Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

The negative impact of living environment on intelligence quotient of primary school children in Baghdad City, Iraq: a cross-sectional study

  • Hasanain Faisal Ghazi1, 2Email author,
  • Zaleha Md Isa1,
  • Syed Aljunid1, 2,
  • Shamsul Azhar Shah1,
  • Azmi Mohd Tamil1 and
  • Mohammed A Abdalqader1
BMC Public Health201212:562

https://doi.org/10.1186/1471-2458-12-562

Received: 16 March 2012

Accepted: 13 July 2012

Published: 27 July 2012

Abstract

Background

Environmental factors play a very important role in the child development process, especially in a situation like that of Iraq. Thirteen years of economic sanctions followed by the 2003 war and 8 years of unstable security have affected the daily life of Iraqi families and children. The objective of this study was to assess the associations between living environment domains and child intelligence quotient (IQ) score.

Methods

A cross-sectional survey was conducted among 529 children aged 7–8 years from five primary schools in Baghdad during September–October, 2011. The five schools represent people living a range of conditions, and include of both high and low socio-economic groups. Living environment was assessed by 13 questionnaire items, consists of three domains: physical safety , mental stress and public services. While IQ was assessed by Raven Colored progressive matrices.

Results

Among the participants, 22% were of low intelligence versus 77% of high intelligence and 19% lived in a poor environment. There were significant associations between the mental stress and service living environment domains and child IQ (p = 0.009 and p = 0.001, respectively).

Conclusion

In Iraq, child IQ was found to be associated with the mental stress and service domains of the living environment. This study findings will help authorities in their efforts to improve living environment.

Keywords

Baghdad City IQ Living environment Primary school children

Background

The consequences of war are not limited to impaired physical health. War may also impair the mental health of affected individuals. The negative consequences for mental health can be significant, especially when the victims are children. Living in an unstable environment during childhood has detrimental effects on children, especially on their cognitive development. A few studies have examined the effects of war and terrorism on child cognitive development. Joshi and Donnell [1] concluded that any war or act of terror, as a sudden, unpredictable, and dramatic event, has a tremendous negative impact at various levels, including the community, family, and individual. Children are usually the most affected by these experiences. Delaney-Black [2] examined the relationship between violence exposure, trauma-related distress and standardized test performance among 299 urban first-grade children and their caregivers. Exposure to violence affected the child’s IQ and reading ability. A child experiencing exposure to violence and trauma-related distress at or above the 90th percentile would be expected to have a 7.5 point decrement in IQ and a 9.8 point decrement in reading achievement. Delaney-Black concluded that for young children, exposure to violence and trauma-related distress was associated with substantial decrements in IQ and reading achievement.

During the past three decades, the health of Iraqi people has substantially deteriorated. Since 1980, the country has been caught up in a continuous wave of war and conflict, which has led to a spread of violence and had detrimental effects on people’s living standards. The most recent 2003 war triggered a new wave of disruption in the country [35]. The conflict has resulted in an increased incidence of violence and killing, a decline in health services, an unstable electricity supply, a deterioration of drinking water and sewerage systems, a lack of adequate food and major disruption in daily household life [6, 7]. It is clear that the recent armed conflict in Iraq has had a profound impact on children’s physical and mental health, but the origins of the problems facing Iraqi children have their roots in the immediate decades prior to 2003. The cumulative effects of this history have left Iraqi children in dire circumstances [8].

This aim of this study was to assess the effect of living in an insecure environment on child intelligence quotients (IQ). We focused on the effects of living in an unstable security situation on the mental health and physical safety of household members and the services provided to the house.

Methods

A cross-sectional survey was conducted among children aged 7–8 years from five different primary schools in Baghdad City during September–October, 2011. Questionnaires were used to assess the living environment and IQ was assessed using standardized measures. Self-administered questionnaires were distributed to the participating children’s parents.

A list of all schools in the city of Baghdad was obtained from the Ministry of Education. Baghdad is divided into five educational areas, and one school was selected from each of them. Simple random sampling was used to select the five schools. The five educational areas represent people living a range of conditions, and include of both high and low socio-economic groups.

From each selected school, a complete list of student names was obtained. Stratified random sampling according to grade was then used to identify 106 children from each school. To avoid a possible influence of puberty on the measures of interest, children aged 7–8 years were selected as the study population.

G*Power version 3 [9] was used to conduct a power analysis. For 95% power, 0.05 type 1 error (alpha) probability and a correlation coefficient of 0.2 (based on [2]) the minimum sample size required was 266 children.

The Raven’s Colored Progressive Matrices (CPM) test was used to obtain child IQ score, with a maximum total score of 36 points. The test consists of 36 items in three sets of 12: A, AB and B. It is designed for use with young children for anthropological studies and for clinical work. It can be used with people who for any reason cannot speak the English language [10]. Any score higher than the 75th percentile is considered to indicate a high IQ whereas a score below the 75th percentile is considered to indicate a low IQ.

Parents who were illiterate or had primary education (the first stage of compulsory education) were classified as having low education. Parents who had secondary school education (the final stage of compulsory education) or a university degree were classified as having high education. Family monthly income details were obtained from the parents and then categorized into low or high income depending on the median family monthly income published by the Iraqi Central Statistical Bureau [11].

The living environment was defined as the place where the child’s family is living. An insecure living environment was defined as lacking a sense of security or affording no ease or reassurance, wherein the living situation is threatened. The living environment questionnaire consists of three domains: physical safety (hearing any gun shots or explosions, or seeing dead bodies), mental stress (worrying about child safety, child witnessing any type of explosion, thinking of leaving the house and relocating to a different area, thinking the living area is insecure), and public services (water quality, hours of electricity supply).

The questionnaire consists of 13 items, each with three response options: never (2), Occasionally (1) and Frequently (0). The maximum total score was 26. A score of 13 was taken as the cut-point because if the respondents were to answer ‘most of the time’ for all questions, the total score is 13. Any score less than 13 indicated a poor living environment, whereas a score above 13 indicated a good living environment.

A pilot test of the questionnaires was carried out among 31 parents. Back-to-back translation was conducted to validate the questionnaires in Arabic language. Face validity was also tested. The living environment scale had a good internal consistency, with a Cronbach’s alpha coefficient of 0.827.

The study was approved by the Research and Ethics Committee of the Universiti Kebangsaan Malaysia Medical Centre. Also approval from Iraqi ministry of education was obtained to conduct the research inside the schools.

Statistical analysis

The association between child IQ status and living environment status (good/poor) was examined by a Chi squared test (for categorical variables). A logistic regression analysis was conducted to determine the factors associated with IQ status. Odds ratios were obtained for each potential factor after adjustment for age, sex, school grade, family income and parent education level. The mental stress, physical safety and public services domains were treated as continuous variables. The reference for gender was male, for educational level was high, and for family income was high. All analyses were performed using SPSS version 16.0 [12].

Results

In total, 529 children aged 7–8 years participated in the study, a response rate of 88.1% (529/600). The participants’ average age was 7.99 years (SD ± 0.55). The IQ scores showed that 77.7% of the participants had a high intelligence level as they scored higher than the 75th percentile. The participants’ median monthly family income was 754,901 Iraqi dinars (approximately 649USD).

Table 1 presents the participants’ socio-demographic characteristics. Slightly more than half (52.2%) were male, and 80.7% had a good living environment.
Table 1

Participants’ sociodemographic characteristics by IQ stat

Variable

N

low IQ N (%)

High IQ N (%)

POR(95%CI)

P-value

Gender

     

Male

276

55 (19.9)

221 (80.1)

0.75 (0.49-1.13)

0.17

Female

253

63 (24.9)

190 (75.1)

  

Mother’s education

     

Low education

92

26 (28.3)

66 (71.7)

1.41 (0.89-2.46)

0.12

High education

433

91 (21.0)

342 (79.0)

  

Father’s education

     

Low education

62

14 (22.6)

48 (77.4)

1.17 (0.61-2.22)

0.62

High education

427

85 (19.9)

342 (80.1)

  

Living environment status

     

Bad

102

52 (51.0)

50 (49.0)

5.66 (3.56-9.08)

<0.01 a

Acceptable

427

66 (15.5)

361 (84.5)

  

Family income

     

Low income

267

74 (27.7)

193 (72.3)

1.90 (1.24-2.89)

0.003 a

High income

262

44 (16.8)

218 (83.2)

  

a Pearson chi-squared, significant at p < 0.05.

POR: prevalence odds ratio.

Low education is illiterate or primary school education, high education is secondary or university education.

Table 2 displays the number and proportion of children in each of the two IQ status groups by questionnaire item. Most of the parents (65.2%) reported that the unstable security situation in the last 8 years occasionally affected their family’s daily life, while 22.9% reported that their family’s daily life was frequently affected.
Table 2

Associations between living environment variables and child IQ status

Living environment

N

Low IQ F (%)

High IQ F (%)

POR

Pvaluea

Mental stress domain

     

Unstable security situation

     

Frequently

121

29 (24)

92 (76)

1.26

0.33

Occasionally

345

71 (20.6)

274 (79.4)

1.54

 

Never

63

18 (28.6)

45 (71.4)

  

Worry about child safety

     

Frequently

171

47 (27.5)

124 (72.5)

0.75

0.11

Occasionally

268

51 (19)

217 (81)

1.21

 

Never

90

20 (22.2)

411 (77.8)

  

Child witnessed any type of explosion

     

Frequently

18

9(50.0)

9 (50.0)

0.22

<0.01

Occasionally

245

60(24.5)

185 (75.5)

0.69

 

Never

266

49(18.4)

217 (81.6)

  

Think of leaving house

     

Frequently

57

15 (26.3)

42 (73.7)

0.68

0.43

Occasionally

258

61 (23.6)

197 (76.4)

0.78

 

Never

214

42 (19.6)

172 (80.4)

  

Living area is insecure

     

Frequently

35

14 (40.0)

21 (60.0)

0.36

0.02

Occasionally

283

63 (22.3)

220 (77.7)

0.84

 

Never

211

41 (19.4)

170 (80.6)

  

Physical safety domain

     

Hear gun shots

     

Frequently

91

19 (20.9)

72 (79.1)

1.17

0.90

Occasionally

349

78 (22.3)

271 (77.7)

1.07

 

Never

89

21 (23.6)

68 (76.4)

  

Hear explosions

     

Frequently

86

16 (18.6)

70 (81.4)

0.98

0.30

Occasionally

345

84 (24.3)

261 (75.7)

0.69

 

Never

98

18 (18.4)

80 (81.6)

  

See dead bodies

     

Frequently

6

4 (66.7)

2 (33.3)

0.10

<0.01

Occasionally

130

45 (34.6)

85 (65.4)

0.40

 

Never

393

69 (17.6)

324 (82.4)

  

Child missed school

     

Frequently

28

16 (57.1)

12 (42.9)

0.20

<0.01

Occasionally

321

64 (19.9)

257 (80.1)

1.07

 

Never

180

38 (21.1)

142 (78.9)

  

Problem in going to school every day?

     

Frequently

33

21 (63.6)

12 (36.4)

0.11

<0.01

Occasionally

253

55 (21.7)

198 (78.3)

0.75

 

Never

243

42 (17.3)

201 (82.7)

  

Services domain

     

Electricity supply

     

< 4 hours per day

110

43 (39.1)

67 (60.9)

0.40

<0.01

4 – 8 hours per day

241

38 (15.8)

203 (84.2)

1.40

 

> 8 hours per day

178

37 (20.8)

141 (79.2)

  

Water quality

     

Below average

66

22 (33.3)

44 (66.7)

0.40

<0.01

Average

242

59 (24.4)

183 (75.6)

0.62

 

Good

221

37 (16.7)

184 (83.3)

  

Problems in getting food

     

Frequently

19

9 (47.4)

10 (52.6)

0.24

<0.01

Occasionally

213

56 (26.3)

157 (73.7)

0.60

 

Never

297

53 (17.8)

244 (82.2)

  

a Pearson chi-squared test.

POR: prevalence odds ratio.

There were significant associations between child IQ status and seeing dead bodies in the street, child witnessing any type of explosion, problems attending school every day, child missing school because of an unstable security situation, electricity supply to the house, problems with grocery shopping, water quality and insecure living area.

Figure 1 displays the mean living environment domain scores (physical safety, mental stress and services provided to the house) by child IQ status. There were significant differences in the mean scores by child IQ status (p < 0.01).
Figure 1

Association between living environment domain and child IQ status. Note: Higher scores indicate more favorable conditions. The figure represent the association between environmental domains ( physical safety , mental stress and public services) with child’s IQ level. The three bars represent the domains mean score in low and high IQ level groups. The values inside the bars represent mean ± standard deviation. Independent t test was performed to assess the association between the three domains and IQ and it appeared to be significant with p value of < 0.01 respectively. The higher the score of the three domains the better the IQ, in mental stress domain the higher score represent less stress, same things for the other two domains.

Table 3 presents the results of the multiple logistic regression analysis. After adjusting for gender, parent education level and monthly family income the living environment, in particular, the mental stress and public service domains, still appears to be the most important factor influencing child IQ.
Table 3

Summary of multiple logistic regression analysis of factors associated with low IQ status

Variable

B

Wald

Pvaluea

Adj OR

95% CI

Gender

0.10

0.27

0.59

1.10

0.76-1.60

Family income

0.18

0.72

0.39

1.19

0.79-1.81

Mother education

0.21

0.55

0.45

1.23

0.70-2.18

Father education

−0.17

0.29

0.58

0.83

0.44-1.58

Physical domain

−0.07

1.01

0.314

0.93

0.80-1.07

Mental domain

0.15

5.21

0.02

1.17

1.02-1.34

Services domain

0.22

9.98

<0.01

1.24

0.95-1.54

a Binary logistic regression.

Adj OR: Adjusted odds ratio.

CI: Confidence interval.

Discussion

The mental stress and public service domains were the two most important living environment conditions affecting child IQ in Baghdad, Iraq. The physical safety domain was not associated with child IQ. Monthly family income was significantly associated with child IQ, which is in agreement with a number of studies that report significant effects of poverty on children’s cognitive and verbal skills [1315]. Low income results in less food and nutrients for the child, which will in turn affect their development. In this study, parent education level was not associated with child IQ status, although other studies have found a significant relationship between parent education level and child IQ [16]. The majority of the parents in our study area had a high education level, which may explain this discrepancy.

More than two-thirds of the children’s parents were found to live in a good environment according to our cut-off point. The Centre for Strategic and International Studies [17] stated in their 2010 report that “There are a wide range of indicators that show the level of violence in Iraq has dropped sharply since the 2006 year, the average number of security incidents between September and November 2009 was only half that of the same period in 2008.” In addition, the Oxford Research Group Security Report [18] concluded that most of the available evidence supports the view that security within Iraq has substantially improved, but there is still endemic violence, especially in the capital city of Baghdad.

Mental stress domain scores were correlated with child IQ, suggesting that exposure to mental stress is detrimental to child IQ. The two most important components of this domain were child witnessing any type of explosion and insecure family living area in which they perceive as movement restriction and lacking of daily living needs. According other studies [19, 20], intensive and continuous exposure to multiple stressful events in conflict and disaster settings is a major risk factor for negative mental health consequences for children and adolescents. Additionally, Tol et al. [21] noted that exposure to violence is a risk factor for adverse child development outcomes in low-income settings, and that childhood mental health problems are difficult to address within the context of ongoing poverty and political instability.

The services domain, which relates to electricity supply to the house, water quality and problems grocery shopping, was also associated with child IQ. It is already established by previous research [2224] that the quality of the home environment accounts for significant variance in child academic outcomes. In this study, the physical safety domain was not associated with child IQ. A possible reason for this is the improvement in the security situation in Baghdad, because the numbers of dead bodies on the streets, gun shots and explosions have decreased in the last year. According to the Iraqi body count project [25], which recorded Iraqi violence-related deaths during 2003–2011, there was a dramatic decrease of more than 70% in the number of deaths in the 2010–2011 period compared with 2006–2008.

Conclusions

In Iraq, child IQ was found to be associated with the mental stress and public service domains of the living environment. We hope that our study results will help the authorities and policy makers in Iraq in their efforts to improve the living situation of Iraqis.

Declarations

Acknowledgments

This study was funded by the Universiti Kebangsaan Malaysia Medical Centre Fundamental Research Grant, Code Number FF-180-2011 without which the study would not have been possible. In addition, we received financial support from the United Nations University, International Institute for Global Health, Kuala Lumpur, Malaysia.

Authors’ Affiliations

(1)
Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre
(2)
International Institute for Global Health, United Nations University

References

  1. Joshi T, O'Donnell A: Consequences of child exposure to war and terrorism. Clin Child Fam Psychol Rev. 2003, 6: 275-292.View ArticlePubMedGoogle Scholar
  2. Delaney-Black V: Violence exposure, trauma, and IQ and/or reading deficits among urban children. Arch Pediatr Adolesc Med. 2002, 156: 280-285.View ArticlePubMedGoogle Scholar
  3. Cockburn P: The occupation, war and resistance in Iraq. 2007, Verso publication, London, 2Google Scholar
  4. Steele J: Defeat: why America and Britain Lost Iraq, I.B. 2008, Tauris & Co Ltd, Great Britain, 1Google Scholar
  5. UNICEF/Donor Consolidated Report 2003. The revised crisis appeal. 2003, , ParisGoogle Scholar
  6. The United Nations Assistance Mission for Iraq. Various last update, UNAMI situation report,. http://www.uniraq.org/docsmaps/sitreps.asp?pagename=sitreps,
  7. Evaluation of UNICEF Emergency Preparedness and Early Response in Iraq (September 2001-June 2003). 2004, © United Nations Children's Fund (UNICEF), New YorkGoogle Scholar
  8. Al-Obaidi A, Budosan B, Jeffrey L: Child and adolescent mental health in Iraq: current situation and scope for promotion of child and adolescent mental health policy. Intervention. 2010, 8: 40-51. 10.1097/WTF.0b013e3283387adf.View ArticleGoogle Scholar
  9. Erdfelder E, Faul F, Buchner A: GPOWER: A general power analysis program. Behav Res Methods Instrum Comput. 1996, 28: 1-11. 10.3758/BF03203630.View ArticleGoogle Scholar
  10. Raven J: Raven coloured progressive matrices manual. harcourt assessment. 1998, J C Raven and J H Raven, San Antonio. Texas. USAGoogle Scholar
  11. Annual abstract of statistics 2010–2011. 2011, , Baghdad, it is available online (http://cosit.gov.iq/english/section_15.php)
  12. Spss Inc, Polar engineering and consulting. 2007, Illinois, ChicagoGoogle Scholar
  13. Korenman S, Miller J, Sjaastad L: Long term poverty and child development in the united states ; Results from NLSY. Child Youth Serv Rev. 1995, 17: 127-155. 10.1016/0190-7409(95)00006-X.View ArticleGoogle Scholar
  14. Liaw F, Brooks-gunn J: Cumulative familial risks and low birth weight children’s cognitive and behavioral development. J Clin Child Psychol. 1994, 23: 360-372. 10.1207/s15374424jccp2304_2.View ArticleGoogle Scholar
  15. Smith JR, Brooks-Gunn J, Klebanov PK: Consequences of living in povertyfor young children’s cognitive and verbal ability and early school achievement. Consequences of Growing Up Poor. Edited by: Duncan GJ, Brooks-Gunn J. 1997, Russell Sage Foundation, NewYork, 132-189.Google Scholar
  16. Rowe D, Jacobson K, Edwin JC, van Den O: Genetic and environmental influences on vocabulary IQ parental education level as moderator. Child Dev. 1999, 70: 1151-1162. 10.1111/1467-8624.00084.View ArticlePubMedGoogle Scholar
  17. Cordesman AH, Arleigh A, Mausner A, Derby E: The uncertain security situation in Iraq: trends in violence, casualties and Iraqi perceptions. 2010, Center for strategic and international studies.Google Scholar
  18. Rogers P: The tipping point: ORG international security report. 2008, Oxford research group, UKGoogle Scholar
  19. Panter-Brick C, Eggerman M, Gonzales V, Safdar S: 9. Violence, suffering, and mental health in Afghanistan: a school-based survey. Lancet. 2009, 374: 807-816. 10.1016/S0140-6736(09)61080-1.View ArticlePubMedPubMed CentralGoogle Scholar
  20. Kar N, Mohapatra KP, Nayak KC, Pattanaik P, Swain SP, Kar CH: Post- traumatic stress disorder in children and adolescents one year after a super-cyclone in Orrisa, India: exploring cross-cultural validity and vulnerability factors. BMC Psychiatry. 2007, 7-8. http://biomedcentral,Google Scholar
  21. Tol AW, Komproe HI, Sussanty D, Jordans JDM, Macy RD, Jong D: School-based Mental Health Intervention for Children affected by Political Violence in Indonesia. JAMA. 2009, 300: 655-662.View ArticleGoogle Scholar
  22. Maslow A: Motivation and Personality. 1954, Harper & Row, New York, NYGoogle Scholar
  23. DeGarmo DS, Forgatch MS, Martinez CR: Parenting of divorced mothers as a link between social status and boys’ academic outcomes: unpacking the effects of socioeconomic status. Child Dev. 1999, 70: 1231-1245. 10.1111/1467-8624.00089.View ArticlePubMedGoogle Scholar
  24. Delaney-Black V, Covington C, Ondersma SJ, Nordstrom-Klee B, Templin T, Ager J, Janisse J, Sokol RJ: Violence Exposure, Trauma, and IQ and/or Reading Deficits Among Urban Children. Arch Pediatr Adolesc Med. 2002, 156: 280-285.View ArticlePubMedGoogle Scholar
  25. Iraqi body count project. Iraqi deaths from violence. 2003, http://www.iraqbodycount.org/analysis/numbers/2011/, –2011,,
  26. Pre-publication history

    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/12/562/prepub

Copyright

© Ghazi et al.; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.