The effect of maternal and child early life factors on grade repetition among HIV exposed and unexposed children in rural KwaZulu-Natal, South Africa

Abstract

Receiving an education is essential for children living in poverty to fulfil their potential. Success in the early years of schooling is important as children who repeat grade one are particularly at risk for future dropout. We examined early life factors associated with grade repetition through logistic regression and explored reasons for repeating a grade through parent report. In 2012-2014 we re-enrolled children aged 7-11 years in rural KwaZulu-Natal who had been part of an early life intervention. Of the 894 children included, 43.1% had repeated a grade, of which 62.9% were boys. Higher maternal education (aOR 0.44; 95% CI 0.2-0.9) and being further along in the birth order (aOR 0.46; 95% CI 0.3-0.9) reduced the odds of grade repetition. In addition, maternal HIV status had the strongest effect on grade repetition for girls (aOR 2.17; 95% CI 1.3-3.8), whereas for boys, it was a fridge in the household (aOR 0.59; 95% CI 0.4-1.0). Issues with school readiness was the most common reason for repeating a grade according to parental report (126/385, 32.7%), while school disruptions was an important reason among HIV-exposed boys. Further research is needed to elucidate the pathways through which HIV affects girls' educational outcomes and potentially impacts on disrupted schooling for boys. Our results also highlight the importance of preparation for schooling in the early years of life; future research could focus on gaining a better understanding of mechanisms by which to improve early school success, including increased quality of reception year and investigating the protective effect of older siblings.

Neurodevelopment of breastfed HIV-exposed uninfected and HIV-unexposed children in South Africa

“…HEU children may be at higher risk of neurodevelopmental delays than their HIV-unexposed (HU) counterparts. [3] While findings have been inconsistent, [4–9] neurodevelopmental delays across cognitive, motor and/or language domains have been documented among preschool HEU children, [3, 10–12] with grade repetition,[13] poor school grades,[14] reduced working memory profiles[15] and lower IQ scores[16] reported among school-age children. However, data come predominantly from non-breastfeeding populations in high income countries, and/or predate the widespread availability of universal ART (treatment for all, irrespective of disease stage) in resource-limited settings.…”

Confirmatory factor analysis of the Kaufman assessment battery in a sample of primary school-aged children in rural South Africa

“…Recent evidence has begun to illustrate the cognitive disadvantages SSA children face from primary school age, with children performing well below expected scores for age , and often experiencing education failure (measured by repeated grades) early in their schooling careers (Mitchell et al, 2016). Promoting children's cognitive abilities is a key factor in encouraging development.…”

“…The number of children at risk for poor development has reduced worldwide in recent years; however, Sub-Saharan Africa (SSA) has seen little improvement and still has the highest number of children failing to fulfil their potential (Lu, Black, & Richter, 2016). Recent evidence has begun to illustrate the cognitive disadvantages SSA children face from primary school age, with children performing well below expected scores for age (Rochat et al, 2017) and often experiencing education failure (measured by repeated grades) early in their schooling careers (Mitchell et al, 2016). Promoting children's cognitive abilities is a key factor in encouraging development.…”

“We Are Small, But We Have Jobs”: A Profile of the Labour Activities of Children and Youth in South Africa

“…The goods often sold are various food items, including fruit and vegetables, clothing, and tourist souvenirs in certain areas (Mosupye and von Holy 2000;Timothy and Wall 1997). Work of this nature is not strictly regulated by labour laws, and some of the occupational risks vendors are exposed to include extreme weather changes, petty theft, and unregulated working hours (Bromley 2000;Mitullah 2003; te Lintelo 2017). Street vendors are found in both rural and urban settlements in South Africa, and many street vendors who work in urban areas, such as city centres, reside in nearby rural areas (Mathaulula, Francis, and Mwale 2015;Sheldon 2018).…”