195 - Impact of Maternal Education on Child Development in Low- and Middle-Income Countries Across Asia: IPUMS-MICS 2019–2023

Publication Number: 1184.195

Xueying Zheng, University of Nevada, Reno School of Medicine, Las Vegas, NV, United States; Donghyun Lim, Stanford University School of Medicine, Chuncheon-si,, Kangwon-do, Republic of Korea; Joseph D. Suh, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Xuanxu Wang, Occidental College, Redmond, WA, United States; Eric C. Yin, Stanford University School of Medicine, Stanford, CA, United States; Seth Tivakaran, Stanford University School of Medicine, Xenia, OH, United States; Malathi Srinivasan, Stanford University School of Medicine, Stanford, CA, United States; Nicholas Panyanouvong, Stanford University School of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States; Osamu Yasui, Stanford University, Palo Alto, CA, United States; Neil Kamdar, Stanford University School of Medicine, Palo Alto, CA, United States; Gloria Kim, Stanford University School of Medicine, Stanford, CA, United States; Robert J. Huang, Stanford University School of Medicine, Stanford, CA, United States; Lester Andrew V. Uy, Stanford University School of Medicine, Palo Alto, CA, United States; Nitya Rajeshuni, Stanford University School of Medicine, Palo alto, CA, United States

Background: Early childhood development (ECD) is a major contributor to health, educational attainment, and socioeconomic outcomes in adulthood, yet approximately one in four children are at risk for developmental delays in low- and middle-income countries (LMICs). Prior studies have established maternal education as a key determinant of child development, but these studies tend to focus on single countries and do not delve into the mechanisms of this relationship.

Objective: In this study, we examined how maternal education influences child development across Asian LMICs and how this relationship varies by social determinants of health.

Design/Methods: We conducted a cross-sectional study using 2019-2023 data from the Integrated Public Use Microdata Series-Multiple Indicator Cluster Surveys (IPUMS-MICS). Maternal education was categorized as less than primary, primary, and secondary or higher. Development in younger children (aged 3-4 years) was characterized using the 10-item Early Childhood Development Index (ECDI). Development in older children (aged 7-14 years) used literacy and numeracy standards from the Foundational Learning Skills (FLS) module. Multivariable logistic regression models adjusting for child, maternal, household, and geographic covariates were conducted, and effect measure modification by age, sex, urban status, and region was evaluated.

Results: Children whose mothers had primary or higher education had greater adjusted odds of meeting ECDI standards than those whose mothers had less than primary education (Primary: aOR 1.11, 95% CI 1.03-1.20; Secondary or Higher: aOR 1.20, 95% CI 1.11-1.30). No significant associations were observed between maternal education and FLS outcomes. Among children aged 3-4 years, four-year-olds (Primary: aOR 1.25, 95% CI 1.13-1.38; Secondary or Higher: aOR 1.46, 95% CI 1.32-1.60) and males (Primary: aOR 1.20, 95% CI 1.08-1.33; Secondary or Higher: aOR 1.32, 95% CI 1.20-1.45) had higher odds of meeting ECDI standards with increasing maternal education. Significant associations were observed when stratified into urban (Secondary or Higher: aOR 1.19, 95% CI 1.05-1.36) and rural (Primary: aOR 1.10, 95% CI 1.01-1.19; Secondary or Higher: aOR 1.21, 95% CI 1.11-1.32) settings.

Conclusion(s): This study assessed how maternal education influences child development in Asian LMICs. By identifying child populations most sensitive to these associations, we can better inform the allocation of educational resources, public attention, and initiatives to increase opportunities for higher maternal education in pursuit of objectives outlined in Sustainable Development Goal (SDG) 4.

Association between maternal education and Early Childhood Development Index (ECDI)
Forest plot of adjusted odds ratios (aOR) and 95% CIs for meeting ECDI standards among children aged 3-4 years by model. Model 1 adjusts for the child covariates age, sex, wasting, stunting, overweight, underweight, and child disability. Model 2 additionally adjusts for the maternal covariates maternal age and Women's Empowerment Index. Model 3 additionally adjusts for the household covariates wealth index, household size, improved water source, improved sanitation, child stimulation, early childhood program attendance, and paternal education. Model 4 additionally adjusts for the contextual covariates region, urban status, country, and year. Maternal education levels secondary or higher and primary are compared to less than primary. Estimates are displayed on a log10 scale. Asterisks denote significance (p < 0.05 = *, <0.01 = **, <0.001 = ***, <0.0001 = ****).

Association between maternal education and Foundational Learning Skills (FLS)
Forest plot of adjusted odds ratios (aOR) and 95% CIs for meeting foundational literacy and numeracy standards among children aged 7-14 years by model. Model 1 adjusts for the child covariates age, sex, and child disability. Model 2 additionally adjusts for the maternal covariates maternal age and Women's Empowerment Index. Model 3 additionally adjusts for the household covariates wealth index, household size, improved water source, improved sanitation, parental involvement, and paternal education. Model 4 additionally adjusts for the contextual covariates region, urban status, country, and year. Maternal education levels secondary or higher and primary are compared to less than primary. Estimates are displayed on a log10 scale. Asterisks denote significance (p < 0.05 = *, <0.01 = **, <0.001 = ***, <0.0001 = ****).

Effect modification of the association between maternal education and Early Childhood Development Index (ECDI)
Forest plot of age, sex, or urban status stratum-specific adjusted odds ratios (aOR) and 95% CIs for meeting ECDI standards among children aged 3-4 years. Columns display comparisons between maternal education levels. Rows group levels of each effect modifier. Estimates come from models fully adjusted for all child, maternal, household, and contextual covariates and include an interaction between maternal education and the effect modifier. Maternal education levels secondary or higher and primary are compared to less than primary within every stratum. Estimates are displayed on a log10 scale. Asterisks denote significance (p < 0.05 = *, <0.01 = **, <0.001 = ***, <0.0001 = ****).