Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda.
BMC Neurol. 2011 Aug 4;11:96. doi: 10.1186/1471-2377-11-96.
Infection with severe malaria in African children is associated with not only a high mortality but also a high risk of cognitive deficits. There is evidence that interventions done a few years after the illness are effective but nothing is known about those done immediately after the illness. We designed a study in which children who had suffered from severe malaria three months earlier were enrolled into a cognitive intervention program and assessed for the immediate benefit in cognitive, academic and behavioral outcomes.
This parallel group randomised study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-one Ugandan children aged 5 to 12 years with severe malaria were assessed for cognition (using the Kaufman Assessment Battery for Children, second edition and the Test of Variables of Attention), academic skills (Wide Range Achievement Test, third edition) and psychopathologic behaviour (Child Behaviour Checklist) three months after an episode of severe malaria. Twenty-eight were randomised to sixteen sessions of computerised cognitive rehabilitation training lasting eight weeks and 33 to a non-treatment group. Post-intervention assessments were done a month after conclusion of the intervention. Analysis of covariance was used to detect any differences between the two groups after post-intervention assessment, adjusting for age, sex, weight for age z score, quality of the home environment, time between admission and post-intervention testing and pre-intervention score. The primary outcome was improvement in attention scores for the intervention group. This trial is registered with Current Controlled Trials, number ISRCTN53183087.
Significant intervention effects were observed in the intervention group for learning mean score (SE), [93.89 (4.00) vs 106.38 (4.32), P = 0.04] but for working memory the intervention group performed poorly [27.42 (0.66) vs 25.34 (0.73), P = 0.04]. No effect was observed in the other cognitive outcomes or in any of the academic or behavioural measures.
In this pilot study, our computerised cognitive training program three months after severe malaria had an immediate effect on cognitive outcomes but did not affect academic skills or behaviour. Larger trials with follow-up after a few years are needed to investigate whether the observed benefits are sustained.
ISRCTN: ISRCTN53183087.
在非洲儿童中，严重疟疾感染不仅与高死亡率有关，还与认知缺陷的高风险有关。有证据表明，疾病发生几年后的干预措施是有效的，但对疾病发生后立即进行的干预措施却一无所知。我们设计了一项研究，其中三个月前患有严重疟疾的儿童被纳入认知干预计划，并评估认知、学业和行为结果的即时获益。
这项平行组随机研究于 2008 年 2 月至 2010 年 10 月在乌干达坎帕拉市进行。61 名 5 至 12 岁患有严重疟疾的乌干达儿童在疟疾发作三个月后接受认知评估（使用 Kaufman 儿童评估量表第二版和注意力变量测试）、学业技能（广泛成就测试第三版）和心理病理行为（儿童行为检查表）。28 名儿童随机分为 16 节为期八周的计算机认知康复训练，33 名儿童为非治疗组。干预后评估在干预结束后一个月进行。使用协方差分析检测干预后评估时两组之间的任何差异，调整因素包括年龄、性别、体重与年龄 z 评分、家庭环境质量、入院与干预后测试时间间隔以及干预前评分。主要结果是干预组注意力评分的改善。这项试验在当前对照试验注册中心注册，编号为 ISRCTN53183087。
干预组在学习平均分（SE）上有显著的干预效果[93.89（4.00）与 106.38（4.32），P=0.04]，但在工作记忆方面，干预组表现不佳[27.42（0.66）与 25.34（0.73），P=0.04]。其他认知结果或任何学业或行为测量均未观察到效果。
在这项初步研究中，我们在严重疟疾发生后三个月进行的计算机认知训练计划对认知结果有即时影响，但对学业技能或行为没有影响。需要进行更大规模的试验，并在几年后进行随访，以调查观察到的益处是否持续。
ISRCTN：ISRCTN53183087。
