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

Article scientifique 2016 Anglais

Résumé

BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

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Idro, R., Kakooza‐Mwesige, A., Asea, B., Ssebyala, K., Bangirana, P., Opoka, R., Lubowa, S., Semrud‐Clikeman, M., John, C., Nalugya, J. (2016). Cerebral malaria is associated with long-term mental health disorders: a cross sectional survey of a long-term cohort. https://doi.org/10.1186/s12936-016-1233-6

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Richard Idro Angelina Kakooza‐Mwesige Benjamin Asea Keron Ssebyala Paul Bangirana Robert O. Opoka Samson K. Lubowa Margaret Semrud‐Clikeman Chandy C. John Joyce Nalugya

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