Cerebral Malaria in Childhood Is Associated With Decreased Long-Term Health-Related Quality of Life

Severe malaria in childhood causes long-term cognitive and behavioral problems; however, its impact on health-related quality of life (HRQoL) remains understudied. We assessed HRQoL 4 to 20 years after cerebral malaria (CM), severe malarial anemia (SMA), or other severe malaria (OSM) in Uganda.

Participants from 3 longitudinal cohorts with CM, SMA, or OSM were included. Asymptomatic community children (CC) served as the reference group. HRQoL was assessed with a mean (SD) duration of 10.0 (3.3) years after enrollment using the EuroQol 5-Dimension 3-Level instrument (EQ-5D-3L) (age ≥12 years) and EQ-5D-Y-3L (age 8 to 11 years). Model-predicted EQ-5D-3L index and visual analog scale (VAS) scores (children ≥12 years) and EQ-5D-Y-3L VAS scores (children 8 to 11 years) were compared across groups using adjusted 2-part models with log transformation.

Among the 479 study participants aged ≥12 years (187 CM, 133 SMA, and 159 CC), model-predicted EQ-5D-3L index and VAS scores were significantly lower in children with CM than SMA or CC, and VAS scores were higher in children with SMA than CC. Among the 313 children aged 8 to 11 years (39 CM, 76 SMA, 130 OSM, and 68 CC), model-predicted EQ-5D-Y-3L VAS scores were significantly lower in children with CM than in those with SMA, OSM, or CC and also lower in children with SMA than OSM or CC.

CM and, to a lesser extent, SMA in childhood are associated with long-term reduction in HRQoL. The chronic effects extend beyond cognition and behavior to affect overall HRQoL.