Nutritional and socio-economic determinants of cognitive function and educational achievement of Aboriginal schoolchildren in rural Malaysia

The Prevalence and Determinants of Anemia Among Indigenous (Orang Asli) Children in Peninsular Malaysia: A Systematic Review

Low- and lower-middle-income countries bear the greatest burden of anemia, particularly those living in rural settings such as an indigenous community. The objective of this systematic review was to determine the prevalence of anemia and its determinants among the Orang Asli children in Peninsular Malaysia. A web-based search of PubMed, Web of Science, Scopus, Medline, and ProQuest from January 2000 to June 2022, using specified search/MeSH (Medical Subject Headings) terms and keywords, was conducted. The search identified studies reported the prevalence of anemia among the children of Orang Asli and its causes. Eight studies were included in the final analysis. The prevalence of anemia among the Orang Asli children was high (61.6%). Most research has focused primarily on iron-deficiency anemia and soil-transmitted helminth infections. Other causes include female gender, mothers with low education levels, and low household incomes. Despite being a public health concern, this study found no studies associating Orang Asli children with hereditary anemia and malaria, which is a limitation. In conclusion, the Orang Asli children are more likely to have anemia compared with the general Malaysian population. To overcome this, a comprehensive examination of the determinants of anemia in this community is required. Thus, interventions can be personalized.

Socio-demographic factors influencing measures of cognitive function of early adolescent students in abuja, Nigeria

BACKGROUND

The brain in the early adolescent period undergoes enhanced changes with the radical reorganisation of the neuronal network leading to improvement in cognitive capacity. A complex interplay exists between environment and genetics that influences the outcome of intellectual capability. We, therefore, aimed to evaluate the relationship between socio-demographic variables and measures of cognitive function (intelligence quotient [IQ] and academic performance) of early adolescents.

METHODS

The study was a descriptive cross-sectional study of early adolescents aged 10-14 years. Raven's Standard Progressive Matrices was used to assess the IQ and academic performance was assessed by obtaining the average of all the subjects' scores in the last three terms that made up an academic year. A confidence interval of 95% was assumed and a value of P < 0.05 was considered statistically significant.

RESULTS

The overall mean (standard deviation) age of the study population was 11.1 years (±1.3) with male-to-female ratio of 1:1. Female sex was associated with better academic performance with P = 0.004. The students with optimal IQ performance were more likely (61.7%) to perform above average than those with sub-optimal IQ performance (28.6%). As the mother's age increased, the likelihood of having optimal IQ performance increased 1.04 times (odds ratio [OR] = 1.04; 95 confidence interval [CI] = 1.01-1.07). Students in private schools were three times more likely to have optimal IQ performance than those from public schools (OR = 2.79; 95 CI = 1.65-4.71).

CONCLUSION

The present study demonstrated that students' IQ performance and the female gender were associated with above-average academic performance. The predictors of optimal IQ performance found in this study were students' age, maternal age and school type.

Systematic review and meta-analysis found that malnutrition was associated with poor cognitive development

AIM

Malnutrition is a major public health issue that has been associated with high susceptibility for impaired brain development and mental functioning. However, to date studies on this topic have not been collated and appraised. This systematic review and meta-analysis investigated the association between malnutrition and cognitive development.

METHODS

We searched the MEDLINE, Scopus, CINAHL, Embase PsycINFO and Cochrane Library databases in English up to 8 December 2020. All studies reporting an association between nutritional status and cognitive development were included. p values of less than 0.05 were considered statistically significant and the results are reported as standardised mean differences (SMD), 95% confidence intervals (95%) and I² statistics.

RESULTS

We included 12 studies comprising 7,607 participants aged 1 to 12 years. Children with malnutrition had worse scores than controls for the Wechsler Intelligence Scale (SMD -0.40; 95% CI -0.60 to -0.20; p < 0.0001; I² 77.1%), the Raven's Coloured Progressive Matrices (SMD -3.75; 95% CI -5.68 to -1.83; p < 0.0001; I² 99.2%), visual processing (SMD -0.85; 95% CI -1.23 to -0.46; p 0.009; I² 11.0%) and short memory (SMD 0.85; 95% CI -1.21 to -0.49; p < 0.0001; I² 0%) tests.

CONCLUSION

Normal cognitive development requires access to good and safe nutrition.

Nutritional Status and Its Association with Cognitive Function among School Aged Children at Soddo Town and Soddo Zuriya District, Southern Ethiopia: Institution Based Comparative Study

About 1 billion stunted school-aged children are growing up with impaired mental development which can lead to low cognitive performance, reduced school achievement, and low productivity. But there is scarce evidence on cognitive function, school performance and their associated factors among school aged children. The main aim of this study was to assess cognitive function, school performance and determine their association with nutritional status among school children aged 7 to 10 years at Soddo Town and Soddo Zuriya Woreda, Wolaita Zone, Southern Ethiopia. Institutional comparative cross-sectional study was conducted on a total sample of 178 primary school children. The Raven’s Color Progressive Matrices (RCPM) and selected tests from Kaufman assessment battery for children second edition were used. Mid-year average students’ examination result was also used. Data were analyzed by using SPSS version 25, WHO Anthro plus, and independent sample t-test. Bivariate and multivariate linear regression analyses were also used. Mean (±SD) cognitive test scores of urban study participants was 18.7 ± 3.4 for RCPM which was higher (P < .001) as compared to rural (16.5 ± 3.3). The urban mean cognitive test scores was also higher for both pattern reasoning and visual processing with (P < .001) as compared to rural counterparts. School performance was higher (P < .001) for urban. Maternal education (P < .002) and wealth index (P < .006) were positively predicted while stunting (P < .001) negatively predicted cognitive function test scores and school performance. Cognitive function and school performance of study participants were associated with their nutritional status and rural participants had significantly lower mean scores as compared to urban counterparts. Further study should be done to community level.

Nutritional Status and Educational Performance of School-Aged Children in Lalibela Town Primary Schools, Northern Ethiopia

Background

Every student has the potential to do well in school. Failing to provide good nutrition puts them at risk for missing out on meeting that potential and leads to long-term irreversible damage to cognitive development. However, taking action today to provide healthier choices in schools can help set students up for a successful future full of possibilities. So, this study is aimed at assessing the effect of nutritional status on academic performance of school-aged children.

Methods

A school-based cross-sectional study was conducted from Feb 05- March 30, 2017 in Lalibela town. A total of 505 primary school students were included in the study. The child anthropometric measures were calculated using AnthroPlus software version 1.0.4 WHO 2007 standards. Bivariable and multivariable ordinal logistic regression were fitted. The proportional odds ratio (POR) with a 95% CI and P value < 0.05 were considered statistically significant.

Results

The overall prevalence of stunting, underweight, and thinness was 29.5%, 35.7%, and 29.5%, respectively. In this study, 14.7% of the study participants had low academic achievement in the semester. The multivariable analysis showed that rural residence (POR = 0.39; 95% CI: (0.21, 0.75)), not studying regularly (POR = 0.49; 95% CI: (0.29, 0.82)), severe underweight (POR = 0.25; 95% CI: (0.09, 0.71)), and severe stunting (POR = 0.03; 95% CI: (0.01, 0.37)) were associated with decreased odds of high average semester score achievement of school-aged children. Additionally, higher maternal educational status (POR = 2.12; 95% CI: (1.10, 4.07)) and family income from 550 to 2999 ETB (POR = 1.71; 95% CI: (1.04, 2.81)) were associated with increased odds of high semester average score achievement.

Conclusion

Nearly one-third of school-aged children in Lalibela town were stunted, thin, and underweight. Rural place of residence, not studying regularly study, underweight, and stunting were associated with decreased academic achievement. While, family monthly income from 550 to 2999 ETB and higher maternal education status were associated with increased academic achievement.

Sociodemographic, nutritional, and environmental factors are associated with cognitive performance among Orang Asli children in Malaysia

Children aged 2 to 6 years are in a crucial period of growth development, during which it is important for them to attain specific cognition related to concentration and attention so that they can perform well in school later in life. Various factors influence children’s cognition during this crucial period. However, to date, only a limited number of studies have examined the cognitive performance of underprivileged children living in poverty, particularly indigenous children (also known as Orang Asli children in Malaysia). Therefore, this cross-sectional study aimed to determine the associations between sociodemographic factors, nutritional factors (body composition and hemoglobin), and environmental factors (home environment and parasitic infections) with cognitive performance among Orang Asli children in Negeri Sembilan, Malaysia. The participants were 269 children (51% boys, 49% girls) aged 2 to 6 years (M = 4.0, SD = 1.2 years) and their mothers, from 14 Orang Asli villages. Face-to-face interviews were conducted with the mothers, and the children’s cognitive performance, operationalized as working memory index (WMI), processing speed index (PSI), and cognitive proficiency index (CPI), was assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). The children’s weight and height were measured, and their blood and stool samples were collected to assess hemoglobin level and parasitic infections, respectively. Multiple linear regression analysis showed that the father’s years of education (β = 0.262–0.342, p < 0.05), availability of learning materials at home (β = 0.263–0.425, p < 0.05), and responsiveness of the parent to the child (β = 0.192–0.331, p < 0.05) were consistently associated with all three cognitive indices (WMI, PSI, and CPI). A holistic approach involving parents, communities, and government agencies should be established to improve the cognitive performance of these underprivileged children.

Low socioeconomic status and severe obesity are linked to poor cognitive performance in Malaysian children

Background

Socioeconomic factors and nutritional status have been associated with childhood cognitive development. However, previous Malaysian studies had been conducted with small populations and had inconsistent results. Thus, this present study aims to determine the association between socioeconomic and nutritional status with cognitive performance in a nationally representative sample of Malaysian children.

Methods

A total of 2406 Malaysian children aged 5 to 12 years, who had participated in the South East Asian Nutrition Surveys (SEANUTS), were included in this study. Cognitive performance [non-verbal intelligence quotient (IQ)] was measured using Raven’s Progressive Matrices, while socioeconomic characteristics were determined using parent-report questionnaires. Body mass index (BMI) was calculated using measured weight and height, while BMI-for-age Z-score (BAZ) and height-for-age Z-score (HAZ) were determined using WHO 2007 growth reference.

Results

Overall, about a third (35.0%) of the children had above average non-verbal IQ (high average: 110–119; superior: ≥120 and above), while only 12.2% were categorized as having low/borderline IQ (< 80). Children with severe obesity (BAZ > 3SD), children from very low household income families and children whose parents had only up to primary level education had the highest prevalence of low/borderline non-verbal IQ, compared to their non-obese and higher socioeconomic counterparts. Parental lack of education was associated with low/borderline/below average IQ [paternal, OR = 2.38 (95%CI 1.22, 4.62); maternal, OR = 2.64 (95%CI 1.32, 5.30)]. Children from the lowest income group were twice as likely to have low/borderline/below average IQ [OR = 2.01 (95%CI 1.16, 3.49)]. Children with severe obesity were twice as likely to have poor non-verbal IQ than children with normal BMI [OR = 2.28 (95%CI 1.23, 4.24)].

Conclusions

Children from disadvantaged backgrounds (that is those from very low income families and those whose parents had primary education or lower) and children with severe obesity are more likely to have poor non-verbal IQ. Further studies to investigate the social and environmental factors linked to cognitive performance will provide deeper insights into the measures that can be taken to improve the cognitive performance of Malaysian children.

A multifactorial approach of nutritional, intellectual, brain development, cardiovascular risk, socio-economic, demographic and educational variables affecting the scholastic achievement in Chilean students: An eight- year follow-up study

The aim of this study was to quantitate the relative impact of nutritional, intellectual, brain development, cardiovascular risk, socio-economic, demographic and educational variables on the results of the 2009 Quality Education Measurement System (SIMCE) tests of language and mathematics for scholastic achievement (SA) applying a multifactorial approach, in school-age children of the 2010 5th elementary school grade (5ESG) and of the 1st grade of high school (1HSG). The purposes were: i) to test the hypothesis that intellectual ability, the level of SA of the educational establishments in the 2009 SIMCE tests, sex, parental schooling levels, and head circumference-for-age Z-score are the most relevant parameters associated with 2009 SIMCE outcomes; ii) to determine the predictive ability of the 2009 SIMCE results in determining the 2013 SIMCE outcomes for the 2010 5ESG cohort (when they graduated from elementary school, 8th grade) and for determining the 2013 University Selection Test (PSU) outcomes for the 2010 1HSG group (for university admission, when they graduated from high school, 4th grade); iii) to determine the association between the 2009 SIMCE results with the 2017 PSU outcomes for the 2010 5ESG group (for university admission, when they graduated from high school, 4th grade). A representative, proportional and stratified sample of 33 schools of the Metropolitan Region of Chile was randomly chosen. In these schools, 1,353 school-age children of both sexes, of the 2010 5ESG (n = 682; mean age = 10.8 years, SD = 0.6) and of the 2010 1HSG (n = 671; mean age = 14.8 years, SD = 0.6) participated. In both grades and tests, the findings confirm the hypotheses formulated. 2009 SIMCE outcomes were positively and significantly associated with 2013 SIMCE and with 2017 PSU and, with 2013 PSU outcomes in school-age children from 2010 5ESG and 1HSG, respectively. These findings may be useful for educational and health planning in Chile and countries in a comparable stage of development.

Reasoning Abilities and Potential Correlates Among Jordanian School Children

Objectives To investigate factors related to reasoning skills in 434 school children aged 5-9 years. Methods The Leiter International Performance Scale-Revised was used to assess reasoning skills. Demographic, work and family income data, information on child's daily behavior and school academic achievement were provided by the participating children's parents. Results Reasoning scores increased by 4.56 points with increasing subject's age, 1.71 points with increasing level of father's occupation, 1.86 points with each increase in the subject's GPA, 1.13 points with consumption of breakfast at home and 1.81 points when child slept more hours. Having a father who smoked and living in a rural area decreased scores in reasoning. Conclusions for Practice Screening of reasoning and associated factors is essential for a comprehensive and accurate understanding of the child's abilities and limitations. Understanding the child's reasoning abilities is critical for establishing intervention goals and planning therapeutic activities.

Determinants of Spatial Heterogeneity of Functional Illiteracy among School-Aged Children in the Philippines: An Ecological Study

Functional literacy is one of the targets of the Sustainable Development Goals (SDGs) of the United Nations. Functional literacy indicators are likely to vary between locations given the geographical variability of its major determinants. This property poses a challenge to decisions around efficient allocation of population services and resources to mitigate the impact of functional literacy in populations most in need. Using functional literacy indicators of 11,313 school-aged children collected in 2008 during the nationwide survey, the current study examined the association between functional literacy and geographical disparities in socioeconomic status (SES), water supply, sanitation and hygiene, household education stimuli, and environmental variables in all three regions of the Philippines (Luzon, the Visayas, and Mindanao). Three nested fixed-effects multinomial regression models were built to determine associations between functional literacy and a wide array of variables. Our results showed the general prevalence rate of functional illiteracy as being 4.7%, with the highest prevalence rate in the Visayas, followed by Mindanao and Luzon (7.5%, 6.9%, and 3.0%, respectively. Our results indicated that in Luzon prevalence of functional illiteracy was explained by variation in household education stimuli scores, sources of drinking water, and type of toilet facility. In Mindanao and the Visayas prevalence of functional illiteracy was primarily explained by geographical variation in SES, and natural environmental conditions. Our study highlights region-specific determinants of functional literacy and the need for geographically targeted, integrated interventions.

INTESTINAL PARASITES, NUTRITIONAL STATUS AND COGNITIVE FUNCTION AMONG PRIMARY SCHOOL PUPILS IN ILE-IFE, OSUN STATE, NIGERIA

Background:

Intestinal parasites are a cause of morbidity and mortality throughout the world particularly in developing countries and they are common health problems of children. This study determined the prevalence of intestinal parasites among primary school children, assessed risk factors predisposing to infection and the nutritional status with cognitive function of the pupils.

Materials and Methods:

It was a cross sectional study and 384 pupils from six public primary schools in Ile-Ife were enrolled. Anthropometric measurements were obtained using standard procedures. The intelligence quotients of the pupils were assessed using the Draw-a-person- test. Stool samples were collected and examined. Data was processed using SPSS Inc USA version 17. Statistical analysis was done using frequency, percentages, tables and Pearson’s chi-square was used to determine the association between intestinal parasites, nutritional status and cognitive function.

Results:

The prevalence of intestinal parasites in the study population was 24% with double infection occurring in 3.2%. Ascaris lumbricoides most prevalent 22.1%, Hookworm 3.4%, Hymenolepis nana 0.3%. Intestinal parasites were present in those that use bush and refuse dump for defeacation. The nutritional status of the pupils showed 95.8% normal weight, 3.6% underweight and 0.5% overweight. In terms of cognition, 65.4% mentally deficient, 14.3% mentally dull and 20.3% average.

Conclusion:

Intestinal parasites were prevalent among primary school children and use of bush or refuse dump for defeacation was a risk factor. There was no association between intestinal parasites, nutritional status and cognition.

Construct validity and internal consistency reliability of the Loewenstein occupational therapy cognitive assessment (LOTCA)

BACKGROUND

Cognitive abilities are essential for children's development and independence. Various cognitive assessments, standardized in Western cultures, have yet to be investigated for their multicultural suitability.

AIMS

To explore the suitability of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) for a Jordanian population.

METHODS

Observed cases of 442 Jordanian children aged 6-12 were used to perform exploratory factor analyses using principal components with Varimax rotation (construct validity evidence) and to compute Cronbach's α coefficient (internal consistency reliability).

RESULTS

High total performance on four subscales and a slightly lower total performance on two subscales were observed. Observed performance increased with age on three subtests, whereas a more modest increase was observed on the other three subscales. The expected one-factorial solution confirming the LOTCA's subscales homogeneity (unidimensionality) structure was found on five of six subscales. Variance explained by the subscales ranged from 39 to 82% and internal consistency reliability measured by Cronbach's alpha ranged from .42 to .78.

CONCLUSIONS

Satisfactory construct validity and internal consistency reliability were demonstrated on two subscales applicable to Jordanian children without adaptation. With adequate cross-cultural adaptation, increasing internal consistency reliability in other subscales could make the LOTCA an effective tool for assessing cognitive abilities in this population.

Memory and potential correlates among children in Jordan

BACKGROUND

Cognitive functioning hugely affects the performance of tasks of different complexity. Memory, one of the most important cognitive skills, allows children to practice and acquire necessary skills and knowledge and interact with the surrounding environment. Therefore, it is crucial to study the factors that influence the memory of children. The main purpose of his study was to investigate different variables related to memory in school aged children (5-9 years, N = 434).

METHODS

Parents of the participants provided information about child's daily behavior, child's school academic achievement, work and family income data and demographics. Memory skills in children were assessed by using the Leiter International Performance Scale -Revised.

RESULTS

The score of memory increased 2.53 points with upsurge in maternal occupation level, 3.08 points when the child ate breakfast and 4.51 points when the child daily slept nine hours and more. By contrast, increased family income and smoking by father resulted in decreased scores in memory.

CONCLUSION

Screening for and understanding of memory and relevant factors are vital for broad understanding of children's capabilities and weaknesses as well as for developing appropriate interventions.

Measuring the Effect of Soil-Transmitted Helminth Infections on Cognitive Function in Children: Systematic Review and Critical Appraisal of Evidence

Recently the role of soil-transmitted helminth (STH) infections in children's cognitive developmental impairment has been under scrutiny. We conducted a systematic review of the evidence for associations between STH infections and cognitive function of children using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. We aimed to identify the domains of cognitive function in three age strata (<24months, 24-59months and ≥60months) and critically appraise the general design protocol of the studies, with a focus on the cognitive function measurement tools used. A total of 42 papers fulfilled the inclusion criteria, including 10 studies from a recent Cochrane review. Our findings demonstrate variation in tested domains, lack of consistency in the use of measurement tools and analysis of results. Cognitive function measures in children aged under 59months have been mainly limited to domains of gross motor, fine motor and language skills, whereas in children aged 60months and above most studies tested domains such as memory and processing speed. Even within the same age group the results on the association between STH infections and measures of cognitive development were often conflicting. The current study highlights the need for methodological consensus in the use of measurement tools and data analysis protocols if the effect of STH infections on cognitive function domains in children is to be correctly established. This will be an imperative next step to generate conclusive evidence of the role of STH infections in cognitive development in children.

Academic Achievement and Psychosocial Profile of Egyptian Primary School Children in South Sinai

BACKGROUND

Population of South Sinai has suffered from negligence for many years. Solving educational problems of this population is the main concern nowadays.

AIM

To assess academic achievement in primary school children in South Sinai in relation to intelligence and psychosocial profile.

SUBJECTS AND METHODS

A descriptive cross-sectional survey was conducted on 407 Bedouin and urban students randomly selected from twelve public primary schools in six cities in South Sinai. Intelligence was assessed using Goodenough-Harris test. The midyear Arabic language and Arithmetic scores were used to assess academic achievement. The teachers completed a Pediatric-Symptom Checklist for evaluation of children behaviour.

RESULTS

A statistically significant difference in academic achievement (P < 0.001), total psychosocial scores, (P < 0.05), and externalization (P < 0.05) was found between urban and Bedouin students with significant gender differences (P < 0.05). Highly significant positive correlations were observed between IQ percentile and mid-year Arabic language scores and Arithmetic scores (P < 0.001), and significant negative correlations with the total score of PSCL and its subscale scores (externalising, inattention, and internalising behaviour) (P < 0.001) among the students.

CONCLUSION

Comorbid academic and psychosocial dysfunction in primary school children were observed in South Sinai. A national strategy to minimise the educational gap between Bedouin and urban areas should be implemented.

Sex differences in the intellectual functioning of early school-aged children in rural China

Background

Gender disparities in China are concentrated in poor rural areas and among poor households. The difference in intelligence between boys and girls is less clear in rural China. The purpose of this paper was to assess sex differences in the intellectual function of early school-aged children in rural China.

Methods

One thousand seven hundred forty four early school-aged offspring of women who had participated in a prenatal supplementation trial with different combinations of micronutrients and continued to reside in two rural counties in China were followed. We measured their Full-Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Working Memory Index (WMI), Perceptual Reasoning Index (PRI) and Processing Speed Index (PSI) using the Wechsler Intelligence Scale for Children (WISC-IV). Multilevel analyses were used to assess sex differences in intellectual functioning in 7-10-year-old children in rural China.

Results

Boys’ adjusted mean FSIQ score was 0.97 points higher (95 % CI: -2.22 − 0.28) than that of girls. Girls obtained higher mean WMI and PSI scores, with 1.32 points (95 % CI: 0.14 − 2.51) and 3.10 points (95 % CI: 1.82–4.38) higher adjusted means, respectively. Boys’ adjusted mean VCI and PRI scores were significantly higher than those of girls, and the mean differences were 2.44 points (95 % CI: 0.95 − 3.94) and 3.68 points (95 % CI: 2.36 − 5.01), respectively.

Conclusions

There is no evidence to suggest sex differences in the general intelligence of early school-aged children in rural China. However, a difference in general intelligence between 10-year-old boys and girls was evident. Girls and boys in rural China tended to show different specific cognitive abilities.

Prenatal Micronutrient Supplementation Is Not Associated with Intellectual Development of Young School-Aged Children

BACKGROUND

Micronutrient supplementation is often prescribed during pregnancy. The effects of prenatal iron and multimicronutrient supplementation on intellectual development in young school-aged children are less than clear.

OBJECTIVE

The aim of this study was to examine the long-term effects of prenatal iron plus folic acid or multiple micronutrient (including iron and folic acid) supplementation vs. folic acid supplementation on the intellectual development of young school-aged children in rural China.

METHODS

Young school-aged children (aged 7-10 y, n = 1744) of women who had participated in a trial of prenatal supplementation with various combinations of micronutrients and remained residents in 2 rural counties in China were followed. We measured their intellectual development by Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV). The WISC-IV generated the Full-Scale Intelligence Quotient (FSIQ), Verbal Comprehension Index (VCI), Working Memory Index (WMI), Perceptual Reasoning Index (PRI), and Processing Speed Index (PSI). Multilevel analyses were used to assess the effect of prenatal micronutrient supplementation on the intellectual development of children.

RESULTS

The mean differences in FSIQ, VCI, WMI, PRI, and PSI, respectively, were not significant between prenatal folic acid supplementation and either iron plus folic acid [-0.34 (P = 0.65), -0.06 (P = 0.95), -0.22 (P = 0.76), -0.01 (P = 0.99), and -1.26 (P = 0.11)] or multimicronutrient [-0.39 (P = 0.60), -0.64 (P = 0.48), 0.11 (P = 0.87), -0.43 (P = 0.59), and -0.34; (P = 0.65)] supplementation after adjusting for confounders.

CONCLUSIONS

There is no evidence to suggest a different effect on intellectual development between prenatal iron plus folic acid, multimicronutrient supplementation, and prenatal folic acid supplementation in children aged 7-10 y. This trial was registered at www.isrctn.com as ISRCTN08850194.

Effects of vitamin A supplementation on iron status indices and iron deficiency anaemia: a randomized controlled trial

Iron deficiency anaemia (IDA) is the most common nutritional deficiency in the world including developed and developing countries. Despite intensive efforts to improve the quality of life of rural and aboriginal communities in Malaysia, anaemia and IDA are still major public health problems in these communities particularly among children. A randomized, double-blind, placebo-controlled trial was conducted on 250 Orang Asli (aboriginal) schoolchildren in Malaysia to investigate the effects of a single high-dose of vitamin A supplementation (200,000 IU) on iron status indices, anaemia and IDA status. The effect of the supplement was assessed after 3 months of receiving the supplements; after a complete 3-day deworming course of 400 mg/day of albendazole tablets. The prevalence of anaemia was found to be high: 48.5% (95% CI=42.3, 54.8). Moreover, 34% (95% CI=28.3, 40.2) of the children had IDA, which accounted for 70.1% of the anaemic cases. The findings showed that the reduction in serum ferritin level and the increments in haemoglobin, serum iron and transferrin saturation were found to be significant among children allocated to the vitamin A group compared to those allocated to the placebo group (p<0.01). Moreover, a significant reduction in the prevalence of IDA by almost 22% than prevalence at baseline was reported among children in the vitamin A group compared with only 2.3% reduction among children in the placebo group. In conclusion, vitamin A supplementation showed a significant impact on iron status indices and IDA among Orang Asli children. Hence, providing vitamin A supplementation and imparting the knowledge related to nutritious food should be considered in the efforts to improve the nutritional and health status of these children as a part of efforts to improve the quality of life in rural and aboriginal communities.

Soil-transmitted helminthiasis: a critical but neglected factor influencing school participation of Aboriginal children in rural Malaysia

Soil-transmitted helminthiasis (STH), among the most common neglected tropical diseases, is a major public health problem in Malaysia with a possible impact on the nutritional status and school participation of rural children. This study was carried out among Aboriginal schoolchildren, living in an endemic area for STH in Malaysia, to determine the possible relationship between intestinal helminthiasis and school absenteeism. We also evaluated whether successful treatment of the infection will affect school attendance among the subjects. Stool analysis revealed that more than 90% of the subjects were infected with at least 1 helminth species, with Ascaris lumbricoides and Trichuris trichiura infections being most prevalent. Infection of moderate-to-heavy worm burdens, low level of fathers' education and anaemia were identified as the significant predictors of high absenteeism among the subjects (P<0·05). Following treatment of the infected children, it was found that school absenteeism was reduced significantly (P<0·01). In conclusion, STH continues to have significant impacts on public health, particularly in rural communities with a negatively significant effect on the school participation of Aboriginal children. A school-based de-worming programme should be introduced and incorporated in the current educational assistance targeted towards the Aboriginal communities, under the auspices of the government.