Severe malarial anaemia in childhood is associated with decreased long-term household wealth

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BACKGROUND: Severe malarial anaemia and cerebral malaria can result in long-term cognitive, behavioral, and mental health impairments that may influence future household wealth. However, the magnitude and mechanisms of this impact on wealth remain unclear. We assessed the association between different forms of severe malaria and household wealth, 4 to 20 years after the episode. METHODS: Data were obtained from children previously enrolled in three prospective cohort studies with one of five forms of severe malaria: cerebral malaria (CM; cohorts 1, 2, and 3), severe malarial anaemia (SMA; cohorts 2 and 3), and malaria with respiratory distress, complicated seizures, or prostration (cohort 3). Community children (CC) from the prior studies served as the reference group. Regression analyses assessed the association between forms of severe malaria types and current household socioeconomic index (SEI). RESULTS: 996 participants and their households were included in the analyses: CM (n = 237), SMA (n = 257), other severe malaria (n = 238), and CC (n = 264). In a regression model including children from cohorts 1, 2 and 3 with CM or SMA, compared to CC, we found that households of children with SMA but not CM had lower SEI than CC (mean difference [95% CI]): SMA, -0.15 (-0.30, -0.01), p = 0.046, at an average of 10.1 years (SD 3.4) following the childhood severe malaria episode. In a regression model for cohort 3, comparing children in this cohort with CM, SMA, or other forms of severe malaria to CC, SMA was the only form of severe malaria associated with lower household SEI compared to CC in unadjusted analysis, and no severe malaria groups was associated with lower household SEI compared to CC after adjustment for household characteristics. CONCLUSIONS: Our findings indicate that severe malarial anaemia in childhood, but not other forms of severe malaria, may be associated with decreased household wealth 4 to 20 years later. Controlling malaria in low-resource settings could protect poor households from worse socioeconomic index over time.

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