Abstract
BackgroundCerebral malaria (CM) and severe malarial anaemia (SMA) are associated with neuro-developmental impairment in African children, but long-term mental health disorders in these children are not well defined.MethodsA cohort of children previously exposed to CM (n = 173) or SMA (n = 99) had neurologic assessments performed and screening for behaviour difficulties using the Strengths and Difficulties Questionnaire (SDQ) a median of 21 months after the disease episode. These findings were compared to concurrently recruited community children (CC, n = 108). Participants with SDQ total difficulties score ≥17 had a mental health interview with the child and adolescent version of the Mini-International Neuropsychiatric Interview (MINI-KID) and a sample had brain magnetic resonance imaging (MRI).ResultsFifty-five children had SDQ score ≥17. On the MINI-KID, these children were classified as having no difficulties (n = 18), behaviour difficulties only (n = 13) or a mental health disorder (n = 24). Behaviour difficulties were seen in similar frequencies in CM (3.5 %), SMA (4.0 %) and CC (2.8 %). In contrast, mental health disorders were most frequent in CM (10.4 %), followed by SMA (4.0 %) and CC (1.8 %). Externalizing disorders (conduct, oppositional defiance and attention deficit hyperactivity) were the most common mental health disorders. The median total coma duration was 72 (IQR 36.0–115.0) h in patients with mental health disorders compared to 48 (IQR 28.5–78.7) h in those without, p = 0.039. Independent risk factors for mental health disorder included neurologic deficit at discharge (OR 4.09 (95 % CI 1.60, 10.5) and seizure recurrences during hospitalization, (OR 2.80, 95 % CI 1.13, 6.97). Brain MRI findings consistent with small vessel ischaemic neural injury was seen in over half of these children.ConclusionsCerebral malaria may predispose children to mental health disorders, possibly as a consequence of ischaemic neural injury. There is urgent need for programmes of follow-up, diagnosis and interventions for these children.
Highlights
Cerebral malaria (CM) and severe malarial anaemia (SMA) are associated with neuro-developmental impairment in African children, but long-term mental health disorders in these children are not well defined
The hypothesis was that, in addition to neurologic and cognitive deficits, cerebral malaria and the other forms of severe malaria predispose children to mental health disorders and that children younger than five years on exposure are at most risk
This study set out to describe behaviour difficulties and mental health disorders following cerebral malaria and the structural brain imaging changes associated with these sequelae, determine the early predictive features and examine if children exposed to other complications of severe malaria and in particular, severe malaria anaemia, have similar increased risk
Summary
Cerebral malaria (CM) and severe malarial anaemia (SMA) are associated with neuro-developmental impairment in African children, but long-term mental health disorders in these children are not well defined. There have been reports of behaviour difficulties and mental health disorders in cerebral malaria exposed children. There is a paucity of cohort-based longitudinal studies of these problems; the burden of these disorders, the pathogenesis, and treatment needs are poorly understood. It is unknown whether the difficulties follow other forms of severe malaria. The hypothesis was that, in addition to neurologic and cognitive deficits, cerebral malaria and the other forms of severe malaria predispose children to mental health disorders and that children younger than five years on exposure are at most risk
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