BACKGROUND Parental education has been suggested to be an effective instrument for improving child health in low- and middle-income countries. Both education and child health have improved, however, as well as related factors. These changes may have implications for the observed association. METHODS We used Demographic and Health Surveys conducted in 43 countries at two points in time, between 1991 and 2016, to test if the association of parental education with child health has changed over time. We explored how changes relate to commonly cited confounders and pathways, including fertility, household living standards, health care use, urbanicity and geographical clustering. We used linear probability models, Gelbach decomposition, and assessed a range of sensitivity specifications. RESULTS The point estimate for an additional year of maternal education has attenuated by 0.27% points (56%) for under-5 mortality, 0.34% points (15%) for child stunting, 0.42% points (30%) for child underweight and 0.09% points (24%) for child wasting. The point estimate for paternal education has attenuated by 0.20% points (53%) for under-5 mortality, 0.15% points (8%) for child stunting, 0.28% points (24%) for underweight and 0.06% points (19%) for wasting. Changes in confounding and mediation by fertility, household living standards and urban-rural differences explain to a large extent the attenuations. Geospatial clustering increasingly drives the association of parental education with child health. CONCLUSIONS The role of parental education in child health has attenuated considerably over time in low-resource settings. Decision makers should take into account this weakening association when designing policies aimed at improving child health.

中文翻译：

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弱化的父母教育协会：43个中低收入国家儿童健康状况的分析。

背景技术在低收入和中等收入国家，父母教育被认为是改善儿童健康的有效手段。但是，教育和儿童健康以及相关因素均得到改善。这些变化可能对观察到的关联有影响。方法我们使用了在1991年至2016年之间两个时间点在43个国家进行的人口与健康调查，以检验父母教育与儿童健康的关联是否随时间变化。我们探讨了变化与常见的混杂因素和途径如何相关，包括生育率，家庭生活水平，医疗保健使用，城市化程度和地域聚类。我们使用了线性概率模型，Gelbach分解，并评估了一系列灵敏度指标。结果：对于5岁以下的死亡率，增加了一年的孕产妇教育的点估计值降低了0.27％点（56％），对于发育迟缓的儿童而言降低了0.34％（15％），对于体重不足的儿童而言降低了0.42％（30％），而0.09浪费儿童的百分点（24％）。五岁以下儿童的父亲教育的得分估计值降低了0.20％（53％），发育迟缓的儿童降低了0.15％（8％），体重过轻降低了0.28％（24％），0.06％（19％）浪费。生育率，家庭生活水平和城乡差异造成的混杂和调解的变化在很大程度上解释了这种衰减。地理空间聚类日益推动父母教育与儿童健康的联系。结论在资源匮乏的环境中，父母教育在儿童健康中的作用随着时间的推移已大大减弱。