Association between early childhood exposure to malaria and children’s pre-school development: evidence from the Zambia early childhood development project

Abstract

BackgroundDespite major progress made over the past 10 years, malaria remains one of the primary causes of ill health in developing countries in general, and in sub-Saharan Africa in particular. Whilst a large literature has documented the frequency and severity of malaria infections for children under-five years, relatively little evidence is available regarding the impact of early childhood malaria exposure on subsequent child development.MethodsThe objective of the study was to assess the associations between early childhood exposure to malaria and pre-school development. Child assessment data for 1,410 children in 70 clusters collected through the 2010 Zambian Early Childhood Development Project was linked with malaria parasite prevalence data from the 2006 Zambia Malaria Indicator Survey. Linear and logistic models were used to estimate the effect of early childhood exposure to malaria on anthropometric outcomes as well as on a range of cognitive and behavioural development measures.ResultsNo statistically significant associations were found between parasite exposure and children’s height and weight. Exposure to the malaria parasite was, however, associated with lower ability to cope with cognitive tasks administered by interviewers (z-score difference −1.11, 95% CI −2.43–0.20), as well as decreased overall socio-emotional development as assessed by parents (z-score difference −1.55, 95% CI −3.13–0.02). No associations were found between malaria exposure and receptive vocabulary or fine-motor skills.ConclusionsThe results presented in this paper suggest potentially large developmental consequences of early childhood exposure to malaria. Continued efforts to lower the burden of malaria will not only reduce under-five mortality, but may also have positive returns in terms of the long-term well-being of exposed cohorts.

Malaria in school‐age children in Africa: an increasingly important challenge

“…This was also the case in Uganda (Nankabirwa et al 2013) and in Mali, although in Mali the effect was not as marked as in children with clinical malaria (Thuilliez et al 2010). In Zambia, a strong association was found between exposure to malaria and cognitive skills and socio-emotional development in young children (mean age 74 months) (Fink et al 2013). *Calculation of the annual incidence assumes uniform incidence throughout the year for areas of perennial transmission, In areas of highly seasonal transmission where transmission is limited to a few months each year, total annual incidence is assumed to equate to that measured during the period of observation.…”

“…In Zambia, a strong association was found between exposure to malaria and cognitive skills and socio‐emotional development in young children (mean age 74 months) (Fink et al . ).…”

Can Touch Screen Tablets be Used to Assess Cognitive and Motor Skills in Early Years Primary School Children? A Cross-Cultural Study

“…For example, cognitive assessments, including motor skills, executive function, and language abilities, have been developed specifically for Zambia (Serpell, 1974; Ezeilo, 1978; Fink et al, 2013), rural Kenya (Kitsao-Wekulo et al, 2012), Bangladesh (Khan et al, 2013), and Malawi (Gladstone et al, 2009, 2010) populations. Assessment designed to determine young children's developmental milestones have also been developed in South Africa (Boyede et al, 2016), Malawi (Gladstone et al, 2009, 2010), Kenya (Prado et al, 2010), Nigeria (Eseigbe, 2013), and Cambodia (Ngoun et al, 2012).…”

Do Price Subsidies on Artemisinin Combination Therapy for Malaria Increase Household Use?: Evidence from a Repeated Cross-Sectional Study in Remote Regions of Tanzania

“…While less of a mortality concern, an increase in appropriate treatment among this age group is also important from an economic and public health perspective. For example, Plasmodium infection among school age children can affect performance and cognition [31], [32], malaria directly affects economic and labor productivity [33]-[36] and there is some recent, controversial evidence suggestive of higher malaria mortality among this age group than previously believed [37]. As younger children become increasingly protected by interventions such as insecticide-treated bed net distributions, older children are becoming more important disease reservoirs in some contexts [38], [39].…”