Abstract
BackgroundThe 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.Methods62 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.ResultsIn 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 a strong association between this latent cognitive ability and each academic performance measure (P<0.0001). Working memory, visual spatial ability and learning were the best predictors of academic performance.ConclusionAcademic performance is strongly associated with the latent variable labelled “cognitive ability” which captures most of the variation in the individual specific cognitive outcome measures. Working memory, visual spatial skills, and learning together stood out as the best combination to predict academic performance.
Highlights
For many children, attainment of an education is associated with a better quality of life, longer life expectancy, and higher socioeconomic status [1,2,3]
Participants were children aged 5 to 12 years presenting with malaria (Plasmodium falciparum on blood smears) and one or more of the following: 1) convulsive seizures lasting over 15 minutes or repeated seizures observed by the parent or during admission at the hospital; 2) impaired consciousness (Glasgow coma scale score of 14 and below); or 3) coma
Working Memory was associated with Reading and Spelling (0.46, 0.13 to 0.78, p = 0.008)
Summary
Attainment of an education is associated with a better quality of life, longer life expectancy, and higher socioeconomic status [1,2,3]. Success in elementary subjects like reading and arithmetic depends on certain cognitive abilities. Working memory is used during arithmetic for multi-digit calculations and for activating, retrieving, and manipulating information in long-term memory [5,6]. The child’s attention capacity aids in reading and is associated with academic performance [9,10]. Deficient performance in any of these cognitive domains resulting from a cerebral insult is likely to affect reading and arithmetic compromising the child’s education. 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
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