Health and educational achievement of school-aged children: The impact of anaemia and iron status on learning

Background Anaemia is a common blood disorder in children and is known to cause complications such as lethargy and stress on bodily organs. Children from disadvantaged communities often fail to achieve their age-related potential with iron deficiency anaemia stated as a risk factor through causing inattentiveness and learning problems. Limited evidence exists for the adverse effects of iron deficiency anaemia on the developing child’s brain from South African studies. Aim The objective of this study was to determine the local prevalence of anaemia and iron deficiency and to examine their association with psychomotor development and school performance in school-aged children. Setting This study was conducted in a peri-urban disadvantaged community from KwaZulu-Natal, South Africa. Methods Children aged 6 to 8 years from KwaZulu-Natal were enrolled (n = 184). Three parameters of assessment were used: clinical data, biochemical data (haemoglobin levels and iron studies) and school performance (interviews with caregivers, teachers and the children). Anaemia presence and iron deficiency were the hypothesised mediating variables through which growth, development and school performance were influenced. Results A high point prevalence of anaemia (23.4%), iron deficiency anaemia (4.9%) and helminth infection (27.1%) was identified. Impaired cognitive assessment scores (20.7%) were prevalent in the children sampled. Behavioural problems (4.3%), poor memory function (4.3%) and impaired attention (1.1%) were of low prevalence. Anaemia and iron deficiency were both associated with impaired fine motor skills (p < 0.05). Anaemia was significantly associated with low cognitive scores (p = 0.01). Neither anaemia, iron status nor helminth infection significantly predicted school performance in the children sampled. Conclusions The point prevalence of anaemia and iron deficiency among the sampled children was higher than the national prevalence. The sample size was however inadequate for drawing statistical conclusions about psychomotor development and school performance because of the low prevalence of the different outcomes that were examined. Practical challenges faced in conducting this investigation in rural South African schools were discussed.

[1]  M. Boivin,et al.  Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: A systematic review and meta-analysis , 2018, PLoS neglected tropical diseases.

[2]  D. Labadarios,et al.  The extent and determinants of diabetes and cardiovascular disease comorbidity in South Africa – results from the South African National Health and Nutrition Examination Survey (SANHANES-1) , 2017, BMC Public Health.

[3]  T. Gwetu.  Anemia, Iron Deficiency and Diet Independently Influence Growth Patterns of School Aged Children in South Africa , 2016 .

[4]  D. Coetzee,et al.  Prevalence of stunting, wasting and underweight in grade 1-learners: The NW-CHILD Study , 2014 .

[5]  C. Draper,et al.  The relationship between gross motor skills and school readiness in early childhood: making the case in South Africa , 2013 .

[6]  B. Koletzko,et al.  The Effect of Iron on Cognitive Development and Function in Infants, Children and Adolescents: A Systematic Review , 2011, Annals of Nutrition and Metabolism.

[7]  Margaret M. Dubeck,et al.  Improving educational achievement and anaemia of school children: design of a cluster randomised trial of school-based malaria prevention and enhanced literacy instruction in Kenya , 2010, Trials.

[8]  P. Kumarasiri,et al.  The association of iron status with educational performance and intelligence among adolescents. , 2009, The Ceylon medical journal.

[9]  D. Bellinger,et al.  Anemia of Inflammation Is Related to Cognitive Impairment among Children in Leyte, The Philippines , 2009, PLoS neglected tropical diseases.

[10]  D. Benton.  The impact of diet on anti-social, violent and criminal behaviour , 2007, Neuroscience & Biobehavioral Reviews.

[11]  L. Allen,et al.  Young Zanzibari children with iron deficiency, iron deficiency anemia, stunting, or malaria have lower motor activity scores and spend less time in locomotion. , 2007, The Journal of nutrition.

[12]  R. Martorell,et al.  Child development in developing countries 3 Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world , 2007 .

[13]  M. Jukes.  The Long-Term Impact of Preschool Health and Nutrition on Education , 2005, Food and nutrition bulletin.

[14]  T. Gera,et al.  Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials , 2005, Public Health Nutrition.

[15]  J. Kvalsvig,et al.  Patterns of Schistosoma haematobium infection, impact of praziquantel treatment and re-infection after treatment in a cohort of schoolchildren from rural KwaZulu-Natal/South Africa , 2004, BMC infectious diseases.

[16]  C. Jinabhai,et al.  Investigating the mental abilities of rural Zulu primary school children in South Africa , 2004, Ethnicity & health.

[17]  J. Connor,et al.  Iron status and neural functioning. , 2003, Annual review of nutrition.

[18]  H. Coovadia,et al.  A randomized controlled trial of the effect of antihelminthic treatment and micronutrient fortification on health status and school performance of rural primary school children , 2001, Annals of tropical paediatrics.

[19]  S. Brooker,et al.  Anaemia in schoolchildren in eight countries in Africa and Asia , 2001, Public Health Nutrition.

[20]  R. Gilbert,et al.  Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia. , 2001, The Cochrane database of systematic reviews.

[21]  M. Boivin,et al.  Effects of treatment for intestinal parasites and malaria on the cognitive abilities of schoolchildren in Zaire, Africa. , 1993, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[22]  J. Kvalsvig,et al.  The effects of parasite infections on cognitive processes in children. , 1991, Annals of tropical medicine and parasitology.