Correction: Digital Device Exposure and Cognition Levels of Children in Low- and Middle-Income Countries: Cross-sectional Study in Cambodia.

[This corrects the article DOI: .].

Digital Device Exposure and Cognition Levels of Children in Low- and Middle-Income Countries: Cross-sectional Study in Cambodia.

BACKGROUND: Policy makers and practitioners in low- and middle-income countries (LMICs) are increasingly focusing on the effectiveness of digital devices in the delivery of medical and educational services to children under resource constraints. It is widely known that digital literacy can be fostered through exposure to and education regarding digital devices, which can improve children's academic performance as well as their search and communication skills in the digital era. However, the correlation between the cognitive function of children and exposure and intensity of the exposure to digital devices has rarely been studied, and the association between digital device exposure and the socioeconomic characteristics and cognitive development of children in LMICs is unknown. OBJECTIVE: This study examines the association among exposure to digital devices, socioeconomic status, and cognitive function in children aged 3 to 9 years in Cambodia. METHODS: We used a survey of 232 children that gathered data on familiarity with digital devices, demographic characteristics, and socioeconomic status, as well as a Cambridge Neuropsychological Test Automated Battery test for cognitive function, to examine the association between possible barriers and factors that may influence the cognitive function of children in 2 Cambodian schools from April 22, 2019, to May 4, 2019. A comparative analysis was performed with and without digital exposure, and an association analysis was performed among the variables from the survey and cognitive function. RESULTS: Significant differences were observed in demographic and socioeconomic characteristics such as school location, family type, and family income according to digital device exposure. The results of the Cambridge Neuropsychological Test Automated Battery tests, except for 1 test related to executive function, indicated no significant differences (P>.05) between group A and group B or among the 4 subgroups. Pretest digital device experience and amount of time spent using digital devices during the test had no significant impacts on the cognitive development of the children. Conversely, the multivariate analyses showed that cognitive function was associated with educational expenses per child, school (location), family type, and family income. CONCLUSIONS: These results provide evidence to policy makers and practitioners on the importance of improving socioeconomic conditions, leading to investment in education by implementing programs for children's cognitive development through digital devices in LMICs.

A Study of the Possibility of Detecting Pediatric Mild Developmental Delay Through a Serious Game: A Randomized Cluster Trial in Cambodia.

Although early diagnosis of developmental delay is important, there are challenges in identifying cognitive status in developing countries because of limited human and financial resources to perform diagnostic tests. Moreover, diagnosis stability of developmental delay in children using neuropsychological tests (NPTs) can remain unsettled. The aim of this study is (1) to verify the effectiveness of a serious game (DoBrain), (2) to identify existing inconsistencies between NPTs, and (3) to explore the potential of the serious game as a complement to diagnostic tools. Eligible children who had completed results of NPTs were selected (n=119/235; 116/235; case, control). With these children's scores, we performed the Mann- Whitney U test to investigate the effectiveness of the serious game by comparing the improvement of scores in both groups. Among the participants, we additionally selected a case group to identify the potential of the serious game for detecting mild developmental delay. Using the results of the CGI-S as a baseline, we defined the participants whose scores indicated more than mild illness (>=2 points) in at least one area as the suspected group. The score improvement related to memory in case group was greater than that of the control group (p<0.05). Furthermore, four of the NPTs were not inconsistent, and the sensitivity/specificity of DDST-II was the highest score considering CGI-S results as the ground truth (0.43; 0.96). Additionally, games measuring discrimination, velocity, memory, and spatial perception showed statistical significance (p<0.05). This study verifies that the serious game can help specific cognitive areas and suggests that the serious game could be used as a low-cost and unconstrained spatiotemporal alternative to NPTs.