What is the association between maternal education and childhood mortality, childhood illnesses and utilisation of child health services in Myanmar?

Soe, Khaing and Holland, Paula and Mateus, Ceu (2019) What is the association between maternal education and childhood mortality, childhood illnesses and utilisation of child health services in Myanmar? PhD thesis, Lancaster University.

Text (2019_Khaing Soe_PhD Public Health)
2019_Khaing_Soe_PhD_Public_Health.pdf - Published Version
Available under License Creative Commons Attribution-NonCommercial-NoDerivs.
Download (2MB)

Abstract

Background: Health equity is strongly linked with underlying socioeconomic differentials. Maternal education is widely regarded as a core social determinant of child health though there are controversies around its independent beneficial effect. Myanmar has limited evidence regarding social determinants of child health in general and the effect of maternal education. The present thesis examined whether there is an association between maternal education and child health and identified pathways of influence through which maternal education exerts its effects. Method: The nationally representative Demographic Health Survey 2015-2016 of Myanmar was analysed. Stepwise logistic regression was used to assess an independent effect of maternal education on childhood mortality, morbidity and health services utilisation among children under five. Multivariate models were developed adjusting for possible demographic and socioeconomic confounding factors relating to parental socioeconomic circumstances and characteristics of the household and community. Mediation analysis was conducted employing four-step regression method to identify pathways of influence of maternal education. Results: Maternal education had a significant independent effect on infant mortality, under-five mortality and pneumonia treatment. It had some effects on neonatal mortality, child stunting and full vaccination, but the effects were not independent as they were accounted for by household wealth status and geographic residence. Maternal education was not associated with the occurrences of diarrhoea and pneumonia and receiving appropriate treatment for diarrhoea among children. Maternal education channelled its effects on child health through four pathways: maternal health knowledge, income, health-related behaviour, and autonomy. Conclusion: Maternal education is an important social determinant of childhood health in the study context. Government policies should focus on ensuring equitable access to education and health services across different population groups, strengthening health-related knowledge and behaviour of girls and women who do not have formal education and boosting economic status of the country populations.