Description
Study Reports on Female Literacy & Its Relevance with Maternal and Infant Mortality Rates:- Infant mortality is the death of a child less than one year of age. Childhood mortality is the death of a child before its fifth birthday. National statistics tend to group these two mortality rates together. Globally, ten million infants and children die each year before their fifth birthday.
Study Reports on Female Literacy & Its Relevance with Maternal and Infant Mortality Rates
ABSTRACT When a female is educated the next generation is bound to be educated hence education has many folds impact on the social and economical development of any nation. Education as such, results in positive externalities. Not only does it have an intrinsic value in the sense of the joy of learning, reading etc, but it also has instrumental, social and process roles. Moreover education may spread through interpersonal motivation. When one family sends their child to school, their neighbor is likely to do so as well. Women's education too, often spreads this way, more specifically, through same sex effects. i.e. an educated woman is far more likely to send her daughter to school than an uneducated woman. Also, she is likely to maintain better conditions of nutrition and hygiene in her household and thereby improve her family's health (Sen 1997). Literacy is directly related to the status of a woman, her age at marriage, her decision power and to mention especially capability to access health care services. Literacy not only increases women's self-confidence but also makes them more exposed to information and thereby altering the way others respond to them. Female literacy improves the chances that women will obtain meaningful employment, reduces their demand for children and improves health- seeking behavior, makes them aware of Nutritional requirements - all these combined improve the chances of survival of both - the mother and the baby. The present paper focuses on the relationship between the female literacy and mortality rates (IMR and MMR) and establishes an inverse relationship between them. INTRODUCTION Not only might women residing in countries with higher female literacy enjoy greater personal safety and physical integrity, they may also have greater inheritance rights, ownership rights in land and loans, and labour market rights (Jütting et al., 2008; Magadi, Madise, & Rodrigues, 2000). Countries with higher female literacy may also devote more resources to the provisioning of maternal health care services along a range of maternal health care delivery models, including physicians, nurses, and traditional birth attendants. In terms of the "inverse equity hypothesis," the greater range of services available to women in
65
countries with higher female literacy may contribute to lower inequalities in use compared to those found in countries with lower female literacy. The United Nations Millennium Development Goals have identified improving women's access to maternal health care as a key target in reducing maternal mortality in the world. Individual socio-demographic and national-level environmental factors may affect women's use of maternal health care. At the individual level, age, income, education, and urban or rural residence may all play a role in women's use of maternal health care services (Gyimah, Baffour, &Addai, 2006; Magadi, Agwanda, & Obare, 2007; Magadi, Zulu, & Brockenhoff, 2003; Obermeyer & Potter, 1991). Differences between countries along such dimensions as female literacy rates or levels of economic development may play a pivotal role in women's reproductive health, and maternal and infant mortality (Frey & Field, 2000; Obermeyer,1993; Shen & Williamson, 1997; Shiffman, 2000; Wang, 2007). National female literacy rates are an important indicator of women's status and autonomy in society (Frey & Field, 2000; Magadi, Agwanda & Obare, 2007). Mortality, which is one of the major structural variables of demography, has continuously been affecting the population structure, particularly in developing countries like India. Most of the countries in the world, developed as well as developing, have experienced drastic improvement in life expectancy. Among various factors responsible for decline in mortality, economic factors: increase in per capita income, social factors: improvement in nutrition, housing and clothing, sanitation, water supply, cleanliness, individual hygienic practices and developments of medical science have played an important role. However, women and children do not equally enjoy fruits of these developments. Women and children are still the deprived sector of the society and maternal and infant mortality remain high in spite of a striking fall in general mortality rate. CONCEPTS OF MATERNAL AND INFANT MORTALITY Maternal mortality is a sensitive indicator of health and general socioeconomic development of a community or of a nation. It is one of the leading causes of death among women in their reproductive age. In India like most developing countries, women of reproductive ages constitute a little more than one-fifth of the total population and are exposed repeatedly to the risk of pregnancy. More maternal deaths occur in India in one week than in all of Europe in one year. In a single day in India, the total number of casualties due to pregnancy and child birthrelated complications is more than recorded in one month in the entire developed world.Maternal mortality is difficult to measure (Campbell and Graham 1990). The tenth revision of the International Classification of Diseases (ICD- 10) defines a maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. While many health indicators are required to arrive at a comprehensive assessment of the health status of a population, a particularly sensitive and widely used summary indicator is the Infant Mortality Rate (Visaria 1985). Infant Mortality refers to death of children in age group 0-1. Infant Mortality Rate (IMR) is the number of infant deaths that occur per thousand live births in a population in one calendar year. It is one of the universally accepted indicators of health status of not only infants but also of the whole population and of socio-economic conditions under which they live. EDUCATION AS AN INTERVENING VARIABLE IN MATERNAL AND INFANT MORTALITY DECLINE It is universally accepted that the higher the female literacy rate, the lower the MMR. Studying at school /college for a longer period will prevent early marriage and early motherhood. Educated women will seek proper antenatal and intra-natal supervision. The female literacy rates in Sri-Lanka and Thailand are over 80 percent and the MMR in these
66
two countries is 60 per 100,000 only. Although economically, there is not much of difference between the MMR of these two countries -340 as compared to 60. Kerala, having the highest female literacy rate in India, has the lowest MMR, compared to Bihar < U.P. and M.P. Mothers residing in countries with higher literacy rates were more likely to use maternal health care, after adjusting for national economic development and individual sociodemographic factors. socio-economic status has been linked to more frequent use of maternal health clinics (Rabe-Hesketh & Skrondal, 2005). Although Magadi et al. (2007) found women in high female literacy countries less likely to make an inadequate number of visits to maternal health care clinics than women in low female literacy countries. The reduction of maternal and infant deaths is high priority for the international community, especially in view of the increased attention on the Millennium Development Goals. Maternal deaths arise from the risks attributable to pregnancy and childbirth as well as from the poor quality care from health services. Ecological analyses have found direct associations between female literacy and national economic development for outcomes such as maternal and infant mortality in positive direction (Jütting, Morrisson, Dayton-Johnson & Drechsler, 2008; Wang, 2007). A number of studies have examined empirical evidences concerning the influence of demographic and socio-economic factors of child survival (Gandotra et al. 1980; Clealand and Ginneken et al. 1988; Miller 1983; Das Gupta 1990; Caldwell 1979; Griffith et al. 2001). All these studies reinforce the existing argument for a greater emphasis on the schooling of girls to give women themselves and the next generation a greater chance of survival. Several authors have discussed the mechanism of literacy influence on infant survival (Caldwell 1979, 1986; Cohrane 1980; Hobecraft et al. 1984; United Nations 1985; Ware 1984; Gokhale et al. 2002; Govindasamy and Ramesh 1997). Ruzika and Kanitkar (1 972) found mother's literacy to be the most effective single factor determining the level of infant mortality in an urban setting. Pooled data from the Demographic and Health Surveys (DHS) of South-Asian countries from the late 1990s to examine the association between female literacy and antenatal care visits and found that women in countries with higher female literacy were more likely to start antenatal care late in their pregnancy, but less likely to make an inadequate number of visits. Women's literacy and their use of health facilities go hand in hand. Krishnan (1985) examined overall death rates in terms of literacy, doctor, hospital and bed population ratio, per capita income expenditure on medical and health services. He observed that literacy was the most important factor while health services also had some explanatory power. A number of cross-section studies for India have explored the impact of female literacy on maternal and child death. Sharma and Retherford (1999) have used 1991 Census data, aggregated to district level, for 326 districts. They show that female literacy would have a significant negative impact on maternal and child deaths. High maternal and infant deaths can be attributed to low status and low capability of women. These deaths are preventable if more and more women are literate thereby exposing them to new ideas. Literacy can make them aware of a range of services from antenatal to nutrition, personal hygiene, immunisation, birth spacing, maternal skills, breast-feeding and overall health. In order to reduce the high maternal mortality in the developing countries, government should work on the causes which are multiple, inter-related and tiered. The most superficial of
67
all the planes are the " direct and indirect" causes of maternal deaths. The direct causes account for 7% of maternal deaths and are the following: 1) Sepsis including septic abortion Obstetric hemorrhages Eclampsia 4) 20-25% 2) 20-22% 3) 5-15%
Accidents of labor (e.g. rupture of uterus) 10-30%
The indirect causes account for 25% cases and are due to associated medical diseases that worsen during pregnancy, the commonest being anemia followed by jaundice and heart diseases. The causes mentioned above are only the tip of the iceberg. The underlying causes of maternal deaths in developing countries, particularly in India are the following. 1) Illiteracy 2) Ineffective health services 3) Inadequate obstetric care 4) Inadequate essential supplies 5) Poor maternal mortality audit 6) Unregulated fertility 7) Infection and infestations 8) Early marriage 9) Poverty 10) Malnutrition 11) Ignorance. These underlying causes can be effectively managed by a single most strong remedy i.e. educate the females, as it is shown already in the developed world by reducing their MMR and IMR to the significant level. If the food habits and nutrition of girls and especially of pregnant women are properly taken care of, infant and maternal mortality may be brought down considerably. At the prepregnancy stage as well as during pregnancy, level of nutrition is an important determinant of complications during pregnancy or childbirth. Various studies confirm the relatively poor nutritional and health status of young women and wide ranging gender disparities in feeding practices. Poor nutrition contributes to poor maternal health and underlies poor pregnancy outcomes in a variety of ways. Literacy is supposed to make women aware of nutritional requirements of pregnant women, young girls and infants as well. It is also possible to change age-old food habits of people through educating them. Maternal health, nutrition and literacy are important for the survival and well-being of women in their own right and are key determinants of the health and well-being of infants. The cause of the high rates of infant mortality, especially neonatal mortality are linked to untimely pregnancies, low birth weight and unsafe delivery, etc. These are also major causes of maternal mortality. Dealing with one of the significant causes of infant and maternal deaths - unsafe deliveries, it is evident from all accounts that literate women are more likely to have their deliveries in an institution or at least attended by trained practitioners. Literacy definitely enhances women's exposure to the modern health sector and the ease and confidence with which they can deal with this sector. This increased confidence leads to an increased ability to deal with emergency situations during pregnancy, delivery, infant illness and therefore to improved women's survival and infant survival. Literate women are more likely to avail
68
themselves of antenatal care, tetanus toxoid injectiion, iron and foliic acid tablets, institutional lv te t a ta id in t l id ta in delivery and complete immunization for the infants. iv le iz io th in Reviews suggest that birth intervals have a noticeably larger impact on infant and maternal ie th in ti c te mortaliity than does maternal age, even maternal age at first birth (IIPS 2002). However, this l th ir irth PS association is not always found true. Litterate women generally delay first childbearing and iatio is lw tr i ly ir i ld complete their familly in a shorter span so as to be free to work outside. th i in te to id
is
A few studies (Jejeebhoy and Kulkami 1989; Mason 1993; Krishnamurthi 1998) have shown tu i e je is that interspouse consultation is an important factor in the process of decision-making with tatio is i m ta to in th io regard to familly size and the adoptiion of family planning practices. Srinivasan (1995) stressed to i iz t ly ic S r the role of schooliing in creatiing greater access to birth control information and more le l in t te t o ir tr extensive use and approval of contraceptive technology. Literacy plays a catalytic role in ti v t e it e ta ly ic le i n enhancing female autonomy, in achieving a greater say in decision-making, which in turn in le in ie te in is result in decline in the number of unwanted birrths, repeated pregnancies and further to infant in in th te i and maternal deaths. More recent studies have found that there is a minimum threshold of th tu ie is in education (at least 5-6 years) that must be achieved before there are significant improvements th ie th ic ts in female autonomy, partiicularly in a highly gender stratified society such as India (Jeffery t la ly and Basu 1996; Jejeebhoy 1995).
The influence of female literacy as a major factor affecting child health in India was in le lite in ild th in ia examined using data from the second Natiional Family Health Survey between 1998 and 1999, in in th t F a ly th S u tw as welll as microlevel data on rural Indian mothers (n=374) and their chilldren (n=281) aged 0l le ta th ir i 3 years. After considering the colllinearitty between several independent variables, te id in l in i tw in i a le comprehensive models were developed for predicting the outcome variables such as stunting, iv lo tin underweight,, anaemia, and under-five mortality. The major variables that determined these ig t models were low maternal body mass index (BMI), lack of colostrum, maternal anaemia, te in lo tr te ia hospittalized deliveries, trreatment with Oral Rehydratiion Solution (ORS), and complete i iz l iv i e t t m th t vaccinations. Addittion of female illliteracy in these regression models improved prediction of outcome i i lite in io io tc variables significantlly. Mean predicted prevalences, after adjustiing for these variables were le t icte le t th ia significantly higher (p
Study Reports on Female Literacy & Its Relevance with Maternal and Infant Mortality Rates:- Infant mortality is the death of a child less than one year of age. Childhood mortality is the death of a child before its fifth birthday. National statistics tend to group these two mortality rates together. Globally, ten million infants and children die each year before their fifth birthday.
Study Reports on Female Literacy & Its Relevance with Maternal and Infant Mortality Rates
ABSTRACT When a female is educated the next generation is bound to be educated hence education has many folds impact on the social and economical development of any nation. Education as such, results in positive externalities. Not only does it have an intrinsic value in the sense of the joy of learning, reading etc, but it also has instrumental, social and process roles. Moreover education may spread through interpersonal motivation. When one family sends their child to school, their neighbor is likely to do so as well. Women's education too, often spreads this way, more specifically, through same sex effects. i.e. an educated woman is far more likely to send her daughter to school than an uneducated woman. Also, she is likely to maintain better conditions of nutrition and hygiene in her household and thereby improve her family's health (Sen 1997). Literacy is directly related to the status of a woman, her age at marriage, her decision power and to mention especially capability to access health care services. Literacy not only increases women's self-confidence but also makes them more exposed to information and thereby altering the way others respond to them. Female literacy improves the chances that women will obtain meaningful employment, reduces their demand for children and improves health- seeking behavior, makes them aware of Nutritional requirements - all these combined improve the chances of survival of both - the mother and the baby. The present paper focuses on the relationship between the female literacy and mortality rates (IMR and MMR) and establishes an inverse relationship between them. INTRODUCTION Not only might women residing in countries with higher female literacy enjoy greater personal safety and physical integrity, they may also have greater inheritance rights, ownership rights in land and loans, and labour market rights (Jütting et al., 2008; Magadi, Madise, & Rodrigues, 2000). Countries with higher female literacy may also devote more resources to the provisioning of maternal health care services along a range of maternal health care delivery models, including physicians, nurses, and traditional birth attendants. In terms of the "inverse equity hypothesis," the greater range of services available to women in
65
countries with higher female literacy may contribute to lower inequalities in use compared to those found in countries with lower female literacy. The United Nations Millennium Development Goals have identified improving women's access to maternal health care as a key target in reducing maternal mortality in the world. Individual socio-demographic and national-level environmental factors may affect women's use of maternal health care. At the individual level, age, income, education, and urban or rural residence may all play a role in women's use of maternal health care services (Gyimah, Baffour, &Addai, 2006; Magadi, Agwanda, & Obare, 2007; Magadi, Zulu, & Brockenhoff, 2003; Obermeyer & Potter, 1991). Differences between countries along such dimensions as female literacy rates or levels of economic development may play a pivotal role in women's reproductive health, and maternal and infant mortality (Frey & Field, 2000; Obermeyer,1993; Shen & Williamson, 1997; Shiffman, 2000; Wang, 2007). National female literacy rates are an important indicator of women's status and autonomy in society (Frey & Field, 2000; Magadi, Agwanda & Obare, 2007). Mortality, which is one of the major structural variables of demography, has continuously been affecting the population structure, particularly in developing countries like India. Most of the countries in the world, developed as well as developing, have experienced drastic improvement in life expectancy. Among various factors responsible for decline in mortality, economic factors: increase in per capita income, social factors: improvement in nutrition, housing and clothing, sanitation, water supply, cleanliness, individual hygienic practices and developments of medical science have played an important role. However, women and children do not equally enjoy fruits of these developments. Women and children are still the deprived sector of the society and maternal and infant mortality remain high in spite of a striking fall in general mortality rate. CONCEPTS OF MATERNAL AND INFANT MORTALITY Maternal mortality is a sensitive indicator of health and general socioeconomic development of a community or of a nation. It is one of the leading causes of death among women in their reproductive age. In India like most developing countries, women of reproductive ages constitute a little more than one-fifth of the total population and are exposed repeatedly to the risk of pregnancy. More maternal deaths occur in India in one week than in all of Europe in one year. In a single day in India, the total number of casualties due to pregnancy and child birthrelated complications is more than recorded in one month in the entire developed world.Maternal mortality is difficult to measure (Campbell and Graham 1990). The tenth revision of the International Classification of Diseases (ICD- 10) defines a maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. While many health indicators are required to arrive at a comprehensive assessment of the health status of a population, a particularly sensitive and widely used summary indicator is the Infant Mortality Rate (Visaria 1985). Infant Mortality refers to death of children in age group 0-1. Infant Mortality Rate (IMR) is the number of infant deaths that occur per thousand live births in a population in one calendar year. It is one of the universally accepted indicators of health status of not only infants but also of the whole population and of socio-economic conditions under which they live. EDUCATION AS AN INTERVENING VARIABLE IN MATERNAL AND INFANT MORTALITY DECLINE It is universally accepted that the higher the female literacy rate, the lower the MMR. Studying at school /college for a longer period will prevent early marriage and early motherhood. Educated women will seek proper antenatal and intra-natal supervision. The female literacy rates in Sri-Lanka and Thailand are over 80 percent and the MMR in these
66
two countries is 60 per 100,000 only. Although economically, there is not much of difference between the MMR of these two countries -340 as compared to 60. Kerala, having the highest female literacy rate in India, has the lowest MMR, compared to Bihar < U.P. and M.P. Mothers residing in countries with higher literacy rates were more likely to use maternal health care, after adjusting for national economic development and individual sociodemographic factors. socio-economic status has been linked to more frequent use of maternal health clinics (Rabe-Hesketh & Skrondal, 2005). Although Magadi et al. (2007) found women in high female literacy countries less likely to make an inadequate number of visits to maternal health care clinics than women in low female literacy countries. The reduction of maternal and infant deaths is high priority for the international community, especially in view of the increased attention on the Millennium Development Goals. Maternal deaths arise from the risks attributable to pregnancy and childbirth as well as from the poor quality care from health services. Ecological analyses have found direct associations between female literacy and national economic development for outcomes such as maternal and infant mortality in positive direction (Jütting, Morrisson, Dayton-Johnson & Drechsler, 2008; Wang, 2007). A number of studies have examined empirical evidences concerning the influence of demographic and socio-economic factors of child survival (Gandotra et al. 1980; Clealand and Ginneken et al. 1988; Miller 1983; Das Gupta 1990; Caldwell 1979; Griffith et al. 2001). All these studies reinforce the existing argument for a greater emphasis on the schooling of girls to give women themselves and the next generation a greater chance of survival. Several authors have discussed the mechanism of literacy influence on infant survival (Caldwell 1979, 1986; Cohrane 1980; Hobecraft et al. 1984; United Nations 1985; Ware 1984; Gokhale et al. 2002; Govindasamy and Ramesh 1997). Ruzika and Kanitkar (1 972) found mother's literacy to be the most effective single factor determining the level of infant mortality in an urban setting. Pooled data from the Demographic and Health Surveys (DHS) of South-Asian countries from the late 1990s to examine the association between female literacy and antenatal care visits and found that women in countries with higher female literacy were more likely to start antenatal care late in their pregnancy, but less likely to make an inadequate number of visits. Women's literacy and their use of health facilities go hand in hand. Krishnan (1985) examined overall death rates in terms of literacy, doctor, hospital and bed population ratio, per capita income expenditure on medical and health services. He observed that literacy was the most important factor while health services also had some explanatory power. A number of cross-section studies for India have explored the impact of female literacy on maternal and child death. Sharma and Retherford (1999) have used 1991 Census data, aggregated to district level, for 326 districts. They show that female literacy would have a significant negative impact on maternal and child deaths. High maternal and infant deaths can be attributed to low status and low capability of women. These deaths are preventable if more and more women are literate thereby exposing them to new ideas. Literacy can make them aware of a range of services from antenatal to nutrition, personal hygiene, immunisation, birth spacing, maternal skills, breast-feeding and overall health. In order to reduce the high maternal mortality in the developing countries, government should work on the causes which are multiple, inter-related and tiered. The most superficial of
67
all the planes are the " direct and indirect" causes of maternal deaths. The direct causes account for 7% of maternal deaths and are the following: 1) Sepsis including septic abortion Obstetric hemorrhages Eclampsia 4) 20-25% 2) 20-22% 3) 5-15%
Accidents of labor (e.g. rupture of uterus) 10-30%
The indirect causes account for 25% cases and are due to associated medical diseases that worsen during pregnancy, the commonest being anemia followed by jaundice and heart diseases. The causes mentioned above are only the tip of the iceberg. The underlying causes of maternal deaths in developing countries, particularly in India are the following. 1) Illiteracy 2) Ineffective health services 3) Inadequate obstetric care 4) Inadequate essential supplies 5) Poor maternal mortality audit 6) Unregulated fertility 7) Infection and infestations 8) Early marriage 9) Poverty 10) Malnutrition 11) Ignorance. These underlying causes can be effectively managed by a single most strong remedy i.e. educate the females, as it is shown already in the developed world by reducing their MMR and IMR to the significant level. If the food habits and nutrition of girls and especially of pregnant women are properly taken care of, infant and maternal mortality may be brought down considerably. At the prepregnancy stage as well as during pregnancy, level of nutrition is an important determinant of complications during pregnancy or childbirth. Various studies confirm the relatively poor nutritional and health status of young women and wide ranging gender disparities in feeding practices. Poor nutrition contributes to poor maternal health and underlies poor pregnancy outcomes in a variety of ways. Literacy is supposed to make women aware of nutritional requirements of pregnant women, young girls and infants as well. It is also possible to change age-old food habits of people through educating them. Maternal health, nutrition and literacy are important for the survival and well-being of women in their own right and are key determinants of the health and well-being of infants. The cause of the high rates of infant mortality, especially neonatal mortality are linked to untimely pregnancies, low birth weight and unsafe delivery, etc. These are also major causes of maternal mortality. Dealing with one of the significant causes of infant and maternal deaths - unsafe deliveries, it is evident from all accounts that literate women are more likely to have their deliveries in an institution or at least attended by trained practitioners. Literacy definitely enhances women's exposure to the modern health sector and the ease and confidence with which they can deal with this sector. This increased confidence leads to an increased ability to deal with emergency situations during pregnancy, delivery, infant illness and therefore to improved women's survival and infant survival. Literate women are more likely to avail
68
themselves of antenatal care, tetanus toxoid injectiion, iron and foliic acid tablets, institutional lv te t a ta id in t l id ta in delivery and complete immunization for the infants. iv le iz io th in Reviews suggest that birth intervals have a noticeably larger impact on infant and maternal ie th in ti c te mortaliity than does maternal age, even maternal age at first birth (IIPS 2002). However, this l th ir irth PS association is not always found true. Litterate women generally delay first childbearing and iatio is lw tr i ly ir i ld complete their familly in a shorter span so as to be free to work outside. th i in te to id
is
A few studies (Jejeebhoy and Kulkami 1989; Mason 1993; Krishnamurthi 1998) have shown tu i e je is that interspouse consultation is an important factor in the process of decision-making with tatio is i m ta to in th io regard to familly size and the adoptiion of family planning practices. Srinivasan (1995) stressed to i iz t ly ic S r the role of schooliing in creatiing greater access to birth control information and more le l in t te t o ir tr extensive use and approval of contraceptive technology. Literacy plays a catalytic role in ti v t e it e ta ly ic le i n enhancing female autonomy, in achieving a greater say in decision-making, which in turn in le in ie te in is result in decline in the number of unwanted birrths, repeated pregnancies and further to infant in in th te i and maternal deaths. More recent studies have found that there is a minimum threshold of th tu ie is in education (at least 5-6 years) that must be achieved before there are significant improvements th ie th ic ts in female autonomy, partiicularly in a highly gender stratified society such as India (Jeffery t la ly and Basu 1996; Jejeebhoy 1995).
The influence of female literacy as a major factor affecting child health in India was in le lite in ild th in ia examined using data from the second Natiional Family Health Survey between 1998 and 1999, in in th t F a ly th S u tw as welll as microlevel data on rural Indian mothers (n=374) and their chilldren (n=281) aged 0l le ta th ir i 3 years. After considering the colllinearitty between several independent variables, te id in l in i tw in i a le comprehensive models were developed for predicting the outcome variables such as stunting, iv lo tin underweight,, anaemia, and under-five mortality. The major variables that determined these ig t models were low maternal body mass index (BMI), lack of colostrum, maternal anaemia, te in lo tr te ia hospittalized deliveries, trreatment with Oral Rehydratiion Solution (ORS), and complete i iz l iv i e t t m th t vaccinations. Addittion of female illliteracy in these regression models improved prediction of outcome i i lite in io io tc variables significantlly. Mean predicted prevalences, after adjustiing for these variables were le t icte le t th ia significantly higher (p