Cerebral Malaria in African Children: Clinical and Ophthalmic Prognostic Indicators, Management, and Long-Term Outcomes — a Narrative Review
Authors
Ayobami Oyetunji ALABI
Department of Paediatrics and Child Health, Ladoke Akintola University of Technology (LAUTECH) & Department of Paediatrics and Child Health, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
Author
Sussanah Temitope ADEPOJU
Department of Ophthalmology, Ladoke Akintola University of Technology (LAUTECH) & Department of Ophthalmology, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
Author
Bukola Adetutu SAYOMI
Department of Paediatrics and Child Health, Ladoke Akintola University of Technology (LAUTECH) & Department of Paediatrics and Child Health, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
Author
Background: Cerebral malaria (CM) is a severe neurological complication of Plasmodium falciparum infection in African children, contributing significantly to morbidity and mortality. This review synthesises evidence on epidemiology, pathogenesis, prognostic
indicators, management, and outcomes of paediatric CM with an emphasis on Nigerian data.
Methods: This narrative review was conducted in accordance with the scale for the assessment of narrative review articles (SANRA). Literature retrieved was sourced from databases utilising a combination of free-text and MeSH terms. The search covered from
January 2010 to May 2025. Evidence was synthesised across thematic domains, including epidemiology, pathogenesis, management, prognostic indicators, and neurocognitive outcomes.
Results: CM accounts for up to 20% of paediatric severe malaria admissions and mortality rates of 15–25% among African children. The typical clinical findings of CM among children include coma, cerebral oedema, seizures, and malarial retinopathy. Prognostic
indicators include the clinical, biochemical parameters, haematological, emerging biomarkers and imaging findings. Supportive care, including seizure control, blood transfusion, and glucose correction and monitoring, remains critical for survival.
Neurological sequelae, including epilepsy, cerebellar dysfunction, cognitive impairments, and behavioural disorders, are generally frequent and prevalent, with Nigerian cohorts reporting impaired school performance and psychosocial challenges.
Conclusions: Paediatric CM is a distinct clinical entity with high mortality and hidden longterm disability. Bedside prognostic indicators remain the most practical in resource-limited settings, while biomarkers and neuroimaging show promise but remain inaccessible. Prompt stabilisation, definitive and improved supportive care, and post-discharge rehabilitation are critical for reducing the burden and poor prognosis of CM in children.
