The Association between Cognition and Academic Performance in Ugandan Children Surviving Malaria with Neurological Involvement

Background: The contribution of different cognitive abilities to academic performance in children surviving cerebral insult can guide the choice of interventions to improve cognitive and academic outcomes. This study’s objective was to identify which cognitive abilities are associated with academic performance in children after malaria with neurological involvement. Methods: 62 Ugandan children with a history of malaria with neurological involvement were assessed for cognitive ability (working memory, reasoning, learning, visual spatial skills, attention) and academic performance (reading, spelling, arithmetic) three months after the illness. Linear regressions were fit for each academic score with the five cognitive outcomes entered as predictors. Adjusters in the analysis were age, sex, education, nutrition, and home environment. Exploratory factor analysis (EFA) and structural equation models (SEM) were used to determine the nature of the association between cognition and academic performance. Predictive residual sum of squares was used to determine which combination of cognitive scores was needed to predict academic performance. Results: In regressions of a single academic score on all five cognitive outcomes and adjusters, only Working Memory was associated with Reading (coefficient estimate = 0.36, 95 % confidence interval = 0.10 to 0.63, p,0.01) and Spelling (0.46, 0.13 to 0.78, p,0.01), Visual Spatial Skills was associated with Arithmetic (0.15, 0.03 to 0.26, p,0.05), and Learning was associated with Reading (0.06, 0.00 to 0.11, p,0.05). One latent cognitive factor was identified using EFA. The SEM found