Abstract
To assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children. Prospective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children. Blantyre, Malawi.ParticipantsChildren discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children. SAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73). Despite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.
Highlights
MethodsThis was a longitudinal cohort study which prospectively followed-up survivors of severe acute malnutrition (SAM) seven years post-discharge from treatment in Blantyre, Malawi, to examine cognitive function and other health outcomes
As severe acute malnutrition (SAM) survival increases, this evidence on its long-term outcomes is much needed, to shape better short-term interventions and to better advocate for prevention strategies. This was a longitudinal cohort study which prospectively followed-up survivors of SAM seven years post-discharge from treatment in Blantyre, Malawi, to examine cognitive function and other health outcomes
Cognitive function Using ordered logistic regression, we found SAM survivors were significantly more likely to be in a lower school grade than age-matched community controls, either with or without adjustment for age, sex, HIV status, height-for-age Z-score (HAZ) and SES (Table 2)
Summary
This was a longitudinal cohort study which prospectively followed-up survivors of SAM seven years post-discharge from treatment in Blantyre, Malawi, to examine cognitive function and other health outcomes. Sibling and age/sexmatched community controls were recruited for comparison. Study setting and participants Full details of the cohort, as well as additional methods and results on other outcomes, have been described elsewhere[8,23,24]. The cohort originally included all patients admitted to the nutrition ward for treatment of SAM in Queen Elizabeth Central Hospital, Blantyre, Malawi, from 12 July 2006 to 9 March 2007 (1024 children). Results of survival and anthropometry at the baseline study and the 1-year follow-up have been described previously[25,26]. One control child per case child undertook CANTAB testing; wherever possible, community controls were prioritized over sibling controls in order to maximize age matching
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