Infections of the Central Nervous System and Child Development in Sub-Saharan Africa



Infectious diseases contribute significantly to child mortality in Africa; however, mortality rates only represent part of the problem. Among those who survive, cognitive, educational, and behavioral impairments have been reported. In the current chapter, I highlight the neurocognitive deficits, mental health problems, and poor educational outcomes associated with exposure to infectious diseases early in life. Special attention is paid to outcomes of HIV-infected children and children exposed to malaria. The chapter concludes by highlighting two approaches to intervention that have been observed to remediate some of the adverse effects of exposure to infections. Given the prevalence of infectious diseases in the African context, there are huge adverse effects and loss in human potential associated with childhood infectious diseases; identifying points of interventions and implementing evidence-based intervention for children infected with these conditions need to be a priority for applied developmental sciences.


Infections Central nervous system Child development HIV/AIDS Malaria Meningitis Neonatal jaundice Sepsis Evidence-based Intervention Disease burden 


  1. Abubakar, A., Holding, P., Newton, C. R., van Baar, A., & van de Vijver, F. J. (2009). The role of weight for age and disease stage in poor psychomotor outcome of HIV-infected children in Kilifi, Kenya. Developmental Medicines and Child Neurology, 51, 968–973.CrossRefGoogle Scholar
  2. Abubakar, A., Van Baar, A., Van de Vijver, F. J., Holding, P., & Newton, C. R. (2008). Paediatric HIV and neurodevelopment in sub-Saharan Africa: A systematic review. Tropical Medicine and International Health, 13, 880–887.CrossRefPubMedGoogle Scholar
  3. Achenbach, T. M., & Rescorla, L. (2001). ASEBA school-age forms & profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
  4. Bagenda, D., Nassali, A., Kalyesubula, I., Sherman, B., Drotar, D., Boivin, M. J., & Olness, K. (2006). Health, neurologic, and cognitive status of HIV-infected, long-surviving, and antiretroviral-naive Ugandan children. Pediatrics, 117, 729–740.CrossRefPubMedGoogle Scholar
  5. Baillieu, N., & Potterton, J. (2008). The extent of delay of language, motor, and cognitive development in HIV-positive infants. Journal of Neurologic Physical Therapy, 32, 118–121.CrossRefPubMedGoogle Scholar
  6. Bangirana, P., Idro, R., John, C. C., & Boivin, M. J. (2006). Rehabilitation for cognitive impairments after cerebral malaria in African children: Strategies and limitations. Tropical Medicine & International Health: TM & IH, 11, 1341–1349.CrossRefGoogle Scholar
  7. Bangirana, P., Allebeck, P., Boivin, M. J., John, C. C., Page, C., Ehnvall, A., & Musisi, S. (2011). Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: A randomised trial. BMC Neurology, 11(1), 96.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Bangirana, P., Nakasujja, N., Giordani, B., Opoka, R. O., John, C. C., & Boivin, M. J. (2009). Reliability of the Luganda version of the Child Behaviour Checklist in measuring behavioural problems after cerebral malaria. Child and Adolescent Psychiatry and Mental Health, 3(1), 38.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Barlow, J. L., Mung’ala-Odera, V., Gona, J., & Newton, C. R. J. C. (2001). Brain damage after neonatal tetanus in a rural Kenyan hospital. Tropical Medicine and International Health, 6, 305–308.CrossRefPubMedGoogle Scholar
  10. Bayley, N. (1993). The Bayley scales of infant development (2nd ed.). New York, NY: Harcourt/Psychological Corporation.Google Scholar
  11. Berhane, R., Bagenda, D., Marum, L., Aceng, E., Ndugwa, C., Bosch, R. J., & Olness, K. (1997). Growth failure as a prognostic indicator of mortality in pediatric HIV infection. Pediatrics, 100, 1–4.CrossRefGoogle Scholar
  12. Boivin, M. J. (2002). Effects of early cerebral malaria on cognitive ability in Senegalese children. Journal of Developmental and Behavioural Pediatics, 23, 353–364.CrossRefGoogle Scholar
  13. Boivin, M. J., Bangirana, P., Byarugaba, J., Opoka, R. O., Idro, R., Jurek, A. M., & John, C. C. (2007). Cognitive impairment after cerebral malaria in children: A prospective study. Pediatrics, 119, e360–e366.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Boivin, M. J., Bangirana, P., Nakasujja, N., Page, C. F., Shohet, C., Givon, D., … Klein, P. S. (2013). A year-long caregiver training program to improve neurocognition in preschool Ugandan HIV-exposed children. Journal of Developmental and Behavioral Pediatrics, 34, 269–278.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Boivin, M. J., Busman, R. A., Parikh, S. M., Bangirana, P., Page, C. F., Opoka, R. O., & Giordani, B. (2010). A pilot study of the neuropsychological benefits of computerized cognitive rehabilitation in Ugandan children with HIV. Neuropsychology, 24, 667–673.CrossRefPubMedGoogle Scholar
  16. Boivin, M. J., Ruel, T. D., Boal, H. E., Bangirana, P., Cao, H., Eller, L. A., … Wong, J. K. (2010). HIV-subtype A is associated with poorer neuropsychological performance compared with subtype D in antiretroviral therapy-naive Ugandan children. AIDS, 24, 1163–1170.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Boivin, M. J., Gladstone, M. J., Vokhiwa, M., Birbeck, G. L., Magen, J. G., Page, C., … Taylor, T. E. (2011). Developmental outcomes in Malawian children with retinopathy-positive cerebral malaria. Tropical Medicine & International Health, 16(3), 263–271.CrossRefGoogle Scholar
  18. Boyede, G. O., Lesi, F. E., Ezeaka, C. V., & Umeh, C. S. (2013a). The neurocognitive assessment of HIV-infected school-aged Nigerian children. World, 3, 124–130.Google Scholar
  19. Boyede, G. O., Lesi, F. E., Ezeaka, V. C., & Umeh, C. S. (2013b). The influence of clinical staging and use of antiretroviral therapy on cognitive functioning of school-aged Nigerian children with HIV infection. Journal of AIDS Clinical Research, 4(195), 2.Google Scholar
  20. Busman, R. A., Page, C., Oka, E., Giordani, B., & Boivin, M. J. (2013). Factors contributing to the psychosocial adjustment of Ugandan preschool children with HIV. In Boivin, M.J. & Giordani, B. (Eds) Neuropsychology of Children in Africa: Perspectives on Risk and Resilience (pp. 95–115). New York, NY: Springer.Google Scholar
  21. Caldwell, B. M., & Bradley, R. H. (2001). HOME Inventory administration manual. Little Rock, AR: University of Arkansas.Google Scholar
  22. Carter, J. A., Lees, J. A., Gona, J. K., Murira, G., Rimba, K., Neville, B. G., & Newton, C. R. (2006). Severe falciparum malaria and acquired childhood language disorder. Developmental Medicine and Child Neurology, 48, 51–57.CrossRefPubMedGoogle Scholar
  23. Carter, J. A., Murira, G. M., Ross, A. J., Mung'Ala-Odera, V., & Newton, C. R. (2003). Speech and language sequelae of severe malaria in Kenyan children. Brain Injury, 17, 217–224.CrossRefPubMedGoogle Scholar
  24. Carter, J. A., Ross, A. J., Neville, B. G., Obiero, E., Katana, K., Mung'ala-Odera, V., … Newton, C. R. J. C. (2005). Developmental impairments following severe falciparum malaria in children. Tropical Medicine International Health, 10, 3–10.CrossRefPubMedGoogle Scholar
  25. Chandran, A., Herbert, H., Misurski, D., & Santosham, M. (2011). Long-term sequelae of childhood bacterial meningitis: An underappreciated problem. The Pediatric Infectious Disease Journal, 30, 3–6.CrossRefPubMedGoogle Scholar
  26. Cluver, L., Orkin, M., Boyes, M. E., Sherr, L., Makasi, D., & Nikelo, J. (2013). Pathways from parental AIDS to child psychological, educational and sexual risk: Developing an empirically-based interactive theoretical model. Social Science & Medicine, 87, 185–193.CrossRefGoogle Scholar
  27. Cluver, L. D., Orkin, M., Gardner, F., & Boyes, M. E. (2012). Persisting mental health problems among AIDS-orphaned children in South Africa. Journal of Child Psychology and Psychiatry, 53, 363–370.CrossRefPubMedGoogle Scholar
  28. Devendra, A., Makawa, A., Kazembe, P. N., Calles, N. R., & Kuper, H. (2013). HIV and childhood disability: A case-controlled study at a paediatric antiretroviral therapy centre in Lilongwe, Malawi. PLoS One, 8(12), e84024.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Drotar, D., Olness, K., Wiznitzer, M., Guay, L., Marum, L., Svilar, G., … Kiziri-Mayengo, R. (1997). Neurodevelopmental outcomes of Ugandan infants with human immunodeficiency virus type 1 infection. Pediatrics, 100, E5.CrossRefPubMedGoogle Scholar
  30. Drotar, D., Olness, K., Wiznitzer, M., Schatschneider, C., Marum, L., Guay, L., … Mayengo, R. K. (1999). Neurodevelopmental outcomes of Ugandan infants with HIV infection: An application of growth curve analysis. Health Psychology, 18, 114–121.CrossRefPubMedGoogle Scholar
  31. Edmond, K., Dieye, Y., Griffiths, U. K., Fleming, J., Ba, O., Diallo, N., & Mulholland, K. (2010). Prospective cohort study of disabling sequelae and quality of life in children with bacterial meningitis in urban Senegal. The Pediatric Infectious Disease Journal, 29, 1023–1029.PubMedGoogle Scholar
  32. Fernando, S. D., Rodrigo, C., & Rajapakse, S. (2010). The ‘hidden’ burden of malaria: Cognitive impairment following infection. Malaria Journal, 9, 366.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Friedman, J. F., Kwena, A. M., Mirel, L. B., Kariuki, S. K., Terlouw, D. J., Phillips-Howard, P. A., … Ter Kuile, F. O. (2005). Malaria and nutritional status among pre-school children: Results from cross-sectional surveys in western Kenya. The American Journal of Tropical Medicine and Hygiene, 73, 698–704.PubMedGoogle Scholar
  34. Halliday, K. E., et al. (2012). Plasmodium falciparum, anaemia and cognitive and educational performance among school children in an area of moderate malaria transmission: Baseline results of a cluster randomized trial on the coast of Kenya. Tropical Medicine & International Health, 17(5), 532–549.CrossRefGoogle Scholar
  35. Holding, P., & Boivin, M. J. (2013). The assessment of neuropsychological outcomes in pediatric severe malaria. In M. Boivin & G. Bruno (Eds.), Neuropsychology of children in Africa (pp. 235–275). New York, NY: Springer.CrossRefGoogle Scholar
  36. Holding, P. A. (1998). Does cerebral malaria constitute a risk factor for special educational needs? London: University of London.Google Scholar
  37. Holding, P. A., Taylor, H. G., Kazungu, S. D., Mkala, T., Gona, J., Mwamuye, B., … Stevenson, J. (2004). Assessing cognitive outcomes in a rural African population: Development of a neuropsychological battery in Kilifi District, Kenya. Journal of the International Neuropsychological Society, 10, 246–260.CrossRefPubMedGoogle Scholar
  38. Idro, R., Carter, J. A., Fegan, G., Neville, B. G., & Newton, C. R. (2006). Risk factors for persisting neurological and cognitive impairments following cerebral malaria. Archives of Disease in Childhood, 91, 142–148.CrossRefPubMedGoogle Scholar
  39. Idro, R., Kakooza-Mwesige, A., Balyejjussa, S., Mirembe, G., Mugasha, C., Tugumisirize, J., & Byarugaba, J. (2010). Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan children. BMC Research Notes, 3, 104.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Jukes, M. C., Pinder, M., Grigorenko, E. L., Smith, H. B., Walraven, G., Bariau, E. M., … Cheung, Y. B. (2006). Long-term impact of malaria chemoprophylaxis on cognitive abilities and educational attainment: Follow-up of a controlled trial. PLOS Hub for Clinical Trials, 1(4), e19.CrossRefGoogle Scholar
  41. Kamau, J. W., Kuria, W., Mathai, M., Atwoli, L., & Kangethe, R. (2012). Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community. AIDS Care, 24, 836–842.CrossRefPubMedGoogle Scholar
  42. Kaufman, A. S., & Kaufman, N. L. (1983). Kaufman assessment battery for children: Administration and scoring manual. Circle Pines, MN: American Guidance Service.Google Scholar
  43. Kihara, M., Carter, J., & Newton, C. (2006). The effects of Plasmodium Falciparum on cognition: A systematic review. Tropical Medicine & International Health, 11, 386–397.CrossRefGoogle Scholar
  44. Kihara, M., Carter, J. A., Holding, P. A., Vargha-Khadem, F., Scott, R. C., Idro, R., … Newton, C. R. (2009). Impaired everyday memory associated with encephalopathy of severe malaria: The role of seizures and hippocampal damage. Malaria Journal, 8, 273.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Kihara, M., de Haan, M., Garrashi, H. H., Neville, B. G., & Newton, C. R. (2010). Atypical brain response to novelty in rural African children with a history of severe falciparum malaria. Journal of the Neurological Sciences, 296, 88–95.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Kihara, M., de Haan, M., Were, E. O., Garrashi, H. H., Neville, B. G., & Newton, C. R. (2012). Cognitive deficits following exposure to pneumococcal meningitis: An event-related potential study. BMC Infectious Diseases, 12, 79.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Laus, M. F., Duarte Manhas Ferreira Vales, L., Braga Costa, T. M., & Sousa Almeida, S. (2011). Early postnatal protein-calorie malnutrition and cognition: A review of human and animal studies. International Journal of Environmental Research and Public Health, 8, 590–612.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Makumbi, F. E., Gray, R. H., Serwadda, D., Nalugoda, F., Kiddugavu, M., Sewankambo, N. K., … Waweru, M. J. (2005). The incidence and prevalence of orphanhood associated with parental HIV infection: A population-based study in Rakai, Uganda. AIDS, 19, 1669–1676.CrossRefPubMedGoogle Scholar
  49. Makumbi, F. E., Nakigozi, G., Sekasanvu, J., Lukabwe, I., Kagaayi, J., Lutalo, T., … Gray, R. (2012). Incidence of orphanhood before and after implementation of a HIV care programme in Rakai, Uganda. Tropical Medicine & International Health, 17, e94–e102.CrossRefGoogle Scholar
  50. McGrath, N., Bellinger, D., Robins, J., Msamanga, G. I., Tronick, E., & Fawzi, W. W. (2006). Effect of maternal multivitamin supplementation on the mental and psychomotor development of children who are born to HIV-1–infected mothers in Tanzania. Pediatrics, 117, e216–e225.CrossRefPubMedGoogle Scholar
  51. McGrath, N., Fawzi, W. W., Bellinger, D., Robins, J., Msamanga, G. I., Manji, K., & Tronick, E. (2006). The timing of mother-to-child transmission of human immunodeficiency virus infection and the neurodevelopment of children in Tanzania. The Pediatric Infectious Disease Journal, 25, 47–52.CrossRefPubMedGoogle Scholar
  52. Menon, A., Glazebrook, C., & Ngoma, M. S. (2009). Mental health of HIV positive adolescents in Zambia. Medical Journal of Zambia, 36, 151–156.Google Scholar
  53. Msellati, P., Lepage, P., Deo-Gratias, H., Van Goethem, C., Van de Perre, P., & Dabis, F. (1993). Neurodevelopmental testing of children born to human immunodeficiency virus Type 1 seropositive and seronegative mothers: A prospective cohort study in Kigali, Rwanda. Pediatrics, 92, 843–848.PubMedGoogle Scholar
  54. Mung’ala-Odera, V., Meehan, R., Njuguna, P., Mturi, N., Alcock, K. J., & Newton, C. R. (2006). Prevalence and risk factors of neurological disability and impairment in children living in rural Kenya. International Journal of Epidemiology, 35, 683–688.CrossRefPubMedGoogle Scholar
  55. Musisi, S., & Kinyanda, E. (2009). Emotional and behavioral disorders in HIV seropositive adolescents in urban Uganda. East African Medical Journal, 86, 16–24.CrossRefPubMedGoogle Scholar
  56. Mwaniki, M. K., Atieno, M., Lawn, J. E., & Newton, C. R. (2012). Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: A systematic review. The Lancet, 379(9814), 445–452.CrossRefGoogle Scholar
  57. Nankabirwa, J., Wandera, B., Kiwanuka, N., Staedke, S. G., Kamya, M. R., & Brooker, S. J. (2013). Asymptomatic plasmodium infection and cognition among primary schoolchildren in a high malaria transmission setting in Uganda. The American Journal of Tropical Medicine and Hygiene, 88, 1102–1108.CrossRefPubMedPubMedCentralGoogle Scholar
  58. Nickel, R. E., Renke, C. A., & Gallenstein, J. S. (1989). The infant motor screen. Developmental Medicine & Child Neurology, 31, 35–42.CrossRefGoogle Scholar
  59. Nyaradi, A., Li, J., Hickling, S., Foster, J., & Oddy, W. H. (2013). The role of nutrition in children’s neurocognitive development, from pregnancy through childhood. Frontiers in Human Neuroscience, 7, 97.CrossRefPubMedPubMedCentralGoogle Scholar
  60. Olney, D. K., Kariger, P. K., Stoltzfus, R. J., Khalfan, S. S., Ali, N. S., Tielsch, J. M., … Pollitt, E. (2009). Development of nutritionally at-risk young children is predicted by malaria, anemia, and stunting in Pemba, Zanzibar. The Journal of Nutrition, 139, 763–772.CrossRefPubMedGoogle Scholar
  61. Potterton, J., Stewart, A., Cooper, P., & Becker, P. (2010). The effect of a basic home stimulation programme on the development of young children infected with HIV. Developmental Medicine & Child Neurology, 52, 547–551.CrossRefGoogle Scholar
  62. Raven, J. C., Court, J. H., & Raven, J. (1977). Manual for Raven’s progressive matrices and vocabulary scales. London: Raven, J.C. Lewis, H.K.Google Scholar
  63. Ruel, T. D., Boivin, M. J., Boal, H. E., Bangirana, P., Charlebois, E., Havlir, D. V., … Wong, J. K. (2012). Neurocognitive and motor deficits in HIV-infected Ugandan children with high CD4 cell counts. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 54, 1001–1009.CrossRefGoogle Scholar
  64. Sandford, J. A. (2007). Captain’s log computerized cognitive training system. Richmond, VA: Brain Train.Google Scholar
  65. Sherr, L., Croome, N., Parra-Castaneda, K., Bradshaw, K., & Herrero-Romero, R. (2014). Developmental challenges in HIV infected children—An updated systematic review. Children and Youth Services Review, 45, 74–89.CrossRefGoogle Scholar
  66. Smith, L., Adnams, C., & Eley, B. (2008). Neurological and neurocognitive function of HIV-infected children commenced on antiretroviral therapy. SAJCH, 2, 108–113.Google Scholar
  67. Ssenkusu, J. M., Hodges, J. S., Opoka, R. O., Idro, R., Shapiro, E., John, C. C., & Bangirana, P. (2016). Long-term behavioral problems in children with severe malaria. Pediatrics, 138(5), e20161965.Google Scholar
  68. Stein, A., Krebs, G., Richter, L., Tomkins, A., Rochat, T., & Bennish, M. L. (2005). Babies of a pandemic. Archives of Childhood Diseases, 90, 116–118.CrossRefGoogle Scholar
  69. Sutcliffe, C. G., van Dijk, J. H., Bolton, C., Persaud, D., & Moss, W. J. (2008). Effectiveness of antiretroviral therapy among HIV-infected children in sub-Saharan Africa. The Lancet Infectious Diseases, 8, 477–489.CrossRefPubMedGoogle Scholar
  70. UNAIDS. (2006). AIDS epidemiology update 2006 (Vol. 2006). New York: UNAIDS.Google Scholar
  71. UNAIDS. (2012). Report on the global AIDS epidemic.Google Scholar
  72. Whitehead, N., Potterton, J., & Coovadia, A. (2013). The neurodevelopment of HIV-infected infants on HAART compared to HIV-exposed but uninfected infants. AIDS Care, 26, 497–504.CrossRefPubMedGoogle Scholar
  73. Wiktor, S. Z., Ekpini, E., & Nduati, R. (1997). Prevention of mother-to-child transmission of HIV1 in Africa. AIDS, 11(Suppl B), S7987.Google Scholar
  74. Wolf, M., Beunen, G., Casaer, P., & Wolf, B. (1997). Extreme hyperbilirubinaemia in Zimbabwean neonates: Neurodevelopmental outcome at 4 months. European Journal of Pediatrics, 156, 803–807.CrossRefPubMedGoogle Scholar
  75. Wolf, M., Beunen, G., Casaer, P., & Wolf, B. (1998). Neurological status in severely jaundiced Zimbabwean neonates. Journal of Tropical Pediatrics, 44, 161–164.CrossRefPubMedGoogle Scholar
  76. Wolf, M.-J., Wolf, B., Beunen, G., & Casaer, P. (1999). Neurodevelopmental outcome at 1 year in Zimbabwean neonates with extreme hyperbilirubinaemia. European Journal of Pediatrics, 158, 111–114.CrossRefPubMedGoogle Scholar
  77. World Health Organization. (2010). International Classification of Diseases (10th Revision).Google Scholar
  78. World Health Organization. (2013). World Malaria Report 2013. Retrieved from

Copyright information

© Springer Science+Business Media LLC 2017

Authors and Affiliations

  1. 1.Department of Culture StudiesTilburg UniversityTilburgThe Netherlands

Personalised recommendations