Abstract
IntroductionCerebral malaria is a common cause of neurological sequelae and death in childhood. Information on persistent neurological sequelae post hospital discharge and their predisposing factors are scarce.MethodsThis is a prospective study describing persisting neurological impairments post discharge among children treated for cerebral malaria. In addition the study was designed to investigate the frequency of persistent neurologic deficits and the risk factors for their persistence in these patients. The case records of 160 patients treated for CM at the Paediatrics Department of University College Hospital, Ibadan from January 2004 to November 2006 were reviewed to recruit cases. Recruited survivors were then followed up for information concerning the presence and persistence of neurological sequelae.ResultsA total of 160 children aged 9 months to 134 months were admitted and treated for CM during the study period. One hundred and thirty one (81.9%) survived while 29 (18.1%) died. The 131 survivors of cerebral malaria consisted of 64 boys and 67 girls. Neurological sequelae occurred in 13.7% of survivors of cerebral malaria at discharge and 4.6% at follow up. Six children with neurological deficits at discharge had persistence of deficits 6 months post-hospital discharge and one at 24 months. No associations were found between hypoglycemia, anemia, age, sex and multiplicity of convulsions, and persistence of neurologic sequelae. The persisting neurologic deficits among survivors at follow up were: memory impairment (1.5%), seizure disorders (0.8%), visual impairment (0.8%), speech impairment (0.8%), monoparesis (0.8%) and hyperactivity (0.8%) at follow up. The longest persisting sequelae lasted for at least 24 months.ConclusionNeurologic deficits are not uncommon complications of CM. Neurologic sequelae may persist for as long as 24 months or more in survivors of childhood CM. There is no association between the risk factors for neurologic deficits and persistent neurologic sequelae.
Highlights
Cerebral malaria is a common cause of neurological sequelae and death in childhood
A total of 160 patients aged 9 months to 134 months were admitted with diagnosis of cerebral malaria during the study period ; 131 (81.9%) survived while 29 (18.1%) died
The majority (71.8%) of children were under 5 years of age
Summary
Cerebral malaria is a common cause of neurological sequelae and death in childhood. Information on persistent neurological sequelae post hospital discharge and their predisposing factors are scarce. Methods: This is a prospective study describing persisting neurological impairments post discharge among children treated for cerebral malaria. Neurological sequelae occurred in 13.7% of survivors of cerebral malaria at discharge and 4.6% at follow up. Cerebral malaria is the most severe neurological presentation of acute falciparum malaria, the clinical hallmark of which is the presence of coma [3]. It is a diffuse encephalopathy associated with seizures in at least 80% and status epilepticus, in up to a third of cases [5,6,7]. Most survivors make a full recovery, neurological sequelae such as hemiplegia, speech problems, cortical blindness and epilepsy occur in 3-31 percent [6,8,9]
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