When nine-year-old James Ssemambo suffered from severe malaria in Kitosi, Uganda, the illness impacted more than just his health. His mother, Sarah Nankya, spent three days at a health centre with him, sacrificing work and caring for her other children while dealing with extra expenses for transport, treatment, and food.
Recovery was not immediate for James. “My child missed school for over a week because of the illness. Even after he came home, he was still weak and sometimes struggled to concentrate on his schoolwork,” Nankya recalled. Her experience highlights a lesser-discussed aspect of malaria: the ongoing challenges faced by children after recovering from the disease.
According to the latest World Health Organisation (WHO) figures, Africa accounts for 94% of malaria cases and 95% of deaths globally, with children under five making up three-quarters of these fatalities. However, the impact of malaria extends beyond mortality. Research led by African scientists indicates that some severe forms of malaria can have long-term consequences.
Dr. Paul Bangirana from Makerere University has studied the neuropsychological effects of childhood malaria for over twenty years. His previous research showed that one in four survivors of childhood cerebral malaria experienced cognitive impairments two years post-illness. A more recent study in 2026 tracked 889 participants and found that those who survived severe childhood malaria demonstrated lower cognitive abilities and maths scores compared to unaffected peers assessed four to fifteen years later, although reading and attention scores did not significantly differ.
Bangirana stated, “Survival from malaria is essential, but the secondary effects of severe episodes can be debilitating.” His team’s findings link severe malaria, especially cerebral forms and severe malarial anaemia, to issues such as cognitive and behavioural problems, education challenges, and diminished quality of life.
Additionally, Bangirana’s research has begun exploring the effects that extend into early adulthood.
Interviews with caregivers of children who endured severe malaria and recurrent attacks revealed changes in behaviour and academic performance, alongside family issues such as disputes over where to obtain help and struggles balancing work and caregiving. Nankya expressed her concerns: “Repeated malaria brings a lot of worry because, as a parent, you are always afraid your child may become seriously ill again.”
These insights underscore the importance of malaria prevention. Various existing interventions, including insecticide-treated nets, medicines, and vaccines, are saving lives, but challenges like drug and insecticide resistance persist. Hence, ongoing research into innovative approaches is crucial.
Target Malaria, a not-for-profit research consortium, is investigating whether genetic technologies could enhance existing malaria control strategies. They are developing gene drive technology aimed at reducing populations of specific malaria-transmitting mosquitoes, with ongoing studies in controlled laboratory environments.
For Bangirana, understanding the broader impacts of malaria is vital. “When the fever goes down, it does not mean the child is fully okay,” he remarked. Preventing severe malaria could potentially avert long-term cognitive, behavioural, and educational issues.
As Africa strives to eradicate malaria, it’s crucial to consider not just the immediate physical effects of the disease but also the broader implications for children returning to school, parents returning to work, and the futures that prevention can help safeguard.
Target Malaria is funded by the Gates Foundation and Coefficient Giving, with Imperial College London as the lead applicant alongside partners in Africa, Europe, and North America.
