Computerized rehabilitation for cognitive deficits after central nervous system malaria in Ugandan children

Background: Malaria infecting the central nervous system (CNS) affects over 575,000 children annually in sub-Saharan Africa leading to cognitive deficits. The effect of this form of malaria on everyday behaviour and academic achievement has not been investigated in Uganda. In addition, no interventions have been carried out for children whose cognitive functioning has been affected by CNS malaria. Main objective: To investigate the effectiveness of a rehabilitation program for cognitive deficits in Ugandan children after CNS malaria. Methods: Five studies were carried out (I-V). Study I investigated the long-term cognitive outcomes of CNS malaria. Children were given cognitive assessments 24 months after the malaria episode. In Study II, this same cohort of children were followed up and randomly assigned to receive either computerised cognitive rehabilitation training or treatment as usual, approximately four years after the CNS malaria episode. Pre- and post-intervention cognitive and behavioural assessments were done. The construct validity of a new cognitive test battery, the Kaufman Assessment Battery for Children second edition (KABC-II), was validated in Study III. The effect of CNS malaria on cognition, behaviour and academic achievement was investigated in Study IV. Study V investigated the effect of immediate computerised cognitive rehabilitation training on cognition, behaviour and academic achievement after an episode of CNS malaria. Chi-square and multiple linear regression analyses were used in Study I, analysis of covariance in studies II, IV, V and factor analysis in Study III. Results: There was a 26.3% prevalence of cognitive impairment two years after CNS malaria with attention most affected. CNS malaria was associated with a 3.67 increased risk for impairment (Study I). At three months assessment, children with malaria had lower attention scores (estimated mean difference = 0.32, 95% confidence interval (CI) = 0.01 to 0.63) and more internalising behavioural problems (0.31, CI, = 0.05 to 0.56) than the community controls (Study IV). Cognitive rehabilitation initiated four years after the illness resulted in improvement in spatial working memory, learning, psychomotor speed and internalising behaviour (Study II) while cognitive rehabilitation initiated three months after the malaria episode improved Learning only (mean difference in adjusted scores between intervention and control groups (standard error), 12.46 (6.05) (Study V). Factor analysis of the KABC-II resulted in five factors measuring Working Memory, Visuospatial skills, Learning and Planning. The fifth factor was composed of items that did not measure a specific cognitive ability (Study III). Conclusion: Both delayed and immediate computerised cognitive rehabilitation result in improved cognition and behaviour after CNS malaria in Ugandan children

Association between parental involvement and academic achievement of deaf children at Mulago school for the deaf, Kampala, Uganda

Background: Deaf children face many challenges in dealing with educational opportunities and ensuring attainment of academic skills. A parent's involvement in the child's education has the potential to enhance academic performance. We sought to study the association between parental involvement and academic achievement among deaf children in Uganda.Methods: Using purposive consecutive sampling, one hundred and eight parents of deaf children (Primary 1 to 7) were recruited from Mulago School for the Deaf in Kampala, Uganda. The Parental Involvement Questionnaire was used to measure parents’ involvement in school activities while the Wide Range Assessment Test, third edition, was used to measure academic achievement (reading, spelling and arithmetic). Linear regression was used to test the association between parental involvement and academic achievement.Results: One hundred and five children with mean age 11.09 years (SD = 2.89) were enrolled of whom 56 (35.3%) were female. With a Beta coefficient of 0.07, a 7% unit increase of summed parental involvement showed no significant association between parental involvement and academic achievement (p = 0.46) of the deaf children.Conclusion: Parental involvement was not associated with academic achievement among deaf children in Kampala. Other factors associated with academic achievement need to be identified to enhance deaf children's performance at school.Keywords: Parental involvement, academic achievement, deaf children, Mulago school for the deaf, Kampala, Uganda

Cognitive and social predictors of generalized anxiety disorder symptoms among fresh undergraduates in Uganda

Background: Generalized anxiety disorder (GAD) is common. It accounts for about one out of four anxiety related clinic consultations. The prevalence of this common disorder and the associated factors in Ugandan students are unknown. The objectives of this study were to determine the prevalence of GAD symptoms, and to evaluate its association with intolerance of uncertainty and parental attachment among fresh undergraduates in Uganda.Methods: The research utilized a cross-sectional approach. Non-clinical participants from 8 colleges (mean age 21.24; 59.7% males, 40.3% females) completed self-report inventories measuring intolerance of uncertainty, parental attachment and GAD symptoms. Pearson’s correlations were run to test relationship between the independent and dependent variables, a stepwise regression analysis was used to identify predictors of GAD, while controlling for age.Results: A total of 401 students were involved in the study. The prevalence of GAD symptoms was 28.9%. There was a significant positive relationship between GAD symptoms and intolerance of uncertainty (r = 0.30, p = 0.001) and with parental attachment (r = 0.21, p = 0.001). Intolerance of uncertainty and parental attachment, predicted GAD symptoms (r = 0.30, 95% CI = 0.30 to 6.16, p = 0.001; r = 0.21, 95% CI = 0.21 to 4.19, p = 0.001, respectively).Conclusion:  The present research suggests that GAD symptoms are prevalent among fresh undergraduates and are associated with both intolerances of uncertainty and parental attachment. Psychological interventions for undergraduate students may be needed to target these factors

Association between parental involvement and academic achievement of deaf children at Mulago school for the deaf, Kampala, Uganda

Background: Deaf children face many challenges in dealing with educational opportunities and ensuring attainment of academic skills. A parent's involvement in the child's education has the potential to enhance academic performance. We sought to study the association between parental involvement and academic achievement among deaf children in Uganda. Methods: Using purposive consecutive sampling, one hundred and eight parents of deaf children (Primary 1 to 7) were recruited from Mulago School for the Deaf in Kampala, Uganda. The Parental Involvement Questionnaire was used to measure parents\u2019 involvement in school activities while the Wide Range Assessment Test, third edition, was used to measure academic achievement (reading, spelling and arithmetic). Linear regression was used to test the association between parental involvement and academic achievement. Results: One hundred and five children with mean age 11.09 years (SD = 2.89) were enrolled of whom 56 (35.3%) were female. With a Beta coefficient of 0.07, a 7% unit increase of summed parental involvement showed no significant association between parental involvement and academic achievement (p = 0.46) of the deaf children. Conclusion: Parental involvement was not associated with academic achievement among deaf children in Kampala. Other factors associated with academic achievement need to be identified to enhance deaf children's performance at school. DOI: https://dx.doi.org/10.4314/ahs.v19i2.53 Cite as: Akellot J, Bangirana P. Association between parental involvement and academic achievement of deaf children at Mulago deaf school, Kampala, Uganda. Afri Health Sci.2019;19(2): 2270-2281. https://dx.doi.org/10.4314/ahs.v19i2.5

Rehabilitation for cognitive impairments after cerebral malaria in African children: strategies and limitations

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72221/1/j.1365-3156.2006.01685.x.pd

The Relationship between Visual-Spatial and Auditory-Verbal Working Memory Span in Senegalese and Ugandan Children

BACKGROUND: Using the Kaufman Assessment Battery for Children (K-ABC) Conant et al. (1999) observed that visual and auditory working memory (WM) span were independent in both younger and older children from DR Congo, but related in older American children and in Lao children. The present study evaluated whether visual and auditory WM span were independent in Ugandan and Senegalese children. METHOD: In a linear regression analysis we used visual (Spatial Memory, Hand Movements) and auditory (Number Recall) WM along with education and physical development (weight/height) as predictors. The predicted variable in this analysis was Word Order, which is a verbal memory task that has both visual and auditory memory components. RESULTS: Both the younger (<8.5 yrs) and older (>8.5 yrs) Ugandan children had auditory memory span (Number Recall) that was strongly predictive of Word Order performance. For both the younger and older groups of Senegalese children, only visual WM span (Spatial Memory) was strongly predictive of Word Order. Number Recall was not significantly predictive of Word Order in either age group. CONCLUSIONS: It is possible that greater literacy from more schooling for the Ugandan age groups mediated their greater degree of interdependence between auditory and verbal WM. Our findings support those of Conant et al., who observed in their cross-cultural comparisons that stronger education seemed to enhance the dominance of the phonological-auditory processing loop for WM

Patterns of traumatic brain injury and six-month neuropsychological outcomes in Uganda

Abstract Background Traumatic brain injuries in Uganda are on the increase, however little is known about the neuropsychological outcomes in survivors. This study characterized patients with traumatic brain injury (TBI) and the associated six-month neuropsychological outcomes in a Ugandan tertiary hospital. Methods Patients admitted at Mulago Hospital with head injury from November 2015 to April 2016 were prospectively enrolled during admission and followed up at six months after discharge to assess cognition, posttraumatic stress symptoms (PTSS), depression symptoms and physical disability. The outcomes were compared to a non-head-injury group recruited from among the caretakers, siblings and neighbours of the patients with age and sex entered as covariates. Results One hundred and seventy-one patients and 145 non-head injury participants were enrolled. The age range for the whole sample was 1 to 69 years with the non-head injury group being older (mean age (SD) 33.34 (13.35) vs 29.34 (14.13) years of age, p = 0.01). Overall, motorcycle crashes (36/171, 38.6%) and being hit by an object (58/171, 33.9%) were the leading causes of TBI. Head injury from falls occurred more frequently in children < 18 years (13.8% vs 2.8%, p = 0.03). In adults 18 years and older, patients had higher rates of neurocognitive impairment (28.4% vs 6.6%, p < 0.0001), PTSS (43.9% vs 7.9%, p < 0.0001), depression symptoms (55.4% vs 10%, p < 0.0001) and physical disability (7.2% vs 0%, p = 0.002). Lower Glasgow Coma Score (GCS) on admission was associated with neurocognitive impairment (11.6 vs 13.1, p = 0.04) and physical disability (10 vs 12.9, p = 0.01) six months later. Conclusion This first such study in the East-African region shows that depth of coma on admission in TBI is associated with neurocognitive impairment and physical disability.https://deepblue.lib.umich.edu/bitstream/2027.42/147735/1/12883_2019_Article_1246.pd

Lack of mortality in 22 children with sickle cell anemia and severe malarial anemia

Retrospective studies suggest that there is high mortality in children with sickle cell anemia (SCA) and severe malaria. We assessed mortality in Ugandan children with severe malarial anemia (SMA, n = 232) or cerebral malaria (CM, n = 267) by sickle cell hemoglobin genotype. Admission and 2‐year follow‐up mortality did not differ among children with SMA who had homozygous form of sickle cell hemoglobin (HbSS) versus normal form of adult hemoglobin (admission, 0/22, 0%, vs. 1/208, 0.5%; follow‐up, 1/22, 4.5%; 7/207, 3.4%, respectively; all P > 0.6). The single child with CM and HbSS survived. The study findings highlight the need for large prospective studies of malaria‐related mortality in children with SCA

Global research priorities for infections that affect the nervous system

Infections that cause significant nervous system morbidity globally include viral (for example, HIV, rabies, Japanese encephalitis virus, herpes simplex virus, varicella zoster virus, cytomegalovirus, dengue virus and chikungunya virus), bacterial (for example, tuberculosis, syphilis, bacterial meningitis and sepsis), fungal (for example, cryptococcal meningitis) and parasitic (for example, malaria, neurocysticercosis, neuroschistosomiasis and soil-transmitted helminths) infections. The neurological, cognitive, behavioural or mental health problems caused by the infections probably affect millions of children and adults in low- and middle-income countries. However, precise estimates of morbidity are lacking for most infections, and there is limited information on the pathogenesis of nervous system injury in these infections. Key research priorities for infection-related nervous system morbidity include accurate estimates of disease burden; point-of-care assays for infection diagnosis; improved tools for the assessment of neurological, cognitive and mental health impairment; vaccines and other interventions for preventing infections; improved understanding of the pathogenesis of nervous system disease in these infections; more effective methods to treat and prevent nervous system sequelae; operations research to implement known effective interventions; and improved methods of rehabilitation. Research in these areas, accompanied by efforts to implement promising technologies and therapies, could substantially decrease the morbidity and mortality of infections affecting the nervous system in low- and middle-income countries