Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial.
Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial.
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DOI：
10.1186/1471-2377-11-96
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发表时间：
2011-08-04
期刊：
影响因子：
2.6
通讯作者：
Musisi S
中科院分区：
文献类型：
--
作者：
Bangirana P;Allebeck P;Boivin MJ;John CC;Page C;Ehnvall A;Musisi S
非洲儿童感染严重疟疾不仅与高死亡率有关，而且与认知缺陷的高风险有关。有证据表明，在发病几年后采取的干预措施是有效的，但对发病后立即采取的干预措施却一无所知。我们设计了一项研究，将三个月前患有严重疟疾的儿童纳入认知干预计划，并评估其在认知、学业和行为方面的直接益处。这项平行组随机研究于2008年2月至2010年10月在乌干达坎帕拉市进行。在严重疟疾发作三个月后，对61名患有严重疟疾的5至12岁乌干达儿童进行了认知评估（使用考夫曼儿童评估单元，第二版和注意变量测试）、学术技能（广泛成就测试，第三版）和精神病理行为（儿童行为检查表）。28人被随机分配到16个为期8周的计算机认知康复训练组，33人被分配到非治疗组。干预后评估在干预结束一个月后进行。采用协方差分析检测干预后评估后两组之间的差异，调整年龄、性别、体重、年龄z分、家庭环境质量、入院与干预后测试之间的时间以及干预前得分。主要结果是干预组注意力得分的提高。本试验已注册为当前对照试验，注册号为ISRCTN53183087。干预组在学习均分（SE）方面的干预效果显著，[93.89（4.00）比106.38 (4.32),P = 0.04]，而在工作记忆方面，干预组表现较差[27.42（0.66）比25.34 (0.73),P = 0.04]。在其他认知结果或任何学术或行为测量中没有观察到任何影响。在这项初步研究中，我们的计算机化认知训练项目在严重疟疾后三个月对认知结果有直接影响，但不影响学术技能或行为。需要在几年后进行更大规模的随访试验，以调查观察到的益处是否持续。ISRCTN: ISRCTN53183087
Infection with severe malaria in African children is associated with not only a high mortality but also a high risk of cognitive deficits. There is evidence that interventions done a few years after the illness are effective but nothing is known about those done immediately after the illness. We designed a study in which children who had suffered from severe malaria three months earlier were enrolled into a cognitive intervention program and assessed for the immediate benefit in cognitive, academic and behavioral outcomes. This parallel group randomised study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-one Ugandan children aged 5 to 12 years with severe malaria were assessed for cognition (using the Kaufman Assessment Battery for Children, second edition and the Test of Variables of Attention), academic skills (Wide Range Achievement Test, third edition) and psychopathologic behaviour (Child Behaviour Checklist) three months after an episode of severe malaria. Twenty-eight were randomised to sixteen sessions of computerised cognitive rehabilitation training lasting eight weeks and 33 to a non-treatment group. Post-intervention assessments were done a month after conclusion of the intervention. Analysis of covariance was used to detect any differences between the two groups after post-intervention assessment, adjusting for age, sex, weight for age z score, quality of the home environment, time between admission and post-intervention testing and pre-intervention score. The primary outcome was improvement in attention scores for the intervention group. This trial is registered with Current Controlled Trials, number ISRCTN53183087. Significant intervention effects were observed in the intervention group for learning mean score (SE), [93.89 (4.00) vs 106.38 (4.32), P = 0.04] but for working memory the intervention group performed poorly [27.42 (0.66) vs 25.34 (0.73), P = 0.04]. No effect was observed in the other cognitive outcomes or in any of the academic or behavioural measures. In this pilot study, our computerised cognitive training program three months after severe malaria had an immediate effect on cognitive outcomes but did not affect academic skills or behaviour. Larger trials with follow-up after a few years are needed to investigate whether the observed benefits are sustained. ISRCTN: ISRCTN53183087