title: Early childhood diarrhea predicts impaired school performance.
abstract: OBJECTIVE
  Diarrhea is a leading cause of mortality worldwide; however, its long-term morbidity is poorly understood. Recently, early childhood diarrhea (ECD) has been associated with impaired physical fitness, growth and cognitive function 6 to 9 years later. We studied the effects of ECD on school functioning in a shantytown in northeastern Brazil.
  
  
  METHODS
  We administered 77 educational surveys. Complete diarrhea surveillance (ie, >90%) in the first 2 years of life and demographic and anthropometric information were available for 73 children. Age at starting school was calculated for 62 children, whereas age appropriateness for the current grade (AFG) was calculated for all 73 children who were >6 years old. Stepwise regression was used to examine the independent effect of ECD on school functioning after controlling for socioeconomic factors, maternal education, breast feeding, growth and cognitive functioning.
  
  
  RESULTS
  ECD correlated with age at starting school (r = 0.55, P = 0.0005) and remained a significant predictor even after controlling for family demographics, days of breast feeding, early growth and TONI-3 test of nonverbal intelligence. This was true despite significant correlations of ECD with growth shortfalls and impaired cognitive functioning. ECD also correlated with AFG (r = 0.38, P = 0.001). Only TONI-3 test scores explained this association, suggesting that ECD may hinder school performance, but only in part school readiness, by impairing cognitive function as measured by performance on the TONI-3 nonverbal intelligence test.
  
  
  CONCLUSIONS
  These findings document effects of early childhood diarrhea on later school readiness and performance and hence potential long-term human and economic costs of ECD, which warrant further attention and far greater investment for the control of ECD and its consequences.
authors.affiliation: Center for Global Health, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Breyette
authors.initials: B
authors.lastname: Lorntz
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Soares
authors.forename: Sean R
authors.initials: SR
authors.lastname: Moore
authors.forename: Relana
authors.initials: R
authors.lastname: Pinkerton
authors.forename: Bruce
authors.initials: B
authors.lastname: Gansneder
authors.forename: Victor E
authors.initials: VE
authors.lastname: Bovbjerg
authors.forename: Helen
authors.initials: H
authors.lastname: Guyatt
authors.forename: Aldo M
authors.initials: AM
authors.lastname: Lima
authors.forename: Richard L
authors.initials: RL
authors.lastname: Guerrant
mesh_terms: D000367:Age Factors; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology; D003967:Diarrhea / Q000150:complications* / Q000175:diagnosis; D003968:Diarrhea, Infantile / Q000150:complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007859:Learning Disabilities / Q000453:epidemiology* / Q000209:etiology*; D016014:Linear Models; D008297:Male; D011203:Poverty; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012424:Rural Population; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013647:Task Performance and Analysis