Mira Johri1, S V Subramanian2, Georges K Koné3, Sakshi Dudeja4, Dinesh Chandra4, Nanor Minoyan5, Marie-Pierre Sylvestre6, Smriti Pahwa4. 1. University of Montreal Hospital Research Center, Montreal, Quebec, Canada; Departments of Health Administration and mira.johri@umontreal.ca. 2. Harvard Center for Population and Development Studies, Cambridge, MA; 3. University of Montreal Hospital Research Center, Montreal, Quebec, Canada; Department of Economics, University of Daloa, Daloa, Ivory Coast; and. 4. Pratham Education Foundation (ASER Center), New Delhi, India. 5. Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada; 6. University of Montreal Hospital Research Center, Montreal, Quebec, Canada; Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada;
Abstract
BACKGROUND: The global burden of child undernutrition is concentrated in South Asia, where gender inequality and female educational disadvantage are important factors. Maternal health literacy is linked to women's education and empowerment, can influence multiple malnutrition determinants, and is rapidly modifiable. OBJECTIVE: This study investigated whether maternal health literacy is associated with child undernutrition in 2 resource-poor Indian populations. METHODS: We conducted cross-sectional surveys in an urban and a rural site, interviewing 1 woman with a child aged 12-23 mo/household. Multivariate logistic regression analyses were conducted independently for each site. The main exposure was maternal health literacy. We assessed respondents' ability to understand, appraise, and apply health-related information with the use of Indian health promotion materials. The main outcomes were severe stunting, severe underweight, and severe wasting. We classified children as having a severe nutritional deficiency if their z score was <-3 SDs from the WHO reference population for children of the same age and sex. Analyses controlled for potential confounding factors including parental education and household wealth. RESULTS: Rural and urban analyses included 1116 and 657 mother-child pairs, respectively. In each site, fully adjusted models showed that children of mothers with high health literacy had approximately half the likelihood of being severely stunted (rural adjusted OR: 0.50; 95% CI: 0.33, 0.74; P = 0.001; urban adjusted OR: 0.58; 95% CI: 0.35, 0.94; P = 0.028) or severely underweight (rural adjusted OR: 0.57; 95% CI: 0.38, 0.87; P = 0.009; urban adjusted OR: 0.48; 95% CI: 0.25, 0.91; P = 0.025) than children of mothers with low health literacy. Health literacy was not associated with severe wasting. CONCLUSIONS: In resource-poor rural and urban settings in India, maternal health literacy is associated with child nutritional status. Programs targeting health literacy may offer effective entry points for intervention.
BACKGROUND: The global burden of child undernutrition is concentrated in South Asia, where gender inequality and female educational disadvantage are important factors. Maternal health literacy is linked to women's education and empowerment, can influence multiple malnutrition determinants, and is rapidly modifiable. OBJECTIVE: This study investigated whether maternal health literacy is associated with child undernutrition in 2 resource-poor Indian populations. METHODS: We conducted cross-sectional surveys in an urban and a rural site, interviewing 1 woman with a child aged 12-23 mo/household. Multivariate logistic regression analyses were conducted independently for each site. The main exposure was maternal health literacy. We assessed respondents' ability to understand, appraise, and apply health-related information with the use of Indian health promotion materials. The main outcomes were severe stunting, severe underweight, and severe wasting. We classified children as having a severe nutritional deficiency if their z score was <-3 SDs from the WHO reference population for children of the same age and sex. Analyses controlled for potential confounding factors including parental education and household wealth. RESULTS: Rural and urban analyses included 1116 and 657 mother-child pairs, respectively. In each site, fully adjusted models showed that children of mothers with high health literacy had approximately half the likelihood of being severely stunted (rural adjusted OR: 0.50; 95% CI: 0.33, 0.74; P = 0.001; urban adjusted OR: 0.58; 95% CI: 0.35, 0.94; P = 0.028) or severely underweight (rural adjusted OR: 0.57; 95% CI: 0.38, 0.87; P = 0.009; urban adjusted OR: 0.48; 95% CI: 0.25, 0.91; P = 0.025) than children of mothers with low health literacy. Health literacy was not associated with severe wasting. CONCLUSIONS: In resource-poor rural and urban settings in India, maternal health literacy is associated with child nutritional status. Programs targeting health literacy may offer effective entry points for intervention.
Authors: Mira Johri; Marie-Pierre Sylvestre; Georges Karna Koné; Dinesh Chandra; S V Subramanian Journal: PLoS One Date: 2019-01-08 Impact factor: 3.240
Authors: Apurv Soni; Nisha Fahey; Zulfiqar A Bhutta; Wenjun Li; Jean A Frazier; Tiffany Moore Simas; Somashekhar M Nimbalkar; Jeroan J Allison Journal: PLoS Med Date: 2021-10-27 Impact factor: 11.069