Long-Term Cardiovascular Risk and Subclinical Organ Damage in Survivors of Severe Childhood Malaria: A Cohort Study in Cross River State, South South Nigeria

The long-term cardiovascular and organ health consequences of severe childhood malaria in African survivors are poorly characterised, representing a research gap with profound implications for adult non-communicable disease burden in malaria-endemic Nigeria. This research investigates long-term cardiovascular risk and subclinical organ damage in adolescents and young adults who survived severe childhood malaria in Cross River State, South South Nigeria. A historical cohort study will recruit 200 individuals aged 15 to 30 years with documented severe malaria hospitalisation in childhood and 200 age and sex-matched community controls without history of severe malaria. Cardiovascular evaluation will include blood pressure, ambulatory blood pressure monitoring, echocardiography for left ventricular geometry and function, and carotid intima-media thickness by ultrasound. Renal evaluation will include spot urine albumin-creatinine ratio, eGFR, and serum cystatin C. Neurocognitive assessment will use validated neuropsychological batteries. Metabolic profiling will include lipid profile, insulin resistance indices, and inflammatory markers including CRP and IL-6. Epigenetic clock analysis will estimate biological ageing relative to chronological age. Path analysis will model mediating pathways between severe malaria exposure and cardiovascular phenotype. Original contributions include the first long-term cardiovascular cohort study of severe malaria survivors in Nigeria, a theoretical framework linking childhood malaria-induced endothelial and immune reprogramming to adult NCD risk, and policy-relevant evidence for post-malaria long-term health surveillance programmes in South South Nigeria. Keywords: severe malaria, cardiovascular risk, long-term outcomes, subclinical organ damage, childhood malaria survivors