The correspondence validity of Malawian preschool developmental assessment and school-age neurocognitive performance in the longitudinal assessment of severe malaria

Abstract

BackgroundLongitudinal studies of the effects of CNS infectious disease in at-risk children must track consistent brain/behaviour outcomes across the developmental span from infancy to adolescence. This study evaluates the correspondence between preschool developmental measures and school-age neurocognitive and behavioural measures in Malawian children. Methods59 cerebral malaria (CM) and 69 non-malaria children had been evaluated as preschoolers within 1 year following hospital discharge, with the Malawi developmental assessment tools (MDAT) and the preschool Achenbach child behavior checklist (CBCL). At least 2 years later they were assessed again with the Kaufman assessment battery for children, 2nd edition (KABC-II), the computerised test of variables of attention (TOVA), and the CBCL (6–18 years). An additive stepwise regression analysis was used to evaluate which MDAT and CBCL predictors were significantly related to school-age KABC-II, TOVA, and CBCL outcomes for the CM and control groups combined. FindingsControlling for age, weight-for-age z score, socioeconomic status, gender, and malaria group (CM or control), MDAT global development was predictive of KABC-II planning (p=0·001), TOVA attention-deficit hyperactivity disorder (ADHD) score (p=0·0005), TOVA D prime signal detection (p=0·001), and CBCL external symptoms total (p=0·015). Preschool CBCL internal (emotional) symptoms total was predictive of TOVA ADHD (p=0·037), school-age CBCL internal symptoms (p=0·0007), and external (behaviour) symptoms total (p=0·0003). Malaria group was significantly predictive of KABC-II simultaneous processing (visual–spatial analysis; p=0·009) and marginally predictive of learning (p=0·056). InterpretationEarly childhood developmental assessment for children recovering from severe malaria can predict their neuropsychological performance years later. Tracking the developmental trajectory of such at-risk children in a longitudinal manner can enable investigators to evaluate how core brain/behaviour domains are affected by disease, prevention, and treatment interventions from very early childhood through adolescence. FundingMichigan State University (Grant: 07-IRGP-1060 [MJB]). The funding source had no role in the writing of the manuscript or in the decision to submit it for publication. Nor did they have any role in the study design, patient recruitment, data collection, analysis, interpretation of findings, or in any other aspect of the study. MJB is the corresponding author and has full access to all the data in the study and final responsibility for the decision to submit for publication.