Prevalence of Stunting and Relationship between Stunting and Associated Risk Factors with Academic Achievement and Cognitive Function: A Cross-Sectional Study with South African Primary School Children

Abstract

Childhood stunting can have negative long-term consequences on cognitive development, academic achievement, and economic productivity later in life. We determined the prevalence of stunting and examined whether stunting and associated risk factors (low dietary diversity, insufficient hemoglobin, food insecurity, and soil-transmitted helminth (STH) infections) are associated with academic achievement and cognitive function among South African children living in marginalized communities. A cross-sectional sample of 1277 children (aged 5–12 years) was analyzed. Stunting was defined according to 2007 WHO growth references. Cognitive functioning was measured with the computerized Flanker task and academic performance via school grades. Blood and stool samples were collected to obtain hemoglobin level and STH infection. Dietary diversity was assessed by a food frequency questionnaire. Associations were examined via mixed linear regression (with school class as a random intercept). Nine percent of the children were stunted (95% CI: 7.6–10.8%). Low dietary diversity (β = 0.13, p = 0.004), food insecurity (β = −0.12, p = 0.034), and stunting (β = −0.13, p = 0.031) were associated with poorer end of the year results among girls. No such associations were found among boys. No significant associations were found for socioeconomic status and hemoglobin levels. The prevalence of stunting and STH infections were low in the present sample. Risk factors seem differently associated with girls’ and boys’ academic achievement. Promoting nutrition may help to promote academic achievement among girls living in low- and middle-income countries.

Long-Term Influences of Stunting, Being Underweight, and Thinness on the Academic Performance of Primary School Girls: The NW-CHILD Study

“…Glewwe et al [9] report findings from Philippine children that were followed from birth until the end of the primary school years where undernourished children reached school readiness at a much later stage and had to be held back more opposed to wellnourished children during their childhood. Similar findings are furthermore also reported by South African researchers based on cross-sectional studies [5,8]. A recent study on 8.3-year-old children conducted in four peri-urban quintile 3 public schools in the Port Elizabeth area of SA confirmed an association between stunting and poorer end of the year results among girls, although not among boys [8].…”

“…Similar findings are furthermore also reported by South African researchers based on cross-sectional studies [5,8]. A recent study on 8.3-year-old children conducted in four peri-urban quintile 3 public schools in the Port Elizabeth area of SA confirmed an association between stunting and poorer end of the year results among girls, although not among boys [8]. Pienaar [5] also report similar results as HAZ was positively associated with school performance.…”

“…Several studies that specifically investigated the relation between academic performance and undernutrition are based on cross-sectional designs [5,7,8]. South African cross-sectional studies confirmed negative influences of undernutrition and thinness on the academic performance of boys and girls [5,8].…”

“…Several studies that specifically investigated the relation between academic performance and undernutrition are based on cross-sectional designs [5,7,8]. South African cross-sectional studies confirmed negative influences of undernutrition and thinness on the academic performance of boys and girls [5,8]. Pienaar [5] recorded a positive relation between stunting (HAZ: height-for-age z-score) and mathematical performance of grade 1 learners in the North West province that included both high and low socio-economic participants, although no gender specific relationships were reported.…”

“…The burden of undernutrition on the future of developing children via the relation between undernutrition and academic performance are also confirmed, although mostly through cross-sectional studies [8,13,26]. Evidence about the relation between undernutrition and academic performance among girls aged 7 to 13 is, however, very limited [5,7,13].…”