Moestue H, Huttly S
Nutrition and Public Health Intervention Research Unit, London School of Hygiene and Tropical Medicine, London, UK.
J Epidemiol Community Health. 2008 Feb;62(2):153-9. doi: 10.1136/jech.2006.058578.
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.
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.
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.
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).
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.
在发展中国家，母亲的教育水平对儿童营养状况有积极影响，这一点已得到充分证实。而其他个体（母亲的朋友、邻居和家人）的教育所产生的影响则较少被探究。
研究母亲、父亲和祖母的教育水平对儿童年龄别身高和年龄别体重Z评分的独立影响，以及社区层面母亲识字率在父母教育水平及其他个体层面因素之外所起的作用。
对印度安得拉邦和越南的5692名儿童的横断面数据进行分析，这些儿童是在“地点”（每个国家20个）内抽样，然后在“社区”（越南31个，印度102个）内抽样。采用多水平回归分析来考虑混杂因素和观察值的地理聚类情况。
儿童营养状况与母亲、父亲和祖母的教育水平呈正相关且具有独立性。仅在印度样本中，与祖母教育水平的关联具有统计学意义，且对男孩的影响更强：与受过教育的祖母生活在一起的男孩和未与受过教育的祖母生活在一起的男孩相比，年龄别身高Z评分的调整后平均差异为0.64（95%可信区间0.29至0.99，p<0.001）。在越南样本中，在调整了父母教育水平和其他混杂因素后，儿童营养状况与社区中识字母亲的比例相关（身高方面为0.81，95%可信区间0.29至1.31，p = 0.002）。
研究结果表明，从个体层面的角度可能无法全面捕捉教育对儿童营养状况的影响，并支持将营养政策和项目的重点从母婴对扩大到其家庭和社区的更广泛背景的呼吁。
