Abstract
BackgroundSevere malaria is associated with long-term mental health problems in Ugandan children. This study investigated the effect of a behavioural intervention for caregivers of children admitted with severe malaria, on the children’s mental health outcomes 6 months after discharge.MethodsThis randomized controlled trial was conducted at Naguru Hospital in Kampala, Uganda from January 2018 to July 2019. Caregiver and child dyads were randomly assigned to either a psycho-educational arm providing information about hospital procedures during admission (control group), or to a behavioural arm providing information about the child’s possible emotions and behaviour during and after admission, and providing age appropriate games for the caregiver and child (intervention group). Pre- and post-intervention assessments for caregiver anxiety and depression (Hopkins Symptom Checklist) and child mental health problems (Strength and Difficulties Questionnaire and the Child Behaviour Checklist) were done during admission and 6 months after discharge, respectively. T-tests, analysis of covariance, Chi-Square, and generalized estimating equations were used to compare outcomes between the two treatment arms.ResultsThere were 120 caregiver-child dyads recruited at baseline with children aged 1.45 to 4.89 years (mean age 2.85 years, SD = 1.01). The intervention and control groups had similar sociodemographic, clinical and behavioural characteristics at baseline. Caregiver depression at baseline, mother’s education and female child were associated with behavioural problems in the child at baseline (p < 0.05). At 6 months follow-up, there was no difference in the frequency of behavioural problems between the groups (6.8% vs. 10% in intervention vs control groups, respectively, p = 0.72). Caregiver depression and anxiety scores between the treatment arms did not differ at 6 months follow-up.ConclusionThis behavioural intervention for caregivers and their children admitted with severe malaria had no effect on the child’s mental health outcomes at 6 months. Further studies need to develop interventions for mental health problems after severe malaria in children with longer follow-up time.Trail registration ClinicalTrials.gov Identifier: NCT03432039
Highlights
Severe malaria is associated with long-term mental health problems in Ugandan children
Recent studies have shown that children surviving severe malaria have behavioural problems up to 24 months post discharge [3, 4]
In Ugandan children, behavioural problems after severe malaria may lead to harsh punishments from caregivers as a way of making a child behave well [7]
Summary
Severe malaria is associated with long-term mental health problems in Ugandan children. This study investigated the effect of a behavioural intervention for caregivers of children admitted with severe malaria, on the children’s mental health outcomes 6 months after discharge. Malaria remains one of the leading causes of morbidity globally with 219 million cases reported in 2017 with over 90% in sub-Saharan Africa [1] Some of these cases are severe leading to death especially in children under 5 years old in Africa [1]. Recent studies have shown that children surviving severe malaria have behavioural problems up to 24 months post discharge [3, 4]. These include internalizing (depression and anxiety) and externalizing problems (attention deficit hyperactivity disorder, oppositional defiant disorder and conduct disorder) [3, 4]. In Ugandan children, behavioural problems after severe malaria may lead to harsh punishments from caregivers as a way of making a child behave well [7]
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