Developmental impairments following severe falciparum malaria in children

Abstract

Summaryobjective 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.

Cerebral malaria: why experimental murine models are required to understand the pathogenesis of disease

“…Moreover, at least 10-20 % of individuals who survive and recover from CM display long-term physical or cognitive dysfunction (Carter et al 2005 a, b;Idro et al 2005 ;Boivin et al 2007). Since the discovery by Marchiafava and Bignami in 1894 of malaria parasites within the brain of humans during infection, attention has focussed on understanding the pathophysiological processes that predispose towards CM, with a view to the development of preventative measures or targeted therapies for the condition.…”

A Role for Natural Regulatory T Cells in the Pathogenesis of Experimental Cerebral Malaria

“…An estimated 10 to 20% of children who develop CM die, and a significant proportion of survivors have permanent neurological damage. [1][2][3] CM can be associated with sequestration of parasitized red blood cells (pRBCs) in the brain microvasculature 4 and secretion of toxic molecules by parasites, 5 as well as inflammatory components of the host immune response, including secretion of cytokines 6 and recruitment of activated leukocytes to the brain. [7][8][9] An experimental model of CM (ECM) caused by infection of C57BL/6 and CBA mice with P. berghei ANKA (PbA) displays many features of human CM and has allowed the identification of several important factors in CM pathogenesis.…”

Language Development in Sub-Saharan Africa

“…Naudé, Louw, and Weideman (2007) suggest using elicited conversation to examine language development of children learning English in multilingual settings in preschools in South Africa, since they have observed that children's spontaneous conversations with each other are rarely in just one language. A highly targeted and comprehensive assessment of language abilities for children aged 8-9 years was developed by Carter and colleagues (Carter, Murira, Ross, Mung'ala-Odera, & Newton, 2003;Carter et al, 2005) for Kigiriama-speaking children in coastal Kenya. The assessment includes syntax, phonology, comprehension and higher-level language.…”