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How consistent are associations between maternal and paternal education and child growth and development outcomes across 39 low-income and middle-income countries?
  1. Joshua Jeong1,
  2. Rockli Kim2,
  3. S V Subramanian2,3
  1. 1 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. 2 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. 3 Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
  1. Correspondence to Mr Joshua Jeong, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; jjeong{at}


Background Maternal and paternal education are associated with improved early child outcomes. However, less is known about how these relative associations compare for preschool children’s growth versus development outcomes; and across country contexts.

Methods We analysed data from 89 663 children aged 36 to 59 months in 39 low-income and middle-income countries (LMICs). We used linear regression models with country fixed effects to estimate the joint associations between maternal and paternal education and children’s growth and development outcomes. Additionally, we examined the variability in these relationships by each country and within subgroups of countries.

Results In the pooled sample, maternal and paternal education were independently associated with 0.37 (95% CI 0.33 to 0.41) and 0.20 (95% CI 0.16 to 0.24) higher height-for-age z-scores, and 0.31 (95% CI 0.29 to 0.34) and 0.16 (95% CI 0.14 to 0.18) higher Early Childhood Development Index z-scores, respectively (comparing secondary or higher to no education). Associations were stronger for maternal education than paternal education but comparable between child outcomes. In country-specific regressions, we found the most heterogeneity in the associations between maternal education and children’s growth; and between paternal education and children’s development. Subgroup analyses suggested that these associations may be systematically patterned by country-level adult illiteracy, infant mortality and food insecurity.

Conclusion Our findings highlight variability in the statistical significance and magnitude of the associations between caregivers’ education and children’s outcomes. Further research is needed to understand the sources of variation that may promote or constrain the benefits of caregivers’ education for children’s early health and development in LMICs.

  • child health
  • education
  • international hlth
  • social epidemiology

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  • Contributors JJ, RK and SVS conceptualised the study and analysis plan. JJ conducted the analyses and drafted the manuscript. RK and SVS reviewed and edited the manuscript. All authors read and approved the final version submitted for publication.

  • Competing interests None declared.

  • Ethics approval This study was deemed exempt from ethics review by the Harvard T.H. Chan School of Public Health Institutional Review Board, as the MICS data used are publicly available and fully de-identified.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are from the Multiple Indicator Cluster Survey (MICS) Program and are available to registered MICS data users.