Background Plasmodium falciparum erythrocyte membrane protein-1 (PfEMP-1) is a highly polymorphic adherence receptor expressed on the surface of infected erythrocytes. Based on sequence homology PfEMP-1 variants have been grouped into three major groups A-C, the highly conserved VAR2CSA variants, and semi-conserved types defined by tandem runs of specific domains (“domain cassettes” (DC)). The PfEMP-1 type expressed determines the adherence phenotype, and is associated with clinical outcome of infection.MethodsParasite isolates from Beninese children or women presenting with, respectively, CM or PAM were collected along with samples from patients with uncomplicated malaria (UM). We assessed the transcript level of var genes by RT-qPCR and the expression of PfEMP-1 proteins by LC-MS/MS.Results Var genes encoding DC8 and Group A PfEMP-1 were transcribed more often and at higher levels in cerebral malaria vs. uncomplicated malaria patients. LC-MS/MS identified peptides from group A, DC8 PfEMP-1 more frequently in cerebral malaria than in uncomplicated malaria and pregnancy-associated malaria samples.ConclusionThis is the first study to show association between PfEMP-1 subtype and disease outcome by direct analysis of parasites proteome. The results corroborate that group A and specifically the PfEMP-1 types DC8 are universally associated with cerebral malaria. This is a crucial observation for promoting studies on malaria pathogenesis.

Objective Few tools are available to screen or assess infant’s cognitive development, especially in French-speaking Africa. This study evaluated the use of the French translation of the Mullen Scales of Early Learning (MSEL), and the ‘Ten Questions’ questionnaire (TQ) in 1-year-old children in Benin, a francophone country. Methods A cross-sectional study was conducted in three health centers serving a semi-rural area in Benin. Three hundred fifty-seven children aged 12 months and their mothers were enrolled in 2011. Infant development was assessed at local health centers followed by a home visit to collect information on socioeconomic status, maternal Raven score, maternal depressive symptoms, and mother–child interactions (HOME Inventory) and to administer the TQ. Results The infant’s gender (female), the HOME and maternal education were associated with a higher Early Learning Composite score in multivariate analyses (P=.02, P=.004, P=.007, respectively). The HOME and family wealth were also associated with the gross motor scale (P=.03 and P=.03, respectively). Mothers were more likely to report difficulties on the TQ when the child presented lower score on the MSEL. When considering the gross motor scale as the gold standard to define moderate delays, the two combined motor-related questions on the TQ showed good sensitivity and specificity (76.5 and 75.7). Conclusion In a low-resource rural setting in Africa, the TQ effectively identified three-quarters of 1-year-old infants with delayed development. After this screening, the MSEL may be useful for further assessment as it showed good feasibility and sensitivity to known risk factors for poor child development.