Factors Influencing Cognitive Intelligence Among Children 6-7 Years Old in Vietnam Open Access

Raines, Kelley (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/j098zc21f?locale=en


Background Countries are aspiring towards societies in which every child has the opportunity to complete primary or basic education; however, it is evident that many children fail to meet their developmental potential. A child’s home learning environment and nutritional intake have been considered influential on cognitive ability in previous research, but there has been limited research including these two factors within analysis of Vietnamese children. The current study assesses these two factors along with other pertinent determinants to observe what significantly associates with childhood cognitive ability in Vietnamese children.


Method A cross-sectional analysis was conducted using data that were collected as part of the PRECONCEPT study, a randomized controlled trial of pre-pregnancy micronutrient supplementation that was conducted in rural Vietnam. The study subjects were a subsample (n=467) born to women who participated in this trial and were followed up at age 6-7 years. Descriptive statistics and multivariate regression analysis were carried out to examine the associations among household environment, maternal characteristics, and child attributes with the Wechsler Intelligence Scale for Children.


Results Socioeconomic status (Low*: Ref, Medium: β [95% CI] = 3.3 [0.6, 5.9], High: 5.7 [2.6, 8.8]), home environment quality (0.3 [0.0, 0.6]), maternal education (Elementary*, Middle: 1.8 [ -2.4, 6.0], High:2.0 [-2.6, 6.6], College:6.3 [1.0, 11.7]) , and childhood growth retardation (-5.2 [-8.8, -1.5]) were significantly associated with children's full-scale IQ.  Similar associations were seen for the subscales that measured working memory, verbal comprehension, and processing speed; whereas socioeconomic status (Low*, Med:4.1 [1.0, 7.3], High: 9.6 [6.2, 12.9]) and diet diversity (Low*, Med: 3.5 [-0.5, 7.], High: 5.5 [1.4, 9.6]) were significantly associated with perceptual reasoning.

Conclusion Child attained size was significantly and positively associated with full-scale IQ at age 6 years even after adjusting for the effects of household socioeconomic status, maternal education, and the quality of the learning environment. A similar relationship was seen for diet diversity and perceptual reasoning. Along with nutritional status, household environment and maternal characteristics produced consistent associations across cognitive indices. These findings indicate the importance of continued nutritional interventions into middle childhood, accompanied with household level improvements, to assure developmental potential.

Table of Contents

Table of Contents


Chapter 1: Comprehensive Review of Literature. 1

Methods of Review.. 1

Table 1: Methodology of Literature Review.. 1

Cognitive Development in Middle Childhood. 1

Household Determinants. 2

Caregiver Determinants. 7

Childhood Determinants. 11

Study Population: Vietnam.. 15

Current Gaps Within Research. 17

Chapter 2: Manuscript 20

Section 1: Introduction. 22

Section 2: Methods. 26

Data Source and Study Population. 26

Outcome Instrument: Wechsler Abbreviated Scale of Intelligence (WASI) 27

Exposure Variables. 28

Statistical Analysis. 30

Section 3: Results. 31

Characteristics of Participants. 31

Cognitive Assessment and Unadjusted Analysis. 32

Section 4: Discussion. 34

General Cognitive Ability. 34

Role of nutrition on Cognitive Ability. 37

Strengths and Limitations. 40

Future Research. 40

Chapter 3: Conclusion and Public Health Recommendations. 42

Conclusions. 42

Public Health Implications. 44

Bibliography. 46

Tables and Figures. 54

Figure 1: Maternal education level by household socioeconomic status. 54

Figure 2: Prevalence of stunting stratified by maternal education, socioeconomic status, and. 54

child diet diversity. 54

Table 2: Descriptive Statistics for Household, Maternal, and Childhood Determinants. 55

Figure 3: Household socioeconomic status stratified by child diet diversity. 56

Figure 4: Box-whisker plot for all five cognitive indices. 56

Figure 5: Bivariate analysis of socioeconomic status and all cognitive indices with means reported 57

Figure 6: Bivariate analysis of Maternal Education and all cognitive indices with means reported 57

Figure 7: Bivariate analysis of Diet Diversity and all cognitive indices with means reported. 58

Figure 8: Bivariate analysis of Home Environment Scale score and all cognitive indices. 58

Table 3: Multivariate prediction models with set predictors for the five measurement of cognition 59

Table 4: Individually fit predictive models for all cognitive indices (WISC) for children 6 -7 years old 59

Table 5: Multivariate linear regression models for Full Scale IQ of children 6 – 7 years old. 60

Index. 61

Table 6: Bivariate analysis of descriptive variables and all cognitive indices. 61

Table 7: Characteristics of household, caregiver, and child by household ethnicity, household socioeconomic status, and child gestational size. 62

Table 8: Characteristics of household, caregiver, and child by household food insecurity, maternal education, and caregiver present during 6 – 7 y assessment 63

Table 9: Characteristics of household, caregiver, and child by child nutritional status and child diet diversity. 64


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