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Free Content Developmental outcomes in Malawian children with retinopathy‐positive cerebral malaria

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Objective  To assess children with retinopathy‐positive cerebral malaria (CM) for neurocognitive sequelae.

Methods  Participants were selected from an ongoing exposure–control study. Eighty‐three Malawian children averaging 4.4 years of age and diagnosed with retinopathy‐positive CM were compared to 95 controls. Each child was classified as delayed or not using age‐based norms for the Malawi Developmental Assessment Tool (MDAT) for developmental delay on the total scale and for the domains of gross motor, fine motor, language and social skills. Groups were also compared on the Achenbach Child Behaviour Checklist (CBCL) (1.5–5 years).

Results  Children with retinopathy‐positive CM were delayed, relative to the comparison group, on MDAT total development (P =0.028; odds ratio or OR = 2.13), with the greatest effects on language development (P =0.003; OR = 4.93). The two groups did not differ significantly on the Achenbach CBCL internalizing and externalizing symptoms total scores. Stepwise regression demonstrated that coma duration, seizures while in hospital, platelet count and lactate level on admission were predictive of assessment outcomes for the children with retinopathy‐positive CM.

Conclusions  Children who suffer retinopathy‐positive CM at preschool age are at greater risk of developmental delay, particularly with respect to language development. This confirms previous retrospective study findings with school‐age children evaluated years after acute illness. The MDAT and the Achenbach CBCL proved sensitive to clinical indicators of severity of malarial illness.
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Language: English

Document Type: Research Article

Affiliations: 1:  International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, MI, USA 2:  Institute of Child Health, University of Liverpool, Liverpool, UK 3:  Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi 4:  Department of Psychiatry, Michigan State University, East Lansing, MI, USA 5:  Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA 6:  Office of the Chief of Psychiatry, Ministry of Health, Blantyre, Malawi 7:  Department of Internal Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA

Publication date: March 1, 2011

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