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Published on: June 8, 2017
Developmental outcomes in Malawian children with retinopathy-positive cerebral malaria
Michael J Boivin1, Melissa J Gladstone, Maclean Vokhiwa
1International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, MI, USA. boivin@msu.edu
Insights
Children with retinopathy-positive cerebral malaria (CM) face increased risk of developmental delays, especially in language. This study highlights the long-term neurocognitive impact of CM in young children.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Developmental Psychology
Background:
- Cerebral malaria (CM) is a severe complication of Plasmodium falciparum infection.
- Neurocognitive sequelae in children surviving CM are a significant public health concern.
- Retinopathy is a clinical marker for CM.
Purpose of the Study:
- To evaluate neurocognitive outcomes in preschool-aged children with retinopathy-positive CM.
- To identify specific domains of developmental delay associated with CM.
- To correlate clinical severity markers with neurocognitive deficits.
Main Methods:
- A cohort of 83 Malawian children with retinopathy-positive CM was compared to 95 controls.
- Developmental delay was assessed using the Malawi Developmental Assessment Tool (MDAT).
- Behavioral outcomes were evaluated using the Achenbach Child Behaviour Checklist (CBCL).
Main Results:
- Children with retinopathy-positive CM showed significant delays in overall development (OR=2.13) and language (OR=4.93).
- No significant differences were observed in internalizing or externalizing behaviors between groups.
- Coma duration, seizures, platelet count, and lactate levels predicted assessment outcomes.
Conclusions:
- Preschool-aged children with retinopathy-positive CM are at higher risk for developmental delays, particularly language deficits.
- Findings corroborate previous studies on school-aged children, indicating persistent effects of CM.
- The MDAT and CBCL are sensitive tools for assessing CM severity and its impact.
Objective:
To assess children with retinopathy-positive cerebral malaria (CM) for neurocognitive sequelae.
Methods:
Participants were selected from an ongoing exposure-control study. Eighty-three Malawian children averaging 4.4 years of age and diagnosed with retinopathy-positive CM were compared to 95 controls. Each child was classified as delayed or not using age-based norms for the Malawi Developmental Assessment Tool (MDAT) for developmental delay on the total scale and for the domains of gross motor, fine motor, language and social skills. Groups were also compared on the Achenbach Child Behaviour Checklist (CBCL) (1.5-5 years).
Results:
Children with retinopathy-positive CM were delayed, relative to the comparison group, on MDAT total development (P = 0.028; odds ratio or OR = 2.13), with the greatest effects on language development (P = 0.003; OR = 4.93). The two groups did not differ significantly on the Achenbach CBCL internalizing and externalizing symptoms total scores. Stepwise regression demonstrated that coma duration, seizures while in hospital, platelet count and lactate level on admission were predictive of assessment outcomes for the children with retinopathy-positive CM.
Conclusions:
Children who suffer retinopathy-positive CM at preschool age are at greater risk of developmental delay, particularly with respect to language development. This confirms previous retrospective study findings with school-age children evaluated years after acute illness. The MDAT and the Achenbach CBCL proved sensitive to clinical indicators of severity of malarial illness.
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