The objective of this study was to assess the effect of maternal education on child nutritional status in the two slums of Nairobi. The prevalence of stunting among children aged up to 42
months in these communities was close to 40
%. We found that mother’s education is an important predictor for child stunting. Compared to other studies [16
], we found that the effect of mother’s education on child stunting is only minimally attenuated by factors at child, maternal, household and community level. Therefore, we find a persisting significance of mother’s education on child’s stunting in this context.
Child level factors including sex and birth weight are independently and strongly associated with stunting. While the association between birth weight and nutritional status has been well documented and understood in sub-Saharan Africa [31
], few studies have documented gender difference with regards to malnutrition in young children particularly in sub-Saharan Africa [17
]. It has been argued that such differences occur in low socio-economic status settings [34
]. Despite the strong significance of these child level factors in influencing child stunting, our study concludes that they do not substantially alter the effect of education on child stunting.
In addition to child level factors, maternal level factors including marital status, parity, ethnicity and mothers’ health knowledge and health related behaviour including pregnancy intentions used as a proxy for family planning, and place of delivery used as a proxy for health seeking behaviour were significantly related to child stunting. The relationship between maternal level factors and child nutritional status has also been documented in several other studies [16
]. These factors however only minimally attenuate the effect of mother’s education on stunting.
The introduction of household wealth index into the model also minimally attenuates the effect of education on stunting, which somehow differs with findings from others settings [16
]. Moreover, we find that SES is also significantly related to child stunting similar to findings from other studies [16
], which found a statistically significant relationship between SES and child malnutrition. We also find that the introduction of slum residence marginally reduces the magnitude of the effect of mother’s education on stunting.
Our results were limited by the absence of direct measures for family planning, SES, and community level characteristics for which proxy measures were used. In the case of SES, an index was constructed from household assets. The use of proxy measures and the construction of an index might have affected the impact of these variables on the dependent variable. Education status, the main predictor variable of interest was collected as a categorical variable. This may reduce the level of precision in measurement of the effect. Overall, our study has significant policy implications for child health in urban slums in Kenya. Evidence indicates that improving nutritional status has many benefits that cannot be overemphasized including improved health and survival, cognitive development and future human capital [5
]. Our study has indicated that mother’s education is an important predictor for child stunting. This suggests that improving mother’s
years of schooling may have significant influence on child nutritional status and ultimately alter the poverty cycle as stunting is a key predictor of human capital. Other factors influencing child nutritional status in the slums of Nairobi include child level factors (sex and birth weight), maternal level factors (marital status, parity, ethnicity, health knowledge and health seeking behaviour) and SES.
Inclusion of health knowledge skills in school curricula may lead to substantial improvement in child nutritional status by directly enabling the girls who are future mothers to have an improved health knowledge, practices, and health seeking behavior [19
]. This study indicates that among children born in the slums, a substantial proportion was born at home or with the assistance of a TBA. This therefore indicates that many mothers do not adequately benefit from the baby-friendly hospital initiative being implemented in Kenya. The aim of the initiative is to enhance optimal breastfeeding and young child feeding practices, thus improving infant and child nutritional status [36
]. The study therefore calls for awareness creation to enhance delivery at health facilities. Policies targeted at improving livelihoods of the urban poor may result in reduced malnutrition and ultimately alter the poverty cycle.