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Published on: August 7, 2017
It takes a village: community education predicts paediatric lower-respiratory infection risk better than maternal
Bradford D Gessner1, Marc-Andre R Chimonas, Sue C Grady
1Alaska Division of Public Health, Anchorage, Alaska, USA. brad.gessner@alaska.gov
Insights
Higher community and maternal education levels significantly reduce lower-respiratory infection (LRI) risk in young children. Community education showed a stronger protective effect, mitigating risks associated with lower maternal education.
Area of Science:
- Pediatric Health
- Epidemiology
- Sociomedical Sciences
Background:
- Lower-respiratory infection (LRI) is a leading cause of mortality in children globally.
- Limited research exists on the impact of community and parental education on pediatric health outcomes like LRI.
- Alaska reports some of the highest LRI incidences worldwide.
Purpose of the Study:
- To investigate the association between maternal and community educational attainment and LRI risk in young children.
- To determine the independent effects of individual and community education levels on LRI risk.
Main Methods:
- Utilized linked Medicaid and birth certificate data for children under 2 years old in Alaska.
- Created community-level data on LRI incidence and census variables.
- Employed multilevel modeling to assess the impact of maternal and community education on LRI risk.
Main Results:
- High statewide incidences of outpatient (42/100 child-years) and inpatient (6/100 child-years) LRI were observed.
- Both maternal and community educational attainment independently predicted LRI risk in a dose-response manner.
- Higher community education levels demonstrated a stronger protective effect, significantly reducing LRI risk, even with lower maternal education.
Conclusions:
- Formal education levels of mothers and community adults are significant factors influencing LRI risk in Alaskan children.
- The precise mechanisms, potentially involving access to health information or belief systems, require further investigation.
Background:
Few studies have evaluated the contribution of community and parental education levels in determining paediatric outcomes, including lower-respiratory infection (LRI), the leading global cause of child mortality.
Methods:
The authors evaluated the association between community and maternal educational attainment and LRI risk among Medicaid-enrolled children age <2 years in Alaska, which has one of the highest LRI incidences ever reported. An individual-level database was created by linking Medicaid data to birth certificate files. A community-level database was created by calculating community LRI incidence rates and linking these values to Department of Labor census variables. Multilevel modelling was used to evaluate the independent effects of maternal and community education levels on LRI risk.
Results:
Statewide outpatient and inpatient LRI incidences were high at 42 and 6 per 100 child-years. When controlling for potential individual and community level confounding variables, a child's risk of outpatient and inpatient LRI was independently predicted in a dose-response manner by the child's mother's educational attainment and the educational attainment of other adults in the child's community. The latter variable had a stronger association and higher community education levels substantially mitigated the risk of poor maternal education.
Conclusions:
LRI risk among Alaskan children is affected by the formal education levels of the child's mother and other adults in their community. The mechanisms by which community education might influence LRI risk remain unknown and may include access to medical knowledge or acceptance of scientific versus traditional beliefs.
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