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Household Wealth and Neurocognitive Development Disparities among School‐aged Children in N epal
Author(s) -
Patel Shivani A.,
MurrayKolb Laura E.,
LeClerq Steven C.,
Khatry Subarna K.,
Tielsch James M.,
Katz Joanne,
Christian Parul
Publication year - 2013
Publication title -
paediatric and perinatal epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 88
eISSN - 1365-3016
pISSN - 0269-5022
DOI - 10.1111/ppe.12086
Subject(s) - neurocognitive , context (archaeology) , medicine , child development , cohort , population , gerontology , demography , environmental health , cognition , geography , psychiatry , archaeology , sociology
Background Wealth disparities in child developmental outcomes are well documented in developed countries. We sought to (1) describe the extent of wealth‐based neurocognitive development disparities and (2) examine potential mediating factors of disparities among a population‐based cohort of children in rural N epal. Methods We investigated household wealth‐based differences in intellectual, executive and motor function of n = 1692 children aged between 7 and 9 years in N epal. Using linear mixed models, wealth‐based differences were estimated before and after controlling for child and household demographic characteristics. We further examined wealth‐based differences adjusted for three sets of mediators: child nutritional status, home environment, and schooling pattern. Results We observed a positive gradient in child neurocognitive performance by household wealth. After adjusting for child and household control factors, disparities between children in the highest and lowest wealth quintiles persisted in intellectual and motor function, but not executive function. No statistically significant wealth‐based differentials in outcomes remained after accounting for nutritional status, home environment, and schooling patterns. The largest differences in neurocognitive development were associated with schooling pattern. Conclusions Household wealth patterns child neurocognitive development in rural N epal, likely through its influence on nutritional status, the home environment, and schooling. In the current context, improving early and regular schooling in this setting is critical to addressing wealth‐based disparities in outcomes.