Carter, Julie Ann; (2003) Epilepsy and developmental impairments following severe malaria in Kenyan children: A study of their prevalence, relationships, clues to pathogenesis and service requirements. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Falciparum malaria produces a range of neurological manifestations, of which seizures in children is the most common. A smaller proportion progress to coma, ie cerebral malaria (CM). Neuro-cognitive impairments have been reported after CM but not in the much larger group of children presenting with seizures without coma. Many of these seizures are complicated (focal, prolonged or repetitive) and potentially damaging. The aim of this study was to determine the prevalence of impairments, including epilepsy, in children with a history of severe malaria, with specific reference to malaria and complicated seizures (M/S). An assessment battery was developed to detect impairments, particularly in language, memory and behaviour but also including non-verbal functioning, motor skills, hearing and vision. Three groups of children were recruited: children previously admitted with CM (n=152) or M/S (n=156) and children unexposed to either condition (n=179). There was an increased prevalence of epilepsy in children with previous CM (OR=4.4 95% C.I.=1.42 - 13.69 p=0.01) and M/S (OR=6.1 95% C.I.=2.02 - 18.25 p=0.001) compared to the unexposed group. Children exposed to CM had a poorer group performance on most of the developmental assessments, while poorer performance in the M/S group was concentrated on pragmatics, phonology and behaviour. Twenty- four percent of the CM and M/S groups had at least one impairment on any of the domains measured in the study. In both groups, children with active epilepsy had lower scores on assessment than those without epilepsy. CM and M/S are associated with an increased prevalence of epilepsy and developmental impairments. Current figures on the neuro-cognitive consequences of severe malaria are likely to be underestimates: this has profound public health implications in terms of education and development for children in sub-Saharan Africa.

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