The Relationship and Pathways between Maternal Education and Child Nutritional Status Dissertation P

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The Relationship and Pathways between Maternal
Education and Child Nutritional Status-
Dissertation Prospectus

• Dissertation Committee
• Anne R. Pebley, Chair
• Majorie Kagawa-Singer
• May C. Wang
• Nancy E. Levine
• By Kunchok Gyaltsen
•  
• November 3, 2008
• Email kunchok_at_ucla.edu 

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Outline

• Background
• Determinants of malnutrition
• Central hypotheses
• Nepal
• Data
• Analysis plan
• Preliminary results
• Study strengths and limitations

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BackgroundWhat is malnutrition?

• Includes both under-nutrition (inadequate growth)
  and over-nutrition (obesity).
• Malnutrition (undernurition) has two
  constituents protein-energy malnutrition (PEM)
  and micronutrient deficiencies.
• Childrens protein-energy malnutrition is
  generally assessed with anthropometric
  measurement
• Underweight (weight for age)
• Stunting (height for age)
• Wasting (weight for height)

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Background (continued) Magnitude of
malnutrition problem among children in developing
world

• 32 (178 million) of children under five years of
  age were estimated to be stunted in all
  developing countries (40 of stunted children
  were found in Africa and Southeast Asia) (2005).
• 27 (or146 million) of children under five years
  old or one out of every four children are
  underweight around the world (78 million or more
  than half of them are from South Asia) (2006).
• 60 million children estimated to have moderate
  acute malnutrition and 13 million children under
  age 5 have severe acute malnutrition (wasting)
  (2001).

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Background (continued) Effect of malnutrition
on childrens health

• Malnutrition is an essential direct and indirect
  risk factor for mortality among young children in
  developing countries.
• Malnutrition is the most important risk factor
  for disease, as malnourished children have longer
  and harsher illnesses.
• Malnutrition affects long-term growth and an
  individuals physical capacity in adulthood.
• Malnutrition has important effects on brain
  development and cognition. The period of early
  childhood is crucial for brain development as
  well as physical growth.

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Determinants of malnutrition

• Basic determinants
• Underlying determinants
• Immediate factors

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Child nutritional status
Chronic growth failure/repeated illness
Outcome
Death

Child characteristics Age/Sex Birth weight Child
activity level Genetic endowment
Adequate dietary intake Breastfeeding Supplement
feeding Food intake
Immediate Factors
Infectious diseases Diarrhea/fever/cough
Food security Availability of food
Health service/environment Prenatal visits Place
of birth/birth attendants Immunization Drinking
water/toilet
Underlying Factors
Health behavior Hand washing Smoking
Empowerment Decision-making
Health knowledge
Maternal education
Household factors Dwelling house
quality Household possession Number of children
Basic Factors
Social factors Ethnicity Religion Marital status
Community factors Residence region/zone Rural/urb
an Districts health facilities Districts health
programs Govt. health expenditure
Economic factors Household income Agriculture
land
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Central hypotheses

• How does maternal education affect childrens
  nutrition?
• Maternal education is an important predictor of
  child malnutrition in part because it is a proxy
  for socioeconomic status at the individual and
  household levels.
• Maternal education influences child nutritional
  status because it affects maternal health
  knowledge, including knowledge about child
  nutrition.
• Womens empowerment or participation in
  decision-making is also be an important mechanism
  through which maternal education affects
  childrens nutritional status.
• Educated mothers are also likely to have better
  health behaviors.
• More educated women are also more likely to use
  health care for themselves and their children.

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Nepal
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• Administrative system and land
• 75 districts
• 5 development regions
• 3 ecological zones
• Total population
• 23 million (only 16 live in Urban)
• Ethnicity and language
• 103 ethnic/caste groups with 92 native languages
• Health indicators
• Infant mortality rate 56 per 1,000 (2000)
• Under five childrens mortality rate 74 per
  1,000 (2005)
• Maternal mortality ratio 740 per 100, 000 (2000)
• Life expectancy 51 for female and 52 for male
  (2007)
• Nutritional issue
• 30 to 40 of Nepalese population suffers from
  hunger
• 45 of the children are underweight and 43 have
  stunted

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Data

• 2006 Nepal Demographic Health Survey (DHS)
• Nepal District Profile 2006 published by Nepal
  Development Information Institute

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Original Nepal DHS 2006 total sample N8,707
households N10,793 women
N5,783 Children lt5 years old
N10,793 Women age 15 to 49 years age
Drop total 563 cases because child not alive,
respondent not presented, refused and child not
measured for other reasons
Drop 5 cases due to missing in respondents
religious affiliation
N5,220 Children measured height and weight
Drop total 288 cases due to missing data on
religion (n3), birth size (n1), times of
breastfed (n1), drinking water and toilet
(n276), and land (n5).
N4,934 Children lt5 years old
N10,788 Women age 15 to 49 years age
Final womens analytic sample
Final child analytic sample
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Analysis Plan

• Part 1 To investigate the prevalence of
  childrens malnutrition in Nepal
• Part 2 To explore the prevalence of maternal
  education in different sectors of the Nepalese
  population
• Part 3 To examine the effect of the maternal
  education on child nutritional status
• Part 4 To explore the role of maternal health
  behavior in relationship maternal education and
  child nutritional status

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Preliminary Result
Percent distribution of childrens nutritional
status in Nepal DHS 2006 (N4,934)

• Cut-off for each measure is less than 2
  standard deviation units below the median

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Nutritional status of children under five years
in Nepal (percent and age in months) DHS 2006
(N4,943)
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Comparison of stunted, wasted, and underweight
among children in Nepal and India based on Nepal
and India DHS data ( 2006)
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Maternal education by womens age group from
Nepal DHS 2006 (N10,788)
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Percent distribution of maternal educational
level by weight for age (Z-score) among children
age under five in Nepal, 2006 (N4,934).
?2 p-value 0.000
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Percent distribution of maternal educational
level by height for age (Z-score) among children
age under five in Nepal, 2006 (N4,934).
?2 p-value 0.000
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Percent distribution of maternal educational
level by weight for height (Z-score) among
children age under five in Nepal, 2006 (N4,934).
?2 p-value 0.000
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Logistic regression result for underweight,
stunting and wasting by maternal educational
level among Nepalese children (gt5 years of age,
2006 (standard errors shown in parenthesis)
(N4,934)
reference category s.e standard error
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• Study Strengths
• A large and nationally representative sample of
  Nepalese women and children with comprehensive
  social, economic, demographic, and health
  information.
• The first comprehensive study of the social
  determinants of childrens nutritional status in
  Nepal.
• Limitations
• Lack of actual yearly or monthly income at the
  household level.
• The Nepal DHS did not collect any information on
  household food security and womens knowledge on
  nutrition.
• This study will be based on cross-sectional data.

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Thank you!

• Questions and Comments?