Long-term Behavioral Problems in Children With Severe Malaria
John Mbaziira Ssenkusu1, James Steven Hodges2, Robert Opika Opoka3
1Division of Biostatistics, School of Public Health, and ssenk001@umn.edu.
Insights
Severe malaria in children, including cerebral malaria (CM) and severe malarial anemia (SMA), is linked to lasting behavioral issues. These conditions contribute to significant mental health challenges in young children in malaria-prone regions.
Area of Science:
- Pediatric infectious diseases
- Neurodevelopmental disorders
- Global child health
Background:
- Severe malaria in children can cause long-term neurocognitive deficits.
- The association between severe malaria and long-term behavioral problems in children remains unclear.
Purpose of the Study:
- To investigate the long-term behavioral outcomes in children under 5 years old following treatment for cerebral malaria (CM) or severe malarial anemia (SMA).
Main Methods:
- Children with CM or SMA and healthy controls were assessed using the Child Behavior Checklist at 0, 12, and 24 months.
- Behavioral outcome z-scores were computed relative to a healthy control group.
- Regression models adjusted for age, nutritional status, and socioeconomic factors were used for comparisons.
Main Results:
- At 12 months, children with SMA showed significantly higher internalizing, externalizing, and total behavioral problems compared to controls.
- Children with CM exhibited increased externalizing problems at 12 months.
- By 24 months, both CM and SMA groups displayed elevated internalizing and externalizing behavioral problems compared to controls.
Conclusions:
- Cerebral malaria and severe malarial anemia are associated with persistent internalizing and externalizing behavioral problems in children.
- These conditions may significantly contribute to the mental health burden in young children in malaria-endemic areas.
Background:
Severe malaria in children is associated with long-term neurocognitive impairment, but it is unclear whether it is associated with long-term behavioral problems.
Methods:
Children <5 years old with cerebral malaria (CM) or severe malarial anemia (SMA) treated at Mulago Hospital, Kampala, Uganda were assessed for behavioral outcomes at 0, 6, 12, and 24 months using the Child Behavior Checklist. Sample sizes at 0, 12, and 24 months were 122, 100, and 80 in the CM group, 130, 98, and 81 in the SMA group, and 149, 123, and 90 in healthy community control (CC) children, respectively. Age adjusted z-scores for behavioral outcomes were computed using scores for the CC group. Study groups were compared using regression models adjusted for age, nutritional status, preschool education, and socioeconomic status.
Results:
At 12 months, children with SMA had higher z-scores than CC children for internalizing (mean difference, 0.49; SE, 0.14; P = .001), externalizing (mean difference, 0.49; SE, 0.15; P = .001), and total problems (mean difference, 0.51; SE, 0.15; P < .001). Children with CM had higher adjusted z-scores than CC children for externalizing problems (mean difference, 0.39; SE, 0.15; P = .009) but not internalizing or total problems. At 24 months, children with CM or SMA both had increased internalizing and externalizing behavioral problems compared with CC children (P ≤ .05 for all).
Conclusions:
CM and SMA are associated with long-term internalizing and externalizing behavioral problems in children. They may contribute substantially to mental health morbidity in children <5 years old in malaria endemic areas.
