Photo: Dr. Paul Bangirana of Makerere University
Severe malaria may affect children’s cognitive abilities and academic performance for years after recovery, with survivors recording lower overall cognitive ability and mathematics scores than children who did not experience the disease, a 2026 study has found.
The study, published in the Journal of the American Medical Association (JAMA), followed 889 participants and assessed the long-term effects of childhood cerebral malaria and severe malarial anaemia.
It found that survivors had lower overall cognitive ability and mathematics achievement scores when assessed four to 15 years after the illness.
However, the researchers found no significant differences in reading or attention scores between the survivors and unaffected children in the community.
The findings highlight the long-term consequences of severe malaria beyond hospitalisation and death, including potential challenges with learning, behaviour, mental health and quality of life.
According to the World Health Organisation (WHO), Africa accounted for 94 per cent of global malaria cases and 95 per cent of malaria deaths in 2024, with children under five accounting for three-quarters of malaria deaths in the region.
Dr Paul Bangirana of Makerere University, Uganda, who co-authored the study, has researched the neuropsychological effects of childhood malaria for more than two decades.
His earlier prospective research found that one in four survivors of childhood cerebral malaria experienced impaired cognition 24 months after the illness.
Bangirana said although survival remained the priority, the secondary effects of severe malaria could be debilitating.
His team’s wider research has linked severe malaria, particularly cerebral malaria and severe malarial anaemia, with difficulties involving cognition, behaviour, mental health, educational attainment and health-related quality of life.
The findings also raise concerns about the burden on families, who may face prolonged caregiving responsibilities, loss of income and additional expenses even after a child has been discharged from hospital.
Nine-year-old James Ssemambo, from Kitosi village in Koome Sub-county, Mukono District, Uganda, experienced these challenges after developing severe malaria.
His mother, Sarah Nankya, spent three days with him at a health centre, leaving work and her other children while the family paid for transportation, treatment and food.
Although James recovered sufficiently to return home, he missed school for more than a week and continued to experience weakness and difficulty concentrating on his schoolwork.
“My child missed school for over a week because of the illness. Even after returning, he was still weak and sometimes had difficulty concentrating on his schoolwork,” Nankya said.
She added that repeated malaria attacks caused anxiety and disrupted the family’s finances because she sometimes had to leave work to care for her son.
“Repeated malaria brings a lot of worry because as a parent, you are always afraid your child may become seriously ill again,” she said.
The findings are consistent with research involving caregivers of children who experienced severe and repeated malaria attacks. The research documented behavioural changes, poorer academic performance and family disruption, including difficulties balancing work and caregiving responsibilities.
The broader implications reinforce the importance of malaria prevention, early diagnosis and effective treatment, alongside efforts to address the long-term needs of survivors.
Existing interventions, including insecticide-treated mosquito nets, medicines and malaria vaccines, have contributed to efforts to reduce the disease burden. However, drug and insecticide resistance remain challenges to malaria control.
Researchers are also exploring additional approaches to complement existing interventions.
One such programme is Target Malaria, a not-for-profit research consortium investigating genetic technologies, including gene drive, to reduce populations of specific malaria-transmitting mosquitoes.
The technology remains under development and is being studied in contained laboratory settings, with research subject to scientific assessment, regulatory oversight and community engagement.
Nankya said the effects of malaria could persist even after the fever had subsided.
“When the fever goes down, it does not mean the child is fully okay,” she said.
Bangirana’s research suggests that preventing severe malaria could offer benefits beyond reducing deaths and acute illness, potentially helping to limit some of the longer-term cognitive and educational difficulties associated with the disease.
The findings underscore the need for malaria control strategies that protect not only children’s lives but also their learning, development and future well-being.