Does education offset the effect of maternal disadvantage on childhood anaemia in Tanzania? Evidence from a nationally representative cross-sectional study

Abstract

Background Despite being preventable, anaemia is a major public health problem that affects a sizable number of children under-five years globally and in Tanzania. This study examined the maternal factors associated with the risk of anaemia among under-five children in Tanzania. We also assessed whether higher maternal education could reduce the risks of anaemia among children of women with poor socio-economic status. Methods Data was drawn from the 2015–16 Tanzania demographic and health survey and malaria indicator survey for 7916 children under five years. Adjusted odds ratios were estimated by fitting a proportional odds model to examine the maternal risk factors of anaemia. Stratified analysis was done to examine how the relationship differed across maternal educational levels. Results The findings revealed that maternal disadvantage evident in young motherhood [AOR:1.43, 95%CI:1.16–1.75], no formal education [AOR:1.53, 95%CI:1.25–1.89], unemployment [AOR:1.31, 95%CI:1.15–1.49], poorest household wealth [AOR:1.50, 95%CI:1.17–1.91], and non-access to health insurance [AOR:1.26, 95%CI: 1.03–1.53] were risk factors of anaemia among children in the sample. Sub-group analysis by maternal education showed that the risks were not evident when the mother has secondary or higher education. However, having an unmarried mother was associated with about four-times higher risk of anaemia if the mother is uneducated [AOR:4.04, 95%CI:1.98–8.24] compared with if the mother is currently in union. Conclusion Findings from this study show that a secondary or higher maternal education may help reduce the socio-economic risk factors of anaemia among children under-5 years in Tanzania.

How soon do single mothers have another child? A competing risk analysis of second premarital childbearing in sub-Saharan African countries

“…Children living in such contexts require high levels of supervision and attention since the mothers are more likely to be young, unlikely to have secondary or higher education, have higher poverty rates, and fewer economic resources than married mothers [16][17][18]. Evidence from sub-Saharan African countries has demonstrated the poor health returns associated with having a single mother with less than secondary education [7,22]. Poverty being an associated factor of single motherhood is also related to poor nutrition and low rates of immunization [46,47].…”

“…We anticipated lower rates of second premarital childbearing and differing patterns across countries, especially in countries where premarital childbearing is highly stigmatized for a few reasons. First, emerging studies have highlighted the health returns of premarital childbearing for children and their mothers [7,22]. As a result, we expect that many single mothers, especially those who are socio-economically disadvantaged, may delay having a second premarital birth and may engage in more protective sexual behaviors to avoid or delay another premarital birth after experiencing the adverse effects of the first premarital birth.…”

“…We hypothesize that the timing of a second premarital birth will differ across key socio-demographic characteristics, mainly because the health disadvantages of premarital childbearing are not evident across all socio-economic spectrums. Secondary or higher levels of maternal education reduce the effect of premarital childbearing on child health and well-being [7,22]. As a result, a rapid progression to second premarital childbearing among single mothers of high socio-economic status may be an indication of choice rather than an unplanned second premarital birth, since premarital childbearing is not at all disadvantageous to this subpopulation [7].…”

“…Over the past decade, evidence on the benefits of marriage for the well-being of children in sub-Saharan Africa, its timing and events within it, has continued to mount. Previous studies have shown that the children of single mothers have higher mortality risks, and poorer health outcomes compared to children born to married mothers [7,21,22]. These findings may partly be because women who have a child before marriage, spend a considerable number of years as a single parent and struggle to care for their child and themselves [5].…”

Predictors of Anaemia prevalence among pregnant women in urban Ghana: a cross-sectional study

“…There have been a number of studies on pregnancy anaemia including those in Ghana (Ewusie et al, 2008;Fuseini et al, 2010;Engmann et al, 2014;Anderson, 2017;Nonterah et al, 2019), Tanzania ( Stephen et al, 2018;Ali et al, 2019;Ojoniyi et al, 2019), Nicaragua (Lubbock and Stephenson, 2008), Nigeria (Adesina et al, 2011;Okafor et al, 2013;Paul et al, 2016;Sholeye et al, 2017), Ethiopia (Melku et al, 2014;Alene, and Dohe, 2014), Pakistan (Baig-Ansari et al, 2008;Khan et al, 2010) and Vietnam (Aikawa et al, 2006). Specifically, the work of Khan et al, (2010) study focus on pregnant women from tertiary health facilities in urban setting and was limited to iron, folate and cobalamin deficiency in anaemic pregnant women.…”