Module 3: Teaching Mothers About Health Education

Research indicates that an adult's own schooling is the most important correlation with his or her health, and parents’ schooling, especially the mother’s education, is the most important correlation with child health.(1) The positive correlation between the mother’s schooling and child health in numerous studies was a driving factor behind the World Bank’s campaign in the 1990s to encourage increased maternal education in developing countries.(2) In the late 1970s, a study was conducted among Kenyan families in which the mother had no formal schooling. The data indicated that the probability of a child dying by age 2 averaged 184 per 1,000 in regions where half of the families lived below the poverty line. Governments can employ a variety of policies to raise the educational levels of their citizens, including compulsory schooling laws, new school construction, and targeted subsidies to parents and students.(3)

In Jamaica, households headed by women eat more nutritious food than those headed by men; they also spend more of their income on child-centered goods. In Côte d’Ivoire, a doubling of household income under women’s control reduces the share of alcohol in the family budget by 26% and the share of cigarettes by 14%. The study also found that educated mothers maintain better domestic hygiene, provide better food, have higher rates of immunizations, and use of medical services more wisely. Educated mothers also are more likely to seek information on health matters.(4)

Education is also associated with increased self-efficacy. Those who are educated are likely to believe that they have control over their own behavior, as opposed to a reliance on another individual or fate. Formal education is also likely to provide exposure to prevention information,(5) and mothers pass this information along to their children.(6)

Mosquito Nets

The use of mosquito nets provides an example of how a mother’s health education can impact her children. Insecticide-treated mosquito nets (ITN) have been found to effectively reduce malaria transmission and related death; however, they are underused. Under-usage may be attributed to a variety of factors, including whether individuals sleep inside, use repellent, have knowledge about how mosquitoes cause malaria, and awareness that malaria is severe in children. Also, effectiveness of ITNs is dependent on their overall acceptability, feasibility, and affordability. As described in a paper by Biswas et al., increased financial accessibility and targeted education messages are needed to increase ownership and use of mosquito nets. In 2005, a local evaluation of the national anti-malaria program in India indicated that 46% of households owned a mosquito net. However, of the owners, only 81% were using the nets. Biswas et al. sought to identify factors associated with use of mosquito nets among mosquito net owners and to formulate recommendations to improve access and use of mosquito nets. Their findings concluded that wealthier households were more likely to own mosquito nets, and at the time of the study, households were buying unsubsidized mosquito nets from the private sector, most of which were not insecticide-treated. Importantly, the study also found that awareness of the severity of malaria in children and the fact that mosquitoes cause malaria led to increased use of ITNs. (7) Similar circumstances were found in The Gambia(8), Ghana(9), Burkina Faso(10), Pakistan(11), and Myanmar(12). In this case, the health knowledge of a child’s primary caregiver, usually the mother, can protect them against malaria.

Research studies about the low usage rates of mosquito nets confirms the importance of designing and implementing locally appropriate communication strategies to accompany mosquito net distribution. Distribution alone will not ensure that the mosquito nets are effectively and correctly utilized. It is most important to inform communities about the importance of nets and about how to use and maintain them properly.(13) In the Shan State in the north of Myanmar, simple health promotion messages administered by village midwives increased mosquito net usage considerably.(14) Biswas et al. also found that younger people were more likely to use mosquito nets, and they were very receptive to health education messages.

Biswas et al. also state that a call to action is necessary, alongside increased financial access to nets, particularly ITNs, so that they become more affordable to the poor. Strategies to reduce cost may include subsidization, bulk purchasing, sales tax exemption, and local tailoring. In India's Purulia District many developments have been made in response to malaria prevalence. The Global Fund has, for example, covered costs for providing free ITNs.(15) Additionally, the new Indian national program guidelines provide support for subsidized nets in qualified areas nationally, as well as free distribution of nets for those below the poverty line.(16) It is further suggested by Biswas et al. that the public and private sectors must collaborate to target vulnerable groups, to promote equity, and to ensure sustainable supplies.(17) Health education and promotion messages may be implemented through maternal and child health programs.(18).(19)

Vaccinations

Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases.(20) Childhood vaccination prevents illness and provides protection against many diseases. The cost of immunizing a child with “basic” coverage against tuberculosis, polio, diphtheria, tetanus, pertussis, and measles is only about US$1. An estimated 2.1 million people around the world died in 2002 of diseases preventable by widely used vaccines, including 1.4 million children.(21)

Mothers and teachers are in a unique position to educate children and to ensure they receive the necessary immunizations to stay healthy. In order for mothers and teachers to promote best health practices, they must be educated about health information themselves.(22) In addition to the essential role of mothers to improve health outcomes,(23) teachers also play a valuable role in health promotion in the school setting. They can help their students to better understand health promotion, develop positive health behaviors, and become advocates for good individual, family, and community health.

Similarly, studies have shown that enhancing initiatives that empower women, and a better implementation of health education strategies, may be effective in preventing mother-to-child transmission of HIV infection. It is important for HIV-infected mothers to understand mother-to-child transmission of HIV in order to decrease rates of infection. The advent of “prevention of mother to child transmission” (PMTCT) treatment in Africa has provided a new approach to preventing transmission of HIV/AIDS.(24)

Footnotes

(1) Shin-Yi Chou & Jin-Tan Liu & Michael Grossman & Theodore J. Joyce, 2007. "Parental Education and Child Health: Evidence from a Natural Experiment in Taiwan," NBER Working Papers 13466, National Bureau of Economic Research, Inc.

(2) World Bank. World Development Report 1993: Investing in Health. New York: Oxford University Press, 1993

(3) Shin-Yi Chou & Jin-Tan Liu & Michael Grossman & Theodore J. Joyce, 2007. "Parental Education and Child Health: Evidence from a Natural Experiment in Taiwan," NBER Working Papers 13466, National Bureau of Economic Research, Inc.

(4) World Bank. World Development Report 1993: Investing in Health. New York: Oxford University Press, 1993.

(5) Gregson S, Zhuwau T, Anderson RM, Chandiwana SK. Is there evidence for behaviour change in response to AIDS in rural Zimbabwe? Soc Sci Med. 1998; 46:321–330.

(6) The Girl Effect. "Impact & Insights" https://www.girleffect.org/what-we-do/impact-and-insights/.

(7) A.K. Biswas, Y.J. Hutin, R. Ramakrishnan, B. Patra, M.D. Gupte. (June 2010) Increased financial accessibility and targeted education messages could increase ownership and use of mosquito nets in Purulia District, West Bengal, India. Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol. 104, Issue 6, Pages 423-428.

(8) Müller O, Cham K, Jaffar S, Greenwood B. The Gambian National Impregnated Bednet Programme: evaluation of the 1994 cost recovery trial. Soc Sci Med. 1997;44:1903–9.

(9) Gyapong M, Gyapong JO, Amankwa J, Asedem J, Sory E. Introducing insecticide impregnated bednets in an area of low bednet usage: an exploratory study in north-east Ghana. Trop Med Int Health. 1996;1:328–33.

(10) Okrah J, Traoré C, Palé A, Sommerfeld J, Müller O. Community factors associated with malaria prevention by mosquito nets: an exploratory study in rural Burkina Faso. Trop Med Int Health. 2002;7:240–8.

(11) Kolaczinski JH, Muhammad N, Khan QS, Jan Z, Rehman N, Leslie TJ, et al. Subsidized sales of insecticide-treated nets in Afghan refugee camps demonstrate the feasibility of a transition from humanitarian aid towards sustainability. Malar J. 2004;3:15.

(12) Lin K, Aung S, Lwin S, Min H, Aye NN, Webber R. Promotion of insecticide-treated mosquito nets in Myanmar. Southeast Asian J Trop Med Public Health. 2000;31:444–7.

(13) WHO. Global Malaria Programme. Insecticide-treated mosquito nets: a WHO position statement. Geneva: World Health Organization;2007. https://www.who.int/mediacentre/news/releases/2007/pr43/en/.

(14) Lin K, Aung S, Lwin S, Min H, Aye NN, Webber R. Promotion of insecticide-treated mosquito nets in Myanmar. Southeast Asian J Trop Med Public Health. 2000;31:444–7.

(15) D. Njama, G. Dorsey, D. Guwatudde, K. Kigonya, B. Greenhouse and S. Musisi et al., Urban malaria: primary caregivers’ knowledge, attitudes, practices and predictors of malaria incidence in a cohort of Ugandan children, Trop Med Int Health 8 (2003), pp. 685–692.

(16) The Global Fund to Fight AIDS, Tuberculosis and Malaria. Proposal form, fourth call for proposals.

(17) NVBDCP. Guidelines distribution of insecticide treated bednets (ITBN). Delhi: National Vector Borne Diseases Control Programme.

(18) World Health Organization. Global Malaria Programme. Insecticide-treated mosquito nets: a WHO position statement. Geneva: World Health Organization; 2007.

(19) A.K. Biswas, Y.J. Hutin, R. Ramakrishnan, B. Patra, M.D. Gupte. (June 2010). Increased financial accessibility and targeted education messages could increase ownership and use of mosquito nets in Purulia District, West Bengal, India. Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol. 104, Issue 6, Pages 423-428.

(20) World Health Organization. “Immunization.” https://www.who.int/topics/immunization/en/.

(21) World Health Organization. “Immunization against disease and public health importance.” 2010.

(22) Schultz, T.P. 1984. Studying the impact of household economic and community variables on child mortality. Population and Development Review Suppl. 10:215–235.

(23) Barrera, A. 1990. The role of maternal schooling and its interaction with public health programs in child health production. Journal of Development Economics. 32:69–91.

(24) Igumbor, O.J., Pengpid, S., Obi, C.L. (2006). Effect of exposure to clinic-based health education interventions on behavioural intention to prevent mother-to-child transmission of HIV infection. SAHARA Journal. 3, 394-402.