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Weakening association of parental education: analysis of child health outcomes in 43 low- and middle-income countries

Karlsson, Omar LU ; De Neve, Jan-Walter and Subramanian, SV (2018) In International Journal of Epidemiology 48(1). p.83-97
Abstract
Background
Parental education has been suggested to be an effective instrument for improving child health in low- and middle-income countries. Both education and child health have improved, however, as well as related factors. These changes may have implications for the observed association.

Methods
We used Demographic and Health Surveys conducted in 43 countries at two points in time, between 1991 and 2016, to test if the association of parental education with child health has changed over time. We explored how changes relate to commonly cited confounders and pathways, including fertility, household living standards, health care use, urbanicity and geographical clustering. We used linear probability models, Gelbach... (More)
Background
Parental education has been suggested to be an effective instrument for improving child health in low- and middle-income countries. Both education and child health have improved, however, as well as related factors. These changes may have implications for the observed association.

Methods
We used Demographic and Health Surveys conducted in 43 countries at two points in time, between 1991 and 2016, to test if the association of parental education with child health has changed over time. We explored how changes relate to commonly cited confounders and pathways, including fertility, household living standards, health care use, urbanicity and geographical clustering. We used linear probability models, Gelbach decomposition, and assessed a range of sensitivity specifications.

Results
The point estimate for an additional year of maternal education has attenuated by 0.27% points (56%) for under-5 mortality, 0.34% points (15%) for child stunting, 0.42% points (30%) for child underweight and 0.09% points (24%) for child wasting. The point estimate for paternal education has attenuated by 0.20% points (53%) for under-5 mortality, 0.15% points (8%) for child stunting, 0.28% points (24%) for underweight and 0.06% points (19%) for wasting. Changes in confounding and mediation by fertility, household living standards and urban-rural differences explain to a large extent the attenuations. Geospatial clustering increasingly drives the association of parental education with child health.

Conclusions
The role of parental education in child health has attenuated considerably over time in low-resource settings. Decision makers should take into account this weakening association when designing policies aimed at improving child health. (Less)
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author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Low- and middle-income countries, parental education, under-5 mortality, stunting, wasting, underweight, Gelbach decomposition
in
International Journal of Epidemiology
volume
48
issue
1
pages
15 pages
publisher
Oxford University Press
external identifiers
  • scopus:85062081721
ISSN
0300-5771
DOI
10.1093/ije/dyy158
language
English
LU publication?
yes
id
fe742740-7b31-4491-ac43-707e1f4fecb2
date added to LUP
2019-04-16 17:37:34
date last changed
2020-12-29 03:18:33
@article{fe742740-7b31-4491-ac43-707e1f4fecb2,
  abstract     = {Background<br/>Parental education has been suggested to be an effective instrument for improving child health in low- and middle-income countries. Both education and child health have improved, however, as well as related factors. These changes may have implications for the observed association.<br/><br/>Methods<br/>We used Demographic and Health Surveys conducted in 43 countries at two points in time, between 1991 and 2016, to test if the association of parental education with child health has changed over time. We explored how changes relate to commonly cited confounders and pathways, including fertility, household living standards, health care use, urbanicity and geographical clustering. We used linear probability models, Gelbach decomposition, and assessed a range of sensitivity specifications.<br/><br/>Results<br/>The point estimate for an additional year of maternal education has attenuated by 0.27% points (56%) for under-5 mortality, 0.34% points (15%) for child stunting, 0.42% points (30%) for child underweight and 0.09% points (24%) for child wasting. The point estimate for paternal education has attenuated by 0.20% points (53%) for under-5 mortality, 0.15% points (8%) for child stunting, 0.28% points (24%) for underweight and 0.06% points (19%) for wasting. Changes in confounding and mediation by fertility, household living standards and urban-rural differences explain to a large extent the attenuations. Geospatial clustering increasingly drives the association of parental education with child health.<br/><br/>Conclusions<br/>The role of parental education in child health has attenuated considerably over time in low-resource settings. Decision makers should take into account this weakening association when designing policies aimed at improving child health.},
  author       = {Karlsson, Omar and De Neve, Jan-Walter and Subramanian, SV},
  issn         = {0300-5771},
  language     = {eng},
  month        = {08},
  number       = {1},
  pages        = {83--97},
  publisher    = {Oxford University Press},
  series       = {International Journal of Epidemiology},
  title        = {Weakening association of parental education: analysis of child health outcomes in 43 low- and middle-income countries},
  url          = {http://dx.doi.org/10.1093/ije/dyy158},
  doi          = {10.1093/ije/dyy158},
  volume       = {48},
  year         = {2018},
}