{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:58:05Z","timestamp":1793318285249,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"18","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,5,12]]},"abstract":"\n Importance<\/jats:title>\n Cerebral malaria and severe malarial anemia are associated with cognitive impairment and decreased academic achievement 1 to 2 years after the initial episode. The extent to which impairment persists into later childhood and adolescence is unknown.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether severe malaria in children is associated with long-term cognitive impairment or decreased academic achievement.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Assessment of Ugandan children enrolled in 2 prior cohort studies of severe malaria; 1247 children completed the prior studies (2008-2018), of whom 958 were traceable (77%), and 939 (75%) enrolled in the present study (2020-2023). Data from 889 individuals younger than 18 years were analyzed.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Cerebral malaria (n\u2009=\u2009184), severe malarial anemia (n\u2009=\u2009249), other forms of severe malaria (respiratory distress, complicated seizures, or prostration, n\u2009=\u2009239), and unaffected community children (n\u2009=\u2009217).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Descriptive analysis including age-adjusted\n z<\/jats:italic>\n scores of overall cognitive ability, attention, and academic achievement (math, reading).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Participants (mean age, 11.1 [SD, 3.4] years; 44.2% female) were tested 4 to 15 years (mean, 8.4 [SD, 2.7] years) after their severe malaria episode. Compared with community children, children with a history of cerebral malaria or severe malarial anemia had lower scores in overall cognition (adjusted mean difference, \u22120.41 [Bonferroni-corrected 95% CI, \u22120.74 to \u22120.09] and \u22120.31 [95% CI, \u22120.61 to \u22120.01], respectively) and math (\u22120.46 [95% CI, \u22120.78 to \u22120.14] and \u22120.32 [95% CI, \u22120.61 to \u22120.03], respectively), while attention and reading scores did not differ significantly. Cognitive and academic scores were not significantly different between children with other forms of severe malaria and community children. In children with cerebral malaria or severe malarial anemia, acute kidney injury, hyperuricemia, and elevated plasma angiopoietin-2 levels at the time of the severe malaria episode were associated with worse\n z<\/jats:italic>\n scores in overall cognitive ability (\u22120.44 [95% CI, \u22120.80 to \u22120.08], \u22120.45 [95% CI, \u22120.88 to \u22120.02], and \u22120.33 [95% CI, \u22120.63 to \u22120.03], respectively). In children with cerebral malaria or severe malarial anemia, acute kidney injury was additionally associated with lower\n z<\/jats:italic>\n scores in reading (95% CI, \u22120.42 [95% CI, \u22120.79 to \u22120.05]) and math (95% CI, \u22120.39 [\u22120.74 to \u22120.04]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Among survivors of a severe childhood malaria episode, cerebral malaria and severe malarial anemia in childhood are associated with cognitive impairment and decreased academic achievement in some metrics 4 to 15 years after the index episode.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.0704","type":"journal-article","created":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T12:30:19Z","timestamp":1776515419000},"page":"1596","source":"Crossref","is-referenced-by-count":7,"title":["Long-Term Cognitive Ability and Academic Achievement After Childhood Severe Malaria"],"prefix":"10.1001","volume":"335","author":[{"given":"Paul","family":"Bangirana","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda"},{"name":"Global Health Uganda, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kagan A.","family":"Mellencamp","sequence":"additional","affiliation":[{"name":"Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline A.","family":"Nakitende","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda"},{"name":"Global Health Uganda, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea L.","family":"Conroy","sequence":"additional","affiliation":[{"name":"Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dibyadyuti","family":"Datta","sequence":"additional","affiliation":[{"name":"Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kautzman","sequence":"additional","affiliation":[{"name":"Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Goings","sequence":"additional","affiliation":[{"name":"Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert O.","family":"Opoka","sequence":"additional","affiliation":[{"name":"Global Health Uganda, Kampala, Uganda"},{"name":"Aga Khan University East Africa Medical College, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Namazzi","sequence":"additional","affiliation":[{"name":"Global Health Uganda, Kampala, Uganda"},{"name":"Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bjarne","family":"Robberstad","sequence":"additional","affiliation":[{"name":"Department of Global Health and Primary Care, University of Bergen, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Idro","sequence":"additional","affiliation":[{"name":"Global Health Uganda, Kampala, Uganda"},{"name":"Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandy C.","family":"John","sequence":"additional","affiliation":[{"name":"Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"joi260004r2","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1001\/jama.2024.22343","article-title":"Artemisinin partial resistance in Ugandan children with complicated malaria.","volume":"333","author":"Henrici","year":"2025","journal-title":"JAMA"},{"issue":"1","key":"joi260004r3","doi-asserted-by":"publisher","first-page":"e92","DOI":"10.1542\/peds.2007-3709","article-title":"Cerebral malaria in children is associated with long-term cognitive impairment.","volume":"122","author":"John","year":"2008","journal-title":"Pediatrics"},{"issue":"3","key":"joi260004r4","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1093\/cid\/ciu293","article-title":"Severe malarial anemia is associated with long-term neurocognitive impairment.","volume":"59","author":"Bangirana","year":"2014","journal-title":"Clin Infect Dis"},{"issue":"2","key":"joi260004r5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-1026","article-title":"Neurodevelopmental impairments 1 year after cerebral malaria.","volume":"143","author":"Langfitt","year":"2019","journal-title":"Pediatrics"},{"issue":"4","key":"joi260004r6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-058310","article-title":"Severe malaria and academic achievement.","volume":"151","author":"Nakitende","year":"2023","journal-title":"Pediatrics"},{"issue":"2","key":"joi260004r8","doi-asserted-by":"publisher","first-page":"e360","DOI":"10.1542\/peds.2006-2027","article-title":"Cognitive impairment after cerebral malaria in children: a prospective study.","volume":"119","author":"Boivin","year":"2007","journal-title":"Pediatrics"},{"issue":"9","key":"joi260004r9","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1093\/cid\/ciac229","article-title":"Acute kidney injury interacts with coma, acidosis, and impaired perfusion to significantly increase risk of death in children with severe malaria.","volume":"75","author":"Namazzi","year":"2022","journal-title":"Clin Infect Dis"},{"issue":"1","key":"joi260004r10","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1186\/s12936-024-05196-3","article-title":"Severe falciparum malaria in young children is associated with an increased risk of post-discharge hospitalization: a prospective cohort study.","volume":"23","author":"Opoka","year":"2024","journal-title":"Malar J"},{"issue":"5","key":"joi260004r11","doi-asserted-by":"publisher","first-page":"790","DOI":"10.4269\/ajtmh.2006.75.790","article-title":"Malarial retinopathy: a newly established diagnostic sign in severe malaria.","volume":"75","author":"Beare","year":"2006","journal-title":"Am J Trop Med Hyg"},{"issue":"3","key":"joi260004r12","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1177\/073428298300100301","article-title":"Kaufman assessment battery for children.","volume":"1","author":"Kaufman","year":"1983","journal-title":"Psychol Assess"},{"issue":"5","key":"joi260004r15","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1097\/00004703-200210000-00010","article-title":"Effects of early cerebral malaria on cognitive ability in Senegalese children.","volume":"23","author":"Boivin","year":"2002","journal-title":"J Dev Behav Pediatr"},{"issue":"3","key":"joi260004r16","first-page":"186","article-title":"A preliminary examination of the construct validity of the KABC-II in Ugandan children with a history of cerebral malaria.","volume":"9","author":"Bangirana","year":"2009","journal-title":"Afr Health Sci"},{"issue":"7","key":"joi260004r17","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1093\/cid\/cir1037","article-title":"Neurocognitive and motor deficits in HIV-infected Ugandan children with high CD4 cell counts.","volume":"54","author":"Ruel","year":"2012","journal-title":"Clin Infect Dis"},{"issue":"5","key":"joi260004r18","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1037\/a0019312","article-title":"A pilot study of the neuropsychological benefits of computerized cognitive rehabilitation in Ugandan children with HIV.","volume":"24","author":"Boivin","year":"2010","journal-title":"Neuropsychology"},{"issue":"2","key":"joi260004r19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0055653","article-title":"The association between cognition and academic performance in Ugandan children surviving malaria with neurological involvement.","volume":"8","author":"Bangirana","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"joi260004r20","doi-asserted-by":"publisher","first-page":"3173","DOI":"10.1038\/s41598-021-82762-8","article-title":"Growth, clinical and neurodevelopmental outcomes at school age are similar for children who received 1-year lamivudine or lopinavir\/ritonavir HIV prophylaxis in early life.","volume":"11","author":"Nagot","year":"2021","journal-title":"Sci Rep"},{"issue":"1","key":"joi260004r21","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s12916-019-1332-7","article-title":"Acute kidney injury is associated with impaired cognition and chronic kidney disease in a prospective cohort of children with severe malaria.","volume":"17","author":"Conroy","year":"2019","journal-title":"BMC Med"},{"issue":"7","key":"joi260004r22","doi-asserted-by":"publisher","DOI":"10.1111\/pim.12438","article-title":"Elevated cerebrospinal fluid tumour necrosis factor is associated with acute and long-term neurocognitive impairment in cerebral malaria.","volume":"39","author":"Shabani","year":"2017","journal-title":"Parasite Immunol"},{"issue":"12","key":"joi260004r23","doi-asserted-by":"publisher","first-page":"e2138515","DOI":"10.1001\/jamanetworkopen.2021.38515","article-title":"Association of plasma tau with mortality and long-term neurocognitive impairment in survivors of pediatric cerebral malaria and severe malarial anemia.","volume":"4","author":"Datta","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"6","key":"joi260004r24","doi-asserted-by":"publisher","DOI":"10.1093\/braincomms\/fcad323","article-title":"Blood biomarkers of neuronal injury in paediatric cerebral malaria and severe malarial anaemia.","volume":"5","author":"Datta","year":"2023","journal-title":"Brain Commun"},{"issue":"16","key":"joi260004r26","doi-asserted-by":"publisher","first-page":"2539","DOI":"10.1089\/neu.2012.2403","article-title":"Functional recovery ten years after pediatric traumatic brain injury: outcomes and predictors.","volume":"29","author":"Catroppa","year":"2012","journal-title":"J Neurotrauma"},{"issue":"3","key":"joi260004r27","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1038\/s41591-024-03430-8","article-title":"Elevated uric acid levels, mortality and cognitive impairment in children with severe malaria.","volume":"31","author":"Bond","year":"2025","journal-title":"Nat Med"},{"issue":"6","key":"joi260004r28","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1093\/cid\/ciz325","article-title":"Elevated cerebrospinal fluid tau protein concentrations on admission are associated with long-term neurologic and cognitive impairment in Ugandan children with cerebral malaria.","volume":"70","author":"Datta","year":"2020","journal-title":"Clin Infect Dis"},{"key":"joi260004r29","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaf712","article-title":"Cerebral malaria and severe malarial anemia, but not other forms of severe malaria, are associated with long-term cognitive impairment.","author":"Bangirana","year":"2026","journal-title":"Clin Infect Dis"},{"key":"joi260004r30","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1186\/1475-2875-9-366","article-title":"The \u201chidden\u201d burden of malaria: cognitive impairment following infection.","volume":"9","author":"Fernando","year":"2010","journal-title":"Malar J"},{"issue":"3","key":"joi260004r31","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/S1473-3099(11)70320-6","article-title":"Intermittent preventive therapy for malaria with monthly artemether-lumefantrine for the post-discharge management of severe anaemia in children aged 4-59 months in southern Malawi: a multicentre, randomised, placebo-controlled trial.","volume":"12","author":"Phiri","year":"2012","journal-title":"Lancet Infect Dis"},{"issue":"23","key":"joi260004r32","doi-asserted-by":"publisher","first-page":"2242","DOI":"10.1056\/NEJMoa2002820","article-title":"Malaria chemoprevention in the postdischarge management of severe anemia.","volume":"383","author":"Kwambai","year":"2020","journal-title":"N Engl J Med"},{"issue":"1","key":"joi260004r33","doi-asserted-by":"publisher","first-page":"e33","DOI":"10.1016\/S2214-109X(23)00492-8","article-title":"Post-discharge malaria chemoprevention in children admitted with severe anaemia in malaria-endemic settings in Africa: a systematic review and individual patient data meta-analysis of randomised controlled trials.","volume":"12","author":"Phiri","year":"2024","journal-title":"Lancet Glob Health"},{"key":"joi260004r13","volume-title":"Test of Variables of Attention Continuous Performance Test","author":"Leark","year":"2007"},{"key":"joi260004r14","author":"Wilkinson","year":"2006"},{"key":"joi260004r25","volume-title":"Kaufman Assessment Battery for Children\u2013Second Edition: Normative Update Manual","author":"Kaufman","year":"2018"},{"key":"joi260004r1","unstructured":"World Malaria Report 2024: Addressing Inequity in the Global Malaria Response. World Health Organization. Published December 11, 2024. Accessed August 11, 2025. https:\/\/www.who.int\/teams\/global-malaria-programme\/reports\/world-malaria-report-2024"},{"key":"joi260004r7","doi-asserted-by":"crossref","unstructured":"Browne? AJ, Sanna? F, Amratia? P, . Estimating the incidence of severe malaria in children in sub-Saharan Africa 2015 to 2024.? SSRN Preprints. Preprint posted online March 4, 2025. doi:10.2139\/ssrn.5159866","DOI":"10.2139\/ssrn.5159866"}],"container-title":["JAMA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/articlepdf\/2847971\/jama_bangirana_2026_oi_260004_1777583539.39847.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:00:43Z","timestamp":1778598043000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2847971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":33,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2026,5,12]]}},"URL":"https:\/\/doi.org\/10.1001\/jama.2026.0704","relation":{},"ISSN":["0098-7484"],"issn-type":[{"value":"0098-7484","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5,12]]}}}