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Relationship between children’s cognitions and later educational progress in rural South Africa: a longitudinal study
  1. Melissa Cortina1,
  2. Helen E Jack2,3,
  3. Rebecca Pearson4,
  4. Kathleen Kahn5,
  5. Stephen Tollman5,
  6. Tintswalo Hlungwani5,
  7. Rhian Twine5,
  8. Alan Stein5,6,
  9. Mina Fazel6
  1. 1 Evidence Based Practice Unit, University College London, London, UK
  2. 2 Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
  3. 3 Department of Medicine, University of Washington, Seattle, Washington, USA
  4. 4 School of Social and Community Medicine, University of Bristol, Bristol, UK
  5. 5 Medical Research Council / Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of the Witwatersrand, Johannesburg, South Africa
  6. 6 Department of Psychiatry, Oxford University, Oxford, UK
  1. Correspondence to Dr Helen E Jack, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AF, UK; helen.jack{at}


Background Children in low-income and middle-income countries (LMICs) who remain in school have better health and employment outcomes. South Africa, like many LMICs, has a secondary school completion rate under 50%, leaving room for improvement if we can identify factors that affect educational attainment. This is the first longitudinal study to examine the effects of childhood mental health and cognitions on educational outcomes in LMIC.

Methods Using the Strengths and Difficulties Questionnaire (SDQ) and Cognitive Triad Inventory for Children (CTI-C), we assessed the psychological functioning and cognition of children aged 10–12 in rural South Africa. We linked that data with measures of educational progress collected 5 years later and examined associations between educational progress and (1) behavioural and emotional problems and (2) cognitive interpretations, adjusting for possible confounders.

Results Educational data were available for 443 individuals. 92% (n=408) of individuals had advanced three or fewer grades in 7 years. Having more positive cognitions (CTIC-C) was positively associated with progressing at least three grade levels (adjusted OR 1.43, 95% CI 1.14 to 1.79). There was no evidence for an association between emotional and behavioural problems (SDQ) and educational progress (OR 0.90, 95% CI 0.72 to 1.11).

Conclusion If children in LMICs can develop more positive perspectives, they may be able to stay in school longer. Cognitions can be modified, and future studies should test interventions that work to improve cognition in childhood, guided, for example, by principles of cognitive–behavioural therapy.

  • international hlth
  • developing countr
  • education
  • mental health

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  • MC and HEJ are joint first authors.

  • Contributors MC and HEJ are joint first authors.

  • Funding The Wellcome Trust, UK provides funding for the MRC/Wits Rural Public Health and Health Transitions Research Unit in which the Agincourt HDSS is a critical foundation (Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z), with further support from the University of the Witwatersrand and Medical Research Council, South Africa.

  • Competing interests None declared.

  • Ethics approval Research ethics approval was obtained from the University of the Witwatersrand (M070221), the Mpumalanga Province Research Committee and the Oxford Tropical Research and Ethics Committee (008–07).

  • Provenance and peer review Not commissioned; externally peer reviewed.