Severe childhood malaria linked to cognitive impairment later in life
Severe childhood malaria is linked to cognitive harm into adolescence, according to a new study.
The findings suggest children who survive cerebral malaria and severe malarial anaemia can experience cognitive and academic impairment that persists later in life. The link points to a need for better prevention strategies and more effective therapies to limit lasting effects.
The World Health Organization reported 282m malaria cases in 2024, with children under five accounting for about 75 per cent of 610,000 deaths worldwide.
The study was carried out by researchers at Indiana University School of Medicine and their collaborators at Makerere University in Uganda.
“Cerebral malaria and severe malarial anaemia, which affect more than a million children every year, are not only causes of death in children, but also associated with very long-term costs in terms of a child’s thinking and their academic achievement,” said Chandy John, the Ryan White professor of paediatrics at Indiana University School of Medicine, who co-led the study. “These costs, particularly in the area of maths skills, can affect their ability to do well in school, to go to college and to get a good job.”
Malaria is caused by parasites spread by mosquitoes, and symptoms can range from mild illness to life-threatening disease. Severe cases can disrupt blood cell production, causing malarial anaemia, and can also trigger serious neurological problems that lead to coma in cerebral malaria.
In the Malarial Impact on Neurobehavioral Development study, children from two earlier cohort studies of severe malaria were followed up four and 15 years after their initial episode. Their scores in cognition and academic achievement were compared with those of children in the community who had not had severe malaria.
Researchers found that children who survived cerebral malaria and severe malarial anaemia experienced cognitive impairment, with cognition scores equivalent to three to seven IQ points below their community peers.
Specific clinical factors in children with cerebral malaria or severe malarial anaemia were also linked to worse long-term cognitive outcomes. These included acute kidney injury, a sudden loss of kidney function, and raised levels of uric acid, a substance needed for some body functions but which can become toxic at high levels.
The group’s future work will focus on whether cerebral malaria and severe malarial anaemia are causing the cognitive impairment, and how to prevent it.
“Cohort studies can show an association, but they can’t prove that these illnesses caused the impairment,” John said. “Instead, we can look at potential pathways in the body and the brain and see how they relate to cognition. That’s what we’re doing in our current study, SMART Brain.”
SMART Brain, short for Severe Malaria and Risk to The Brain, will allow scientists to use models of the brain to explore further the link between specific processes that occur in severe malaria and brain injury.
“If we can identify pathways that lead to brain injury, then we can come up with interventions that may prevent brain injury, and test these in clinical trials,” John said. “That could potentially protect the brain and improve cognitive and academic outcomes for hundreds of thousands of children in countries with malaria.”
This research was supported by funding from the National Institutes of Health.
