Malaria Retinopathy among Under-Five Children with Severe and Uncomplicated Malaria in a Tertiary Health Institution in Southwest Nigeria: A Comparative Study

Abstract

Introduction: Malaria retinopathy refers to retinal abnormalities unique to malaria resulting from prolonged parasitization by Plasmodium falciparum.Identifying these features and treating them promptly could prevent lethal complications of malaria. Therefore, this study was conducted to identify and compare retinal findings in severe and uncomplicated malaria. Methods: A cross-sectional study of 260 subjects was equally divided into two groups of severe and uncomplicated malaria. Direct ophthalmoscopy was done at recruitment for all subjects. Information on sociodemographics, physical examination, nutritional status, and retinal abnormalities were recorded. A p-value <5% was considered significant. Results: There were 141 (54.2%) males and 70 (26.9%) aged between 13 -24 months. Severe anaemia, multiple convulsions, prostration, and cerebral malaria were the predominant forms of severe malaria. Twenty-three (17.7%) subjects with severe malaria and none with uncomplicated malaria had retinopathy. Retinal whitening (17.7%), vessel changes (16.2%), and retinal haemorrhages (5.4%) were the major forms of retinopathy. Retinopathy occurred in 43.8% of those with cerebral malaria. Retinal whitening and vessel changes were significantly associated with multiple convulsions, cerebral malaria, and metabolic acidosis; retinal haemorrhage was associated with cerebral malaria and haemoglobinuria (p = 0.022) and vessel changes with hypoglycaemia (p = 0.037). Cerebral malaria was an independent predictor of retinal whitening (p = 0.004

Exploring the hidden mental health consequences of malaria beyond the fever

“…Including malaria retinopathy in diagnostic criteria may enhance accuracy and prevent pre-existing CNS injuries as it is an in vivo perspective on the brain pathophysiology of CM that is not achievable by any other means ( Beare, 2024 ). CM and hemoglobinuria are signs of retinopathy, requiring regular fundoscopic checks and comprehensive ophthalmoscopic training for healthcare professionals to manage severe cases ( Olayinka et al, 2023 ). Experimental studies on CM in mice reveal that inflammation and bleeding can cause brain injury, affecting critical cognitive regions, and malaria-induced immune responses disrupting balance, leading to neurological impairments like seizures, altered consciousness, psychomotor difficulties, and behavioral abnormalities among other complications such as neurocognitive function, behavior, and thought processes, with coma development occurring gradually in adults ( Velagapudi et al, 2019 ; GBD 2021 Nervous System Disorders Collaborators, 2024 ).…”