Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 9;12(5):e054134.
doi: 10.1136/bmjopen-2021-054134.

Mediating role of social capital in the association between socioeconomic status and childcare practices in rural Malawi: a cross-sectional study

Suhyoon Choi  1 , Junko Kiriya  2 , Akira Shibanuma  1 , Masamine Jimba  1
Affiliations

Mediating role of social capital in the association between socioeconomic status and childcare practices in rural Malawi: a cross-sectional study

Suhyoon Choi et al. BMJ Open. .

Abstract

Objectives: Childcare practices determine the child nutritional outcomes, but resources for good practices are unequally distributed across socioeconomic status (SES). This study first examined the associations between social capital and childcare practices separately across SES groups. It then investigated the mediation effect of social capital between SES and childcare practices.

Design: This cross-sectional study used the Short Version of the Adapted Social Capital Assessment Tool to measure structural social capital (group membership, social support and citizenship activities) and cognitive social capital of mothers. Data were analysed using multilevel logistic regressions with random intercepts and mediation modellings.

Setting: Rural Lilongwe, Malawi.

Participants: A total of 320 mothers with a child aged between 12 months and 23 months.

Primary outcome measures: Childcare practice outcomes included were minimum dietary diversity, handwashing and complete vaccination.

Results: Among structural social capital dimensions, social support was found to be positively associated with minimum dietary diversity (adjusted OR (AOR)=1.44, 95% CI 1.22 to 1.71; p<0.001) and handwashing for all mothers (AOR=1.42, 95% CI 1.23 to 1.64; p<0.001). In the subgroup analysis, the higher SES group had higher odds of meeting the minimum dietary diversity (AOR=1.63, 95% CI 1.18 to 2.26; p=0.01) and handwashing with increased social support (AOR=1.53, 95% CI 1.13 to 2.08; p=0.01) than the lower SES. The mediation effect of social support accounted for 27.3% of the total effect between SES and minimum dietary diversity. Cognitive social capital was negatively associated with vaccination for the lower SES group (AOR=0.07, 95% CI 0.01 to 0.68; p=0.03).

Conclusions: To improve feeding and handwashing practices and to reduce health inequalities in rural Malawi, governments and organisations should consider promoting the value of social support and health. Future research is needed to explain the negative association between cognitive social capital and vaccination among the lower SES group.

Keywords: Community child health; NUTRITION & DIETETICS; SOCIAL MEDICINE.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Hypothesised conceptual framework on the association between mother’s socioeconomic status, social capital and childcare practices.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Black RE, Allen LH, Bhutta ZA, et al. . Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008;371:243–60. 10.1016/S0140-6736(07)61690-0 - DOI - PubMed
    1. UNICEF . Strategy for improved nutrition of children and women in developing countries. New York: UNICEF, 1990.
    1. Victora CG, Adair L, Fall C, et al. . Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008;371:340–57. 10.1016/S0140-6736(07)61692-4 - DOI - PMC - PubMed
    1. UNICEF . Unicef data – malnutrition. Available: https://data.unicef.org/topic/nutrition/malnutrition/ [Accessed May 2021].
    1. Wells JC, Sawaya AL, Wibaek R, et al. . The double burden of malnutrition: aetiological pathways and consequences for health. Lancet 2020;395:75–88. 10.1016/S0140-6736(19)32472-9 - DOI - PMC - PubMed

LinkOut - more resources