Maternal Education and Low Birth Weight in Low- and Middle-Income Countries: Systematic Review and Meta-Analysis.

OBJECTIVE: Adverse birth outcomes, including low birth weight (LBW), remain the leading causes of child morbidity and mortality in many low- and middle-income countries (LMICs). We carried out a systematic review and meta-analysis to assess the strength and consistency of the association between maternal education and LBW in LMICs. METHODS: We conducted an electronic search of studies published between 2000 and 2014 in four databases using three MeSH keywords - birth outcomes including LBW; individual-level socioeconomic measures including maternal education; and a list of LMICs. The methodological quality of each eligible study was evaluated following the GRADE approach. A total of 26 studies were entered into meta-analysis. Subgroup analyses were performed to account for heterogeneity in the measurement of exposure and country development level. FINDINGS: The meta-analysis revealed a statistically significant pooled estimate (OR = 0.67; 95% CI = 0.61-0.74) indicating that maternal education is protective against LBW in LMICs. Heterogeneity was found high in subgroup analyses in studies from lower-middle income countries and in those measuring maternal education in academic classes, but drops considerably in studies from low-income countries and those measuring it in number of years of schooling. The quality of the overall body of evidence is moderate due to high observed heterogeneity in some subgroup analyses and the presence of studies with high risk of bias. INTERPRETATION: Higher maternal education associates with a moderate but statistically significant decrease in the risk of delivering a LBW infant in LMICs. Enhancing girls' and women's access to education operates through a number of pathways to improve birth outcomes and reduce LBW in LMICs.

Integration of Palestinian Refugee Children from Syria in UNRWA Schools in Lebanon.

Following the Syrian conflict that began in 2011, Lebanon received more than one million refugees including 44,000 Palestinian refugees from Syria (PRS). PRS children were integrated into existing schools run by the United Nations Relief and Works Agency (UNRWA). Despite efforts by UNRWA to integrate the newly displaced into its services in Lebanon, only 58% of 6-18-year-old PRS children were enrolled in school in 2014. Informed by ecological systems theory, we examined the role of parental characteristics in determining school enrollment among PRS children following displacement into Lebanon. Utilizing data from the 2014 UNRWA Vulnerability Assessment (N = 12,378 6-18-year-old children), we specified crude and adjusted logistic regression models to predict child school non-enrollment including a set of variables on head of family characteristics (gender, age, education, and presence/absence of chronic disease) and post-displacement household characteristics (crowding, wealth, camp residence, region, and type of dwelling). The results show that, adjusting for household characteristics, a child living in a family whose head has secondary education or higher is more likely to be enrolled in school compared to one living in a family headed by someone with less than secondary education. Parental education remains the strongest predictor of child school enrollment despite displacement-related household disadvantage. To break the cycle of intergenerational educational disadvantage, it is critical for UNRWA to proactively design school retention programs for PRS children living in families whose head had limited access to education. Supplementary Information: The online version contains supplementary material available at 10.1007/s12134-020-00793-y.

A test of the epidemiological paradox in a context of forced migration: low birthweight among Syrian newborns in Lebanon.

BACKGROUND: Studies on immigrants revealed an epidemiological paradox whereby low-socioeconomic status (SES) immigrant mothers exhibit favourable birth outcomes compared with native-born mothers. We tested the epidemiological paradox in a context of forced migration, comparing associations of low birthweight (LBW) and maternal SES between Syrian and Lebanese newborns in Lebanon. METHODS: We used data from the National Collaborative Perinatal Neonatal Network (NCPNN) of 31 Lebanese hospitals, including 45 442 Lebanese and 4910 Syrian neonates born 2011-13. We assessed associations between LBW and maternal SES for both groups. Logistic regression models examined interactions between maternal origin and SES. RESULTS: Syrian births increased exponentially between 2011 and 2013, along with the group's forced migration into Lebanon. Although Syrian mothers are more socioeconomically disadvantaged compared with Lebanese mothers, Syrian LBW (6.2%) was only marginally higher than Lebanese LBW (5.6%; P = 0.059). Only 20-24-years-old Syrian women [odds ratio (OR) = 1.70 (1.22-2.36)] and those with ≥ university education [OR = 2.02 (0.98-4.16)] exhibited higher odds of delivering an LBW baby compared with Lebanese women of the same age and education. CONCLUSIONS: The findings do not provide strong evidence for the epidemiological paradox in a forced migration context. However, the relatively advantageous LBW profile among Syrian neonates, despite their mothers' low SES and exposure to acute and chronic psychological stress, points to protective mechanisms. One of these mechanisms may be a collective response by the displaced population to improve neonatal outcomes as a way of recovering from loss and death.