Maternal Years Of Schooling Research Articles

Intergenerational effects of education on child mortality: Evidence from the compulsory primary schooling law in Vietnam

We leverage the introduction of Vietnam’s primary compulsory schooling law as a natural experiment to provide new evidence on the effects of parents’ education on child mortality. Employing data from the 2009 Vietnam Population and Housing Census and a regression discontinuity design, we show that the reform increased average schooling duration by approximately half a year. Our key findings reveal that one additional year of maternal schooling induced by the law reduced child mortality by 29.4%, with the majority of improvements concentrated among women residing in rural areas, minor ethnicities, and female children. While increased paternal education also exhibited a negative impact on child mortality, the effect diminished in magnitude and became statistically insignificant when controlling for maternal education. This suggests that neglecting to account for spousal education does not introduce substantial biases in estimates of maternal education’s effect on child mortality but may lead to an upward bias in estimates for fathers’ education. Further, our results indicate that increased maternal education was associated with increasing age at marriage and first birth, reducing total fertility, and engaging more in paid work, all of which could serve as potential pathways for child mortality reduction.

Evaluating the Prevalence and Factors Associated With an Optimal Neurodevelopmental Outcome in 4- to 6-Year-Old Children With Fontan Circulation.

We sought to evaluate the prevalence and factors associated with "optimal" neurodevelopmental outcomes in 4- to 6-year-old children with Fontan circulation. Patients followed through the Western Canadian Complex Pediatric Therapies Follow-Up Program, and born between September 1996 and December 2015, were included. Optimal neurodevelopmental outcome was defined as full-scale intelligence quotient; visual-motor integration; adaptive behaviour assessment system-general adaptive composite scores of ≥ 80 each; and the absence of chronic motor disability, permanent hearing loss, visual impairment, and seizure disorder. Multivariable regression models and decision algorithms evaluated variables associated with optimal outcomes. The Fontan procedure was completed on 225 children, with neurodevelopmental outcome data available for 205 (mean [standard deviation]) age at Fontan 3.4 (0.9) years, 37% female). Optimal neurodevelopmental outcome was identified in 55% (112 of 205). Factors independently associated with optimal neurodevelopmental outcome were female sex (odds ratio [OR], 2.1; 95% confidence interval [CI] 1.1-4.1), years of maternal schooling (OR, 1.2 [1.1-1.4]), age at Fontan (years) (OR, 0.97 [0.94-1.0]), need for concomitant atrioventricular valve (AVV) intervention (OR, 0.4 [0.2-1.0]), and time (hours) for lactate to be ≤ 2 mmol/L (OR, 0.9 [0.8-1.0]). Of those with Fontan completion < 3.25 years, without concomitant AVV intervention and lactate normalization within 8 hours post-Fontan, 87% (27 of 31) had optimal neurodevelopmental outcomes. Optimal neurodevelopmental outcome was present in more than one-half of 4- to 6-year-old children with Fontan circulation in this cohort study, with important associated factors identified, including potentially modifiable factors such as younger age at Fontan surgery and lack of concomitant AVV intervention.

Predicting Low Cognitive Ability at Age 5-Feature Selection Using Machine Learning Methods and Birth Cohort Data.

Objectives: In this study, we applied the random forest (RF) algorithm to birth-cohort data to train a model to predict low cognitive ability at 5years of age and to identify the important predictive features. Methods: Data was from 1,070 participants in the Irish population-based BASELINE cohort. A RF model was trained to predict an intelligence quotient (IQ) score ≤90 at age 5years using maternal, infant, and sociodemographic features. Feature importance was examined and internal validation performed using 10-fold cross validation repeated 5 times. Results The five most important predictive features were the total years of maternal schooling, infant Apgar score at 1min, socioeconomic index, maternal BMI, and alcohol consumption in the first trimester. On internal validation a parsimonious RF model based on 11 features showed excellent predictive ability, correctly classifying 95% of participants. This provides a foundation suitable for external validation in an unseen cohort. Conclusion: Machine learning approaches to large existing datasets can provide accurate feature selection to improve risk prediction. Further validation of this model is required in cohorts representative of the general population.

Does education enhance entrepreneurship?

Formal education is correlated with entrepreneurial activity and success, but correlation does not indicate causation. Education and entrepreneurship are both influenced by other related factors. The current study estimates the causal effects of formal education on entrepreneurship outcomes by instrumenting for an individual’s years of schooling using cohort mean years of maternal schooling observed decades prior. We differentiate self-employment by industry employment growth and firm incorporation status. Policymakers are especially interested in entrepreneurship with the potential to create substantial employment growth. We find that an additional year of schooling increases self-employment in high-growth industries by 1.12 percentage points for women and by 0.88 percentage points for men. Education reduces the probability of male self-employment in shrinking industries. Education also increases incorporated self-employment for women and men and reduces unincorporated self-employment among men but not women. The overall probability of self-employment increases with education for women but is unaffected by education for men. The results suggest that formal education enhances entrepreneurship.

Predicting low cognitive ability at age 5 using machine learning methods and birth cohort data

Abstract Background Early intervention is essential to address disparities in cognitive development. Current developmental screening will not detect the vast majority of children who go on to have below average cognitive ability at school age. In this study, we applied the random forest (RF) algorithm, a highly interpretable machine learning method, to birth-cohort data to train a model to predict low cognitive ability at 5 years of age using perinatal features. Methods Data was from 1,070 participants in the Irish population-based BASELINE birth cohort. A RF model was trained to predict an intelligence quotient (IQ) score &amp;lt;90 at age 5 years using a broad selection of maternal, infant, birth, and sociodemographic features, all of which could be easily measured at a population level in the perinatal period. Feature importance was examined using mean decrease in Gini impurity, mean decrease in accuracy, and mean minimal depth. Recursive feature elimination was used to develop a parsimonious model. Internal validation was performed using 10-fold cross validation repeated 5 times. Results The most predictive features for low cognitive ability at 5 years of age were the total years of maternal schooling, infant Apgar score at 1 minute, socioeconomic index, maternal BMI, and units of alcohol consumed in the first trimester. A parsimonious RF model based on 11 features showed excellent predictive ability, with a sensitivity of 0.89 and a specificity of 0.98, providing a foundation suitable for external validation in an unseen cohort. Conclusions Machine learning approaches to large existing datasets can provide accurate feature selection to improve risk prediction. Further validation of this model is required in additional cohorts, representative of the general population. Accurate risk prediction can facilitate targeted screening and intervention. Key messages • The application of machine learning to large population-based data can improve feature selection and accuracy in risk prediction models. • Accurate risk prediction may enable early intervention to address disparities in cognitive development. Individual interventions must occur in conjunction with population level policy changes.

Basic determinants of child linear growth outcomes in sub-Saharan Africa: a cross-sectional survey analysis of positive deviants in poor households

Childhood malnutrition is a significant public health problem confronting countries across the globe. Although there is evidence of a downward trend in undernutrition globally, sub-Saharan Africa did not experience significant improvement in the past decades. This study investigated the basic determinants of linear growth among children living in poor households. We analysed a nationally representative sample of children aged 0–59 months (N = 24,264). The study countries were Ghana, Kenya, the Democratic Republic of Congo (DRC), Nigeria, and Mozambique. The child’s height-for-age Z-scores (HAZ), categorised into HAZ > − 2 standard deviations (SD) (not stunted) and HAZ < − 2 SD (stunted) was the outcome variable of interest. We used logistic regression as our analytical strategy. In DRC, Ghana, Kenya and Nigeria, maternal years of schooling was associated with positive linear growth among children living in poor households. In Ghana and DRC, four antenatal visits had a positive effect on better linear growth, while in Nigeria, healthy maternal body mass index (kg/m2) had a positive effect on child's linear growth. The putative socio-demographic determinants investigated in our study can promote the linear growth of children living in poor households. Interventions aimed at fostering linear growth among children living in poverty should focus on enhancing these factors.

Child health and maternal health knowledge: evidence from Vietnam

The care and protection of children are vital because children are the future of the country. Their health links to the development of adult human capital and the national economy. Informal maternal education is the major driver of child health but has never been formalized. This paper investigates the effects of maternal health knowledge on child health using a survey of 200 households in Ho Chi Minh City, Vietnam. The theory of household production has been applied to create a child health model. Anthropometric indicators of weight-for-age and height-for-age are set as the proxies for child health. The models are regressed separately for the weight-for-age and height-for-age Z-scores of children under five. The research results showed that the number of years of maternal schooling does have a positive impact on child anthropometric outcomes but its effects are crowded out by maternal health gained from the mother’s access to health information through pubic media and genetic inheritance, but these are inferior to environmental factors such as housing, sanitation, and health knowledge. The findings confirm that Vietnam can improve the status of child care and protection can be improved even under the constraints of limited access to maternal formal education).

The Effect of Maternal Education on Child Mortality in Bangladesh

AbstractThis paper examines the effect of maternal education on child mortality in Bangladesh by exploiting quasi‐experimental variations in the duration of exposure to a school stipend project for identification. Results from the instrumental variable estimation indicate that an additional year of maternal schooling reduces both under‐five and infant mortality by about 20 percent. The findings are statistically significant and robust to a number of model specifications, including survival models controlling for right censoring of child mortality. Analysis of potential mechanisms suggests that maternal education reduces child mortality through greater wealth and literacy, positive assortative mating, lower fertility, delayed marriage and childbearing, greater health‐related knowledge, better health‐seeking behaviors, and female empowerment, but not through female employment.

Effectiveness of a longitudinal psychosocial intervention to strengthen mother–child interactions: The role of biological and contextual moderators

IntroductionEarly parent–child relationships shape children’s future. Child development and parent–child interactions are multidetermined, and the combination of biological risks and social disadvantages can further compromise both outcomes. Interventions that promote responsive parenting may mitigate the risks for child development. We examined the effectiveness of a longitudinal psychosocial intervention to strengthen maternal interactive skills and the moderative role of biological and contextual variables. MethodsThe present study is part of a large study designed as a pragmatic quasi-experimental trial. The intervention was implemented in a public mother–child healthcare service, which is a reference for high-risk deliveries. The sample was a convenience subsample of the large project, comprised 67 mother–child dyads. The Intervention Group (IG) and Comparison Group (CG) included 33 and 34 dyads, respectively. The intervention consisted of two individual Newborn Behavioral Observation (NBO) sessions and six group sessions with the mothers. It was delivered at childbirth and 2, 4, 6, 9, and 12 months of child age. CG received usual care at the same age. IG and CG mothers were video recorded playing with their 12-month-old children; maternal interactive skills were assessed using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO). PICCOLO captures mothers’ skills across four domains: affection, responsiveness, encouragement, and teaching. We performed a multiple linear regression to identify the moderative effect of the intervention on maternal interactive skills; the initial model included biological and contextual variables, the group, and the interaction between potential moderators and the group. ResultsIn general, most infants were boys, born preterm, and with low birth weight. On average, the mothers studied for 10 years, and most families were classified as having low or very low socioeconomic status. In general, IG mothers’ mean scores were higher than CG mothers’ in all PICCOLO domains, although without statistical significance. Lower maternal schooling moderated the effect of the intervention on mothers’ overall interaction and encouragement skills. Lower gestational age moderated the effect on PICCOLO total scores. Final regression models explained 22% and 14% of the variability of PICCOLO total and encouragement scores, respectively; no intervention’s effect was observed in other domains. ConclusionThe effects of our longitudinal psychosocial intervention on maternal interactive skills were moderated by infants’ gestational age and maternal years of schooling. These findings suggest that the intervention was more effective for vulnerable groups, specifically for mothers with less schooling and whose infants were born extremely preterm, confirming our hypothesis of the differential effect of the intervention.

EVALUATING THE PREVALENCE AND FACTORS ASSOCIATED WITH AN OPTIMAL NEURODEVELOPMENTAL OUTCOME IN CHILDREN WITH FONTAN CIRCULATION

<h3>BACKGROUND</h3> While youth with Fontan circulation are at increased risk for adverse neurodevelopmental outcomes, not all children encounter these limitations. We sought to evaluate the prevalence and factors associated with "optimal" neurodevelopmental outcomes in 4-6 year old children with Fontan circulation. <h3>METHODS AND RESULTS</h3> Patients who underwent the Fontan procedure born between September 1996 and December 31, 2015 and followed through the Western Canadian Complex Pediatric Therapies Follow-up Program (CPTFP) were included. All patients underwent a comprehensive neurocognitive assessment between 48-72 months of age. A composite outcome termed optimal neurodevelopmental outcome was defined as the absence of intellectual disability (full-scale intellectual quotient (FSIQ) < 80, visual motor index < 80, adaptive behavior assessment system, general adaptive composite < 80), chronic motor disability, permanent hearing loss, visual impairment, seizure disorder, or autism spectrum disorder. Multivariable regression models and decision algorithms (utilizing variables from the multivariable regression analysis, with cut-points determined to optimize a global accuracy index) were generated to evaluate demographic and clinical factors associated with optimal neurodevelopmental outcome. The Fontan procedure was completed on 225 children in the study period, with neurodevelopmental outcome data available for 205 (age at Fontan 3.4 +/- 0.9 years, age at assessment 4.6 +/- 0.5 years, 37% female). Optimal neurodevelopmental outcome was identified in 55% (112/205). In the multivariable regression analysis, factors independently associated with an increased odds ratio of optimal neurodevelopmental outcome were female sex [2.1 (95% confidence interval (CI) 1.1-4.1)], years of maternal schooling [1.2 (1.1-1.5)], age at Fontan (years) [0.97 (0.9-1.0)], need for concomitant atrioventricular valve (AVV) intervention [0.4 (0.2-1.0)], and time (hours) for lactate to be < 2mmol/L [0.9 (0.8-1.0)]. There was a wide range in the prevalence of optimal neurodevelopmental outcomes according to the presence or absence of clinical and demographic variables (Table). For example, if a patient was < 3.25 years at Fontan, did not have a concomitant AVV intervention, and the lactate was < 2mmol/L within eight hours post-operatively, 87% (27/31) had an optimal neurodevelopmental outcome. Conversely, the absence of each of these variables (>/=3.25 years, need for AVV intervention, and >/=8 hours to clear lactate) was associated with 7% (1/14) having optimal neurodevelopmental outcomes. <h3>CONCLUSION</h3> Optimal neurodevelopmental outcome was present in over half of 4-6 year old children with Fontan circulation in this single-center study, with important associated factors identified, including potentially modifiable factors such as younger age at Fontan and lack of concomitant AVV intervention. Multi-center evaluations are needed to further evaluate this previously undefined composite outcome.

Prevalence of psychiatric symptoms among refugee adolescents in Turkey: a controlled study.

Objective:To investigate prevalence of internalized and externalized psychological symptoms and war-related adverse events among a representative secondary-school sample of Syrian refugee adolescents, and to compare levels of depression, anxiety, and stress between Syrian refugee adolescents and Turkish adolescents.Methods:Syrian refugee adolescents (n=70) and Turkish adolescents (n=70) were asked to complete the Depression, Anxiety, and Stress Scales (DASS-42) and Strengths and Difficulties Questionnaire (SDQ).Results:DASS and SDQ scores were significantly different between the two groups; scores in all problem areas were higher in refugees. Loss of a family member increased depression, stress, and total difficulty scored, whereas witnessing death increased anxiety and stress and experiencing multiple events increased depression, anxiety, and total difficulty scores. Maternal years of schooling correlated inversely with SDQ emotional symptoms, conduct problems, and hyperactivity/inattention problem scores. Both parents’ years of schooling correlated inversely with SDQ total difficulties scores.Conclusion:Syrian refugee adolescents had higher depression, anxiety, behavioral problems, peer relationship problems, and general difficulties than their Turkish peers. Facilitating refugees’ access to mental health services, educating their parents, consulting, and monitoring at-risk children may contribute to reducing psychosocial problems in refugee children.

Inequalities in stunting among under-five children in Tanzania: decomposing the concentration indexes using demographic health surveys from 2004/5 to 2015/6

BackgroundChild stunting is a global health concern. Stunting leads to several consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania from from 50% in 1991/92 to 34% in 2016 although the prevalence is still high (34%)Stunting varyies across socioeconomic determinants with a larger burden among the socioeconomic disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021 and hence attain zero malnutrition by 2030 under Sustainable Development Goal 2.2.This study aimed at determining the trend, contributing factors and changes of inequalities in stunting among children aged 3–59 months from 2004 to 2016.MethodsData were drawn from the Tanzania Demographic and Health Surveys. The concentration index (CIX) was used to quantify the magnitude of inequalities in stunting. The pooled Poisson regression model was used to determine the factors for stunting, decision criterion for significant determinants was at 5% level of significance. The CIX was decomposed using the Wagstaff and Watanabe decomposition methods., the percentage contribution of each factor to the toal concentration index was used to rank the factors for socioeconomic inequalities in stutning.ResultsInequalities in stunting were significantly concentrated among the poor; evidenced by CIX = − 0.019 (p < 0.001) in 2004, − 0.018 (p < 0.001) in 2010 and − 0.0096 (p < 0.001) in 2015. There was insignificant decline in inequalities in stunting; the difference in CIX from 2004 to 2010 was 0.0015 (p = 0.7658), from 2010 to 2015/6 was − 0.0081 (p = 0.1145). The overall change in CIX from 2004 to 2015/6 was 0.00965 (p = 0.0538). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) had positive impacts on the levels of inequalities in stunting for all surveyed years. Rural-urban differences reduced inequalities in stunting although the contribution changed over time.ConclusionInequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities in stunting. Reducing stunting among the disadvantaged groups requires initiatives which should be embarked on the distribution of social services including maternal and reproductive education among women of reproductive age, water and health infrastructures in remote areas.

Low birth weight in a subnormal urban cluster under Family Health Strategy’s care

Abstract Objectives: to identify the prevalence and to analyze the factors associated with low birth weight in a subnormal urban cluster in Pernambuco under Family Health Strategy’s care. Methods: a cross-sectional study with a census sample carried out between July and October in 2015. The variables studied were age and years of maternal schooling, social status, housing, water supply, waste disposal, prenatal care, alcohol consumption and cigarette smoking during pregnancy, along with gender, birth weight and prematurity. Stata 12.1 was utilized in order to understand the factors associated with low birth weight through uni-and-multivariate Poisson analysis, adjusted and gross prevalence ratios, composing a final statistical model considering p value &lt;0.05 for statistical significance. Results: regarding the 294 children the LBW prevalence was 12.2% (CI95% = 8.7-16.5). Children whose mothers reported drinking during pregnancy were 2.78 times more at risk of being born with low birth weight (p&lt;0.001) when compared with children whose mothers did not report this practice in gestation. Conclusions: the study evidenced the relevance maternal habits bears in the newborns’ health.

Nurturing Environments and Nutrient-Rich Diets May Improve Cognitive Development: Analysis of Cognitive Trajectories from Six to Sixty Months from the MAL-ED Study (OR10-01-19)

ObjectivesTo identify clusters of cognitive developmental trajectories and associated differentiating factors of children aged 6 to 60 months old in 5 low to middle-income sites. MethodsWe followed 835 children and assessed anthropometry at enrolment (≤ 17 d old); bi-weekly illness data (0–24 and 60 mo); non-diarrheal and diarrheal stools (0–24 mo) analyzed for a panel of enteropathogens; quantitative complementary food intakes (9–24 and 60 mo); micronutrient status (Fe, Zn, Vit A; 7, 15, and 24 mo); quality of the child’s home environment (6, 24, and 60 mo) and maternal reasoning ability and depressive symptoms via questionnaire. Child cognitive development was assessed by the Bayley Scales of Infant Development III (6, 15 and 24 mo) and Wechsler Preschool and Primary Scale of Intelligence (60 mo). Clusters of trajectories were identified using a latent class mixed model. Differences between clusters were described using discriminant analysis to rank the contribution of each variable using correlation-adjusted t-scores (CAT). ResultsFive clusters were identified. From 51 discriminatory factors, 10 had greatest descriptive power: HOME score at 60 mo (mean CAT2 ± SD: 34.6 ± 0.35), proportion of days ill from 0–24 mo (23.9 ± 0.18), years of maternal schooling (13.8 ± 0.23), mean nutrient densities of zinc (12.3 ± 0.07), protein (8.95 ± 0.09), vitamin B6 (8.2 ± 0.10), phytate (7.91 ± 0.05) and mean energy (7.82 ± 0.04) from complementary foods (9–24 mo), % days of exclusive breastfeeding (0–6 mo; 6.42 ± 0.10) and weight-for-age at enrolment (6.14 ± 0.17). The discriminant analysis model fit was statistically significant (Wilk’s λ 0.54, P < 0.01). ConclusionsEarly life factors associated with higher scoring trajectories included stimulation and support for the child in their home, complementary feeding that typified greater diversity and animal-source foods, and maternal years of schooling. Influences associated with lower scoring trajectories included lower weight at enrolment and higher prevalence of illness. Policies promoting maternal and child nutrition, education and fostering a nurturing environment are likely to have greatest impact on child development. Funding SourcesThe MAL-ED study was supported by the Bill & Melinda Gates Foundation, with grants to the Foundation for the NIH and NIH/FIC.

Factors associated with the use of supplemental oxygen or positive pressure ventilation in the delivery room, in infants born with a gestational age ≥ 34 weeks

BackgroundApproximately 5–10 % of newborns require some form of resuscitationupon delivery; several factors, such as maternal abnormal conditions, gestational age and type of delivery could be responsible for this trend. This study aimed to describe the factors associated with the need for positive pressure ventilation (PPV) via a mask or endotracheal tube and the use of supplemental O2 in newborns with a gestational age greater than 34 weeks in Brazil.MethodsWe performed a cross-sectional study and obtained data from the Birth in Brazil Survey. The inclusion criterion was a gestational age ≥34 weeks. Exclusion criteria were newborns with congenital malformations, and cases with undetermined gestational age or type of delivery (vaginal, pre labor cesarean section and cesarean section during labor). The primary outcomes were need of PPV via a mask or endotracheal tube and the use of supplemental oxygen without PPV. Confounding variables, including maternal age, source of birth payment, years of maternal schooling, previous birth, newborn presentation, multiple pregnancy, and maternal obstetric risk, were analyzed.ResultsWe included 22,720 newborns. Of these, 2974 (13.1 %) required supplementary oxygen. PPV with a bag and mask was used for 727 (3.2 %) newborns and tracheal intubation for 192 (0.8 %) newborns. Chest compression was necessary for 136 (0.6 %) newborns and drugs administered in 114 (0.5 %). 51.3 % of newborns were delivered by cesarean section, with the majority of cesarean sections (88.7 %) being performed prior to labor. Gestational age (late preterm infants: (Relative Risk-(RR) 2.46; 95 % (Confidence interval-CI 1.79–3.39), maternal obstetric risk (RR 1.59; 95 % CI1.30–1.94), and maternal age of 12–19 years old (RR 1.36; 95 % CI1.06–1.74) contributed to rates of PPV in the logistic regression analysis. Newborns aged between 37–38 weeks of gestaional age weren´t less likely to require PPV compared with those aged 39–41 weeks of gestational age.ConclusionsLate preterm infants, previous maternal obstetric risks and maternal age contributed to the higher needs of PPV and use of O2 in the delivery room. These variables need to be considered in planning care in the delivery room.

Duration of exclusive breastfeeding in a Brazilian population: new determinants in a cohort study

BackgroundDeterminants of the duration of exclusive breastfeeding (EBF) differ in effect and magnitude across populations. The present study aimed to identify factors associated with discontinuation of EBF in a municipality in northeastern Brazil, including variables that have received little or no attention in previous literature.MethodsThis cohort study involved 1,344 mother-child pairs selected from maternity hospitals in Feira de Santana, Bahia, Brazil. Subjects were followed up for 6 months through monthly home visits, and discontinuation of EBF was recorded. Possible determinants were tested using Cox’s four-level hierarchical survival model, taking into consideration the temporal proximity of the predisposing factors to interruption of EBF. Median duration of EBF was estimated using Kaplan-Meier’s survival curve.ResultsMedian duration of EBF was 89 days. Out of the 19 variables tested, 9 showed an association with EBF cessation; of these, two had never been evaluated in Brazilian studies, namely, mother partner’s appreciation for breastfeeding (hazard ratio [HR] 0.62; 95% confidence interval [95% CI] 0.48-0.79) and limiting the number of nighttime feeds at the breast (HR 1.58; 95% CI 1.11-2.23). Another two variables that had been previously evaluated, but had never been described as determinants of discontinuation of EBF showed association: presence of cracked nipples (HR 2.54; 95% CI 2.06-3.13) and prenatal care provided by public services (HR 1.34; 95% CI 1.17-1.55). Other variables showing associations with the outcome were: guidance on breastfeeding received at the hospital (HR 0.80; 95% CI 0.68-0.92), birth in a Baby-Friendly Hospital (HR 0.85; 95% CI 0.73-0.99), less than or equal to 8 years of maternal schooling (HR 1.34, 95% CI 1.17-1.53), mother working outside the home (HR 1.73; 95% CI 1.53-1.95), and use of a pacifier (HR 1.40; 95% CI 1.14-1.71).ConclusionsThe study confirmed that the factors associated with EBF duration are multiple, variable, and dependent on the population being evaluated. Characteristics that had never been previously evaluated or described, at least in Brazilian studies, behaved as determinants of EBF in the present study, and thus allow to expand the existing list of factors determining this practice.

Independent Associations of Maternal Education and Household Wealth with Malaria Risk in Children

Despite evidence that they play similar but independent roles, maternal education and household wealth are usually conflated in studies of the effects of socioeconomic status (SES) on malaria risk. Demographic and Health Survey and Malaria Indicator Survey data from nine countries in sub-Saharan Africa were used to explore the relationship of malaria parasitemia in children with SES factors at individual and cluster scales, controlling for urban/rural residence and other important covariates. In multilevel logistic regression modeling, completion of six years of maternal schooling was associated with significantly lower odds of infection in children (OR = 0.73), as was a household wealth index at the 40th percentile compared to the lowest percentile (OR = 0.48). These relationships were nonlinear, with significant quadratic terms for both education and wealth. Cluster-level wealth index was also associated with a reduction in risk (OR = 0.984 for a one percentile increase in mean wealth index), as was urban residence (OR = 0.59). Among other covariates, increasing child’s age and household size category were positively correlated with infection, and sleeping under an insecticidetreated bednet the previous night (OR = 0.80) was associated with a moderate reduction in risk. Considerable variation in parameter estimates was observed among country-specific models. Future work should clearly distinguish between maternal education and household resources in assessing malaria risk, and malaria prevention and control efforts should be aware of the potential benefits of supporting the development of human capital.

Clinically Unapparent Infantile Thiamin Deficiency in Vientiane, Laos

BackgroundBeriberi occurs in Vientiane, Lao PDR, among breastfed infants. Clinical disease may be the tip of an iceberg with subclinical thiamin deficiency contributing to other illnesses. Thiamin treatment could improve outcome.Methodology/Principal FindingsA cohort of 778 sick infants admitted during one year without clinical evidence of beriberi were studied prospectively and erythrocyte transketolase assays (ETK) performed. Biochemical thiamin deficiency was defined both in terms of the activation coefficient (α>31%) and basal ETK activity <0.59 micromoles/min/gHb. Of the 778 infants, median (range) age was 5 (0–12) months, 79.2% were breastfed, 5.1% had α>31% and 13.4 % basal ETK<0.59 micromoles/min/gHb. Infants ≥2 months old had a higher frequency of biochemical markers of thiamin deficiency. Mortality was 5.5% but, among infants ≥2 months old, mortality was higher in those with basal ETK<0.59 micromoles/min/gHb (3/47, 6.4%) than in those with basal ETK≥0.59 micromoles/min/gHb (1/146, 0.7%) (P = 0.045, relative risk = 9.32 (95%CI 0.99 to 87.5)). Multivariate regression analysis indicated that infant age ≥2 months and fewer maternal years of schooling were independently associated with infant basal ETK<0.59 micromoles/min/gHb.Conclusions/SignificanceClinically unapparent thiamin deficiency is common among sick infants (≥2 months old) admitted to hospital in Vientiane. This may contribute to mortality and a low clinical threshold for providing thiamin to sick infants may be needed.

Maternal schooling and children’s relative inequalities in developmental outcomes: evidence from the 1947 school leaving age reform in Britain

This paper investigates whether mothers’ participation in post‐compulsory education impacts on children’s relative inequalities across four developmental outcomes. The empirical analysis uses information from children born in 1958 in Britain. Mothers of the 1958 British cohort were affected by the 1947 school leaving age reform, which increased the age of compulsory schooling from 14 to 15 years. We selected the first‐born cohort members whose mothers were born in 1933 and 1934 and whose mothers completed compulsory schooling only. We found that the additional year of maternal schooling was significantly associated with relative improvements in mathematics attainment for their children, but no significant differences for reading or behavioural outcomes. The impact on mathematics was mainly for boys. These results suggest wider dispersion in mathematics attainment between sons whose mothers benefited from the additional year of schooling in 1947 and those whose mothers did not.

Greater years of maternal schooling and higher scores on academic achievement tests are independently associated with improved management of child diarrhea by rural Guatemalan mothers.

Appropriate home management can alleviate many of the consequences of diarrhea including malnutrition, impaired development, growth faltering, and mortality. Maternal cognitive ability, years of schooling, and acquired academic skills are hypothesized to improve child health by improving maternal child care practices, such as illness management. Using information collected longitudinally in 1996-1999 from 466 rural Guatemalan women with children <36 months, we examined the independent associations between maternal years of schooling, academic skills, and scores on the Raven's Progressive Matrices and an illness management index (IMI). Women scoring in the lowest and middle tertiles of academic skills scored lower on the IMI compared to women in the highest tertile (-0.24 [95% CI: -0.54, 0.07]; -0.30 [95% CI: -0.54, -0.06], respectively) independent of sociodemographic factors, schooling, and Raven's scores. Among mothers with less than 1 year of schooling, scoring in the lowest tertile on the Raven's Progressive Matrices compared to the highest was significantly associated with scoring one point lower on the IMI (-1.18 [95% CI: -2.20, -0.17]). Greater academic skills were independently associated with maternal care during episodes of infant diarrhea. Schooling of young girls and/or community based programs that provide women with academic skills such as literacy, numeracy and knowledge could potentially improve mothers' care giving practices.