Determinants of Nutritional Status and Cognitive Performance among School Aged Children in Rural and Peri Urban Communities in the Effutu Municipality

Abstract

Background: Malnutrition has been found to be the leading cause of morbidity and mortality in low- and middle-income countries. It is linked to about 2.6 million deaths each year and impairs the physical and cognitive development of over 450 million children. The school age (6-12 years) is a crucial period for both cognitive and physical development. Nutritional deficit during this period causes adverse consequences including low school enrolment, school dropout, and poor cognitive performance. Objectives: This study examined at the association among school-aged (6-12 years) children's dietary intake, cognitive performance and nutritional status, as well as the predictors both cognitive performance and nutritional status. Methodology: A cross-sectional study design was employed to recruit 360 school-aged children aged 6-12 years from two rural and two peri-urban communities in the Effutu municipality, in the Central Region of Ghana. The Urit 12, lancet, and haemoglobin strips were used to determine the prevalence of anaemia, and a structured questionnaire was employed to collect data on their sociodemographic and dietary intake. The study focused on BMI for age Z score to assess the school aged children’s nutritional status, because it requires only weight, height and age of the participants and it also assess both undernutrition and over nutrition. The Raven’s Coloured Progressive Matrices and anthropometric assessment were used to measure the outcome of interest which was their cognitive performance and nutritional status. Cognitive performance of SAC was grouped into average cognitive performance and poor cognitive performance, where cognition status was defined as follows: <50th percentile poor cognitive performance and ≥50th percentile as average cognitive performance. Participants who had good nutritional status had a z-score between -2 and 2 and those who had poor nutritional status had a z-score below -2. Means ± standard deviations and frequencies were used to summarize continuous and categorical variables, respectively. The chi-square test was used to investigate the association between cognitive performance and nutritional status. Logistic regression was used to determine the factors affecting cognitive performance and nutritional status with a 95% confidence interval and a statistical significance of p<0.05. Results: The mean age of the participants was 10.9 ±1.3 years and the mean household size was 8.21 ± 4.9. 61.7% of the total participants were females. More than half of the participants 54.4% were in class 4. Among the 360 participants, 38.3% were average, 58.6% were below average, while 3.1% were deficit. Overall, none of the children were superior and above average. 75.8% of the participants had adequate dietary diversity; whiles 24.2% of the participants had inadequate dietary diversity. For BMI-for-age Zscore, 5.9% of my participants were thin, 72.5% were normal, 15.8% were overweight and 5.8% were obese. 6.7% had severe anaemia 35.3% had moderate anaemia, 15.8% had mild anaemia and 42.2% had no anaemia. Children who have female caregivers were associated with average cognitive performance than those with male caregivers (OR=1.55, 95% CI: 0.89-2.69). Children who had adequate dietary diversity were more likely to have average cognitive performance (OR=1.02, 95% CI: 0.61-1.72) than those below. Children with male caregivers had 55% lower odds of having good nutritional status compared to those with female caregivers (OR = 0.45, 95% CI: 0.23, 0.88). Children whose caregivers who work as professionals had lower odds of good nutritional status (OR = 0.52, 95% CI: 0.27, 0.97). Conclusion: Malnutrition and suboptimal cognitive performance remain significant concerns among school-aged children in the Effutu Municipality. Although most children had adequate dietary diversity and normal nutritional status, a high proportion exhibited below-average cognitive performance and a considerable burden of anaemia. Caregiver characteristics, particularly sex and occupation, emerged as important predictors of both nutritional status and cognitive outcomes. These findings emphasize the need for integrated, context-specific interventions that address not only dietary intake but also household and caregiver factors to improve the nutritional wellbeing and cognitive development of school-aged children. Recommendation: Educational interventions programmes focused on early childhood education should be implemented in primary schools by the Effutu Municipal assembly to educate and enhance cognitive skills among SAC and also identify and support children who are at risk of poor cognitive outcomes.