Maternal Education and Micro-geographic Disparities in Nutritional Status Among School-aged Children in Rural Northwestern China

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2013 Dec 17

PMID 24340034

Citations 7

Authors

Cuili Wang

Robert L Kane

Dongjuan Xu

Lingui Li

Weihua Guan

Hui Li

Qingyue Meng

Affiliations

Soon will be listed here.

Abstract

Objectives: Prior evidence suggests geographic disparities in the effect of maternal education on child nutritional status between countries, between regions and between urban and rural areas. We postulated its effect would also vary by micro-geographic locations (indicated by mountain areas, plain areas and the edge areas) in a Chinese minority area.

Methods: A cross-sectional study was conducted with a multistage random sample of 1474 school children aged 5-12 years in Guyuan, China. Child nutritional status was measured by height-for-age z scores (HAZ). Linear mixed models were used to examine its association with place of residence and maternal education.

Results: Micro-geographic disparities in child nutritional status and the level of socioeconomic composition were found. Children living in mountain areas had poorer nutritional status, even after adjusting for demographic (plain versus mountain, β = 0.16, P = 0.033; edge versus mountain, β = 0.29, P = 0.002) and socioeconomic factors (plain versus mountain, β = 0.12, P = 0.137; edge versus mountain, β = 0.25, P = 0.009). The disparities significantly widened with increasing years of mothers' schooling (maternal education*plain versus mountain: β = 0.06, P = 0.007; maternal education*edge versus mountain: β = 0.07, P = 0.005). Moreover, the association between maternal education and child nutrition was negative (β = -0.03, P = 0.056) in mountain areas but positive in plain areas (β = 0.02, P = 0.094) or in the edge areas (β = 0.04, P = 0.055).

Conclusions: Micro-geographic disparities in child nutritional status increase with increasing level of maternal education and the effect of maternal education varies by micro-geographic locations, which exacerbates child health inequity. Educating rural girls alone is not sufficient; improving unfavorable conditions in mountain areas might make such investments more effective in promoting child health. Nutrition programs targeting to the least educated groups in plain and in edge areas would be critical to their cost-effectiveness.

Citing Articles

Prevalence and associated risk factors of stunting, wasting/thinness, and underweight among primary school children in Kandahar City, Afghanistan: a cross-sectional analytical study.

Rahimi B, Khalid A, Lali W, Khalid W, Rahimi J, Taylor W BMC Public Health. 2024; 24(1):2321.

PMID: 39192206 PMC: 11348593. DOI: 10.1186/s12889-024-19858-z.

Stunting and associated factors among school-age children (5-14 years) in Mulo district, Oromia region, Ethiopia.

Berhanu A, Garoma S, Arero G, Mosisa G SAGE Open Med. 2022; 10:20503121221127880.

PMID: 36212231 PMC: 9536101. DOI: 10.1177/20503121221127880.

Prevalence and factors associated with stunting and thinness among school-age children in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia.

Tariku E, Abebe G, Melketsedik Z, Gutema B PLoS One. 2018; 13(11):e0206659.

PMID: 30388149 PMC: 6214544. DOI: 10.1371/journal.pone.0206659.

The role of parental education in child disability in China from 1987 to 2006.

He P, Chen G, Wang Z, Guo C, Zheng X PLoS One. 2017; 12(10):e0186623.

PMID: 29040333 PMC: 5645139. DOI: 10.1371/journal.pone.0186623.

Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh.

Khatun F, Heywood A, Hanifi S, Rahman M, Ray P, Liaw S BMC Health Serv Res. 2017; 17(1):573.

PMID: 28821243 PMC: 5563057. DOI: 10.1186/s12913-017-2523-6.

References

Attanasio O, Gomez L, Rojas A, Vera-Hernandez M . Child health in rural Colombia: determinants and policy interventions. Econ Hum Biol. 2004; 2(3):411-38. DOI: 10.1016/j.ehb.2004.10.005. View

Chen Y, Li H . Mother's education and child health: is there a nurturing effect?. J Health Econ. 2008; 28(2):413-26. DOI: 10.1016/j.jhealeco.2008.10.005. View

Mushtaq M, Gull S, Abdullah H, Shahid U, Shad M, Akram J . Prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children. BMC Public Health. 2011; 11:724. PMC: 3195095. DOI: 10.1186/1471-2458-11-724. View

Black R, Allen L, Bhutta Z, Caulfield L, de Onis M, Ezzati M . Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008; 371(9608):243-60. DOI: 10.1016/S0140-6736(07)61690-0. View

Pongou R, Ezzati M, Salomon J . Household and community socioeconomic and environmental determinants of child nutritional status in Cameroon. BMC Public Health. 2006; 6:98. PMC: 1523206. DOI: 10.1186/1471-2458-6-98. View

Pfeiffer J, Gloyd S, Ramirez Li L . Intrahousehold resource allocation and child growth in Mozambique: an ethnographic case-control study. Soc Sci Med. 2001; 53(1):83-97. DOI: 10.1016/s0277-9536(00)00311-7. View

Boyle M, Racine Y, Georgiades K, Snelling D, Hong S, Omariba W . The influence of economic development level, household wealth and maternal education on child health in the developing world. Soc Sci Med. 2006; 63(8):2242-54. DOI: 10.1016/j.socscimed.2006.04.034. View

Senbanjo I, Oshikoya K, Odusanya O, Njokanma O . Prevalence of and risk factors for stunting among school children and adolescents in Abeokuta, southwest Nigeria. J Health Popul Nutr. 2011; 29(4):364-70. PMC: 3190367. DOI: 10.3329/jhpn.v29i4.8452. View

Frost M, Forste R, Haas D . Maternal education and child nutritional status in Bolivia: finding the links. Soc Sci Med. 2004; 60(2):395-407. DOI: 10.1016/j.socscimed.2004.05.010. View

10.

Rahman A, Chowdhury S . Determinants of chronic malnutrition among preschool children in Bangladesh. J Biosoc Sci. 2006; 39(2):161-73. DOI: 10.1017/S0021932006001295. View

11.

Currie A, Shields M, Price S . The child health/family income gradient: Evidence from England. J Health Econ. 2006; 26(2):213-32. DOI: 10.1016/j.jhealeco.2006.08.003. View

12.

Henry Mosley W, Chen L . An analytical framework for the study of child survival in developing countries. 1984. Bull World Health Organ. 2003; 81(2):140-5. PMC: 2572391. View

13.

Semba R, de Pee S, Sun K, Sari M, Akhter N, Bloem M . Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet. 2008; 371(9609):322-8. DOI: 10.1016/S0140-6736(08)60169-5. View

14.

Lavy V, Strauss J, Thomas D, de Vreyer P . Quality of health care, survival and health outcomes in Ghana. J Health Econ. 1996; 15(3):333-57. DOI: 10.1016/0167-6296(95)00021-6. View

15.

Mohsena M, Mascie-Taylor C, Goto R . Association between socio-economic status and childhood undernutrition in Bangladesh; a comparison of possession score and poverty index. Public Health Nutr. 2010; 13(10):1498-504. DOI: 10.1017/S1368980010001758. View

16.

Pebley A, Goldman N, Rodriguez G . Prenatal and delivery care and childhood immunization in Guatemala: do family and community matter?. Demography. 1996; 33(2):231-47. View

17.

Levine R, Rowe M . Maternal literacy and child health in less-developed countries: evidence, processes, and limitations. J Dev Behav Pediatr. 2009; 30(4):340-9. DOI: 10.1097/DBP.0b013e3181b0eeff. View

18.

Janevic T, Petrovic O, Bjelic I, Kubera A . Risk factors for childhood malnutrition in Roma settlements in Serbia. BMC Public Health. 2010; 10:509. PMC: 2936427. DOI: 10.1186/1471-2458-10-509. View

19.

Chopra M . Risk factors for undernutrition of young children in a rural area of South Africa. Public Health Nutr. 2003; 6(7):645-52. DOI: 10.1079/phn2003477. View

20.

Ezzati M, Lopez A, Rodgers A, Vander Hoorn S, Murray C . Selected major risk factors and global and regional burden of disease. Lancet. 2002; 360(9343):1347-60. DOI: 10.1016/S0140-6736(02)11403-6. View