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

Malaria Journal

Research

Robert O. Opoka¹  Richard Idro¹  Benjamin Asea¹  Keron Ssebyala¹  Joyce Nalugya¹  Samson K. Lubowa¹  Paul Bangirana¹  Angelina Kakooza-Mwesige²  Margaret Semrud-Clikeman³  Chandy C. John⁴ 

[1] Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda;Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda;Neuropediatric Research Unit, Astrid Lindgren Children’s Hospital, Karolinska Institutet, Solna, Stockholm, Sweden;Department of Pediatrics, University of Minnesota, Minneapolis, DE, USA;Departments of Pediatrics, Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, USA;

关键词: Behaviour;    Mental health;    Psychiatric;    Disorder;    Children;    Cerebral malaria;   

DOI  :  10.1186/s12936-016-1233-6

 received in 2015-10-02, accepted in 2016-03-15,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundCerebral 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.MethodsA 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).ResultsFifty-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.ConclusionsCerebral 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.

【 授权许可】

CC BY   
© Idro et al. 2016