title: The effect of maternal and child early life factors on grade repetition among HIV exposed and unexposed children in rural KwaZulu-Natal, South Africa.
abstract: Receiving an education is essential for children living in poverty to fulfil their potential. Success in the early years of schooling is important as children who repeat grade one are particularly at risk for future dropout. We examined early life factors associated with grade repetition through logistic regression and explored reasons for repeating a grade through parent report. In 2012-2014 we re-enrolled children aged 7-11 years in rural KwaZulu-Natal who had been part of an early life intervention. Of the 894 children included, 43.1% had repeated a grade, of which 62.9% were boys. Higher maternal education (aOR 0.44; 95% CI 0.2-0.9) and being further along in the birth order (aOR 0.46; 95% CI 0.3-0.9) reduced the odds of grade repetition. In addition, maternal HIV status had the strongest effect on grade repetition for girls (aOR 2.17; 95% CI 1.3-3.8), whereas for boys, it was a fridge in the household (aOR 0.59; 95% CI 0.4-1.0). Issues with school readiness was the most common reason for repeating a grade according to parental report (126/385, 32.7%), while school disruptions was an important reason among HIV-exposed boys. Further research is needed to elucidate the pathways through which HIV affects girls' educational outcomes and potentially impacts on disrupted schooling for boys. Our results also highlight the importance of preparation for schooling in the early years of life; future research could focus on gaining a better understanding of mechanisms by which to improve early school success, including increased quality of reception year and investigating the protective effect of older siblings.
authors.affiliation: 1Africa Centre for Health and Population Studies,University of KwaZulu-Natal,South Africa.
authors.forename: J M
authors.initials: JM
authors.lastname: Mitchell
authors.affiliation: 1Africa Centre for Health and Population Studies,University of KwaZulu-Natal,South Africa.
authors.forename: T J
authors.initials: TJ
authors.lastname: Rochat
authors.affiliation: 5Australian Demographic and Social Research Institute,The Australian National University,Canberra,Australia.
authors.forename: B
authors.initials: B
authors.lastname: Houle
authors.affiliation: 3Section of Child and Adolescent Psychiatry,Department of Psychiatry,University of Oxford,Oxford,UK.
authors.forename: A
authors.initials: A
authors.lastname: Stein
authors.affiliation: 1Africa Centre for Health and Population Studies,University of KwaZulu-Natal,South Africa.
authors.forename: M L
authors.initials: ML
authors.lastname: Newell
authors.affiliation: 1Africa Centre for Health and Population Studies,University of KwaZulu-Natal,South Africa.
authors.forename: R M
authors.initials: RM
authors.lastname: Bland
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D018479:Early Intervention, Educational; D004522:Educational Status; D005260:Female; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007859:Learning Disabilities / Q000453:epidemiology*; D008297:Male; D000072741:Maternal Inheritance; D011446:Prospective Studies; D012424:Rural Population; D012574:Schools; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology
keywords: HIV exposure; South Africa; early life factors; grade repetition