To evaluate existing capacity of and need for neurorehabilitation in pediatric cerebral malaria (CM) survivors at a major referral center in a malaria-endemic region (Queen Elizabeth Central Hospital, Blantyre, Malawi).

CM is the most severe complication of malaria and is associated with debilitating neurological sequelae in over one third of survivors. There are significant knowledge gaps regarding the neurorehabilitation needs of post-CM children.

A mixed-methods study was performed evaluating current neurorehabilitation infrastructure and assessing common post-CM neurodisabilities via the International Classification for Functioning and Disability framework. We quantitatively measured neurorehabilitation needs of post-CM children through the validated Therapy Assessment Tool, Liverpool Outcome Score (LOS), and Gross Motor Function Classification Scale (GMFCS). Qualitative evaluation with caregivers, healthcare workers, and community rehabilitation workers involved in CM care sought to identify common disabilities and attitudes regarding access to and availability of neurorehabilitation for post-CM children.

60 post-CM children (3 months to 16 years) were evaluated. 63% (N=38) were LOS Level 2, suggesting severe sequelae that impaired function sufficiently to necessitate dependence. 71% (N=42) were GMFCS Level 1 and could perform gross motor skills limited in speed, balance, and coordination given age-specific expectations. 41% (N=24) attended any rehabilitation post-hospital discharge. Existing rehabilitation encompassed one inpatient team and one clinic for outpatient occupational therapy. All interviewees (N=39) noted major barriers to accessing rehabilitation, including centralized urban inpatient services and lack of outpatient services, insufficient rehabilitation staff, disability stigma, and inadequate transportation to attend distant services.

Despite a heavy burden of functional sequelae in CM survivors, over half of patients, many with significant disability, did not attend rehabilitation. This likely correlates with interviewee concerns regarding barriers and inequitable access to rehabilitation determined by geographic location and inability to finance transport. Future work is critical to develop infrastructure, particularly in rural settings, to better support children post-CM.