Maternal Education and Home Environment Quality Protect Infants in Low Asset Families From Poor Growth
Authors: Black Maureen M , Tilton Nicholas , Hurley Kristen M , Rao Sylvia Fernandez , Balakrishna N , Harding Kimberly , Reinhart Gregory A , Radhakrishna KV , Ravinder P , Nair K Madhavan 
Published: November 2023

OBJECTIVEEconomic inequities are common in low and middle‐income countries, and are associated with poor growth among young children. To examine whether maternal education and home environment quality attenuate the association between economic inequities and children's growth.METHODSThe sample included baseline data from 512 infants and 321 preschoolers in 26 villages in rural India (Project Grow Smart). Data collection included child growth (weight and length/height measured and converted to wt/age, ln/ht/age and BMI/age z‐scores, WAZ, LAZ/HAZ, BAZ) and hemoglobin (Hb); maternal education, wt/ht and Hb; and economic inequities measured by household assets (weighted score 0–8) and observations of home environment quality (HOME Inventory). Maternal education (completion of primary school or beyond) and home quality (top quartile) were combined into a 3‐level education/home protective factor (PF; high education and home quality, neither [0], either [1], both [2]). Data were analyzed using linear mixed models for infants and preschoolers separately, adjusted for gender and clustering within villages, and including asset by PF interactions. Interactions were interpreted at low/high assets (mean±SD).RESULTSFindings for infants/preschoolers: mean age 8.6/36.6 mo; underweight (WAZ<−2): 18.9%/45.9%; stunting (LAZ/HAZ<−2): 19.5%/40.6%; anemic (Hb<11.0 g/dL): 68.8%/48.6%. Findings for mothers of infants/preschoolers: mean age: 22.9/25.0 y; underweight (BMI<18.5): 37.8%/43.0%; anemic (Hb<12.0 g/dL): 43.7%/34.2%, primary school or beyond: 75.1%/55.2%. Among infants, relationships between assets and WAZ and LAZ are significantly attenuated by PF (p<0.01 for both) and relationships between assets and BAZ are marginally attenuated (p<0.10). Among infants, at low asset levels, PF accounts for 1.3 difference in WAZ (β= 0.65, p<0.01), a 1.38 difference in LAZ (β=0.69, p<0.01), and a 0.7 difference in BAZ (β=0.35, p<0.01). At high asset levels, the WAZ gap between children with/without PF narrows by 0.14 for 1 PF and 0.28 for both PFs (interaction β=0.14, p<0.01) (Figure 1); the LAZ gap narrows by 0.13 for 1 PF and 0.26 for both PFs (interaction β=0.13, p<0.01); and the BAZ gap narrows by 0.08 for 1 PF and 0.16 for both PFs (interaction β=0.08, p<0.10). Among preschoolers, PF have a marginal independent association with BAZ (p<0.10), with no attenuation in relationships between assets and children's growth.CONCLUSIONSMaternal education and home environment quality may protect infants in low‐asset families from poor growth, illustrating the importance of the care giving context in offsetting the negative consequences of economic inequities on growth during infancy. Among preschoolers, maternal education and home environment quality do not provide growth protection from economic inequities in areas with high rates of stunting. To promote infant growth in low‐asset families, findings support early responsive care giving intervention.Support or Funding InformationMicronutrient Initiative, The Mathile Institute for the Advancement of Human Nutrition