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. OBJECTIVES: 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). CONCLUSION: 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.

Conclusions about differences in linear growth between Bangladeshi boys and girls depend on the growth reference used.

OBJECTIVE: To examine sex differences in height-for-age z-scores and the percentage stunting among Bangladeshi children estimated using three growth references. DESIGN, SETTING AND SUBJECTS: Data collected between 1990 and 1999 by Helen Keller International's nutritional surveillance system in rural Bangladesh were analyzed for 504 358 children aged 6-59 months. Height-for-age z-scores were estimated using the 1977 NCHS, 2000 CDC and 1990 British growth references. RESULTS: The shape of the growth curves for Bangladeshi boys and girls, and their positions relative to one another, depend on which of the three growth references is used. At 6 months of age the British reference showed no sex difference whereas the NCHS and CDC showed girls to have higher average z-scores than boys by 0.14 and 0.28 s.d., respectively. While all references showed a faster deterioration of girls' z-scores from 6 to 24 months, the magnitude and direction of the sex differences, and how they changed with age, were different. There was greater disagreement about girls' z-scores than boys. Discontinuities at 24 months in the NCHS and CDC produced jagged curves whereas the British curves were smooth. CONCLUSIONS: The assessment of sex differences in linear growth depends on the growth reference used. Reasons for the different results need to be determined and may aid the final development of the new WHO international growth reference and the guidelines for its use. The findings suggest that anthropometry as a tool to explore the effects of societal gender inequality must be used with caution.

An association between chronic undernutrition and educational test scores in Vietnamese children.

OBJECTIVE: To examine the association between results of educational tests and the anthropometric status of schoolchildren. DESIGN: Cross-sectional data collected during the baseline survey of a randomised trial. SETTING: Eighty-one primary schools in three districts of northern Vietnam. SUBJECTS: A total of 3055 schoolchildren enrolled in class 3 and born in 1990. MAIN OUTCOME MEASURES: Tests of mathematics and Vietnamese language developed not to show floor or ceiling effects, and Z-scores of height-for-age, weight-for-age and weight-for-height. RESULTS: After controlling for age, sex, district and school the results of test scores in both mathematics and Vietnamese were significantly negatively correlated with Z-scores of height-for-age (P<0.001) and weight-for-age (P<0.001), but not with weight-for-height (P=0.75). CONCLUSIONS: A cross-sectional negative association was observed in Vietnamese primary school children between indicators of chronic undernutrition and tests of educational achievement. SPONSORSHIP: The study was funded by donors to the Partnership for Child Development including the Rockefeller Foundation and the World Bank.