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Brain MRI and cognitive function seven years after surviving an episode of severe acute malnutrition in a cohort of Malawian children

  • Natasha Lelijveld (a1) (a2) (a3), Alhaji A Jalloh (a4), Samuel D Kampondeni (a4), Andrew Seal (a1), Jonathan C Wells (a5), Magdalena Goyheneix (a6), Emmanuel Chimwezi (a2), Macpherson Mallewa (a4), Moffat J Nyirenda (a2) (a7), Robert S Heyderman (a2) (a8) and Marko Kerac (a2) (a6)...

Abstract

Objective

To assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children.

Design

Prospective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children.

Setting

Blantyre, Malawi.

Participants

Children discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children.

Results

SAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73).

Conclusions

Despite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Corresponding author: Email Natasha.lelijveld.11@ucl.ac.uk

References

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Brain MRI and cognitive function seven years after surviving an episode of severe acute malnutrition in a cohort of Malawian children

  • Natasha Lelijveld (a1) (a2) (a3), Alhaji A Jalloh (a4), Samuel D Kampondeni (a4), Andrew Seal (a1), Jonathan C Wells (a5), Magdalena Goyheneix (a6), Emmanuel Chimwezi (a2), Macpherson Mallewa (a4), Moffat J Nyirenda (a2) (a7), Robert S Heyderman (a2) (a8) and Marko Kerac (a2) (a6)...

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