This study attempted to assess the association of nutritional status with academic performance and to determine the socio-demographic and economic predictors of academic performance among public primary school children in Debre-Tabor Town, Amhara regional state North-Central Ethiopia.
The overall prevalence of any form of malnutrition for the current study was 56% which is higher than the finding of Hawa Gelan in 2017 in Oromia, Ethiopia (34.6% ) [25]. However, this finding is less than the finding in Sri Lanka in 2015 (60.2%) [17]. This variation could be due to a difference in the two countries’ socio-economic differences.
The finding of this study revealed that the prevalence of stunting was 22% which is higher than a finding from Oromia, Ethiopia (20.6%), Harar, Ethiopia (8.9%), Adama, Ethiopia (15.6%), India (18.5%) and Brazil (1.7%) [20, 25, 32-34]. On contrary, this finding was less than the findings of Fogera, Ethiopia (37.2%), Kenya (24.5%), Egypt (53.2%) and Lambani, India (37%) [15, 35-37]. The higher prevalence of stunting could be early life malnutrition in the young infant period which is a sensitive period for nutrient deficiencies. This disparity could be due to a difference in the composition of diets with essential nutrients like proteins, carbohydrates, fats, vitamins and minerals. These macro and micronutrients are vital for body makeup, immunity and cognitive development of children.
The prevalence of wasting in this study was 32.4% which was almost similar to a finding in India (33.3%) [38]. However, this finding was higher than a finding in Fogera, Ethiopia (30.7%), Hawa Gelan in Oromia, Ethiopia (12.7%), Sidama, Ethiopia (28.2%) and that of Kenya (9.7%) [25, 35, 36, 39]. The finding of wasting in this study was lesser when compared with a finding in Sri Lanka (50.4%) [17]. The discrepancy in acute malnutrition might be due to a difference in children’s health status, nutrient composition (balanced diet), diet size and frequencies of the meal. Acute conditions like diarrhea and upper respiratory problems are also key factors for children’s acute malnutrition since it reduces their appetite and impede their immunity.
Again in this study, the prevalence of underweight was 24.3% which was almost similar to a finding in Bahir Dar, Ethiopia (24.8%) and the regional state of the study area (24%) [28, 40]. This finding was higher than the findings in Adama, Ethiopia (21.3%), Oromia, Ethiopia (14.2%), Kenya (14.9%) and that of Lambani, India (14.66 %) [15, 25, 33, 35]. On contrary, this finding was lesser than findings in Fogera, Ethiopia (59.7%) and Sri Lanka (33.7%) [17, 36]. The inconsistency might be due to differences in socio- economic status and cultural beliefs about foods. Children from rural areas are more at risk for malnutrition than urban children. Additionally meal frequencies affect children’s nutritional status in which children having regular meals at morning, lunch and night will have better status than those having any of the three meals.
The prevalence of overweight in this study was 1.3%. This result is less than a finding in Adama in 2016, Ethiopia (3.3%), Nigeria in 2013 (37%), Malaysia in 2014 (18.1%) and that of Brazil in 2014 (22%) [20, 33, 41, 42]. This disparity might be due to variations in individual nutrient intake and food preferences. Also, differences in socio-economic status could be the reason as Ethiopia is a lower-income country. Lower income countries are at risk of food insecurity which affects children’s diet composition, diet size, and frequency of meal.
For the current study, the mean academic performance for study participants were (71.65±12.63 SD) which is a higher achievement when compared with a study done in Hawa Gelan in Oromia, Ethiopia (67.2% ±15.4% SD), Tach-Gaynt, South Gondar, Ethiopia (62.25%), Hawassa, Ethiopia (35.1 ± 4.1SD), Sri Lanka in 2015 (<40%) and Nigeria (66.19 ± 17.00 SD) [17, 25, 26, 43, 44]. The variation could be the difference in the assessment of academic performance, learning methods, learning resources accessibility, tutors given and grading or scoring systems. In this study males perform better (72.02±11.57 SD) academically when compared with female students (71.24±13.73 SD). This finding is consistent with a research finding in North-Central and South Central Ethiopian that males have performed 2.39 times better than females in academic performances [24, 26]. In contrary findings in Nigeria, Morocco, India and Asia, revealed that girls have better educational performance than boys [11, 17, 22, 43]. It may be related to the social status of females in the community and recognition of their learning. Moreover, the lack of role model and a high percent of students were not passing through preschool training may contribute to the disparities.
In this study, primary school children from high monthly income parents performed better (72.91±1234 SD) than those from low (69.53±14.46 SD) income parents. Educational achievement was poor for those who absent for more than five days (69.42±12.61SD) when compared to those absent for five days (7.343±12.21 SD). Children who were overweight perform better (73.70±9.75 SD) academically when compared with those underweight (70.87±15.84 SD). Well-nourished children perform better (72.22±13.05 SD) academically when compared with stunted children (69.65±11.18 SD). Study participants who ate breakfast
sometimes perform poorly (70.04±13.54 SD) when compared with those ate always
(72.54±11.36 SD). Students in the age group 7-10 perform well (76.61±11.81SD) academically when compared with those 11-14 years (69.84±12.45 SD).
The result of this finding shows that there was a statistically significant positive relationship between HAZ and academic achievement (p-value=0.009) which is in line with the finding done in Goba town and Hawa Gelan in Oromia, Ethiopia and Sri Lanka [12, 17, 25]. It is also consistent with a finding in Morocco in 2016 [11]. This indicates that as children become well-nourished their height for age z-score increases to the appropriate growth and development stage which in turn resulted in positive educational achievement.
In the current analysis, WAZ and BAZ did not show a statistically significant relationship with the academic performance of the study participants which is consistent with a finding in various areas of Ethiopian: Tach-Gynt, South Gondar; Gurage Zone; and Goba town [12, 24, 26]. However, this is not consistent with the finding in Oromia, Ethiopia and Sri Lanka in which both WAZ and BAZ had significant positive associations with learning achievement [17, 25]. Even though, it is beyond the scope of this study the discrepancy could be variation in nutrients taken by children which may have either synergistic or antagonistic effects with each other. At this point, this finding sought a more powerful study design that can indicate a causal relationship among factors.
In this study age of child and absenteeism have a statistically significant negative association with educational achievement. Predictors including head of the house, attending preschool and breakfast habit associated positively with the educational achievement of the school-age children. In this study monthly income did not show significant association with the academic performance which is opposing to Hawa Gelan finding that study participant from high monthly income households perform 2.85 times better than those from low monthly income households [25]. In this study breakfast habits and attending preschool were significantly positively associated with academic performance. This finding is conflicting to the finding in Goba town, Oromia that breakfast habits and attending preschool did not show significant association [12]. Variables including sex of the child, residence, maternal education, paternal education, parental occupation,and family size were not significantly associated with an academic performance which is parallel to the finding of Goba town in Oromia, Ethiopia [12]. Absenteeism was significantly associated with school-age children’s academic performance which is parallel to the finding of Tach-Gynt in South Gonar, Ethiopia [26].
This study revealed that as the age of child increases by a unit of year in children aged 11-14 years their educational achievement decreases by 5.07 when compared to those aged 7-10 years (B: -5.07, 95% CI: -7.86, -2.28). These variations could be due to more attention for pubertal period changes rather than learning and attending classes as age increases from 7-10 years to 11-14 years. Adolescence is a period where secondary physiological characteristics are seen which occupied children’s attention not to focus on learning and attending classes. The academic performance of study participants who have eaten breakfast increases by 7.61 unit change when compared with those who have not eaten breakfast (B: 7.61, 95% CI: 0.97, 14.24). This could be the positive effect of breakfast as it replaces energy loss in children who spent most of their time on different recreational activities. It also makes students alert and active to learn, participate and attend classes. A unit changes in absenteeism decreases the academic performance of students by 3.89 when compared to those who have not absent (B: -3.89, 95% CI: -6.55, -1.25). This could be due to the negative effect of absenteeism in which students miss important opportunities like lectures and class exercise solutions from their teachers, group discussions with their classmates and other school populations.
Attending preschool enhances academic performance by 3.03 unit change when compared with those who didn’t attend preschool (B: 3.03, 95% CI: 0.53, 5.52). This might be the opportunity that children who have attended preschool could have better awareness about the school environment, enhanced communication skill and better social interaction which prepared them for learning and attending class.
STRENGTHS AND LIMITATIONS OF THE STUDY
Using a wider range of student class grades from two to eight and a large sample size can be taken as strength of this study. But, this study was confined to public schools, as a result, it may decrease confidence about all students in the study area a since significant number of students were attending education in private schools. This study also fails to provide evidence about the causal relationship and only limited to thedescription of a possible association. Moreover, it would have been better and more powerful if the study was incorporated measurements of biochemical parameters in addition to anthropometric measurements that may help to describe and rationalize some of the discrepancies with other studies. Using of reported age without conformation may also limit the strength of the evidence A limited number of variables under study may not show the whole factor of school performance and the absence of follow-up and control group also decrease the power of analysis. Furthermore, other factors of poor academic performance like peer influence, teaching style, and teacher factors were not also considered in this study which can also be taken as a limitation.