Cerebral malaria is associated with long-term mental health disorders: a cross sectional survey of a long-term cohort.

Journal: Malaria journal

Volume: 15

Issue: 

Year of Publication: 2016

Affiliated Institutions:  Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box , Kampala, Uganda. ridro@gmail.com. Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box , Kampala, Uganda. Department of Pediatrics, University of Minnesota, Minneapolis, DE, USA. Departments of Pediatrics, Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, USA.

Abstract summary 

Cerebral malaria (CM) and severe malarial anaemia (SMA) are associated with neuro-developmental impairment in African children, but long-term mental health disorders in these children are not well defined.A cohort of children previously exposed to CM (n = 173) or SMA (n = 99) had neurologic assessments performed and screening for behaviour difficulties using the Strengths and Difficulties Questionnaire (SDQ) a median of 21 months after the disease episode. These findings were compared to concurrently recruited community children (CC, n = 108). Participants with SDQ total difficulties score ≥ 17 had a mental health interview with the child and adolescent version of the Mini-International Neuropsychiatric Interview (MINI-KID) and a sample had brain magnetic resonance imaging (MRI).Fifty-five children had SDQ score ≥ 17. On the MINI-KID, these children were classified as having no difficulties (n = 18), behaviour difficulties only (n = 13) or a mental health disorder (n = 24). Behaviour difficulties were seen in similar frequencies in CM (3.5%), SMA (4.0%) and CC (2.8%). In contrast, mental health disorders were most frequent in CM (10.4%), followed by SMA (4.0%) and CC (1.8%). Externalizing disorders (conduct, oppositional defiance and attention deficit hyperactivity) were the most common mental health disorders. The median total coma duration was 72 (IQR 36.0-115.0) h in patients with mental health disorders compared to 48 (IQR 28.5-78.7) h in those without, p = 0.039. Independent risk factors for mental health disorder included neurologic deficit at discharge (OR 4.09 (95% CI 1.60, 10.5) and seizure recurrences during hospitalization, (OR 2.80, 95% CI 1.13, 6.97). Brain MRI findings consistent with small vessel ischaemic neural injury was seen in over half of these children.Cerebral malaria may predispose children to mental health disorders, possibly as a consequence of ischaemic neural injury. There is urgent need for programmes of follow-up, diagnosis and interventions for these children.

Authors & Co-authors:  Idro Richard R Kakooza-Mwesige Angelina A Asea Benjamin B Ssebyala Keron K Bangirana Paul P Opoka Robert O RO Lubowa Samson K SK Semrud-Clikeman Margaret M John Chandy C CC Nalugya Joyce J

Study Outcome 

Source Link: Visit source

Statistics
Citations :  WHO. World Malaria Report 2014. Geneva: World Health Organization; 2014. [http://www.who.int/malaria/media/world_malaria_report_2014/en/].
Authors :  10
Identifiers
Doi : 184
SSN : 1475-2875
Study Population
Male,Female
Mesh Terms
Child
Other Terms
Behaviour;Cerebral malaria;Children;Disorder;Mental health;Psychiatric
Study Design
Cross Sectional Study,Cohort Study
Study Approach
Country of Study
Publication Country
England