CEREBRAL malaria (CM) and severe malarial anaemia (SMA), but not other forms of severe malaria, are tied to long-term cognitive impairment in children younger than 5-years-old, according to a new prospective cohort study of Ugandan children.
Prevalence of CM and SMA
In the prospective cohort study, researchers analysed results from 600 Ugandan children from 6 months to 4-years-old with CM, respiratory distress, malaria with multiple seizures, SMA, or prostration – the five most common forms of severe malaria.
Overall cognitive ability, attention, and associative memory were evaluated 12 months after hospital discharge and the children were reportedly followed anywhere from four to 15 years after their severe malaria episode.
Speaking at ESCMID Global 2026 on 18th April, Chandy John, distinguished professor, Indiana University School of Medicine, Indiana, US, said: “To give context, malaria continues to be a major cause of morbidity and mortality in children.
“There are more than 280 million cases of malaria every year, with more than 600,000 deaths and 75% of those occur in African children under five years of age.”
CM, he explained, is the deadliest form of malaria and SMA is the most common form of severe malaria, affecting more than a million children per year but carrying a significantly lower mortality rate than CM.
Impaired Cognition in Children with CM or SMA
Children with CM or SMA had substantially lower overall cognition scores than other children from the same community.
John continued: “Kids with SMA typically have no neurologic findings and we did not expect them to have cognitive impairment, but they did.”
Alternatively, cognition scores did not significantly differ between children with respiratory distress, multiple seizures, or prostration, compared with other children in the community.
“The take home is that these problems with cognition, that we had seen a year or two years later, persisted out to eight years,” John added.
“But interestingly no effects at all on attention.
“And in the area of academic achievement, very interestingly, no differences at all – not even a signal – in reading, but strong differences in math, in both children with CM and SMA.”
Researchers called for further investigation into the mechanisms underling cognitive impairment in CM and SMA, to drive and guide targeted interventions.
Reference
Bangirana P et al. Cerebral malaria and severe malarial anemia, but not other forms of severe malaria, are associated with long-term cognitive impairment. Clin Infect Dis. 2026;DOI:10.1093/cid/ciaf712.
Featured image: Julian on Adobe Stock
