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

Autor: Idro R; Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda. ridro1@gmail.com., Kakooza-Mwesige A; 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., Asea B; Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda., Ssebyala K; Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda., Bangirana P; Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda., Opoka RO; Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda., Lubowa SK; Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda., Semrud-Clikeman M; Department of Pediatrics, University of Minnesota, Minneapolis, DE, USA., John CC; Departments of Pediatrics, Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, USA., Nalugya J; Department of Paediatrics and Child Health, Mulago Hospital, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda.
Jazyk: angličtina
Zdroj: Malaria journal [Malar J] 2016 Mar 31; Vol. 15, pp. 184. Date of Electronic Publication: 2016 Mar 31.
DOI: 10.1186/s12936-016-1233-6
Abstrakt: 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.
Databáze: MEDLINE
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