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Severe Malaria and Academic Achievement.

Ann Jacquelline Nakitende^1,2, Paul Bangirana^1,2, Noeline Nakasujja¹

¹Department of Psychiatry.

|March 2, 2023

Summary

Children with cerebral malaria (CM) or severe malarial anemia (SMA) show lower long-term reading skills. Subsequent malaria infections worsen these academic outcomes, suggesting a need for post-discharge prevention strategies.

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Area of Science:

Pediatric Neurology
Infectious Diseases
Neuroscience

Background:

Cerebral malaria (CM) and severe malarial anemia (SMA) are known to cause childhood neurocognitive impairment.
The long-term impact of CM and SMA on academic achievement remains largely unknown.
Understanding these long-term effects is crucial for comprehensive child health strategies.

Purpose of the Study:

To investigate the long-term effects of childhood cerebral malaria (CM) and severe malarial anemia (SMA) on academic achievement.
To identify factors contributing to academic deficits in children with a history of severe malaria.
To inform potential interventions for improving educational outcomes in affected children.

Main Methods:

A longitudinal study involving Ugandan children (5-12 years) with a history of CM (n=73) or SMA (n=56), compared to community controls (n=100).
Academic achievement was assessed using the Wide Range Achievement Test, Fourth Edition, measuring reading, comprehension, spelling, and math.
Age-adjusted z-scores were calculated using community children's scores as a reference.

Main Results:

Children with CM or SMA exhibited significantly lower reading scores compared to community controls, even after adjusting for age and time since enrollment.
Post-discharge malaria episodes were associated with poorer spelling and reading scores in the CM group, and poorer spelling in the SMA group.
Pathway analysis indicated that post-discharge uncomplicated malaria significantly contributed to the association between CM/SMA and reduced reading proficiency.

Conclusions:

Children surviving CM or SMA demonstrate persistent deficits in long-term reading skills.
Recurrent malaria infections after the initial severe episode exacerbate academic underachievement.
Post-discharge malaria chemoprevention warrants investigation as a potential intervention to mitigate long-term academic consequences.