Children In Rural Kenya Research Articles

Individual level determinants for not receiving immunization, receiving immunization with delay, and being severely underimmunized among rural western Kenyan children

BackgroundEstimating vaccination coverage and delays are important because these measures can identify at risk sub-populations who can be targeted with interventions and public health policies. This paper sought to determine estimates and risk factors for children in rural western Kenya who did not receive immunization, received immunization with delay, or were severely underimmunized. MethodsCaregivers of children aged 12–23 months old were surveyed for immunization history using written records from the immunization booklet. Risk factors for not receiving immunization, delayed immunization, and severe underimmunization were calculated using log-binomial regression. Children were categorized as delayed if a given immunization was received greater than four weeks from the age-appropriate scheduled date. Severely underimmunized children were those who were fully unvaccinated for more than 90 days and had three or more vaccines delayed or not given. ResultsImmunization coverage for pentavalent1, pentavalent3, measles, and fully immunized child (FIC; BCG, three doses of polio, three doses of pentavalent, and measles vaccines) were 99%, 94%, 83%, and 80%, respectively. Approximately, 10%, 24%, and 29%, of children were delayed for pentavalent1, pentavalent3, and measles, respectively. Each model produced a unique combination of risk factors with only advanced maternal age as a risk factor common to all models. Children with delayed receipt of pentavalent1 were at risk for not receiving pentavalent3 (RR: 5.20; 95%CI 3.48, 7.77), measles vaccine (RR: 1.48; 95%CI 1.12, 1.95), and not achieving FIC (RR: 1.88; 95%CI 1.51, 2.34) compared with children who received pentavalent1 on time. ConclusionsImmunization coverage among 12–23 month old children was high, yet a substantial proportion of children were vaccinated with delay. Although vaccine coverage and timeliness are often conceptualized as separate measures, the finding that delayed pentavalent1 receipt was a strong risk factor for not receiving future immunizations indicates the two measures are intertwined.

Modification of Local Diets Could Fill Gaps in B-Vitamin Intakes but Calcium, Iron, and Zinc Intake Gaps Require External Solutions for Breastfed Children in Rural Kenya

Modification of Local Diets Could Fill Gaps in B-Vitamin Intakes but Calcium, Iron, and Zinc Intake Gaps Require External Solutions for Breastfed Children in Rural Kenya

Caregiver Perceptions of Children who have Complex Communication Needs Following a Home-based Intervention Using Augmentative and Alternative Communication in Rural Kenya: An Intervention Note

A high level of unmet communication need exists amongst children with developmental disabilities in sub-Saharan Africa. This study investigated preliminary evidence of the impact associated with a home-based, caregiver-implemented intervention employing AAC methods, with nine children in rural Kenya who have complex communication needs. The intervention used mainly locally-sourced low-tech materials, and was designed to make use of the child's strengths and the caregiver's natural expertise. A pretest-posttest design was used in the study. Data were gathered using an adapted version of the Communication Profile, which was based on the International Classification of Functioning, Disability, and Health (ICF) framework. The non-parametric Wilcoxon signed-rank test was applied to data from the first two sections of the Communication Profile-Adapted. Qualitative analysis was conducted on the final section. The data provided evidence of statistically significant positive changes in caregiver perceptions of communication at the levels of Body Structure and Function, and Activities for Communication. Also, analysis of the Participation for Communication section revealed some expansion to the children's social activities. The potential impact of the home-based intervention would benefit from investigation on a larger scale. Limitations of the study are discussed.

Kinetics of the Neutralizing Antibody Response to Respiratory Syncytial Virus Infections in a Birth Cohort

The kinetics of respiratory syncytial virus (RSV) neutralizing antibodies following birth, primary and secondary infections are poorly defined. The aims of the study were to measure and compare neutralizing antibody responses at different time points in a birth cohort followed-up over three RSV epidemics. Rural Kenyan children, recruited at birth between 2002 and 2003, were monitored for RSV infection over three epidemic seasons. Cord and 3-monthly sera, and acute and convalescent sera following RSV infection, were assayed in 28 children by plaque reduction neutralization test (PRNT). Relative to the neutralizing antibody titers of pre-exposure control sera (1.8 log10 PRNT), antibody titers following primary infection were (i) no different in sera collected between 0 and 0.4 months post-infection (1.9 log10 PRNT, P = 0.146), (ii) higher in sera collected between 0.5 and 0.9 (2.8 log10 PRNT, P < 0.0001), 1.0–1.9 (2.5 log10 PRNT, P < 0.0001), and 2.0–2.9 (2.3 log10 PRNT, P < 0.001) months post-infection, and (iii) no different in sera collected at between 3.0 and 3.9 months post-infection (2.0 log10 PRNT, P = 0.052). The early serum neutralizing response to secondary infection (3.02 log10 PRNT) was significantly greater than the early primary response (1.9 log10 PRNT, P < 0.0001). Variation in population-level virus transmission corresponded with changes in the mean cohort-level neutralizing titers. It is concluded that following primary RSV infection the neutralizing antibody response declines to pre-infection levels rapidly (∼3 months) which may facilitate repeat infection. The kinetics of the aggregate levels of acquired antibody reflect seasonal RSV occurrence, age, and infection history.

Free-living physical activity and energy expenditure of rural children and adolescents in the Nandi region of Kenya

Purpose: To examine the relationship between physical activity and energy demands in children and adolescents with highly active lifestyles.Methods: Physical activity patterns of 30 rural Kenyan children and adolescents (14 ± 1 years, mean ± SD) with median body mass index (BMI) z-score = −1.06 [−3.29–0.67] median [range] were assessed by accelerometry over 1 week. Daily energy expenditure (DEE), activity-induced energy expenditure (AEE) and physical activity level (PAL) were simultaneously determined using doubly-labelled water (DLW). Active commuting to school was assessed by global positioning system.Results: Mean DEE, AEE and PAL were 12.2 ± 3.4, 5.7 ± 3.0 MJ/day and 2.3 ± 0.6, respectively. A model combining body mass, average accelerometer counts per minute and time in light activities predicted 45% of the variance in DEE (p < 0.05) with a standard error of DEE estimate of 2.7 MJ/day. Furthermore, AEE accounted for ∼47% of DEE. Distance to school was not related to variation in DEE, AEE or PAL and there was no association between active commuting and adiposity.Conclusion: High physical activity levels were associated with much higher levels of energy expenditure than observed in Western societies. These results oppose the concept of physical activity being stable and constrained in humans.

Supplemental Material for Healthy Skepticism: Do Adults Trust Health Information From Children in Rural Kenya?

Supplemental Material for Healthy Skepticism: Do Adults Trust Health Information From Children in Rural Kenya?

Healthy Skepticism: Do Adults Trust Health Information From Children in Rural Kenya?

Despite the frequent use of schools and schoolchildren to disseminate information to wider communities in sub-Saharan Africa, little research has been done examining whether children are seen as trustworthy sources of information. Participants (67 women and 66 men aged 19–77 years living in coastal Kenya) listened to different claims made by an adult informant and a child informant in a video scenario. The competing claims pertained to both health and nonhealth dilemmas. One claim was consistent with traditional practices, whereas the other was consistent with modern, school-based knowledge. We asked respondents the extent to which they would endorse the adult’s claim rather than the child’s and the traditional claim rather than the modern claim. Surprisingly, no preference was seen for adult advice over children’s advice. Modern claims were endorsed over traditional claims in the domain of health and particularly among more educated adults. Children’s advice was trusted less by participants who favored a high level of adult authority over children rather than a more egalitarian relationship. This study shows that children can convey credible messages to adults in Kenya and that adults who are educated and value more equal relationships with children are more receptive to the messages.

Risk Factors for Death among Children Less than 5 Years Old Hospitalized with Diarrhea in Rural Western Kenya, 2005–2007: A Cohort Study

Diarrhea is a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Data on risk factors for mortality are limited. We conducted hospital-based surveillance to characterize the etiology of diarrhea and identify risk factors for death among children hospitalized with diarrhea in rural western Kenya. We enrolled all children <5 years old, hospitalized with diarrhea (≥3 loose stools in 24 hours) at two district hospitals in Nyanza Province, western Kenya. Clinical and demographic information was collected. Stool specimens were tested for bacterial and viral pathogens. Bivariate and multivariable logistic regression analyses were carried out to identify risk factors for death. From May 23, 2005 to May 22, 2007, 1,146 children <5 years old were enrolled; 107 (9%) children died during hospitalization. Nontyphoidal Salmonella were identified in 10% (118), Campylobacter in 5% (57), and Shigella in 4% (42) of 1,137 stool samples; rotavirus was detected in 19% (196) of 1,021 stool samples. Among stools from children who died, nontyphoidal Salmonella were detected in 22%, Shigella in 11%, rotavirus in 9%, Campylobacter in 5%, and S. Typhi in <1%. In multivariable analysis, infants who died were more likely to have nontyphoidal Salmonella (adjusted odds ratio [aOR] = 6·8; 95% CI 3·1-14·9), and children <5 years to have Shigella (aOR = 5·5; 95% CI 2·2-14·0) identified than children who survived. Children who died were less likely to be infected with rotavirus (OR = 0·4; 95% CI 0·2-0·8). Further risk factors for death included being malnourished (aOR = 4·2; 95% CI 2·1-8·7); having oral thrush on physical exam (aOR = 2·3; 95% CI 1·4-3·8); having previously sought care at a hospital for the illness (aOR = 2·2; 95% CI 1·2-3·8); and being dehydrated as diagnosed at discharge/death (aOR = 2·5; 95% CI 1·5-4·1). A clinical diagnosis of malaria, and malaria parasites seen on blood smear, were not associated with increased risk of death. This study only captured in-hospital childhood deaths, and likely missed a substantial number of additional deaths that occurred at home. Nontyphoidal Salmonella and Shigella are associated with mortality among rural Kenyan children with diarrhea who access a hospital. Improved prevention and treatment of diarrheal disease is necessary. Enhanced surveillance and simplified laboratory diagnostics in Africa may assist clinicians in appropriately treating potentially fatal diarrheal illness.

The impact of morbidity on food intake in rural Kenyan children

Objective: To quantify the effect of common illnesses on energy intake in rural Kenyan children.Design, setting and subjects: Toddlers in rural Kenya (n = 110) were studied longitudinally from 18–30 months of age in the mid-1980s.Outcome measures: Morbidity data were collected weekly using an illness questionnaire and physical inspection. Food intake was quantitatively assessed on two successive days each month. Food intake on days of illness was compared to food intake on days of wellness and during convalescence.Results: Significant decreases in mean daily energy intake were seen between days of wellness vs. days of severe illness. Above usual intake was observed during convalescence. Girls showed a greater reduction in intake during illness compared to boys. Food intake reductions were greatest in children with gastrointestinal (diarrhoea) and lower respiratory tract infections, measles and other febrile illnesses. In the case of severe illness, a compensatory increase in intake during week one of the convalescence period was observed, being greater in girls (376 kcal vs. 71 kcal extra per day for boys).Conclusion: Food intake is decreased during common acute illnesses in children and increased above their usual intake during convalescence. Food should not be withheld from sick children and feeding should be actively encouraged during illness, particularly during convalescence with the return of appetite. These data, although somewhat dated, are still applicable to toddlers in rural Africa where malnutrition and feeding practices have changed very little.

Pedometer-Determined Physical Activity of Western Kenyan Children

It is speculated that rural Kenyan children are more physically active than those in developed countries. The purpose of this study was to examine pedometer-measured physical activity levels of western Kenyan youth. Participants in this study were children in Levels 3 and 5 who attended a private primary school. The sample (n = 72) consisted of 43 girls and 29 boys (average age = 9.8 ± 1.1, range = 8-12 years). Age, gender, tribe, and height and weight measures were collected. Weight status category was determined according to CDC guidelines. Participants wore a sealed Yamax pedometer for 4 weekdays during the measurement period. Data analysis included descriptive statistics and 2-way ANOVA (age × gender). The total sample averaged 14558 ± 3993 daily steps. There was no significant effect for age [F(4,68) = 1.682, P = .102] nor significant age × gender interaction [F(4,68)=1.956, P = .117]. There was a significant effect for gender [F(1,68) = 4.791, P = .033], with boys (16262 ± 4698) significantly more active than girls (13463 ± 3051). The observed daily steps are higher than those observed in the U.S., similar to samples in other developed countries, but lower than Amish youth.

Child obesity and fitness levels among Kenyan and Canadian children from urban and rural environments: A KIDS-CAN Research Alliance Study

This study was designed to gather anthropometric and fitness-related data on Kenyan children living in urban (UKEN) and rural (RKEN) environments and to compare them with previous data collected on Canadian children in order to examine the potential nutrition-physical activity transition. Height, weight, waist circumference, triceps skinfolds were directly measured on rural (RKEN) and urban Kenyan (UKEN) children (n = 179, 9-13 years) and compared with existing data from Canadian children living in urban and rural environments (n = 274, 9-13 years). Aerobic fitness was measured using the 20 m shuttle run, flexibility using the sit-and-reach test and isometric handgrip strength was assessed. None of the RKEN children were overweight or obese (OWO). However, 6.8% of UKEN boys and 16.7% of girls were OWO. The RKEN children had lower BMI, waist circumference, and triceps skinfolds than all other groups (UKEN, and Canadian: p < 0.05). UKEN children were leaner than Canadian children (p < 0.05). Male and female RKEN children had higher running speeds, and aerobic fitness than UKEN children (p < 0.001). Isometric strength was not different between Kenyan groups and was not different from urban living Canadian children. UKEN children were the least flexible group, and girls were more flexible than boys in all groups. Urban Kenyan children appear to be showing signs of the nutrition-physical activity transition, as judged by the anthropometric similarities to contemporary living Canadian children. Further support is provided by examining the difference in prevalence of overweight/obesity among UKEN compared with their RKEN counterparts and their lower aerobic fitness level.

Determinants Of Daily Energy Expenditure In Active Kenyan Children

Integrating data on physical activity and energy expenditure in diverse non-laboratory conditions is central to a complete understanding of the etiology of obesity, coronary heart disease, osteoporosis, cancer and other chronic diseases. PURPOSE: To determine the effects of body mass (BM) and physical activity on daily energy expenditure (DEE) in a cohort of rural Kenyan children from the Nandi region, where many elite Kenyan runners come from. METHODS: Physical activity levels and patterns in 30 Kenyan children (aged 14±1 yrs, mean±s.d.), with an average body mass index of 16±2 kg·m2 were assessed by uni-axial accelerometry for 7 consecutive days. DEE was determined using the doubly labeled water method. RESULTS: Kenyan children accumulated an average of 956±215 × 103 accelerometer counts per day (CPD); with a mean engagement in moderate to vigorous physical activity (MVPA) of 116±34 counts per minute (CPM) which was 14.5% of the monitored time; using Puyau cut-points (>3200 CPM). Kenyan children engaged in 77 min of MVPA bouts (bout = least 5 min of consecutive MVPA, allowing for 20% of interruption within a bout i.e. if a bout was exactly 5 min, then 1 min interruption was permitted). The DEE for Kenyan children was 12.2±3.4 MJ/day. A multiple stepwise linear regression model showed that 40.3% of the variance in DEE could be predicted by CPD (Partial r2 = 20.5%; P =0.007) and body mass (Partial r2 = 19.8%; P = 0.018). CONCLUSION: Body mass and physical activity as assessed by uni-axial accelerometry are major predictors of DEE in active children.

Dietary diversity scores predict dietary micronutrient adequacy among school children in rural Kenya

We explored the ability of dietary diversity scores to predict micronutrient intake among school children in rural Kenya. Three non‐consecutive 24‐hour recalls were administered to assess 520 school children's dietary intake in May‐August 1998. Diversity scores were calculated as counts of the number of food groups reported. Food groups included cereals/tubers; dark‐green leafy vegetables; vitamin A‐rich fruits/vegetables; vitamin C‐rich fruits/vegetables; other fruits/vegetables; dairy; meat/fish/poultry and legumes/nuts. Three diversity scores were constructed based on minimum amount required to make a food group count: DDS for a minimum intake of 1g, DDS‐15 for a minimum intake of 15g, and DDS‐V with variable minimum intake levels across food groups. The probability approach was used to estimate dietary adequacy of 12 vitamins and minerals. The mean probability of adequacy, ranging from 0 to 1 and a mean of 0.59 ± 0.07, was used as a measure of overall dietary adequacy. All three diversity scores were significantly associated with MPA. Correlations ranged from 0.46 for DDS to 0.51 for DDS‐V. Thus, all three measures of diversity may be used as indicators of dietary nutrient adequacy, although DDS‐V performed somewhat better than DDS or DDS‐15. The analysis contributes to the continued search for simpler indicators of dietary micronutrient adequacy and is the first among school children in Africa.

Correction: Defining Clinical Malaria: The Specificity and Incidence of Endpoints from Active and Passive Surveillance of Children in Rural Kenya

Correction: Defining Clinical Malaria: The Specificity and Incidence of Endpoints from Active and Passive Surveillance of Children in Rural Kenya

Defining Clinical Malaria: The Specificity and Incidence of Endpoints from Active and Passive Surveillance of Children in Rural Kenya

BackgroundFebrile malaria is the most common clinical manifestation of P. falciparum infection, and is often the primary endpoint in clinical trials and epidemiological studies. Subjective and objective fevers are both used to define the endpoint, but have not been carefully compared, and the relative incidence of clinical malaria by active and passive case detection is unknown.MethodsWe analyzed data from cohorts under active and passive surveillance, including 19,462 presentations with fever and 5,551 blood tests for asymptomatic parasitaemia. A logistic regression model was used to calculate Malaria Attributable Fractions (MAFs) for various case definitions. Incidences of febrile malaria by active and passive surveillance were compared in a subset of children matched for age and location.ResultsActive surveillance identified three times the incidence of clinical malaria as passive surveillance in a subset of children matched for age and location. Objective fever (temperature≥37.5°C) gave consistently higher MAFs than case definitions based on subjective fever.ConclusionThe endpoints from active and passive surveillance have high specificity, but the incidence of endpoints is lower on passive surveillance. Subjective fever had low specificity and should not be used in primary endpoint. Passive surveillance will reduce the power of clinical trials but may cost-effectively deliver acceptable sensitivity in studies of large populations.

Rotavirus Genetic Diversity, Disease Association, and Temporal Change in Hospitalized Rural Kenyan Children

The effectiveness of rotavirus vaccines will be dependent on the immunity conferred against prevalent and emergent variants causing severe diarrheal disease. Longitudinal surveillance of disease-causing strains is a prerequisite to intervention. Molecular characterization was conducted on rotavirus-positive stool samples from children admitted with diarrhea to a rural district hospital during 2002-2004. Extracted viral RNA was separated by polyacrylamide gel electrophoresis, and rotavirus VP4 (P types) and VP7 (G types) specificities were determined. Among 558 investigated cases, the predominant genotype was P[8]G1 (42%), followed by P[8]G9 (15%), P[4]G8 (7%), P[6]G8 (6%), and P[8]G8 (4%), with 10% mixed strains. Overall, there were 6 different P types and 7 G types. No association was identified between genotype and child age, sex, or severity of diarrhea. The P and G genotypes and polyacrylamide gel electropherotypes showed significant temporal variation in frequency: P[8]G1 decreased from 51% (95% confidence interval [CI], 43%-58%) in 2002 to 30% (95% CI, 24%-37%) in 2004, and P[4]G8 increased from 2% (95% CI, 0%-5%) in 2002 to 13% (95% CI, 9%-19%). Quarterly data revealed seasonally endemic and emergence and/or decay patterns. Our study of rotavirus strains causing severe diarrhea in rural Kenyan children showed a predominance of P[8]G1 and confirms the importance of G8 and G9 strains in sub-Saharan Africa. Considerable genetic diversity of rotavirus strains was observed, including substantial mixed and unusual types, coupled with significant temporal strain variation and emergence. These results warn of variable vaccine efficacy and the need for long-term surveillance of circulating rotavirus genotypes.

Pattern of Limb Amputation Among Rural Kenyan Children and Adolescents

In Brief The causes of limb amputation among children differ between and within countries. These data are valuable in prevention and planning of rehabilitation strategies for the victims but are scarcely reported. The aim of this study was to investigate the causes of amputation in children and adolescents in rural Kenya. Records of patients aged 18 years and younger who underwent major limb amputation in PCEA Kikuyu and Tenwek Hospitals between January 1998 and December 2008 were analyzed retrospectively for cause and age. Data were analyzed by SPSS (version 11.50). Only complete records for age and confirmed diagnosis were included. Eighty-eight of 290 (30.3%) amputation cases were in individuals aged 2 weeks to 18 years. Trauma was the most common cause (42%), followed by congenital defects (29.5%), infection (12.5%), and tumors (11.4%). Of the trauma cases, burns were the most common cause (27%), followed by animal bites (18.9%), road traffic accidents (16.2%), and falls (13.5%). A total of 77.2% of the patients presented after the age of 5 years. The male:female ratio was 2:1. These data imply that more than 70% of amputations among rural Kenyan children result from preventable causes that may be related to poor socioeconomic status. Improvement of living standards, formulation of public health education, and planning for rehabilitation programs are recommended. Causes of limb amputation among children differ between and within countries. These data are valuable in prevention and planning of rehabilitation strategies for the victims, but are seldom reported. The aim of this study was to investigate causes of amputation in children and adolescents in rural Kenya.

The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya

To explore the impact of distance on utilisation of peripheral health facilities for sick child visits in Asembo, rural western Kenya. As part of a demographic surveillance system (DSS), censuses of all households in the Asembo population of 55,000 are conducted three times a year, data are collected at all outpatient pediatric visits in seven DSS clinics in Asembo, and all households are GIS-mapped and linkable to a child's unique DSS identification number. Between May 1, 2003 and April 30, 2004, 3501 clinic visits were linked to 2432 children among 10,973 DSS-resident children < 5 years of age. Younger children and children with more severe illnesses travelled further for clinic visits. The median distance travelled varied by clinic. The rate of clinic visits decreased linearly at 0.5 km intervals up to 4 km, after which the rate stabilised. Using Poisson regression, controlling for the nearest DSS clinic for each child, socio-economic status and maternal education, and accounting for household clustering of children, for every 1 km increase in distance of residence from a DSS clinic, the rate of clinic visits decreased by 34% (95% CI, 31-37%) from the previous kilometer. Achieving equity in access to health care for children in rural Kenya will require creative strategies to address a significant distance-decay effect in health care utilisation.

Fraction of all hospital admissions and deaths attributable to malnutrition among children in rural Kenya

Background:Malnutrition is common in the developing world and associated with disease and mortality. Because malnutrition frequently occurs among children in the community as well as those with acute illness, and because anthropometric indicators of nutritional status are continuous variables that preclude a single definition of malnutrition, malnutrition-attributable fractions of admissions and deaths cannot be calculated by simply enumerating individual children. Objective:We determined the malnutrition-attributable fractions among children admitted to a rural district hospital in Kenya, among inpatient deaths and among children with the major causes of severe disease. Design:We analyzed data from children between 6 and 60 mo of age, comprising 13 307 admissions, 674 deaths, 3068 admissions with severe disease, and 562 community controls by logistic regression, using anthropometricz scores as the independent variable and admission or death as the outcome, to calculate the probability of admission as a result of “true malnutrition” for individual cases. Probabilities were averaged to calculate attributable fractions. Results:Z scores < −3 were insensitive for malnutrition-attributable deaths and admissions, and no single threshold was both specific and sensitive. The overall malnutrition-attributable fraction for in-hospital deaths was 51% (95% CI: 42%, 61%) with midupper arm circumference. Similar malnutrition-attributable fractions were seen for the major causes of severe disease (severe malaria, gastroenteritis, lower respiratory tract infection, HIV, and invasive bacterial disease). Conclusions:Despite global improvements, malnutrition still underlies half of the inpatient morbidity and mortality rates among children in rural Kenya. This contribution is underestimated by using conventional clinical definitions of severe malnutrition.

Dietary micronutrients are associated with higher cognitive function gains among primary school children in rural Kenya

With the exception of iodine and Fe, there is still very limited information on the effect of micronutrients on cognitive function, especially among school-age children. The present analysis evaluates the relationship between dietary Fe, Zn and B vitamins (B12, B6, folate and riboflavin) and gains in cognitive test scores among school children in rural Kenya. Data for the present study were obtained from The Child Nutrition Kenya Project, a 2-year longitudinal, randomised controlled feeding intervention study using animal source foods. Dietary nutrient values were based on monthly and bimonthly 24 h recall data collected during the study period. In longitudinal regression analyses, available Fe, available Zn, vitamin B12 and riboflavin showed significant relationships with improved cognitive test scores, after controlling for confounders such as energy intake, school, socio-economic status and morbidity. Available Fe intake was associated with significantly higher gains in Raven's Coloured Progressive Matrices test scores over time. Available Zn intake was associated with significantly higher gains in digit span-total test scores over time, while vitamin B12 and riboflavin intakes were each associated with significantly higher gains in digit span-forward test scores over time. This analysis demonstrates the influence of improved dietary micronutrient status on school children's cognitive function.