HMN 2026: Why survivors may struggle in school years later

A disease transmitted by the bite of a tiny insect—one that once devastated entire armies—remains among the leading causes of death worldwide. In 2024 alone, there were 282 million cases of malaria reported and 610,000 deaths caused by the illness. Among those who have survived malaria due to proper treatment, the aftereffects can linger for a long time.

This was made even more evident by a study that found children who survived severe forms of malaria scored lower in cognitive tests and academic performance compared to other children of the same age group in their community.

Researchers always suspected that malaria in childhood might not be completely over once the illness passes, and could leave subtle effects that only show up years later.

To explore this, they carried out a long-term follow-up study in Uganda, involving children and adolescents under the age of 18. They discovered that survivors of childhood cerebral malaria and severe malarial anemia experienced significant brain-related challenges four to 15 years after the illness. The findings are published in JAMA.

Identifying the imprints left by the illness

According to the World Health Organization, the burden of malaria falls overwhelmingly on Africa, which accounts for 94% of cases and 95% of deaths. The continent also witnesses children under five making up 76% of fatalities from the illness.

Scientists have known for quite some time that cerebral malaria, which can sometimes lead to a coma, creates a lasting impact on the brain. Studies show that severe malaria doesn’t have to reach its most extreme forms to cause lasting harm. Even cases with breathing problems or seizures, without coma, can leave a mark. Children who survive severe malaria have shown thinking and learning problems even one to two years after the illness.

In this study, the researchers wanted to know whether these children eventually caught up to their peers or whether these brain-related challenges persisted into their teenage years.

The study followed 889 children and adolescents under 18: survivors of cerebral malaria, severe malarial anemia, and severe malaria with breathing problems or seizures, alongside healthy children from the same households or neighborhoods who had never had severe malaria. The survivors had taken part in two earlier malaria studies between 2008 and 2018.

Researchers tracked them down years later and reassessed their cognitive abilities, reading, math and attention span about four to 15 years after their initial illness.

The tests revealed that children who had cerebral malaria or severe malarial anemia scored lower in overall thinking ability and math compared to other children in their community, with a difference of roughly equivalent to 3 to 7 IQ points.

Reading ability and attention levels were largely on par with those of children who had never experienced severe malaria. However, there was no evidence of lasting learning or academic problems in cases of severe malaria with respiratory distress or seizures and no coma.

The researchers also identified certain health factors during the initial illness as strong predictors of who would struggle years later. Lower scores were more common among children whose malaria involved acute kidney injury or unusual levels of uric acid and angiopoietin-2, a protein that indicates blood vessel stress.

The study brings to light the urgent need for not just malaria prevention but also post-illness support for children who have suffered from severe malaria. The researchers are hopeful that the findings will help inform health policy and educational programs in regions where malaria is widespread.

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