Associations of childhood exposure to malaria with cognition and behavior outcomes: a systematic review protocol

Abstract

Background: Malaria is one of the major contributing risk factors for poor development of children living in lowand middle-income countries (LMICs). However, little is known about the specific domains of cognition and behavior that are impacted by malaria, the extent of these deficits, and the different types of the malaria spectrum that are associated with these deficits. The objective of this systematic review is to determine the association of the different types of malaria infection on cognition and behavioral outcomes among children living in LMICs. Methods and analysis: We will systematically search online bibliographic databases including MEDLINE (via PubMed), CINAHL (via EBSCO), PsycINFO (via EBSCO), Embase, and The Cochrane Central Register of Controlled Trials (CENTRAL) as well as Google Scholar and bibliographies of pertinent articles. We will include studies with a comparison group (e.g., clinical trials, cohort, observational, cross-sectional case-control, and controlled before and after or interrupted-time-series studies) involving children under 18 years of age living in LMICs, as determined by the World Bank criteria, with either an active malaria infection or history of malaria. Included articles must also measure cognitive and/or behavior outcomes determined by standardized psychological assessments (questionnaire-based scales and or neurocognitive assessments). Studies will be excluded if they are not in English, lack a control group, take place in a high-income country, or if a standardized instrument was not used. Two reviewers will independently review all articles to determine if they meet eligibility criteria. Any conflicts will be resolved after discussion with a third reviewer. When a list of included articles is finalized, two reviewers will extract data to populate and then cross check within an electronic table. Risk of bias and the strength of evidence and recommendations will be assessed independently using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and a final score will be given upon consensus. For sufficiently homogeneous data on measured outcomes in multiple studies, we will investigate the possibility of pooling data to perform a meta-analysis.

Impact of Plasmodium vivax malaria on executive and cognitive functions in elderlies in the Brazilian Amazon

“…The impact of malarial infections on cognition has been assessed in severe and non-severe falciparum and vivax malaria, and the studies are almost exclusively performed in children 33 , 34 . These studies show that malaria affects language development, attention span in children and adolescents and negatively impacts their cognitive development and school performance 7 , 35 .…”

Exploring the hidden mental health consequences of malaria beyond the fever

“…Malaria has a noticeable effect on children’s cognitive development, which is often overlooked as it is still unclear how CM impacts a child’s abilities and functions beyond the aspects related to neurological consequences ( Fernando et al, 2010 ; White, 2022 ). However, it affects children’s cognitive development, leading to neurological, cognitive, and behavioral issues exacerbated by anemia and malnutrition, especially in low- and middle-income countries (LMICs), due to disruption of brain oxygen delivery and impaired cognition in infected adults which hinders education and employment leading to adverse cognitive and behavioral outcomes, particularly affecting memory, attention, language, and externalizing behavioral issues ( Ssemata et al, 2020 ). Research in Uganda shows that children with severe malarial anemia (SMA) and CM have lower reading scores in comparison to uncomplicated malaria, suggesting post-discharge malaria chemoprevention measures that could improve long-term academic performance ( Nakitende et al, 2023 ).…”