The primary objective of this study was to identify the factors governing cognitive function of primary school children in Pakistan.

This was a prospective observational study conducted in 2 governments and 2 low class private public schools in a small district of Pakistan.

Two hundred children (90 male, 110 female), age 7–12 years class 3, 4 and 5 were assessed using McCarthy scale of child cognition. Child health, immunization status/immunization compliance, play facilities, parental education, parental income, child parenting (mother/father/both/relatives), parent-child interaction time, family system (single/extended), family income were assessed against child cognitive function.Data was analysed using SPSS 18.

Girls demonstrated better mathematical ability and memory (p < 0.05). 5.5% children may have missed/poor compliance with immunization. 1.5% children were parented by single mother, 3% with fathers and 0.5% were parented by with relatives. Better play facilities, compliance with immunization, parental education, parental income, a minimum of 3 hours interaction time had a positive impact on child cognitive function (all p < 0.05). Single family system was observed in 62%, extended family system 38% children. Extended family system was not associated with adverse child cognition (p > 0.05)

Better health, play facilities, immunization, parental education, parental income, a minimum of 3 hours interaction time has a positive impact on child cognitive function. Overall girls demonstrated better cognitive skills compared to boys. Family system (single/extended) does not effect the child cognition and development in rural areas of Pakistan.