Background 

Severe malaria continues to infect and kill many children despite the gains from improved treatment and prevention of malaria in the last 30 years. Some of the consequences of being ill with severe malaria include thoughts and emotional problems, learning difficulties, and convulsions including epilepsy; all of which can affect involvement in schooling. The nature of malarial disease and measures of exposure to malaria during and after vaccinations influences the occurrence of these brain outcomes. Some of these problems may be addressed by prevention of malaria through vaccination and use of bednets, but the impact needs to be tested in research studies. 

Aims and purpose 

We are funded by EDCTP to assess if children who received a malaria vaccine 10 years ago, and those who slept under a bednet 26 years ago, are at the present showing fewer thoughts and emotional problems, learning difficulties, convulsions including epilepsy and non-attendance at school, compared to their peers who did not receive these malaria prevention measures. 

Study sites and sampling 

The malaria vaccine follow-up study will be conducted by researchers from KEMRI research centre in Kilifi county, in a defined area that undergoes routine monitoring of births, migrations deaths and exposure to malaria (in some areas) and in two research centers in Western Kenya (KEMRI/Walter Reed Project in Kombewa and KEMRI/CDC Research and Public Health Collaboration in Siaya). Outcomes for 368 children who received either a phase II malaria vaccine in Kilifi or phase III malaria vaccine in Kombewa and Siaya will be compared with those who did not receive the vaccine (N=368). For fresh assessments in the bednet study, 368 children will be selected by chance from those who slept in bednets and similar numbers from 9,963 who did not use bednets. 

Expected benefits 

Findings from this study may inform inclusion of routine evaluation of brain function into future malaria prevention interventions including vaccines. Additionally, feedback of these results may encourage the community to embrace future malaria prevention measures.