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Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria:
Paul Bangirana1, Peter Allebeck, Michael J Boivin
1Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda. pbangirana@yahoo.com
Insights
Computerized cognitive training improved learning in children three months after severe malaria but did not impact academic or behavioral outcomes. Further research is needed to determine if these cognitive benefits persist over time.
Area of Science:
- Neuroscience
- Pediatrics
- Cognitive Psychology
Background:
- Severe malaria in African children leads to high mortality and cognitive deficits.
- Interventions for post-malaria cognitive deficits are effective years later, but immediate interventions are understudied.
- This study investigated the immediate impact of cognitive intervention shortly after severe malaria in children.
Purpose of the Study:
- To assess the immediate benefits of a computerized cognitive rehabilitation program on cognitive, academic, and behavioral outcomes in children recovering from severe malaria.
- To evaluate the effectiveness of early intervention in mitigating cognitive deficits post-malaria.
Main Methods:
- A parallel-group randomized study in Kampala, Uganda, involving 61 children (5-12 years) three months post-severe malaria.
- Intervention group received 16 sessions of computerized cognitive rehabilitation; control group received no treatment.
- Cognition, academic skills, and behavior were assessed pre- and post-intervention using standardized tests; analysis of covariance was used for comparisons.
Main Results:
- The intervention group showed significant improvement in learning scores (P=0.04).
- The intervention group performed worse in working memory (P=0.04).
- No significant effects were observed in other cognitive, academic, or behavioral measures.
Conclusions:
- Computerized cognitive training three months post-severe malaria demonstrated immediate effects on specific cognitive outcomes, notably learning.
- The intervention did not improve academic skills or behavior in the short term.
- Larger trials with long-term follow-up are necessary to ascertain sustained benefits of this early cognitive intervention.
Background:
Infection with severe malaria in African children is associated with not only a high mortality but also a high risk of cognitive deficits. There is evidence that interventions done a few years after the illness are effective but nothing is known about those done immediately after the illness. We designed a study in which children who had suffered from severe malaria three months earlier were enrolled into a cognitive intervention program and assessed for the immediate benefit in cognitive, academic and behavioral outcomes.
Methods:
This parallel group randomised study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-one Ugandan children aged 5 to 12 years with severe malaria were assessed for cognition (using the Kaufman Assessment Battery for Children, second edition and the Test of Variables of Attention), academic skills (Wide Range Achievement Test, third edition) and psychopathologic behaviour (Child Behaviour Checklist) three months after an episode of severe malaria. Twenty-eight were randomised to sixteen sessions of computerised cognitive rehabilitation training lasting eight weeks and 33 to a non-treatment group. Post-intervention assessments were done a month after conclusion of the intervention. Analysis of covariance was used to detect any differences between the two groups after post-intervention assessment, adjusting for age, sex, weight for age z score, quality of the home environment, time between admission and post-intervention testing and pre-intervention score. The primary outcome was improvement in attention scores for the intervention group. This trial is registered with Current Controlled Trials, number ISRCTN53183087.
Results:
Significant intervention effects were observed in the intervention group for learning mean score (SE), [93.89 (4.00) vs 106.38 (4.32), P = 0.04] but for working memory the intervention group performed poorly [27.42 (0.66) vs 25.34 (0.73), P = 0.04]. No effect was observed in the other cognitive outcomes or in any of the academic or behavioural measures.
Conclusions:
In this pilot study, our computerised cognitive training program three months after severe malaria had an immediate effect on cognitive outcomes but did not affect academic skills or behaviour. Larger trials with follow-up after a few years are needed to investigate whether the observed benefits are sustained.
Trial Registration:
ISRCTN: ISRCTN53183087.
