Department of Community and Global Health, The University of Tokyo, Bunkyo-ku, Japan.
Department of Community and Global Health, The University of Tokyo, Bunkyo-ku, Japan
BMJ Open. 2022 May 9;12(5):e054134. doi: 10.1136/bmjopen-2021-054134.
Childcare practices determine the child nutritional outcomes, but resources for good practices are unequally distributed across socioeconomic status (SES). This study first examined the associations between social capital and childcare practices separately across SES groups. It then investigated the mediation effect of social capital between SES and childcare practices.
This cross-sectional study used the Short Version of the Adapted Social Capital Assessment Tool to measure structural social capital (group membership, social support and citizenship activities) and cognitive social capital of mothers. Data were analysed using multilevel logistic regressions with random intercepts and mediation modellings.
Rural Lilongwe, Malawi.
A total of 320 mothers with a child aged between 12 months and 23 months.
Childcare practice outcomes included were minimum dietary diversity, handwashing and complete vaccination.
Among structural social capital dimensions, social support was found to be positively associated with minimum dietary diversity (adjusted OR (AOR)=1.44, 95% CI 1.22 to 1.71; p<0.001) and handwashing for all mothers (AOR=1.42, 95% CI 1.23 to 1.64; p<0.001). In the subgroup analysis, the higher SES group had higher odds of meeting the minimum dietary diversity (AOR=1.63, 95% CI 1.18 to 2.26; p=0.01) and handwashing with increased social support (AOR=1.53, 95% CI 1.13 to 2.08; p=0.01) than the lower SES. The mediation effect of social support accounted for 27.3% of the total effect between SES and minimum dietary diversity. Cognitive social capital was negatively associated with vaccination for the lower SES group (AOR=0.07, 95% CI 0.01 to 0.68; p=0.03).
To improve feeding and handwashing practices and to reduce health inequalities in rural Malawi, governments and organisations should consider promoting the value of social support and health. Future research is needed to explain the negative association between cognitive social capital and vaccination among the lower SES group.
儿童保育实践决定了儿童的营养状况，但良好实践的资源在社会经济地位（SES）方面分配不均。本研究首先分别在 SES 群体中检验了社会资本与儿童保育实践之间的关联。然后，研究了社会资本在 SES 与儿童保育实践之间的中介效应。
本横断面研究使用经过改编的社会资本评估工具的简短版本来衡量母亲的结构性社会资本（群体成员、社会支持和公民活动）和认知社会资本。使用具有随机截距的多层逻辑回归和中介模型分析数据。
马拉维农村利隆圭。
共有 320 名年龄在 12 个月至 23 个月之间的儿童的母亲。
儿童保育实践结果包括最低饮食多样性、洗手和完全接种疫苗。
在结构性社会资本维度中，发现社会支持与最低饮食多样性呈正相关（调整后的比值比（AOR）=1.44，95%置信区间 1.22 至 1.71；p<0.001），且对所有母亲的洗手行为也呈正相关（AOR=1.42，95%置信区间 1.23 至 1.64；p<0.001）。在亚组分析中，较高 SES 组达到最低饮食多样性（AOR=1.63，95%置信区间 1.18 至 2.26；p=0.01）和增加社会支持的洗手行为（AOR=1.53，95%置信区间 1.13 至 2.08；p=0.01）的可能性均高于较低 SES 组。社会支持的中介效应占 SES 与最低饮食多样性之间总效应的 27.3%。认知社会资本与较低 SES 组的疫苗接种呈负相关（AOR=0.07，95%置信区间 0.01 至 0.68；p=0.03）。
为了改善农村马拉维的喂养和洗手习惯，并减少健康不平等，政府和组织应考虑促进社会支持和健康的价值。需要进一步研究来解释认知社会资本与较低 SES 组疫苗接种之间的负相关关系。
