
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Bergemann TL, Bangirana P, Boivin MJ, Connett JE, Giordani BJ, John CC. Statistical Approaches to Assess the Effects of Disease on Neurocognitive Function Over Time. ACTA ACUST UNITED AC 2013; Suppl 7. [PMID: 25383237 DOI: 10.4172/2155-6180.s7-016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Assessment of the effects of disease on neurocognitive outcomes in children over time presents several challenges. These challenges are particularly pronounced when conducting studies in low-income countries, where standardization and validation is required for tests developed originally in high-income countries. We present a statistical methodology to assess multiple neurocognitive outcomes over time. We address the standardization and adjustment for age in neurocognitive testing, present a statistical methodology for development of a global neurocognitive score, and assess changes in individual and global neurocognitive scores over time in a cohort of children with cerebral malaria. METHODS Ugandan children with cerebral malaria (CM, N = 44), uncomplicated malaria (UM, N = 54) and community controls (N = 89) were assessed by cognitive tests of working memory, executive attention and tactile learning at 0, 3, 6 and 24 months after recruitment. Tests were previously developed and validated for the local area. Test scores were adjusted for age, and a global score was developed based on the controls that combined the assessments of impairment in each neurocognitive domain. Global normalized Z-scores were computed for each of the three study groups. Model-based tests compare the Z-scores between groups. RESULTS We found that continuous Z-scores gave more powerful conclusions than previous analyses of the dataset. For example, at all four time points, children with CM had significantly lower global Z-scores than controls and children with UM. Our methods also provide more detailed descriptions of longitudinal trends. For example, the Z-scores of children with CM improved from initial testing to 3 months, but remained at approximately the same level below those of controls or children with UM from 3 to 24 months. Our methods for combining scores are more powerful than tests of individual cognitive domains, as testing of the individual domains revealed differences at only some but not all time points.
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Affiliation(s)
- Tracy L Bergemann
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA ; Cardiac Rhythm Disease Management, Medtronic, Mounds View, Minnesota, USA
| | - Paul Bangirana
- Department of Psychiatry, Makerere University School of Medicine, Kampala, Uganda ; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Michael J Boivin
- International Neurologic and Psychiatric Epidemiology Program, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA ; Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - John E Connett
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bruno J Giordani
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Chandy C John
- Division of Global Pediatrics, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Nogo-A expression in the brain of mice with cerebral malaria. PLoS One 2011; 6:e25728. [PMID: 21980529 PMCID: PMC3183069 DOI: 10.1371/journal.pone.0025728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 09/09/2011] [Indexed: 02/07/2023] Open
Abstract
Cerebral malaria (CM) is associated with a high rate of transient or persistent neurological sequelae. Nogo-A, a protein that is highly expressed in the endoplasmic reticulum (ER) of the mammalian central nervous system (CNS), is involved in neuronal regeneration and synaptic plasticity in the injured CNS. The current study investigates the role of Nogo-A in the course of experimental CM. C57BL/6J mice were infected with Plasmodium berghei ANKA blood stages. Brain homogenates of mice with different clinical severity levels of CM, infected animals without CM and control animals were analyzed for Nogo-A up-regulation by Western blotting and immunohistochemistry. Brain regions with Nogo-A upregulation were evaluated by transmission electron microscopy. Densitometric analysis of Western blots yielded a statistically significant upregulation of Nogo-A in mice showing moderate to severe CM. The number of neurons and oligodendrocytes positive for Nogo-A did not differ significantly between the studied groups. However, mice with severe CM showed a significantly higher number of cells with intense Nogo-A staining in the brain stem. In this region ultrastructural alterations of the ER were regularly observed. Nogo-A is upregulated during the early course of experimental CM. In the brain stem of severely affected animals increased Nogo-A expression and ultrastructural changes of the ER were observed. These data indicate a role of Nogo-A in neuronal stress response during experimental CM.
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Thuilliez J. Malaria and Primary Education: A Cross-country Analysis on Repetition and Completion Rates. ACTA ACUST UNITED AC 2009. [DOI: 10.3917/edd.235.0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Mankoski RE, Collins M, Ndosi NK, Mgalla EH, Sarwatt VV, Folstein SE. Etiologies of autism in a case-series from Tanzania. J Autism Dev Disord 2007; 36:1039-51. [PMID: 16897390 DOI: 10.1007/s10803-006-0143-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Most autism has a genetic cause although post-encephalitis cases are reported. In a case-series (N = 20) from Tanzania, 14 met research criteria for autism. Three (M:F = 1:2) had normal development to age 22, 35, and 42 months, with onset of autism upon recovery from severe malaria, attended by prolonged high fever, convulsions, and in one case prolonged loss of consciousness. In four other cases (M:F = 3:1), the temporal relationship between onset of autism and severe infection was close, but possibly spurious since malaria is common in Tanzania and there were indications of abnormal development in the child or a family member. In seven cases, (M:F = 6:1) autism onset was unrelated to malaria. The excess of non-verbal cases (N = 10) is related local diagnostic practice.
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Affiliation(s)
- Raymond E Mankoski
- Tufts University School of Medicine and Sackler School of Graduate Biomedical Sciences, Boston, MA, USA
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Bangirana P, Idro R, John CC, Boivin MJ. Rehabilitation for cognitive impairments after cerebral malaria in African children: strategies and limitations. Trop Med Int Health 2006; 11:1341-9. [PMID: 16930255 DOI: 10.1111/j.1365-3156.2006.01685.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cerebral malaria results in short- to long-term cognitive impairments in many of its child survivors. Although some of the risk factors for impairments have been identified, no attempts have been made to address the plight of those who develop cognitive impairments. This paper discusses the burden of cognitive impairment caused by cerebral malaria and suggests some rehabilitation strategies based on brain injury and cognitive rehabilitation studies. Potential cognitive rehabilitation solutions such as cognitive exercises, environmental enrichment, nutritional supplementation, physical therapy and speech therapy are highlighted. The limitations of implementing these interventions and solutions are discussed in light of the limited human resources and infrastructure of the developing countries that are malaria endemic.
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Affiliation(s)
- Paul Bangirana
- Department of Mental Health and Community Psychology, Makerere University Institute of Psychology, Kampala, Uganda.
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Kihara M, Carter JA, Newton CRJC. The effect ofPlasmodium falciparumon cognition: a systematic review. Trop Med Int Health 2006; 11:386-97. [PMID: 16553922 DOI: 10.1111/j.1365-3156.2006.01579.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Systematic review to investigate the relationship between Plasmodium falciparum infection and cognitive function. METHOD We searched MEDLINE, EMBASE and PsycINFO, and hand-searched journals and PhD theses. The inclusion criteria were (1) use of standardized tests for the specific populations and/or appropriate controls; (2) clear differentiation between children and adults. Eighteen studies were eligible, of which three gave information on all cognitive domains considered in the review. RESULTS Deficits in attention, memory, visuo-spatial skills, language and executive functions may occur after malaria infection. These deficits are not only caused by cerebral falciparum malaria, but also appear to occur in less severe infections. P. falciparum seems to affect the brain globally, not in a localised fashion. Outcome depends on both biological and social risk factors. CONCLUSION Future research should seek to establish the extent of these cognitive deficits using culturally appropriate techniques and well-defined criteria of disease.
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Affiliation(s)
- Michael Kihara
- The Centre for Geographical Medicine Research (Coast), KEMRI, Kilifi, Kenya.
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Mung'ala-Odera V, Meehan R, Njuguna P, Mturi N, Alcock KJ, Newton CRJC. Prevalence and risk factors of neurological disability and impairment in children living in rural Kenya. Int J Epidemiol 2006; 35:683-8. [PMID: 16492712 DOI: 10.1093/ije/dyl023] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is little data on the burden of neurological impairment (NI) in developing countries, particularly in children of Africa. METHODS We conducted a survey of NI in children aged 6-9 years in a rural district of Kenya. First, we screened for neurological disability by administering the Ten Questions Questionnaire (TQQ) to parents/guardians of children in a defined population. In phase two, we performed a comprehensive clinical and psychological assessment on children who tested positive on TQQ and on a similar number of children who tested negative. RESULTS A total of 10 218 children were screened, of whom 955 (9.3%) were positive on TQQ. Of these, 810 (84.8%) were assessed, and of those who tested negative 766 (8.3%) were assessed. The prevalence for moderate/severe NI was 61/1000 [95% confidence interval (95% CI) 48-74]. The most common domains affected were epilepsy (41/1000), cognition (31/1000), and hearing (14/1000). Motor (5/1000) and vision (2/1000) impairments were less common. Of the neurologically impaired children (n = 251), 56 (22%) had more than one impairment. Neonatal insults were found to have a significant association with moderate/severe NI in both the univariate [odds ratio (OR) = 1.70; 95% CI 1.12-2.47] and multivariate analyses (OR = 1.30; 95% CI 1.09-1.65). CONCLUSIONS There is a considerable burden of moderate/severe NI in this area of rural Kenya, with epilepsy, cognition, and hearing being the most common domains affected. Neonatal insults were identified as an important risk factor.
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Affiliation(s)
- V Mung'ala-Odera
- Center for Geographic Medicine-Coast, Kenya Medical Research Institute, PO 428, Kilifi, Kenya.
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Idro R, Carter JA, Fegan G, Neville BGR, Newton CRJC. Risk factors for persisting neurological and cognitive impairments following cerebral malaria. Arch Dis Child 2006; 91:142-8. [PMID: 16326798 PMCID: PMC2082712 DOI: 10.1136/adc.2005.077784] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Persisting neurological and cognitive impairments are common after cerebral malaria. Although risk factors for gross deficits on discharge have been described, few studies have examined those associated with persistent impairments. METHODS The risk factors for impairments following cerebral malaria were determined by examining hospital records of 143 children aged 6-9 years, previously admitted with cerebral malaria, who were assessed at least 20 months after discharge to detect motor, speech and language, and other cognitive (memory, attention, and non-verbal functioning) impairments. RESULTS The median age on admission was 30 months (IQR 19-42) and the median time from discharge to assessment was 64 months (IQR 40-78). Thirty four children (23.8%) were defined as having impairments: 14 (9.8%) in motor, 16 (11.2%) in speech and language, and 20 (14.0%) in other cognitive functions. Previous seizures (OR 5.6, 95% CI 2.0 to 16.0), deep coma on admission (OR 28.8, 95% CI 3.0 to 280), focal neurological signs observed during admission (OR 4.6, 95% CI 1.1 to 19.6), and neurological deficits on discharge (OR 4.5, 95% CI 1.4 to 13.8) were independently associated with persisting impairments. In addition, multiple seizures were associated with motor impairment, age <3 years, severe malnutrition, features of intracranial hypertension, and hypoglycaemia with language impairments, while prolonged coma, severe malnutrition, and hypoglycaemia were associated with impairments in other cognitive functions. CONCLUSIONS Risk factors for persisting neurological and cognitive impairments following cerebral malaria include multiple seizures, deep/prolonged coma, hypoglycaemia, and clinical features of intracranial hypertension. Although there are overlaps in impaired functions and risk factors, the differences in risk factors for specific functions may suggest separate mechanisms for neuronal damage. These factors could form the basis of future preventive strategies for persisting impairments.
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Affiliation(s)
- R Idro
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute/Wellcome Trust Research Labs, Kilifi, Kenya.
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Carter JA, Lees JA, Gona JK, Murira G, Rimba K, Neville BGR, Newton CRJC. Severe falciparum malaria and acquired childhood language disorder. Dev Med Child Neurol 2006; 48:51-7. [PMID: 16359594 DOI: 10.1017/s0012162206000107] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2005] [Indexed: 01/28/2023]
Abstract
Language disorders have been reported after severe falciparum malaria but the deficits have not been described in detail. We assessed language outcome in three groups of children aged 6 to 9 years (n=487): those previously admitted to Kilifi District Hospital, Kenya, with cerebral malaria (CM; n=152; mean age 7y 4 mo [SD 1y 1mo]; 77 males, 75 females); or those with malaria and complicated seizures (M/S; n=156; mean age 7y 4mo [SD 1y 2mo]; 72 males, 84 females); and those unexposed to either condition (n=179; mean age 7y 6mo [SD 1y 1mo]; 93 males, 86 females). Median age at hospital admission was 28 months (interquartile range [IQR] 19 to 44 mo) among children with a history of CM and 23 months (IQR 12 to 35mo) among children with a history of M/S. A battery of eight assessments covering the major facets of speech and language was used to measure language performance. Cognitive performance, neurological/motor skills, behaviour, hearing, and vision were also measured. Eighteen (11.8%) of the CM group, 14 (9%) of the M/S group, and four (2.2%) of the unexposed group were found to have a language impairment. CM (odds ratio 3.68, 95% confidence interval 1.09 to 12.4, p=0.04) was associated with significantly increased odds of an impairment-level score relative to the unexposed group. The results suggest that falciparum malaria is one of the most common causes of acquired language disorders in the tropics.
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Affiliation(s)
- Julie A Carter
- Neurosciences Unit, Institute of Child Health, The Wolfson Centre, London, UK.
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Carter JA, Lees JA, Murira GM, Gona J, Neville BGR, Newton CRJC. Issues in the development of cross-cultural assessments of speech and language for children. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2005; 40:385-401. [PMID: 16195197 DOI: 10.1080/13682820500057301] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND There is an increasing demand for the assessment of speech and language in clinical and research situations in countries where there are few assessment resources. Due to the nature of cultural variation and the potential for cultural bias, new assessment tools need to be developed or existing tools require adaptation. However, there are few guidelines on how to develop 'culturally appropriate' assessment tools. AIMS To review the literature on cross-cultural assessment in order to identify the major issues in the development and adaptation of speech and language assessments for children and to illustrate these issues with practical examples from our own research programme in Kenya. METHODS & PROCEDURES Five broad categories pertaining to cross-cultural assessment development were identified: the influence of culture on performance, familiarity with the testing situation, the effect of formal education, language issues and picture recognition. It was outlined how some of these issues were addressed in our research. The results of the review were integrated to produce a list of ten guidelines highlighting the importance of collaboration with mother tongue speakers; piloting; familiar assessment materials; assessment location; and practice items and prompts. CONCLUSIONS There are few clinicians and assessors, whether in the UK or abroad, who do not assess or treat children from a culture different to their own. Awareness of cultural variation and bias and cooperative efforts to develop and administer culturally appropriate assessment tools are the foundation of effective, valid treatment programmes.
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Affiliation(s)
- Julie A Carter
- Neurosciences Unit, Institute of Child Health, The Wolfson Centre, London, UK.
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Maitland K, Nadel S, Pollard AJ, Williams TN, Newton CRJC, Levin M. Management of severe malaria in children: proposed guidelines for the United Kingdom. BMJ 2005; 331:337-43. [PMID: 16081449 PMCID: PMC1183138 DOI: 10.1136/bmj.331.7512.337] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kathryn Maitland
- Kenya Medical Research Institute/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, PO Box 230, Kilifi, Kenya.
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Carter JA, Mung'ala-Odera V, Neville BGR, Murira G, Mturi N, Musumba C, Newton CRJC. Persistent neurocognitive impairments associated with severe falciparum malaria in Kenyan children. J Neurol Neurosurg Psychiatry 2005; 76:476-81. [PMID: 15774431 PMCID: PMC1739592 DOI: 10.1136/jnnp.2004.043893] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES There is little information on the characteristics of persisting impairments associated with severe forms of falciparum malaria. Previous work has suggested the existence of a group of children with particularly poor performance on neurocognitive assessments in the context of average group performance. The aim of this study was to provide a detailed characterisation of impairments in this subgroup. METHODS Three groups of children were recruited: children admitted up to nine years earlier with cerebral malaria (CM) (n = 152), malaria and complicated seizures (M/S) (n = 156), or those unexposed to either condition (n = 179). Each child underwent a series of developmental assessments. Standard definitions were used to classify impairment. RESULTS Twenty-four percent of the CM and M/S groups had at least one impairment in the major domains assessed in the study, compared with 10% of the unexposed group. CM was associated with a higher proportion of multiple impairments and an increased risk of mortality in the first year after recovery in those identified with impairments on discharge. CONCLUSIONS After severe malaria, some children have neurocognitive impairments that are evident as long as nine years later. Impairments may become more evident as children progress and face more complex cognitive and linguistic demands, socially and educationally. The child's neurological status at discharge was not a good predictor of later neurocognitive impairment. This highlights the importance of follow up for children with severe malaria and the involvement of therapists and educators in the provision of services for this population.
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Affiliation(s)
- J A Carter
- Centre for International Child Health, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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Carter JA, Ross AJ, Neville BGR, Obiero E, Katana K, Mung'ala-Odera V, Lees JA, Newton CRJC. Developmental impairments following severe falciparum malaria in children. Trop Med Int Health 2005; 10:3-10. [PMID: 15655008 DOI: 10.1111/j.1365-3156.2004.01345.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Neurological deficits are reported in children after cerebral malaria (CM) but little is known about the prevalence and characteristics of persisting neurocognitive consequences. The prevalence of developmental impairments following other complications of falciparum malaria, such as multiple, prolonged or focal seizures, is not known. Thus, our objective was to investigate the long-term developmental outcome of CM and malaria with complicated seizures (M/S). METHODS We followed up a cohort of children previously exposed to CM or M/S and children unexposed to either condition. All children between 6 and 9 years of age, exposed to CM, and an equal number of children exposed to M/S were identified from databases of hospital admissions from 1991 to 1998. The unexposed group was randomly selected from a census database. The children's performance was measured using assessments of cognition, motor, speech and language, hearing and vision. A parental questionnaire was used to identify children with epilepsy. RESULTS CM group scores were significantly lower than unexposed group scores on the assessments of higher level language (adjusted mean difference -1.63, 95% CI: -2.99 to -0.27), vocabulary (-0.02, 95% CI: -0.04 to -0.01), pragmatics (OR 2.81, 95% CI: 1.04-7.6) and non-verbal functioning (-0.33, 95% CI: -0.61 to -0.06). The areas of significantly reduced functioning for the M/S group were concentrated on phonology (OR 2.74, 95% CI: 1.26-5.95), pragmatics (OR 3.23, 95% CI: 1.2-8.71) and behaviour (OR 1.8, 95% CI: 1.0-3.23). The performance of the active epilepsy group was significantly poorer than that of the group without epilepsy on the tests of comprehension, syntax, pragmatics, word finding, memory, attention, behaviour and motor skills. CONCLUSIONS CM and M/S are associated with developmental impairments. If these impairments persist, this may have implications for least 250,000 children in Sub-Saharan Africa each year. Active epilepsy significantly increases the risk of cognitive and behavioural problems in children with a history of severe malaria.
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Affiliation(s)
- Julie A Carter
- Neurosciences Unit, Institute of Child Health, London, UK.
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Holding PA, Taylor HG, Kazungu SD, Mkala T, Gona J, Mwamuye B, Mbonani L, Stevenson J. Assessing cognitive outcomes in a rural African population: development of a neuropsychological battery in Kilifi District, Kenya. J Int Neuropsychol Soc 2004; 10:246-60. [PMID: 15012845 DOI: 10.1017/s1355617704102166] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2003] [Revised: 07/22/2003] [Indexed: 11/08/2022]
Abstract
The ability to measure neuropsychological outcomes in a comparable manner in different cultural groups is important if studies conducted in geographically diverse regions are to advance knowledge of disease effects and moderating influences. The purpose of this study was to evaluate the application of neuropsychological test procedures developed for use in North America and Europe to children in a rural region of Kenya. Our specific aim was to determine if these methods could be adapted to a non-Western culture in a manner that would preserve test reliability and validity. Procedural modifications yielded reliable tests that were sensitive to both the sequelae of cerebral malaria and to children's social and school backgrounds. Results suggest that adaptations of existing tests can be made in such a way as to preserve their utility in measuring the cross-cultural sequelae of childhood neurological diseases.
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Affiliation(s)
- Penny A Holding
- KEMRI Centre for Geographic Medicine-Coast, P.O. Box 230, Kilifi, Kenya
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Davidson LL, Durkin MS, Khan NZ. Studies of children in developing countries. How soon can we prevent neurodisability in childhood? Dev Med Child Neurol 2003; 95:18-24. [PMID: 12898986 DOI: 10.1111/j.1469-8749.2003.tb04651.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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