Association of severe malaria with cognitive and behavioural outcomes in low- and middle-income countries: a meta-analysis and systematic review.

Journal: Malaria journal

Volume: 22

Issue: 1

Year of Publication: 2023

Affiliated Institutions:  Department of Psychiatry, School of Medicine, Makerere University, P. O. Box , Kampala, Uganda. andrewssemata@yahoo.co.uk. Department of Psychiatry, School of Medicine, Makerere University, P. O. Box , Kampala, Uganda. Department of Mental Health and Community Psychology, School of Psychology, Makerere University, Kampala, Uganda. Richard M. Fairbanks School of Public Health, Indiana University-Purdue University, Indianapolis, USA. School of Medicine, City University of New York (CUNY), New York City, USA. Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, USA. Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.

Abstract summary 

Malaria affects 24 million children globally, resulting in nearly 500,000 child deaths annually in low- and middle-income countries (LMICs). Recent studies have provided evidence that severe malaria infection results in sustained impairment in cognition and behaviour among young children; however, a formal meta-analysis has not been published. The objective was to assess the association between severe malaria infection with cognitive and behavioural outcomes among children living in LMICs.Six online bibliographic databases were searched and reviewed in November 2022. Studies included involved children < 18 years of age living in LMICs with active or past severe malaria infection and measured cognitive and/or behaviour outcomes. The quality of studies was assessed. Definitions of severe malaria included cerebral malaria, severe malarial anaemia, and author-defined severe malaria. Results from all studies were qualitatively summarized. For studies with relevant data on attention, learning, memory, language, internalizing behaviour and externalizing behaviour, results were pooled and a meta-analysis was performed. A random-effects model was used across included cohorts, yielding a standardized mean difference between the severe malaria group and control group.Out of 3,803 initial records meeting the search criteria, 24 studies were included in the review, with data from 14 studies eligible for meta-analysis inclusion. Studies across sub-Saharan Africa assessed 11 cohorts of children from pre-school to school age. Of all the studies, composite measures of cognition were the most affected areas of development. Overall, attention, memory, and behavioural problems were domains most commonly found to have lower scores in children with severe malaria. Meta-analysis revealed that children with severe malaria had worse scores compared to children without malaria in attention (standardized mean difference (SMD) -0.68, 95% CI -1.26 to -0.10), memory (SMD -0.52, 95% CI -0.99 to -0.06), and externalizing behavioural problems (SMD 0.45, 95% CI 0.13-0.78).Severe malaria is associated with worse neuropsychological outcomes for children living in LMICs, specifically in attention, memory, and externalizing behaviours. More research is needed to identify the long-term implications of these findings. Further interventions are needed to prevent cognitive and behavioural problems after severe malaria infection.This systematic review was registered under PROSPERO: CRD42020154777.

Authors & Co-authors:  Ssemata Andrew Sentoogo AS Nakitende Ann Jacquelline AJ Kizito Simon S Thomas Melissa R MR Islam Sumaiya S Bangirana Paul P Nakasujja Noeline N Yang Ziyi Z Yu Yunpeng Y Tran Tuan M TM John Chandy C CC McHenry Megan S MS

Study Outcome 

Source Link: Visit source

Statistics
Citations :  WHO . World malaria report 2021. Geneva: World Health Organization; 2021.
Authors :  12
Identifiers
Doi : 227
SSN : 1475-2875
Study Population
Male,Female
Mesh Terms
Child
Other Terms
Study Design
Case Control Trial,Cross Sectional Study
Study Approach
Qualitative,Systemic Review
Country of Study
Publication Country
England