Topical Area: Maternal, Perinatal and Pediatric Nutrition
Objectives : To examine the association of maternal functional health literacy (FHL), a mother’s ability to understand health information written in words and pictures, with child health, growth, and development in rural Malawi.
Methods : Maternal FHL was measured at six months postpartum among 671 participants in the International Lipid-Based Nutrient Supplements (iLiNS) DYAD-M trial in Malawi. Field staff asked comprehension questions about written health materials that were common in Malawi, such as medication instructions, breastfeeding information, and growth charts. Outcomes were child length-for-age (LAZ) and weight-for-length (WLZ) z scores at age 6 and 18 mo, change in LAZ and WLZ from 6 to 18 mo, motor and language development at 18 mo, and illness monitored weekly from birth to 18 mo (highest quartile prevalence of diarrhea, highest quartile prevalence of malaria or undefined fever, and incidence of acute respiratory infection). In Model 1, we examined the unadjusted association between maternal FHL and each outcome. In Model 2, we adjusted for household and parental background characteristics collected at baseline, child age and sex, and trial group. In Model 3, we added maternal cognition, depression, and caregiving characteristics collected after baseline.
Results :
Over 90% of participants understood the growth charts, immunization record, and breastfeeding information in the health passport. Understanding of medication instructions was lower, with 72% understanding malaria, 81% Panadol, and 63% erythromycin instructions (Figure 1). Maternal FHL z score significantly predicted motor (β±SE= 0.087±0.040, p=0.029) and language z scores (β±SE= 0.093±0.040, p=0.020) at 18 mo in unadjusted models. However, after adjusting for covariates, these associations were not significant. Maternal FHL was not significantly associated with any other outcomes.
Conclusions : Revision of written medication instructions in Malawi may be needed to increase mothers’ understanding of how to deliver medication to their children. However, in this sample, maternal FHL was not associated with indicators of child growth, development, or illness after adjusting for parental, household, and caregiving characteristics.
Funding Sources : This publication is based on research funded by a grant to the University of California, Davis from the Bill & Melinda Gates Foundation.
Katherine Cox
University of California, Davis
Ulla Ashorn
University of Tampere
John Phuka
University of Malawi, College of Medicine
Kenneth Maleta
Professor
School of Public Health and Family Medicine, University of Malawi, College of Medicine
John Sadalaki
School of Public Health and Family Medicine, University of Malawi College of Medicine
Stephen Vosti
Department Of Agricultural And Resource Economics
Per Ashorn
Center for Child Health Research, Tampere University, Tampere, Finland
Kathryn Dewey
Department of Nutrition, University of California, Davis, USA;
Elizabeth Prado
University of California, Davis