The role of pre-primary classes on school-age cognition in rural Nepal

Objectives In rural Nepal, we assessed the factors associated with pre-primary school attendance and its relationship to cognitive testing and school progress. Study design Sociodemographic, household, and schooling data were collected among 1466 children age 7-9 years from Sarlahi, Nepal. We performed the Universal Nonverbal Intelligence Test, backward digit span, go/no-go test, Movement Assessment Battery for Children, finger-tapping test, and Stroop numbers test. We conducted adjusted regression analyses to determine the association of pre-primary school attendance with test results and school progress. Results We found that pre-primary class enrollment was lower among children of female sex, Madheshi ethnicity, and low socioeconomic status. In adjusted analyses, pre-primary school enrollment was associated with beneficial scores on all cognitive tests. In addition, children who attended pre-primary school were less likely to repeat grade 1 (prevalence ratio 0.15, 95% CI 0.08-0.30, P <.001) or ever fail a grade (prevalence ratio 0.48, 95% CI 0.26-0.90, P =.02). Conclusions In rural Nepal, there continue to be disparities in pre-primary school attendance; however, independent of these factors, pre-primary school attendance was associated with benefits in multiple cognitive domains and early school performance.