title: Household wealth and neurocognitive development disparities among school-aged children in Nepal.
abstract: BACKGROUND
  Wealth disparities in child developmental outcomes are well documented in developed countries. We sought to (1) describe the extent of wealth-based neurocognitive development disparities and (2) examine potential mediating factors of disparities among a population-based cohort of children in rural Nepal.
  
  
  METHODS
  We investigated household wealth-based differences in intellectual, executive and motor function of n = 1692 children aged between 7 and 9 years in Nepal. Using linear mixed models, wealth-based differences were estimated before and after controlling for child and household demographic characteristics. We further examined wealth-based differences adjusted for three sets of mediators: child nutritional status, home environment, and schooling pattern.
  
  
  RESULTS
  We observed a positive gradient in child neurocognitive performance by household wealth. After adjusting for child and household control factors, disparities between children in the highest and lowest wealth quintiles persisted in intellectual and motor function, but not executive function. No statistically significant wealth-based differentials in outcomes remained after accounting for nutritional status, home environment, and schooling patterns. The largest differences in neurocognitive development were associated with schooling pattern.
  
  
  CONCLUSIONS
  Household wealth patterns child neurocognitive development in rural Nepal, likely through its influence on nutritional status, the home environment, and schooling. In the current context, improving early and regular schooling in this setting is critical to addressing wealth-based disparities in outcomes.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Shivani A
authors.initials: SA
authors.lastname: Patel
authors.forename: Laura E
authors.initials: LE
authors.lastname: Murray-Kolb
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
mesh_terms: D002648:Child; D002657:Child Development; D003071:Cognition; D005191:Family Characteristics; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D009390:Nepal; D012959:Socioeconomic Factors
keywords: Nepal; child development; cognitive function; health disparities; household wealth; motor function