Adult education and child nutrition: the role of family and community.
BACKGROUND
It is well established that mothers' education has positive effects on child nutrition in developing countries. Less explored is the effect exerted by the education of other individuals--mothers' friends, neighbours and family.


OBJECTIVE
To examine independent effects of mothers', fathers' and grandmothers' education on child height-for-age and weight-for-age z-score, and the role of community-level maternal literacy over and above parental education and other individual-level factors.


METHODS
Cross-sectional data were analysed for 5692 children from Andhra Pradesh State in India and Vietnam sampled within "sites" (20 from each country) and then within "communities" (31 from Vietnam and 102 from India). Multilevel regression analysis was undertaken to account for confounders and geographical clustering of observations.


RESULTS
Child nutrition is positively and independently associated with mothers', fathers' and grandmothers' education. The association with grandmothers' education was statistically significant in the India sample only and was stronger for boys: the adjusted mean difference in height-for-age z-scores between boys living with an educated grandmother and those not was 0.64 (95% CI 0.29 to 0.99, p<0.001). In the Vietnam sample, child nutrition was associated with the proportion of literate mothers in the community, adjusting for parental education and other confounders (height 0.81, 95% CI 0.29 to 1.31, p = 0.002).


CONCLUSIONS
The results imply that an individual-level perspective may fail to capture the entire impact of education on child nutrition, and support a call for a widening of focus of nutrition policy and programmes from the mother-child pair towards the broader context of their family and community.
Moestue
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Nutrition and Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, London, UK. helenmoestue@gmail.com
Huttly
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D000886:Anthropometry / Q000379:methods; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004522:Educational Status; D005190:Family; D005219:Father-Child Relations; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000209:etiology; D009034:Mother-Child Relations; D009752:Nutritional Status; D012111:Residence Characteristics; D012307:Risk Factors; D012931:Social Environment; D014744:Vietnam / Q000453:epidemiology