title: The role of pre-primary classes on school-age cognition in rural Nepal.
abstract: OBJECTIVE
  In rural Nepal, we assessed the factors associated with pre-primary school attendance and its relationship to cognitive testing and school progress.
  
  
  METHODS
  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.
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Devan
authors.initials: D
authors.lastname: Jaganath
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal.
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.affiliation: Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Murray-Kolb
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal.
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: pchrist1@jhu.edu.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
mesh_terms: D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012424:Rural Population; D012574:Schools; D012959:Socioeconomic Factors; D013334:Students / Q000523:psychology*