It is well established that mothers' education has positive effects on child nutrition in developing countries. In school, girls can acquire skills which are later used to access modern health services and comprehend health messages. Less explored, however, is the effect exerted by the education of other individuals – the mothers' friends, neighbours and family – which may influence child nutrition directly or modify the effect of maternal education. Furthermore, questions remain about the mechanisms underlying the adult education–child nutrition relationship, especially the role of mothers' health and nutrition (HN) knowledge which has been debated in recent literature. Future research into the impact of adult education on child nutrition should therefore widen the focus from mothers only to others in her household, community and communication network and specifically examine the mediating role of mothers' HN knowledge.
The thesis has two main components. In the first part,data collected in 2002 from the Young Lives (YL) study in Vietnam and Andhra Pradesh (AP) in India is analysed to assess the association between child height- and weight-for-age z-scores and adult education in the household and community. Adult education was measured as the level of formal schooling completed and community-level education was measured by aggregating individual-level data. Data were collected on 6019 households in 20 sites and 133 communities with children aged either 1 or 8 years old.
The second part of the thesis presents the results of a cross-sectional study undertaken in 2004 of a sub-sample of YL mothers in AP, the Knowledge and Networks (KN) study, which was designed to explore mediators of the education effect, specifically the role of HN knowledge. Data were collected on the education, HN knowledge, general awareness, media, communication ability and communication networks of 302 mothers. Multi-level regression modelling in Stata and MLwiN is used to adjust simultaneously for confounding and the hierarchical structure of the data-sets. The instrumental variable approach was used in an attempt to adjust for 'endogeneity' of knowledge.
The thesis demonstrates the important role of education among 'influential others' beyond the mother in determining child nutrition, thereby calling for a less individualistic approach to research and policy. It concludes by outlining key recommendations for future research which address both the methodological weaknesses of the present study and the remaining knowledge gaps in the literature.
Moestue, H. Adult Education and Child Nutrition in India and Vietnam: The Role of Family, Neighbours and Friends. (2005) 286 pp. [PhD Thesis, London School of Hygiene and Tropical Medicine]