How are academic achievement and inhibitory control associated with physical fitness, soil-transmitted helminth infections, food insecurity and stunting among South African primary schoolchildren?

Markus Gerber,Sebastian Ludyga,Uwe Pühse,Harald Seelig,Stefanie Gall,Jürg Utzinger,Madeleine Nienaber,Siphesihle Nqweniso,Kurt Z Long,Christin Lang,Johanna Beckmann,Rosa Du Randt,Ivan Müller,Cheryl Walter,Peter Steinmann

doi:10.1186/s12889-021-10779-9

Abstract

BackgroundCardiovascular fitness has been associated with both executive function and academic achievement in multiple cohort studies including children and adolescents. However, research is scarce among children from low- and middle-income countries. Hence, this paper focuses on South African primary schoolchildren living in marginalized areas and examines if academic achievement and inhibitory control can be explained by children’s age, socioeconomic status, soil-transmitted helminth infections, food insecurity, stunting, grip strength, and cardiorespiratory fitness.MethodsThe sample of this cross-sectional study consisted of 1277 children (48% girls, mean age: 8.3 years). Data were assessed via questionnaires, stool samples, anthropometric measurements, 20 m shuttle run test, grip strength test, Flanker task, and school grades. Data were analysed with mixed linear regression models with random intercepts for school classes, separately for boys and girls.ResultsHigher socioeconomic status was most closely associated with academic achievement among boys (p < 0.05), whereas higher levels of cardiorespiratory fitness and not being stunted explained most variance in academic achievement in girls (p < 0.05). Higher age turned out to be associated with better performance in the Flanker task (p < 0.01). Additionally, in boys, higher grip strength was associated with better information processing and inhibitory control of attention (p < 0.01), whereas in girls, higher cardiorespiratory fitness levels were positively associated with these cognitive abilities (p < 0.05).ConclusionsAcademic performance has been shown to be compromised in schoolchildren living in marginalised areas, compared to schoolchildren in less disadvantaged parts of South Africa. The present study suggests that cardiorespiratory fitness and grip strength are two potentially modifiable factors that are associated with children’s academic achievement and cognitive performance, and that should be targeted in future school-based interventions.

Highlights

Among the different cognitive domains, executive function has been identified as an important predictor of fluid and crystallised intelligence [1], school readiness [2], academic achievement [3] and mental wellbeing [4]
The present study suggests that cardiorespiratory fitness and grip strength are two potentially modifiable factors that are associated with children’s academic achievement and cognitive performance, and that should be targeted in future school-based interventions
Little’s MCAR tests showed that data were missing completely at random, χ2(df = 1406) = 1434.5, p = 0.293, so full information maximum likelihood (FIML) could be applied to impute missing data

Summary

Introduction

Among the different cognitive domains, executive function has been identified as an important (positive) predictor of fluid and crystallised intelligence [1], school readiness [2], academic achievement [3] and mental wellbeing [4]. While most of the evidence on the relationship between executive function and academic performance comes from high-income countries, a recent study among West African preschool-aged children corroborates that executive function predicts children’s literacy and numeracy skills in low-resource settings [5]. Executive function includes and is defined as a multitude of different cognitive processes that are coordinated for goal-directed behaviour and problem-solving [8]. This domain can be subdivide into (1) inhibitory control (suppression of irrelevant stimuli or overriding a prepotent response), (2) working memory (holding information in mind and manipulating information) and (3) cognitive flexibility (ability to shift between mental sets) [9]. This paper focuses on South African primary schoolchildren living in marginalized areas and examines if academic achievement and inhibitory control can be explained by children’s age, socioeconomic status, soil-transmitted helminth infections, food insecurity, stunting, grip strength, and cardiorespiratory fitness

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