Associations between selective attention and soil-transmitted helminth infections, socioeconomic status, and physical fitness in disadvantaged children in Port Elizabeth, South Africa: An observational study

Abstract

BackgroundSocioeconomically deprived children are at increased risk of ill-health associated with sedentary behavior, malnutrition, and helminth infection. The resulting reduced physical fitness, growth retardation, and impaired cognitive abilities may impede children’s capacity to pay attention. The present study examines how socioeconomic status (SES), parasitic worm infections, stunting, food insecurity, and physical fitness are associated with selective attention and academic achievement in school-aged children.MethodologyThe study cohort included 835 children, aged 8–12 years, from eight primary schools in socioeconomically disadvantaged neighborhoods of Port Elizabeth, South Africa. The d2-test was utilized to assess selective attention. This is a paper and pencil letter-cancellation test consisting of randomly mixed letters d and p with one to four single and/or double quotation marks either over and/or under each letter. Children were invited to mark only the letters d that have double quotation marks. Cardiorespiratory fitness was assessed via the 20 m shuttle run test and muscle strength using the grip strength test. The Kato-Katz thick smear technique was employed to detect helminth eggs in stool samples. SES and food insecurity were determined with a pre-tested questionnaire, while end of year school results were used as an indicator of academic achievement.Principal findingsChildren infected with soil-transmitted helminths had lower selective attention, lower school grades (academic achievement scores), and lower grip strength (all p<0.05). In a multiple regression model, low selective attention was associated with soil-transmitted helminth infection (p<0.05) and low shuttle run performance (p<0.001), whereas higher academic achievement was observed in children without soil-transmitted helminth infection (p<0.001) and with higher shuttle run performance (p<0.05).Conclusions/SignificanceSoil-transmitted helminth infections and low physical fitness appear to hamper children’s capacity to pay attention and thereby impede their academic performance. Poor academic achievement will make it difficult for children to realize their full potential, perpetuating a vicious cycle of poverty and poor health.Trial registrationClinicalTrials.gov ISRCTN68411960

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“…The developed intervention toolkit was pilot-tested among fourth graders in disadvantaged primary schools in Port Elizabeth, South Africa. The preliminary findings suggest that (i) the prevalence of parasitic worm infection was high in several schools [25]; (ii) children infected with soil-transmitted helminths had lower maximal oxygen uptake compared to their non-infected peers [26]; (iii) helminth infections and low physical fitness were significant predictors of low selective attention and poor academic achievement [27]; (iv) increased levels of physical activity were associated with a higher health-related quality of life (HRQoL) [28]; (v) increased physical activity levels were associated with lower risks of obesity and hypertension, but increased risk for soil-transmitted helminth infections [29]; and (vi) the DASH physical activity component resulted in small but significant decreases in the body mass index (BMI) of the children [30] and had a positive impact on academic performance within one year [31]. The intervention teaching material used in the DASH study was further elaborated and adapted and then pilot-tested among schoolchildren in grades 4-7 from two disadvantaged primary schools in Port Elizabeth.…”