Arthur Scott-Geddes Deputy Editor, Global Health Security

Severe malaria may be doing long-lasting damage to children’s brains, according to a major study in Uganda.

Researchers collected data on a group of nearly 1,000 children up to 15 years after infection and found that those who had survived cerebral malaria or severe anaemia caused by malaria performed worse on cognitive tests many years later.

Cerebral malaria is considered the most severe form of the disease and occurs when infected blood cells get stuck inside small blood vessels in the brain, restricting blood flow and causing swelling, often leading to a coma and death.

Along with anaemia, it is believed to affect up to two million children each year, mostly in sub-Saharan Africa, causing hundreds of thousands of deaths.

The research, which was published in the Journal of the American Medical Association (JAMA) last week, is the latest in a series of studies on the impact of severe malaria led by Paul Bangira of the Makerere University Hospital in Kampala, Uganda, and Chandy John of Indiana University.

Known as the Malarial Impact on Neurobehavioral Development (MIND) study, the researchers have been following the same cohort of 1,438 children since 2008.

The first study found that children who had cerebral malaria scored lower on cognitive tests two years after their infection while a second, carried out between 2014 and 2018, confirmed these results.

The most recent test began in 2020, with the researchers hoping to find out whether the children’s cognitive deficits had improved. They managed to track down 939 of the original cohort and had them sit tests in mathematics, reading, attention and overall cognition.

The researchers found that scores in mathematics and overall cognition were significantly lower among children who had either cerebral malaria or severe malarial anaemia than in those who did not.

Those who had survived severe malaria as children suffered a hit to their cognitive abilities equal to between four and seven IQ points in adolescence.

Professor Samuel Wassmer, a parasitologist at the London School of Hygiene and Tropical Medicine whose research focuses on the effects of malaria infection on the brain, said that what might seem like a relatively minor impact adds up when the number of infections is considered.

“When this applies across the board – at population level – it really has a tremendous impact,” he told The Telegraph.

“If the findings are confirmed more broadly, I think the implications could be very substantial – we’re talking about common, high-burden diseases affecting a large number of children,” said Prof Wassmer, who was not involved in the study.

“Even modest reductions in cognitive performance could translate into huge effects on school attainment, later employment and overall economic productivity at the population level.”

Despite its long duration, the study does have some limitations, notably that it was conducted in a single country. It is also not yet clear how exactly cerebral malaria or anaemia cause cognitive impairment.

The study nevertheless adds to a mounting body of evidence linking severe malaria, which is caused by parasites transmitted by mosquitoes, to long-lasting neurological disorders.

Previous research has shown how severe malaria can lead to impaired motor skills and visual coordination, as well as cause seizures and attention deficit hyperactivity disorder (ADHD).

More broadly, malaria has also been linked to economic damage.

Research commissioned by Malaria No More UK in 2024 found that cutting malaria by 90 per cent by 2030 – in line with the UN’s sustainable development goals – could boost the economies of countries where it is endemic by as much as £105.5 billion.

In a commentary on the JAMA paper, Audrey John, an infectious disease specialist at the Children’s Hospital of Philadelphia, writes: “The findings of the MIND study are a poignant reminder that the burden of malaria extends far beyond the acute infection and reinforce the importance of continued investment in malaria elimination.”

After decades of progress, the fight against malaria has stalled in recent years amid funding shortages and rising drug resistance.

The World Health Organization (WHO) reported 282 million malaria cases in 2024. Children under five accounted for more than three-quarters of the 610,000 deaths.

But there is some cause for optimism.

Since 2021, two malaria vaccines have been introduced, primarily targeting children in sub-Saharan Africa. As of late 2025, over 40 million doses had been delivered to 24 countries, according to Unicef.

Protect yourself and your family by learning more about Global Health Security