Association between maternal health literacy and child vaccination in India: a cross-sectional study

Abstract

BackgroundEducation of mothers may improve child health. We investigated whether maternal health literacy, a rapidly modifiable factor related to mother's education, was associated with children's receipt of vaccines in two underserved Indian communities.MethodsCross-sectional surveys in an urban and a rural site. We assessed health literacy using Indian child health promotion materials. The outcome was receipt of three doses of diphtheria-tetanus-pertussis (DTP3) vaccine. We used multivariate logistic regression to investigate the relationship between maternal health literacy and vaccination status independently in each site. For both sites, adjusted models considered maternal age, maternal and paternal education, child sex, birth order, household religion and wealth quintile. Rural analyses used multilevel models adjusted for service delivery characteristics. Urban analyses represented cluster characteristics through fixed effects.ResultsThe rural analysis included 1170 women from 60 villages. The urban analysis included 670 women from nine slum clusters. In each site, crude and adjusted models revealed a positive association between maternal health literacy and DTP3. In the rural site, the adjusted OR was 1.57 (95% CI 1.11 to 2.21, p=0.010) for those with medium health literacy, and OR=1.30 (95% CI 0.89 to 1.91, p=0.172) for those with high health literacy. In the urban site, the adjusted OR was 1.10 (95% CI 0.65 to 1.88, p=0.705) for those with medium health literacy, and OR=2.06 (95% CI 1.06 to 3.99, p=0.032) for those with high health literacy.ConclusionsIn these study settings, maternal health literacy is independently associated with child vaccination. Initiatives targeting health literacy could improve vaccination coverage.

Maternal Health Literacy Is Associated with Early Childhood Nutritional Status in India

“…The study size was calculated for each site independently in relation to the principal hypothesis, which concerned the association between maternal health literacy and child vaccination (20). For this analysis, calculations assuming a significance level of a = 0.05 and a power of 80% indicated a sufficient sample size to detect a difference between exposed and unexposed groups for a dichotomous outcome representing nutritional status, under diverse assumptions concerning effect size and clustering.…”

“…The rural site used 2-stage probability proportional-to-size cluster sampling (26). A census was conducted in the urban site (20).…”

“…Study design and methods have been described elsewhere (20). Briefly, data were collected by using identical instruments and procedures from a poor-performing rural district (Hardoi, Uttar Pradesh) with a population of ;4 million (22) and from an urban slum settlement in New Delhi (Kirti Nagar) comprising ;20,000 households in 9 neighborhoods.…”

“…Poor health literacy is believed to limit recognition and understanding of health problems and interactions with the health care system (18). Health literacy is an acknowledged determinant of population health in high-income settings (19); however, studies in low-and middle-income countries are only now being initiated (20,21).…”

Social determinants of health and the International Monetary Fund

“…Disentangling and intervening on the context-specific pathways of education is likely to provide an opportunity to impact child health, particularly because uneducated adult parents are unlikely to return to school and gain a specific level of formal educational attainment. Providing health literacy to mothers, for example, has been shown to be independently related to child immunization, suggesting that there are potentially mitigating pathways for parents who are not formally educated (15). Furthermore, there may be "threshold" levels of formal education to detect and intervene on specific pathways (16).…”