Factors associated with the cognitive competence of children ages 4 to 5 years in Karachi Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


In developing countries like Pakistan, developmental psychology and childcare has not yet gained its due importance and is in the stage of infancy. Cognition refers to intellectual or mental processes where by an individual acquires knowledge. Studies from the developed countries have shown that cognitive abilities at early childhood are not just a separate biological identity, instead it is an indicator of quality of "child's ecosystem" consisting of determinants from antenatal care, nutritional care, home environment, child rearing practices etc. The specific factors that determine the cognitive level of Pakistani children are still unknown. The aim of this study is to investigate the effects of the biological and socio-cultural factors on the cognitive impairment of children ages 4 to5 years. A questionnaire was designed which included relevant variables to determine cognitive impairment. A validated tool developed by the National Institute of Psychology, Islamabad Pakistan was used to assess the cognition level of children. A three-week training was given to the 4 interviewers at the Aga Khan University Hospital in the pediatric ward and pediatrics clinics, during which they had practiced the different aspects of the psychological testing, Anthropometric measurements and pre-tested the questionnaire. The data collection was done mainly during the months of August and September 1998. Aga Khan Health Services of Pakistan's Mother and Child Health Center records were searched and then children who fulfilled the criteria were called to the Mother and Child Health Center. Psychometric and physical measurements were obtained from the children and simultaneously the mother. Information regarding the maternal antenatal and newborns' variables was taken from the respective maternity homes and hospitals. Children who had overall cognitive scores below the 20th percentile for their age groups were considered to have low, level of cognitive development. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors for low cognition development of the children. Based on multivariate analysis the following variables were identified as risk factors for low- levels of cognitive development. These factors include, cesarean delivery [OR=2.34, 95% C.I (1.08, 5.04)1, Absence of Co-residency [OR=1 .16, 95% C.I (0.99, 3.15)], being Non employed mother [OR=2.4, 95% C.I (1 .16, 5.08)]. Among continuous independent variables, gestational age and years of pre-schooling were identified as those, which have positive influence on the level of cognitive development. However, crowding, tonsillitis infection and hyperactivity exhibited negative influence on the cognitive development. To validate our cut off value of 20th percentile we also analyzed the data using the actual scores of the psychometric test as the outcome variable through a multiple linear regression model. All the above variables were significantly associated with the outcome variables again as well. Our findings suggest that perhaps cesarean delivery may have adverse effects. In addition, it highlights the importance of presence of co-residents in cognitive development of the children. The issue of non-working mothers, hyperactivity and tonsillitis infection requires further research as it might be confounded by other factors. Finally the issue of early education of children should be re-emphasized.

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