Pediatric Survivors of Severe Malaria: Academic Performance Following a Cognitive Intervention in Uganda

Malaria;Cognition;Pediatric;Nursing;Health Sciences;Nursing

Finn, KatherineLori, Jody Rae ;

University of Michigan

关键词: Malaria;    Cognition;    Pediatric;    Nursing;    Health Sciences;    Nursing;   

Others  :  https://deepblue.lib.umich.edu/bitstream/handle/2027.42/144150/kgfinn_1.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

Background: Severe malarial infection manifests in sub-Saharan pediatric populations in two ways – severe malaria anemia and cerebral malaria. Both cause damage to brain physiology, causing deficits in cognitive functions such as memory, attention, problem solving, and motor control. Malaria mortality has decreased due to increased pharmaceutical availability, but damage is often already done prior to accessing treatment. Consistently high rates of malaria have resulted in malaria becoming a leading cause of cognitive impairment in sub-Saharan Africa. Though efforts must be made in illness prevention, it is necessary for effective tertiary therapies to exist until prevention is more effective. Computerized cognitive rehabilitation therapy (CCRT) offers promising, low-cost, acceptable cognitive benefits for children surviving severe malaria, but validation for real world impact is lacking. Objectives: The objectives of this research are to evaluate the desirability and functional impact of CCRT among pediatric survivors of severe malaria. The hypothesis driving this objective is that CCRT-based cognitive improvements evident in children, will lead to improved performance in the academic setting. Evidence of academic improvements resulting from exposure to CCRT would indicate that translational effects of such an intervention are valid in regards to a measure of everyday functioning (school work). This information has the potential to provide a rationale for the continued use of cognitive training to improve long-term outcomes.Methods: Three studies were conducted to address the objectives. First, a qualitative analysis of the Ugandan perspective of CCRT. Ugandan professionals familiar with CCRT were interviewed regarding facilitators and barriers to CCRT and its implementation. Second, a descriptive study of academic performance differences between healthy children and survivors of severe malaria. Third, an analysis of change in academic performance over one year, following training with CCRT. All analyses take into account moderating variables that may influence CCRT’s functional impact (i.e., socio-economic status, home environment, age, and gender). The second and third studies were a post hoc analysis of school reports collected from participants enrolled in a randomized controlled trial in Uganda.Results: The qualitative analysis identified potential facilitators and barriers that may be encountered regarding CCRT implementation. Ugandan professionals demonstrated the hope and opportunity for the implementation while acknowledging that challenges, such as geography and resource availability, must be considered. The baseline study found no statistically significant difference between healthy children and survivors of severe malaria in academic domains of Arithmetic, English, Reading, Writing, and Luganda. The final study also found no statistically significant differences in academic performance over time following training with CCRT.Conclusion: Ugandan teachers, researchers, and health providers see great potential and desirability for implementing CCRT in the academic setting. Their unique areas of expertise can inform future endeavors of dissemination through identifying barriers, such as resource availability, and facilitators, such as perceived value. Stakeholders place value on this intervention, however, the second study was not able to identify differences in academic performance between survivors of severe malaria and healthy children. The lack of differences may indicate the impact of malaria on cognitive outcomes is not as severe as previously thought, but it may also indicate the limitations of the measure. Finally, evidence of academic change over time was lacking in the third study. These results may indicate CCRT has no direct influence upon academic performance, or as noted before, may result from limitation of the measure of academic performance.