Mental disorders, also called psychiatric disorders, refer to unconventional or anomalous behavioral patterns, feelings, thoughts, perceptions and beliefs that cause distress or disability, and which are not developmentally or socially acceptable. Plasmodium falciparum (P. falciparum) malaria is the most common parasitic infection of the central nervous system and sub-Saharan Africa has the highest burden of this disease. Children living in this region of the world bear the brunt of P. falciparum malaria and neurological complications commonly associated with it.
The objective of this review was to synthesize the best available evidence on the association of P. falciparum malaria and the short-term and long-term mental disorders of children.
Types of participants
Study participants aged five to 19 years who were residing in sub-Saharan Africa.
Types of intervention(s)/phenomena of interest
This review considered studies that examined the association between P. falciparum malaria (cerebral malaria, repetitive uncomplicated malaria or asymptomatic malaria) as exposure and a range of mental disorders as an outcome.
Types of studies
This review considered epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental trials, prospective and retrospective cohort studies, case control studies and analytical cross-sectional studies.
Types of outcomes
This review considered studies that included (but were not limited to) the following mental disorder outcome measures: cognitive deficits and impairments, acquired language disorder, school performance and psychomotor skills. There are many tests to measure these outcomes. Cognitive deficits and impairments are commonly measured with the Mini-Cog Test, language disorders with the Language Delays Assessment Test and psychomotor skills are measured with the Two-point Threshold Test (distance perception) and the Color Timing Test that measures mental speed. School performance is not commonly measured with norm-referenced standardized tests due to the large disparities in achievement between schools. This outcome measure is often picked from class assessment and examination records of the students, relative to their classmates.
A three-step search strategy was utilized in this review. Relevant studies published in the English language from 1980 to 2012, when the association between malaria and mental disorders was highlighted, were considered for inclusion in this review. Unpublished data was also searched for within the same period. The databases searched included PubMed, CINAHL, PsycARTICLES, PsycBITES, PsycINFO, Social Science Citation Index, ProQuest Dissertations and Theses (PQDT)/Digital dissertations, ProQuest Social Services abstracts, ProQuest Sociological abstracts, World Bank, British Library for Development Studies, SCOPUS and Mednar.
Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute (i.e. JBI-MAStARI). Any disagreements that arose between the reviewers were resolved through discussion.
Data were extracted from quantitative papers included in the review using the standardized data extraction tool from JBI-MAStARI. The data extracted included specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives.
Meta-analysis was not done because the nature of the results from included studies did not make it statistically prudent to pool the results.
A total of eight studies which met the inclusion criteria for this review were identified. Four (50%) studies were conducted in Kenya, three (37.5%) from Uganda and one (12.5%) from Senegal. The results of the review suggested that P. falciparum malaria was associated with mental disorders.
The review suggested that P. falciparum malaria is associated with mental disorders. However, there should be collaboration between investigators in this area so that multi-center trials can be conducted to ascertain the effects of P. falciparum malaria on more focused mental disorder outcomes.
Recommendation for practice
The results from the present review suggest that P. falciparum malaria is associated with mental disorders. Health professionals should therefore be aware of the vulnerability of survivors of malaria to mental disorders and make referrals to mental health professionals when they suspect any mental disorders during the management of malaria cases. However, the scope of the study did not cover temporality to show that P. falciparum malaria led to mental disorders.
Recommendations for research
The current review has shown that there is paucity of studies which focus on common endpoints, methodologies and analysis. There is therefore the need for researchers to collaborate and conduct a multicenter trial in this area.