Relationship between five common viruses and febrile seizure in children

Objectives

To examine the role of viruses in febrile seizures (FS) by comparing the relative risk (RR) of developing FS with common viral infections and subsequent risk of recurrence.

Methods

We matched the medical records of all children admitted with FS over 5 years and the contemporary records for all admissions for febrile illnesses associated with influenza, adenovirus, parainfluenza, respiratory syncytial virus (RSV) and rotavirus to calculate the RR of FS following these viral infections. For patients admitted for a first FS, we carried multivariate analysis for type of viral infection, age of onset, family history, complex FS features and maximum temperature during the episode, to identify the risk factors for recurrence.

Results

There were 923 admissions for FS, of which 565 were for first seizures. The five most common viruses in FS were influenza (163/923, 17.6%), adenovirus (63/923, 6.8%), parainfluenza (55/923, 6%), RSV (25/923, 2.7%) and rotavirus (12/923, 1.3%). Incidences of FS in febrile illnesses due to these viruses were 20.8% (163/785) for influenza, 20.6% (55/267) for parainfluenza, 18.4% (63/343) for adenovirus, 5.3% (25/468) for RSV and 4.3% (12/280) for rotavirus. Complex FS occurred in 20.6% (n = 191) and the risk of developing complex FS was similar for the five viruses. Overall recurrence rate was 20.5% and was not predicted by type of viral infection.

Conclusion

The risk of developing FS is similar with influenza, adenovirus or parainfluenza and is higher than with RSV or rotavirus. Type of viral infection is not important in predicting complex features or future recurrences.     

Efficacy of Preoperative Chemotherapy in Treatment of Children With Wilms’ Tumor: A Meta-Analysis

Context:

To assess the efficacy of preoperative chemotherapy in Wilms’ tumor patients and explore its true value for specific subgroups.

Objectives:

In the presence of these controversies, a meta-analysis that examines the efficacy of preoperative chemotherapy in Wilms’ tumor patients and specific subgroups is needed to clarify these issues. The objective of this meta-analysis is to assess the efficacy of preoperative chemotherapy in Wilms’ tumor patients and explore its true value for specific subgroups.

Data Sources:

Computer-based systematic search with “preoperative chemotherapy”, “Neoadjuvant Therapy” and “Wilms’ tumor” as search terms till January 2013 was performed.

Study Selection:

No language restrictions were applied. Searches were limited to randomized clinical trials (RCTs) or retrospective studies in human participants under 18 years. A manual examination of references in selected articles was also performed.

Data Extraction:

Relative Risk (RR) and their 95% Confidence Interval (CI) for Tumor Shrinkage (TS), total Tumor Resection (TR), Event-Free Survival (EFS) and details of subgroup analysis were extracted. Meta-analysis was carried out with the help of the software STATA 11.0. Finally, four original Randomized Clinical Trials (RCTs) and 28 retrospective studies with 2375 patients were included.

Results:

For preoperative chemotherapy vs. up-front surgery (PC vs. SU) group, the pooled RR was 9.109 for TS (95% CI: 5.109 - 16.241; P < 0.001), 1.291 for TR (95% CI: 1.124 - 1.483; P < 0.001) and 1.101 for EFS (95% CI: 0.980 - 1.238; P = 0.106). For subgroup short course vs. long course (SC vs. LC), the pooled RR was 1.097 for TS (95% CI: 0.784 - 1.563; P = 0.587), 1.197 for TR (95% CI: 0.960 - 1.493; P = 0.110) and 1.006 for EFS (95% CI: 0.910 - 1.250; P = 0.430).

Conclusions:

Short course preoperative chemotherapy is as effective as long course and preoperative chemotherapy only benefits Wilms’ tumor patients in tumor shrinkage and resection but not event-free survival.     

Sport participation, sport injury, risk factors and sport safety practices in Calgary and area junior high schools

OBJECTIVES:

To examine rates of sport participation, sport injury, risk factors and sport safety practices in young adolescents.

DESIGN:

Cross-sectional.

SETTING:

Calgary and area junior high schools.

PARTICIPANTS:

A random sample of 1466 students (aged 12 to 15 years).

OUTCOME MEASURES:

Sport injury within one year prior to completing the survey.

RESULTS:

Ninety-three per cent of students participated in sports in the previous year. The injury rate was 60.85 injuries/100 students/year (95% CI 58.29 to 63.35) for students reporting at least one sport injury, 29.4 injuries/100 students/year (95% CI 27.08 to 31.81) for medically treated injuries, and 12.28 injuries/100 students/year (95% CI 10.64 to 14.07) for injuries presenting to a hospital emergency department. The greatest proportion of injuries occurred in basketball (14%), soccer (12%), hockey (8.6%) and snowboarding/skiing (7.1%).

CONCLUSIONS:

The rates of participation and injury in sports are high in junior high school students. Future research should focus on prevention strategies in sports with high participation and injury rates to have the greatest population health impact.     

Sex disparity and perception of obesity/overweight by parents and grandparents

OBJECTIVE:

To explore the factors associated with the sex disparity showing a greater prevalence of obesity/overweight in boys compared with girls in Chinese school children.

METHODS:

Sampled students and their parents were asked to complete a questionnaire. Perceptions of weight status by the parents, grandparents and children themselves were collected. A logistic regression analysis was used.

RESULTS:

The sampled students included 327 obese/overweight students and 1078 students with normal body mass index (BMI). The crude OR of obesity/overweight for boys compared with girls was 1.57 (95% CI 1.22 to 2.01). The increased risk of childhood obesity/overweight for boys remained after adjustment for prenatal and infant factors, daily habits and family situation, but disappeared after adjustment for perception of weight status (OR 1.27 [95% CI 0.93 to 1.67]). There were differences in underestimation of children’s weight status between boys and girls by their parents and grandparents (OR 1.33 [95% CI 1.08 to 1.64] and OR 1.42 [95% CI 1.15 to 1.75], respectively).

CONCLUSIONS:

Misconceptions about a child’s weight status were prevalent among parents and grandparents, and boys’ weight status was more frequently underestimated than girls. The disparity of underestimating weight according to sex may partially contribute to the difference in the prevalence of obesity/overweight between boys and girls among Chinese school children.     

Low Birth Weight and Its Related Risk Factors in Northeast Iran

Objective

This study was conducted to determine the prevalence of low birth weight (LBW) and its related risk factors in an appropriate sample of neonates in Shahroud, northeast Iran.

Methods

At this study, a random sample of 1000 neonates were selected of which 72 neonates were LBWs. We used univariate and multivariate logistic regression methods to evaluate the LBW risk factors in LBWs compared to normal weight infants.

Findings

7.2% of neonates were LBWs and 6.1% born before 37 weeks of gestation. Prematurity, high-risk pregnancy and maternal age have significant statistical association with LBW. Odds Ratio (OR) for prematurity was 42.82 (95%CI; 21.93-83.57), for high risk pregnancy 2.76 (95%CI; 1.47-5.19) and for maternal age group more than 35 years in comparison to 19-35 years age group 0.2 (95%CI; 0.05-0.71).

Conclusion

Based on this study; prematurity and high risk pregnancy were the most important risk factors for LBW. There was also a reverse association between maternal age and LBW.     

Epilepsy Prevalence in the 0-17 Age Group in Trabzon,Turkey

Objective

Epilepsy is a most common serious neurological disorder and is one of the world''s most prevalent non-communicable diseases. The aim of this study was to determine the prevalence and risk factors of epilepsy in 0–17 year old children in Trabzon, Turkey.

Methods

A cross-sectional epidemiological investigation was performed in two phases, a screening phase and a confirmation of the diagnosis phase. The gold standard was a clinical investigation and neurological examination. The diagnosis of epilepsy followed clinical guidelines proposed by the International League against Epilepsy (ILAE). The chi-square test was used in analysis of the results and P-value <0.05 was calculated.

Findings

The prevalence per 1000 participants of epilepsy was 8.6 (5.9–11.4; ^95%CI). We detected 37 cases (18 males and 19 females) of epilepsy. The male/female ratio was 0.95. This study showed an increased risk for epilepsy with low socioeconomic level, a history of postpartum seizure, meningitis, head trauma, febrile convulsion and family history of epilepsy. More than one seizure type was present in 15 (40.5%) of epileptic children. Generalized tonic-clonic seizures were determined in 24 patients (64.9%) and absence type in 9 (24.3%). It was found that 25.0% of children with epilepsy had never visited the school at the time the study was performed due to the disease and attendant seizures.

Conclusion

The prevalence of epilepsy in Trabzon is low compared to other parts of Turkey and other developing countries.     

Disparity in childhood immunizations

BACKGROUND

Incomplete immunization coverage is common in low-income families and Aboriginal children in Canada.

OBJECTIVE

To determine whether child immunization coverage rates at two years of age were lower in low-income neighbourhoods of Saskatoon, Saskatchewan.

METHODS

Parents who were and were not behind in child immunization coverage were contacted to determine differences in knowledge, beliefs and opinions on barriers and solutions. A multivariate regression model was designed to determine whether Aboriginal cultural status was associated with being behind in childhood immunizations after controlling for low-income status.

RESULTS

Reviewing the past five years in Saskatoon, the six low-income neighbourhoods had complete child immunization coverage rates of 43.7% (95% CI 41.2 to 45.9) for measles-mumps-rubella, and 42.6% (95% CI 40.1 to 45.1) for diphtheria, pertussis, tetanus, polio and Haemophilus influenzae type B. The five affluent neighbourhoods had 90.6% (95% CI 88.9 to 92.3) immunization coverage rates for measles-mumps-rubella, and 78.6% (95% CI 76.2 to 81.0) for diphtheria, pertussis, tetanus, polio and H influenzae type B. Parents who were behind in immunization coverage for their children were more likely to be single, of Aboriginal or other (non-Caucasian or non-Aboriginal) cultural status, have lower family income and have significant differences in reported beliefs, barriers and potential solutions. In the final regression model, Aboriginal cultural status was no longer associated with lower immunization status.

INTERPRETATION

Child immunization coverage rates in Saskatoon’s six low-income neighbourhoods were approximately one-half the rate of the affluent neighbourhoods. The covariates with the strongest independent association with complete childhood immunization status were low income and other cultural status. Aboriginal cultural status was not associated with low child immunization rates after controlling for income status.     

Klippel-Trenaunay-Weber Syndrome with Hemimegalencephaly; Report of a Pediatric Case

Background

Klippel-Trenaunay-Weber Syndrome (KTWS) is a rare neurocutaneous syndrome. Hemimegalencephaly (HME) and seizure episodes have been reported previously in a few cases with KTWS.

Case Presentation

We report here a 3 day-old girl with partial motor seizures, extensive port-wine staining and mild structural deformities in the feet, and a hemimegalencephaly.

Conclusion

Occurrence of partial motor seizures in addition to bilateral lower extremities extensive port-wine staining is a unique feature seen in our case.     

A Comparison of Buccal Midazolam and Intravenous Diazepam for the Acute Treatment of Seizures in Children

Objective

The purpose of the present study is to compare efficacy and safety of buccal midazolam with intravenous diazepam in control of seizures in Iranian children.

Methods

This is a randomized clinical trial. 92 patients with acute seizures, ranging from 6 months to 14 years were randomly assigned to receive either buccal midazolam (32 cases) or intravenous diazepam (60 cases) at the emergency department of a children''s hospital. The primary outcome of this study was cessation of visible seizure activity within 5 minutes from administration of the first dosage. The second dosage was used in case the seizure remained uncontrolled 5 minutes after the first one.

Findings

In the midazolam group, 22 (68.8%) patients were relieved from seizures in 10 minutes. Meanwhile, diazepam controlled the episodes of 42 (70%) patients within 10 minutes. The difference was, however, not statistically significant (P=0.9). The mean time required to control the convulsive episodes after administration of medications was not statistically significant (P=0.09). No significant side effects were observed in either group. Nevertheless, the risk of respiratory failure in intravenous diazepam is greater than in buccal midazolam.

Conclusion

Buccal midazolam is as effective as and safer than intravenous diazepam in control of seizures.     

Do obese children experience more severe fractures than nonobese children? A cross-sectional study from a paediatric emergency department

OBJECTIVES:

To determine whether there is an association between childhood obesity and severe extremity fractures. Associations between obesity and complications related to the fracture and/or fracture management were also examined.

METHODS:

The present study was a retrospective, cross-sectional study conducted at a tertiary care children’s emergency department. Eligible cases for review were children (two to 17 years of age) with an extremity fracture. Severe extremity fractures were defined as those requiring manipulation under anesthesia, open operative repair and/or admission to hospital. The primary outcome was the proportion of severe extremity fractures and the secondary outcome was the proportion of complications.

RESULTS:

A total of 1340 charts of children who presented with extremity fracture from January 2008 to December 2010 were reviewed. The mean (± SD) age of the study population was 9.1±4.0 years and 62.1% were male. Overall, 19.9% (95% CI 17.8% to 22.0%) were obese and 39.6% (95% CI 36.7% to 39.1%) sustained a severe extremity fracture. The OR of severe extremity fractures among obese versus nonobese children was 1.00 (95% CI 0.76 to 1.32), adjusted for age, sex and mechanism of injury. In addition, the OR of experiencing complications among obese relative to nonobese children was 1.12 (95% CI 0.68 to 1.85).

CONCLUSIONS:

The results of the present study demonstrated that in children with extremity fractures, obese children were not at increased risk for sustaining more severe extremity fractures or subsequent complications compared with nonobese children.     

Doctor shopping before and after a visit to a paediatric emergency department

BACKGROUND:

Use of multiple care providers is known to be associated with poor continuity of care.

OBJECTIVES:

To estimate the prevalence of and identify risk factors for doctor shopping by parents of children with common acute illnesses seen in the emergency department (ED) of a children’s hospital.

SETTING:

ED at the Montreal Children’s Hospital (MCH), Montreal, Quebec.

METHODS:

Doctor shopping was defined as visiting three or more different care sites (the MCH ED, other EDs, outpatient clinics or private offices) for a single illness episode, including all visits occurring within successive 72 h periods up to a maximum of 15 days before and after an ED visit from April 1995 to March 1996. Logistic regression was used to compare characteristics of illness episodes with doctor shopping versus those without.

RESULTS:

Of the total 40,150 visits during the study period, doctor shopping was observed in 18% of the visits. The risk of doctor shopping was positively associated with an initial visit at other EDs (odds ratio [OR] 9.08, 95% CI 7.16 to 11.52), outpatient clinics (OR 4.47, 95% CI 3.71 to 5.37) or private offices (OR 1.71, 95% CI 1.48 to 1.96) versus those who visited the MCH ED first. The risk did not differ according to whether a paediatrician versus a general practitioner saw the child during the initial visit (OR 0.99, 95% CI 0.86 to 1.15). Some diagnoses (the reference category was upper respiratory infection), including urinary tract infection (OR 3.31, 95% CI 2.58 to 4.23) and gastroenteritis (OR 1.59, 95% CI 1.35 to 1.88), were associated with an increased risk of doctor shopping, while asthma was associated with a reduced risk (OR 0.71, 95% CI 0.60 to 0.86).

CONCLUSION:

Doctor shopping is common among parents of children with acute illnesses. Parents of children who were seen in the MCH ED first were less likely to doctor shop, perhaps because the parents were more confident about the advice and treatment received. Further research should investigate the underlying reasons for doctor shopping, eg, services other than an ED were not available and parents’ perceptions of the quality of health services.     

Detection of hypertension and prehypertension in paediatric patients with type 1 diabetes using a simple blood pressure table

BACKGROUND:

The diagnosis of hypertension is often unrecognized in the general paediatric and type 1 diabetes populations. Reference to a simple blood pressure table has been proposed as a screening tool for the identification of abnormal paediatric blood pressure. This simple table lists one cut-off blood pressure value for each sex and year of age, compared with the standard blood pressure tables, which list 476 abnormal and normal blood pressure values.

OBJECTIVE:

To determine the sensitivity and specificity of the simple blood pressure table in identifying hypertensive and abnormal (hypertensive or prehypertensive) blood pressure values in children with type 1 diabetes.

METHODS:

A retrospective cohort study was conducted. Data regarding baseline characteristics and blood pressure measurements were collected. Blood pressure values were categorized as nonhypertensive, prehypertensive or hypertensive using the standard and simple blood pressure tables. Sensitivity and specificity of the simple blood pressure table was determined for the identification of hypertensive and abnormal (hypertensive or prehypertensive) blood pressure values using a generalized estimating equation approach.

RESULTS:

The simple blood pressure table had sensitivities of 100% (95% CI 95.7% to 100%) and 100% (95% CI 97.6% to 100%), and specificities of 61.1% (95% CI 54.0% to 67.8%) and 81.3% (95% CI 74.4% to 86.6%), for the identification of hypertensive and abnormal blood pressure values, respectively.

CONCLUSION:

The simple blood pressure table is an effective screening tool that may enable earlier detection and timely treatment of abnormal blood pressure.     

Incidence of Childhood Cancers in Golestan Province of Iran

Objective

This paper presents the incidence rates of childhood cancers using the data obtained from Golestan population based cancer registry (GPCR) between 2004 and 2006.

Methods

GPCR registers only primary cancers based on standard protocols of the international association of cancer registries (IACR). We collect data on newly diagnosed (incident) cancer cases from all public and private diagnostic and therapeutic centers of the whole province. CanReg-4 software was used for data entry and analysis.

Findings

Totally 5076 cancer cases (all ages) were diagnosed in GPCR between 2004 and 2006. Of these, 139 (2.74 %) were children (aged 0–14 years) with mean (±SD) age of 8.06 (±4.48) years. The age standardized incidence rates for childhood cancer were 119.8 and 78.3 per 1000000 person-years in male and female children, respectively. Leukemia was the most common childhood cancer in Golestan province of Iran. Lymphomas and central nervous system tumors were the second and third ones, respectively.

Conclusion

The incidence rates of childhood cancers were relatively high in Golestan province of Iran. So, controlling of childhood cancers should be mentioned as an important issue in health policy making in this area.     

Rate of mother to child transmission of HIV and factors associated among HIV exposed infants in Oromia Regional State,Ethiopia: Retrospective study

Background

Mother to Child Transmission of HIV (MTCTH) is a major public health challenge in Ethiopia. Monitoring and evaluation of the rate of HIV transmission among infants born to HIV positive mothers is the major indicator to understand the performance of a national HIV control program. However, this is not well documented in Oromia Regional State, Ethiopia.

Correlation between Hypoglycemia and Positive Rate of Inborn Error of Metabolism in Neonatal Intensive Care Unit

Objective

To investigate the correlation between hypoglycemia and positive rate of inborn error of metabolism (IEM) in neonatal intensive care unit.

Methods

160 patients from a neonatal intensive care unit were enrolled. Blood glucose was measured by Roche Modular chemistry. The dry blood on filter papers, collected from 160 patients, was tested by tandem mass spectrometry to detect 35 inborn errors of metabolism. Clinical follow-up of all the patients was at least in an interval of 12 months. The mean observation period was 13.5 months per child.

Findings

Based on the ROC curve, the optimal cut-off value of hypoglycemia as an indicator for screening for IEMs was projected to be 2.8 mmol/L, which yielded a sensitivity of 71.4% and a specificity of 76.5%. The patients were divided into two groups: hypoglycemia group (48 cases) and the control group (112 cases). 5(10.4%) of the 48 patients in the hypoglycemia group were positive, while only 2(1.8%) of the 112 patients in the control group were positive. The difference of the positive rate in the screening for IEMs between the two groups was significant (χ²=4.10, P<0.05); the relative risk (RR) was 5.83 (95% CI: 1.06–32.12).

Conclusion

The risk of patients with hypoglycemia suffering from IEMs was significantly higher than that of the non-hypoglycemia patients in NICU, based on cut-off value of 2.8mmol/L.     

Thyroid Disorders in Children and Adolescents with Type 1 Diabetes Mellitus in Isfahan,Iran

Objective

Studies in different populations have shown great variation in the prevalence of thyroid diseases in patients with type 1 diabetes mellitus (T1DM). Our aim was to study the prevalence of thyroid disorders such as autoimmunity of thyroid (AIT), thyroid dysfunction, and goiter in children and adolescents with T1DM, compared with age- and sex-matched healthy controls in Isfahan.

Methods

One hundred patients with T1DM who were referred to Isfahan Endocrine and Metabolism Research Center and 184 healthy schoolchildren matched for age and sex were included. They were examined for goiter by two endocrinologists. Thyroid function test and serum thyroid antibodies (anti-TPO Ab and anti-Tg Ab) were measured.

Findings

The prevalence of subclinical hypothyroidism was high in both groups (18%). T1DM patients had lower frequency of goiter (21% vs. 38%, P=0.001), and higher prevalence of positive AIT (22% vs. 8%, P=0.001), anti-TPO Ab positivity (19.3% vs. 5.3%, P=0.000), and anti-Tg Ab (11.1% vs. 6.4%, P=0.1) in comparison with the control group. Being positive for AIT in diabetic patients meant an odds ratio of 5 (CI 95%: 1.5-15.6) for thyroid dysfunction. There was no association between age, sex, duration of diabetes and HbA_1C with serum anti-TPO Ab and anti-Tg Ab concentrations in this group.

Conclusion

Our results demonstrated the high prevalence of AIT and thyroid dysfunction in patients with T1DM. We suggest regular thyroid function and antibody testing in these patients.     

Risk factors for positional plagiocephaly and appropriate time frames for prevention messaging

OBJECTIVE:

To determine potential risk factors for developing positional plagiocephaly in infants seven to 12 weeks of age in Calgary, Alberta.

METHODS:

A prospective cohort design was used. Healthy term infants (n=440), seven to 12 weeks of age, from well-child clinics at four community health centres in Calgary, Alberta were assessed by the primary author and a registered nurse research assistant using Argenta’s plagiocephaly assessment tool. Parents completed a questionnaire surveying risk factors.

RESULTS:

The incidence of positional plagiocephaly was estimated to be 46.6%. The following risk factors were identified using multiple logistic regression: right-sided head positional preference (OR 4.66 [95% CI 2.85 to 7.58]; P<0.001), left-sided head positional preference (OR 4.21 [95% CI 2.45 to 7.25]; P<0.001), supine sleep position (OR 2.67 [95% CI 1.58 to 4.51]; P<0.001), vacuum/forceps assisted delivery (OR 1.88 [95% CI 1.02 to 3.49]; P=0.04) and male sex (OR 1.55 [95% CI 1.00 to 2.38]; P=0.05).

CONCLUSION:

Advice to vary infants’ head positions needs to be communicated to parents/guardians well before the two-month well-child clinic visit. This could occur in the prenatal period by prenatal care providers or educators, or during the neonatal period by postpartum and public health nurses. Prevention education may be emphasized for parents/guardians of male infants and infants who have had assisted deliveries.     

Prevalence of Nocturnal Enuresis and Related Factors in Children Aged 5-13 in Istanbul

Objective

Enuresis is a health problem frequently encountered in childhood. This study was carried out in two socio-demographically different districts of the province of Istanbul, for the purpose of determining the relationship between the prevalence of primary nocturnal enuresis and certain demographic characteristics.

Methods

The study design is a cross-sectional carried out on 420 children (5 to 13 yr old) through random sampling. The research was conducted at two health centers in two different districts in the province of Istanbul. Data was collected with a questionnaire created by the researchers. Diagnosis of enuresis considered nocturnal voiding twice a week for at least three consecutive months.

Findings

Enuresis was a complaint expressed by 16.2% of the cases in the study group; 8.3% reported intermittent bedwetting. The data collected in the two districts pointed to a significant difference in terms of the frequency of enuresis in favor of the district where socio-demographic features were inferior (P<0.005). When family histories were explored in cases of children with enuresis, it was found that the mothers of 76.2% had the problem of enuresis while 14.9% had enuretic fathers. Thus statistically, the presence of enuresis in the family history was seen to have had a markedly significant impact on the occurrence of enuresis in the child (P<0.001).

Conclusion

It was concluded that familial predisposition to the condition constituted a more significant risk factor for enuresis compared to socio-demographic or economic characteristics.     

Risk factors for persisting neurological and cognitive impairments following cerebral malaria

Background

Persisting neurological and cognitive impairments are common after cerebral malaria. Although risk factors for gross deficits on discharge have been described, few studies have examined those associated with persistent impairments.

Methods

The risk factors for impairments following cerebral malaria were determined by examining hospital records of 143 children aged 6–9 years, previously admitted with cerebral malaria, who were assessed at least 20 months after discharge to detect motor, speech and language, and other cognitive (memory, attention, and non‐verbal functioning) impairments.

Results

The median age on admission was 30 months (IQR 19–42) and the median time from discharge to assessment was 64 months (IQR 40–78). Thirty four children (23.8%) were defined as having impairments: 14 (9.8%) in motor, 16 (11.2%) in speech and language, and 20 (14.0%) in other cognitive functions. Previous seizures (OR 5.6, 95% CI 2.0 to 16.0), deep coma on admission (OR 28.8, 95% CI 3.0 to 280), focal neurological signs observed during admission (OR 4.6, 95% CI 1.1 to 19.6), and neurological deficits on discharge (OR 4.5, 95% CI 1.4 to 13.8) were independently associated with persisting impairments. In addition, multiple seizures were associated with motor impairment, age <3 years, severe malnutrition, features of intracranial hypertension, and hypoglycaemia with language impairments, while prolonged coma, severe malnutrition, and hypoglycaemia were associated with impairments in other cognitive functions.

Conclusions

Risk factors for persisting neurological and cognitive impairments following cerebral malaria include multiple seizures, deep/prolonged coma, hypoglycaemia, and clinical features of intracranial hypertension. Although there are overlaps in impaired functions and risk factors, the differences in risk factors for specific functions may suggest separate mechanisms for neuronal damage. These factors could form the basis of future preventive strategies for persisting impairments.