Abstract
BackgroundApproximately 66% of children under the age of 5 in Sub-Saharan African countries do not reach their full cognitive potential, the highest percentage in the world. Because the majority of studies investigating child cognitive development have been conducted in high-income countries (HICs), there is limited knowledge regarding the determinants of child development in low- and middle-income countries (LMICs).MethodsThis analysis includes 401 mother-child dyads from the South Africa and Tanzania sites of the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) longitudinal birth cohort study. We investigated the effect of psychosocial and environmental determinants on child cognitive development measured by the Wechsler Preschool Primary Scales of Intelligence (WPPSI) at 5 years of age using multivariable linear regression.ResultsSocioeconomic status was most strongly associated with child cognitive development (WPSSI Score Difference (SD):14.27, 95% CI:1.96, 26.59). Modest associations between the organization of the home environment and its opportunities for cognitive stimulation and child cognitive development were also found (SD: 3.08, 95% CI: 0.65, 5.52 and SD: 3.18, 95% CI: 0.59, 5.76, respectively).ConclusionThis study shows a stronger association with child cognitive development at 5 years of age for socioeconomic status compared to more proximal measures of psychosocial and environmental determinants. A better understanding of the role of these factors is needed to inform interventions aiming to alleviate the burden of compromised cognitive development for children in LMICs.
Highlights
66% of children under the age of 5 in Sub-Saharan African countries do not reach their full cognitive potential, the highest percentage in the world
Socioeconomic status, the organization of the home environment, and opportunities for cognitive stimulation were associated with child cognitive development at 5 years of age among children in the South African and Tanzanian sites of the MAL-ED study
This study shows a stronger association with child cognitive development at 5 years of age for socioeconomic status compared to other psychosocial and environmental factors which, we had hypothesized, were more proxy determinants of child cognitive development
Summary
66% of children under the age of 5 in Sub-Saharan African countries do not reach their full cognitive potential, the highest percentage in the world. Children who do not fully develop to the level of cognitive development that would be expected in an optimal environment are less likely to enroll in and complete primary school [2,3,4]. These educational disadvantages can have lasting effects and are associated with adverse outcomes in adult life, e.g., lower incomes, high fertility rates, and suboptimal care for their own children [2, 5]. Studies show that there is a positive association between a nurturing home and optimal learning environment and children’s health and development [12,13,14]
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