World Malaria Report 2015: Fewer Neurologically Compromised African Children in the Years to Come?

Good news. The 2015 World Malaria report recently released by the World Health Organization estimates that the number of malaria deaths fell by ~42% between 2000 and 2015. Most of the decreased mortality occurred in the WHO African region where most deaths occur and where severe disease occurs largely in children. Although the Malaria Report doesn’t capture neurological disabilities that result from malaria infections, multiple African studies have shown that 12-30% of pediatric cerebral malaria survivors experience neurologic sequelae including epilepsy, neurodevelopmental disabilities, cognitive impairment and behavioral disorders [1-9]. Assuming severe malaria infections have also decreased with mortality, many “brains” are also being saved by global reductions in malaria infections.

References

  1. Birbeck GL, et al. The Blantyre Malaria Project Epilepsy Study (BMPES): Neurologic Outcomes in a Prospective Exposure-Control Study of Retinopathy-Positive Pediatric Cerebral Malaria Survivors. Lancet Neurology 2010; 9: 1173-1181.
  2. Carter JA., et al. Severe falciparum malaria and acquired childhood language disorder. Dev Med Child Neurol 2006; 48: 51-7.
  3. Carter JA, et al. Persistent neurocognitive impairments associated with severe falciparum malaria in Kenyan children. J Neurol Neurosurg Psychiatry 2005;76:476-81.
  4. Carter JA, et al. Increased prevalence of epilepsy associated with severe falciparum malaria in children. Epilepsia 2004; 45:978-81.
  5. Carter JA, et al. Developmental impairments following severe falciparum malaria in children. Trop Med Int Health; 2005:3-10.
  6. Chomba E, et al. Seizure recurrence in rural Zambian children admitted with febrile seizures. Open Journal of Tropical Medicine 2008; 1: 101-107.
  7. Bangirana P. et al. The association between cognition and academic performance in Ugandan children surviving malaria with neurological involvement. PLoS One 2013. 8: e55653.
  8. Bangirana, P. et al. Malaria with neurological involvement in Ugandan children: effect on cognitive ability, academic achievement and behaviour. Malar J; 2011. 10: 334.
  9. John, CC, et al. Cerebral malaria in children is associated with long-term cognitive impairment. Pediatrics 2008. 122: e92-9.
Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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