Mothers' education but not fathers' education, household assets or land ownership is the best predictor of child health inequalities in rural Uganda

Abstract

BackgroundHealth and nutrition inequality is a result of a complex web of factors that include socio-economic inequalities. Various socio-economic indicators exist however some do not accurately predict inequalities in children. Others are not intervention feasible.ObjectiveTo examine the association of four socio-economic indicators namely: mothers' education, fathers' education, household asset index, and land ownership with growth stunting, which is used as a proxy for health and nutrition inequalities among infants and young children.MethodsThis was a cross-sectional survey conducted in the rural district of Hoima, Uganda. Two-stage cluster sampling design was used to obtain 720 child/mother pairs. Information on indicators of household socio-economic status and child anthropometry was gathered by administering a structured questionnaire to mothers in their home settings. Regression modelling was used to determine the association of socio-economic indicators with stunting.ResultsOne hundred seventy two (25%) of the studied children were stunted, of which 105 (61%) were boys (p < 0.001). Bivariate analysis indicated a higher prevalence of stunting among children of: non-educated mothers compared to mothers educated above primary school (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.4–4.4); non-educated fathers compared to fathers educated above secondary school (OR 1.7, 95% CI 0.8–3.5); households belonging in the "poorest" quintile for the asset index compared to the "least poor" quintile (OR 2.1, 95% CI 1.2–3.7); Land ownership exhibited no differentials with stunting. Simultaneously adjusting all socio-economic indicators in conditional regression analysis left mothers' education as the only independent predictor of stunting with children of non-educated mothers significantly more likely to be stunted compared to those of mothers educated above primary school (OR 2.1, 95% CI 1.1–3.9). More boys than girls were significantly stunted in poorer than wealthier socio-economic strata.ConclusionsOf four socio-economic indicators, mothers' education is the best predictor for health and nutrition inequalities among infants and young children in rural Uganda. This suggests a need for appropriate formal education of the girl child aimed at promoting child health and nutrition. The finding that boys are adversely affected by poverty more than their female counterparts corroborates evidence from previous studies.

Prevalence and predictors of undernutrition among underfive children in Arusha District, Tanzania

“…This finding is consistent with other studies conducted in Africa which suggested paternal education to be a protective factor against childhood stunting (Agho et al., 2009; Amsalu & Tigabu, 2008; Wamani, Tylleskär, Åstrøm, Tumwine, & Peterson, 2004). The rationale attributed to this linkage appears to align with the increased economic power to provide quality food and services for the family (Islam et al., 2013), as in most developing contexts the presence of a father contributes to the economic power of the family.…”

Measuring Socioeconomic Inequalities in Relation to Malaria Risk: A Comparison of Metrics in Rural Uganda

“…We observed that female caregiver's education was better able to predict differences in malaria incidence than other metrics of SEP. Good education is commonly associated with improved health outcomes elsewhere 26,40 and generally considered to be a useful metric of SEP since it is a proxy for knowledge-based assets and can be strongly related to other measures of SEP such as income and occupation. 6,20 However, education was not associated with HBR nor parasite prevalence, and the epidemiological meaning of this remains unclear.…”

“…19,20 Previous studies of health inequalities have compared the household rankings produced by different SEP indicators 12,14,[21][22][23][24] and evaluated the association of different indicators with specific health outcomes. 14,[25][26][27] However, to our knowledge, only one study has previously evaluated indicators for measuring socioeconomic inequalities in relation to malaria risk. 28 In that study, three indices were developed using data from 25 Tanzanian villages: a consumption index and two wealth indices derived from principal component analysis (PCA).…”

Women's Empowerment and Nutritional Status of their Children: A Community-based Study from Villages of Bhaktapur District, Nepal

“…Similarly, children of mothers who own land are significantly less likely to be severely underweight (AOR=0.54) (23). On the other hand a study from Uganda found that land ownership exhibited no differentials with child stunting (24).…”