5th Edition of International Neurology Conference 2026

Abstract

The issue: Neurologic complications from malaria are a major cause of morbidity among school-aged children worldwide where the disease is endemic, but are preventable with early diagnosis and effective treatment. Social determinants of health impact access to appropriate care; there is now a moral imperative to provide equitable access to WHO-advocated management as school-based programs offer an proven way to reduce morbidity, and currently very large numbers of children globally continue to suffer adverse neurologic consequences from malaria. 

Pathophysiology: During the acute reproductive stage of plasmodium falciparum infections adhesion of malaria parasite-infected red blood cells occurs which causes acute disruption of flow in small cerebral blood vessels. The consequences of compromised microvascular blood flow are irreversible and can be lethal; they include vascular occlusion, cerebral inflammation from an excessive immune response (cytokine storm), and adherence of infected red blood cells to the endothelium of blood vessels (sequestration).

Neurological sequelae: While most survivors of an acute infection recover, up to a third of infected children develop neurological deficits and cognitive sequelae, and untreated, partially treated and repetitive infections cause cumulative neurologic effects which rob children of their intellect and academic potential over time. Common neurological sequelae include ataxia, paralysis, paresis, cortical blindness, epilepsy, deafness, behavioral disorders, language disorders, and cognitive impairment. 

Prevention: Death and disability from malaria in school-aged children can be prevented by timely diagnosis and prompt treatment, and the World Health Organization (WHO) continues to call for innovative interventions to improve accurate diagnosis and effective treatment despite the recent availability of malaria vaccines because malaria-related child mortality and morbidity remain so high. Schools are a logical location to access the at risk target population, and a novel school-based, teacher-driven model is now available that has been shown in trials in Uganda and Malawi to be able to significantly reduce malaria morbidity; this model is applicable wherever malaria is endemic; and by lowering the risk of neurologic impairment from malaria, most probably will sustain children’s academic potential.

School-based care: Teachers can be trained to do a rapid diagnostic test (RDT) for malaria on a drop of blood from a finger prick using a test kit based on antigen detection.  Each day all children appearing ill at school are tested and those who are positive are then promptly treated with Artemesinin combination therapy (ACT). The trials of this model evaluated the effect of introducing teacher-driven RDT and ACT on the duration of absence from school (a recognized surrogate for morbidity due to malaria). In Uganda in the year pre-intervention 953 of 1764 pupils were sent home due to presumed infectious illness and the mean duration of absence from school was 6.5 school days. During school-based teacher-administered RDT/ACT (year 2), 1066 of 1774 pupils were identified as sick, 765 of these had a positive RDT and received ACT, and their duration of absence fell to 0.6 school days (P < 0.001).

Conclusion: Current rates of neurologic complications from malaria are unacceptable in school-aged children. Both RDT and ACT are WHO-endorsed management strategies and key components of most national malaria programs. Problematically, social determinants of health (e.g. remote/rural geographic location and poverty) impact both the availability of and access to these diagnostic and treatment entities. In addition to this school-based, teacher-driven model being a logical and relevant way to improve morbidity from malaria, its scale-up would meet the moral imperative to address the long recognized inequities in malaria care that continue to disproportionately affect the health and academic potential of school-aged children.