Relationship between children's cognitions and later educational progress in rural South Africa: A longitudinal study

Melissa Cortina, Helen E. Jack*, Rebecca Pearson, Kathleen Kahn, Stephen Tollman, Tintswalo Hlungwani, Rhian Twine, Alan Stein, Mina Fazel

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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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.

Original languageEnglish
Pages (from-to)422-426
Number of pages5
JournalJournal of Epidemiology and Community Health
Issue number5
Early online date6 Mar 2019
Publication statusPublished - 1 May 2019

Bibliographical note

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.


  • developing countr
  • education
  • international hlth
  • mental health


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