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The 'hidden' burden of malaria: cognitive impairment following infection.

By Maimunat Alex-Adeomi Moderator | 30 Mar, 2017

Dear colleagues,

In line with a previous article shared by Sungano on asymptomatic malaria in school age children in a region in Rwanda, please see abstract and attached article below on the "hidden" burden of malaria by Fernando et al in the Malaria journal.


The burden of post-malaria cognitive impairment is often overlooked. Given the large number of infections occurring worldwide, the magnitude of the problem is likely to be substantial. The objectives of this paper are; (i) to assess the evidence on post malarial cognitive impairment or impact on school education; (ii) to assess the possible positive impact of malaria drug prophylaxis on cognition; and (iii) to suggest recommendations on minimizing the burden of post-malarial cognitive impairment

PUBMED and SCOPUS were searched for all articles with the key word 'Malaria' in the title field and 'cognitive impairment' in any field. Google Scholar was searched for the same keywords anywhere in the article. The search was restricted to articles published in English within the last 15 years (1995-2010). After filtering of abstracts from the initial search, 44 papers had research evidence on this topic.

Results & Discussion
Cognitive abilities and school performance were shown to be impaired in sub-groups of patients (with either cerebral malaria or uncomplicated malaria) when compared with healthy controls. Studies comparing cognitive functions before and after treatment for acute malarial illness continued to show significantly impaired school performance and cognitive abilities even after recovery. Malaria prophylaxis was shown to improve cognitive function and school performance in clinical trials when compared to placebo groups. The implications of these findings are discussed.




Pierre Bush, PhD Moderator Replied at 10:54 PM, 30 Mar 2017

Thank you Maimunat for sharing this article. These hidden cases could be averted by a regular Screen & Mass drug administration (MDA).
See attached the World Health Organization Guidelines on MDA.

Attached resource:

Sungano Mharakurwa Moderator Replied at 1:17 PM, 1 Apr 2017

Thanks Maimunat. This is one of the reasons malaria has to be eradicated! Although far from there yet, and the battle remains fierce, I still agree with the theme for the next World Malaria Day: "End Malaria for Good" (see http://www.dw.com/en/malaria-deaths-on-the-rise-in-burundi-and-rwanda/a-37934323; http://www.who.int/campaigns/malaria-day/2017/en/).

Dinesh Koirala Replied at 1:04 PM, 2 Apr 2017

Malaria is a endemic in our country nepal as well. Itbcauses death of many people in our country so it has to be eradicated for better world.

Bekilizwe MSHANGA Replied at 4:05 PM, 2 Apr 2017

1- Cognitive decline post malaria infection cannot be limited to Malaria infection alone. The study seems to have compared children who had malaria and those that did not. It did not compare with children who had other infections such as bacterial meningitis.
2- using the parameters given for measuring post infection 'cognitive decline' , it is very difficult to tell whether the apparent decline was due to academic time lost due to infection or as a result of the infection itself. It is not a secret that many modalities used to measure cognitive function (including in the named study) have a heavy impact from academic attainment.
3- Malaria prophylaxis was a terrible idea and no wonder we no longer use it. No wonder we have resistance to previously effective drugs. As quoted by Bush above, Mass Drug Administration of full therapeutic dose to treat is a much better way to go. Giving sub-optimal doses in the name of prophylaxis will actually lead to much more drug resistance.

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