Nutritional status and psychosocial stimulation associated with cognitive development in preschool children: A cross-sectional study at Western Terai, Nepal.

Quality education at the age of foundation to produce dynamic manpower is a public concern in developing countries including Nepal. Preschool children do not get proper care and support from their parents due to insufficient knowledge of proper feeding habits, nutrition status and methods of psychosocial stimulation, which may affect their proper cognitive development. This study aimed to identify the factors that influence cognitive development in preschool children aged 3-5 years in Rupandehi district of western Terai, Nepal. In this school based cross-sectional survey, a total of 401 preschool children were selected using a multistage random sampling technique. The study was conducted from 4th February to 12th April, 2021 in Rupandehi district of Nepal. Data on the children's socio-economic and demographic status, level of psychosocial stimulation, nutritional status, and stage of cognitive development were collected through scheduled interviews and direct observation. Stepwise regression analysis was performed to determine the predictors of cognitive development in preschool children. A p-value less than 0.05 considered as statistical significance. Of 401 participants, 44.1% had a normal nutritional status based on height for age Z-score (HAZ). Only 1.2% of primary caregivers provided their children with high levels of psychosocial stimulation, and 49.1% of children had a medium level of cognitive development. Furthermore, cognitive development in preschoolers is positively associated with nutritional status based on the height for age z score (β = 0.280; p<0.0001), psychological stimulation from caregivers (β = 0.184; p<0.0001), and advantageous castes/ethnicity (β = 0.190; p<0.0001), but negatively associated with the child's age (β = - 0.145; p = 0.002) and family type (β = -0.157; p = 0.001). Nutritional status and psychosocial stimulation appear to be major factors affecting cognitive development of preschoolers. Nutritional promotion strategies, as well as techniques for optimal psychosocial stimulation behavior, may play an important role in enhancing preschoolers' cognitive development.