Maternal Health Literacy Is Associated with Early Childhood Nutritional Status in India.
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.



This study investigated whether maternal health literacy is associated with child undernutrition in 2 resource-poor Indian populations.



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.



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.



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.
University of Montreal Hospital Research Center, Montreal, Quebec, Canada; Departments of Health Administration and mira.johri@umontreal.ca.
Mira
0000-0001-5642-787X
M
Johri
Harvard Center for Population and Development Studies, Cambridge, MA;
S V
SV
Subramanian
University of Montreal Hospital Research Center, Montreal, Quebec, Canada; Department of Economics, University of Daloa, Daloa, Ivory Coast; and.
Georges K
GK
Koné
Pratham Education Foundation (ASER Center), New Delhi, India.
Sakshi
S
Dudeja
Pratham Education Foundation (ASER Center), New Delhi, India.
Dinesh
D
Chandra
Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada;
Nanor
N
Minoyan
University of Montreal Hospital Research Center, Montreal, Quebec, Canada; Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada;
Marie-Pierre
0000-0001-5803-4615
MP
Sylvestre
Pratham Education Foundation (ASER Center), New Delhi, India.
Smriti
S
Pahwa
D000293:Adolescent; D000328:Adult; D005260:Female; D057220:Health Literacy; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007228:Infant Nutrition Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D007227:Infant Nutritional Physiological Phenomena; D016015:Logistic Models; D008875:Middle Aged; D009035:Mothers; D015999:Multivariate Analysis; D009752:Nutritional Status; D055815:Young Adult
child nutrition disorders; cross-sectional studies; developing countries; malnutrition/epidemiology; multilevel analysis; nutritional status; social determinants of health