Rita Reber, administrator, Chandy John, M.D., M.S., pediatric
infectious disease specialist and director, Center for Global
Pediatrics, and Cindy Howard, M.D., M.P.H.T.M., associate
director, Center for Global Pediatrics.

Improving the health of children worldwide

Every year more than 700,000 children in sub-Saharan Africa develop cerebral malaria, a disease that affects the brain and leads to fever and coma. As many as 20 percent of children with cerebral malaria die from the disease.

Chandy John, M.D., M.S., pediatric infectious disease specialist and director, Center for Global Pediatrics at the University of Minnesota and colleagues from the University of Minnesota, Makerere University in Uganda and Michigan State University have determined that cerebral malaria is related to long-term cognitive impairment in one of four child survivors.

In a study titled, “Cerebral Malaria in Children is Associated with Long-term Cognitive Impairment,” published in the July 2008 issue of Pediatrics, John and colleagues evaluated cognitive function in areas of attention, working memory and tactile learning in children ages 5-12 years old with cerebral malaria in Uganda. Children were evaluated at hospitalization, six months after the initial malaria episode and two years after the initial malaria episode.

John and colleagues found that six months after the initial malaria episode, 21 percent of children with cerebral malaria had cognitive impairment compared to 6 percent of healthy children in the community. Two years after the initial malaria episode, 26 percent of children with cerebral malaria had cognitive impairment compared to 8 percent of children in the community.

“Retrospective studies suggested that children with cerebral malaria had cognitive impairment, but no prospective studies had been performed to validate this,” says John. “Since more than 700,000 children develop cerebral malaria every year in Africa, we knew that if a significant number of these children had long-term cognitive impairment, it would be an important finding.”

John and colleagues received a $2.6 million grant from the National Institutes of Health (NIH) to follow-up on the study to assess how cerebral malaria affects thinking in children under five years of age and to assess the processes in the body that lead to developing cognitive impairment in children with cerebral malaria.

“If we can identify particular processes that relate to long-term brain injury, we can then rationally design clinical trials of drugs that could prevent these processes and therefore prevent the brain injury,” says John.

Center for Global Pediatrics

Research in developing countries, such as John’s studies, is conducted through the Center for Global Pediatrics at the University of Minnesota.

The Center for Global Pediatrics is among a few pediatrics programs in the country to have a program and faculty dedicated to global health. The mission of the Center for Global Pediatrics is to improve the health of children globally through medical education, translational research and clinical service.

Currently, the Center for Global Pediatrics has the largest global health track of any department of pediatrics in the United States and has developing country partner sites in Uganda, Cambodia, Kenya, Ethiopia, Bolivia and Nicaragua. The center is undertaking major initiatives in global health competency-based curriculum and outcomes assessment.

The Center for Global Pediatrics’ primary clinical service is the International Adoption Clinic at University of Minnesota Children’s Hospital, Fairview which provides specialized, consultative care to children who were adopted from other countries.

The International Adoption Clinic is the leading international adoption medicine program in the country, with more than 400 patient clinic visits and more than 1,500 pre-adoption reviews performed each year.

>> For more information about the Center for Global Pediatrics, contact Rita Reber, administrator, at rer@umn.edu.

At a Glance

International Adoption Medicine Program at University of Minnesota Children’s Hospital, Fairview

A multidiscplinary team offers medical evaluations prior to adoption, post-adoption clinical care and psychology services, to address the needs of children who were internationally or domestically adopted.

• Pediatric Specialty Clinic (Minneapolis)

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The Center for Global Pediatrics at University of Minnesota has NIH-funded studies of malaria immunology and epidemiology in Kenya and Uganda, and an NIH Fogarty Center training grant in Kenya.  Other center based studies and collaborations include studies by:

• Cindy Howard, M.D., M.P.H.T.M., pediatric infectious disease specialist, on infectious disease problems in internationally adopted children.
• Tina Slusher, M.D., pediatrician, on brain injury from high levels of bilirubin in neonates in Nigeria.
• Dana Johnson, M.D., Ph.D., neonatologist, on medical evaluation of internationally adopted children.
• Maria Kroupina, Ph.D., child psychologist, on developmental issues in internationally adopted children.
• Judith Eckerle Kang, M.D., pediatrician, on fetal alcohol syndrome in internationally adopted children.
• Antoinette Moran, M.D., pediatric endocrinologist, on diabetes care for children in Uganda.
• Gerry Rosen, M.D., pediatrician, on sickle cell and sleep apnea in Uganda.