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Open Access Research article

Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial

Paul Bangirana12*, Peter Allebeck2, Michael J Boivin34, Chandy C John5, Connie Page6, Anna Ehnvall78 and Seggane Musisi1

Author Affiliations

1 Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda

2 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

3 International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, MI, USA

4 Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

5 Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

6 Department of Statistics and Probability, Michigan State University, East Lansing, MI, USA

7 Institute of Clinical Neurosciences, Department of Psychiatry, Gothenburg University, Gothenburg, Sweden

8 Psychiatric Clinic of Varberg, Halland County Council, Sweden

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BMC Neurology 2011, 11:96  doi:10.1186/1471-2377-11-96

Published: 4 August 2011

Abstract

Background

Infection with severe malaria in African children is associated with not only a high mortality but also a high risk of cognitive deficits. There is evidence that interventions done a few years after the illness are effective but nothing is known about those done immediately after the illness. We designed a study in which children who had suffered from severe malaria three months earlier were enrolled into a cognitive intervention program and assessed for the immediate benefit in cognitive, academic and behavioral outcomes.

Methods

This parallel group randomised study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-one Ugandan children aged 5 to 12 years with severe malaria were assessed for cognition (using the Kaufman Assessment Battery for Children, second edition and the Test of Variables of Attention), academic skills (Wide Range Achievement Test, third edition) and psychopathologic behaviour (Child Behaviour Checklist) three months after an episode of severe malaria. Twenty-eight were randomised to sixteen sessions of computerised cognitive rehabilitation training lasting eight weeks and 33 to a non-treatment group. Post-intervention assessments were done a month after conclusion of the intervention. Analysis of covariance was used to detect any differences between the two groups after post-intervention assessment, adjusting for age, sex, weight for age z score, quality of the home environment, time between admission and post-intervention testing and pre-intervention score. The primary outcome was improvement in attention scores for the intervention group. This trial is registered with Current Controlled Trials, number ISRCTN53183087.

Results

Significant intervention effects were observed in the intervention group for learning mean score (SE), [93.89 (4.00) vs 106.38 (4.32), P = 0.04] but for working memory the intervention group performed poorly [27.42 (0.66) vs 25.34 (0.73), P = 0.04]. No effect was observed in the other cognitive outcomes or in any of the academic or behavioural measures.

Conclusions

In this pilot study, our computerised cognitive training program three months after severe malaria had an immediate effect on cognitive outcomes but did not affect academic skills or behaviour. Larger trials with follow-up after a few years are needed to investigate whether the observed benefits are sustained.

Trial registration

ISRCTN: ISRCTN53183087