Association of parental characteristics with offspring anthropometric failure, anaemia and mortality in India

Evolutionary biology highlights the significant role of parental characteristics in offspring health. This influence manifests through intrauterine exposure, maternal care during pregnancy, parental healthcare choices, dietary provisions, emotional support, and environmental factors. These choices are shaped by parental resources, health knowledge, behaviors, and community characteristics. A literature review focusing on India revealed that child marriage (girls marrying before 18) increased offspring morbidity and mortality. Studies also showed that younger parents (15-24 years) had children with higher risks of anemia, stunting, and incomplete immunization. Early motherhood was associated with shorter stature and poorer mathematical performance in children. Furthermore, children of uneducated parents experienced poorer health outcomes compared to those with educated parents. Parental employment, particularly maternal employment in professional roles, was linked to better child health. Parental phenotypic traits like height and BMI also correlated with children's health, though the relative strength of maternal and paternal effects varied across studies. Parental tobacco use was detrimental, linked to adverse birth outcomes and increased child mortality. Similarly, alcohol misuse was associated with poor child health and behavioral problems. Finally, parental non-communicable diseases (NCDs) like diabetes and hypertension could negatively impact child health, partly through genetic factors and access to healthcare. Existing studies often examined limited parental characteristics and child health indicators. This study aimed to address these gaps by using a comprehensive dataset to analyze a wider range of parental characteristics and their effects on anthropometric failure, anemia, and mortality among 0–59-month-old children in India. Findings could inform strategies to reduce the burden of these child health issues.

The literature review extensively examined existing research on the relationship between parental characteristics and offspring health in India, focusing on studies that analyzed parental sociodemographic and behavioral characteristics, parental health status, and their effects on offspring health. Key findings from previous studies indicated that child marriage of girls was associated with increased risk of offspring morbidity and mortality. Younger parental age correlated with elevated risk of anaemia, stunting, and incomplete immunisation. Lower parental education was associated with poorer child health outcomes. Maternal education demonstrated a protective association with various forms of malnutrition. Parental employment, particularly in non-agricultural sectors, showed a positive correlation with better child health. Parental height and BMI were also studied, although the magnitude of their respective influences remained a point of debate. Parental tobacco and alcohol use were identified as strong risk factors for adverse child health outcomes. The presence of NCDs like diabetes and hypertension in parents also demonstrated negative associations with child health. The review highlighted the limited scope of previous studies, often focusing on specific parental characteristics and limited child health indicators, motivating the present study’s more comprehensive approach.

This study utilized data from the 2015-2016 National Family Health Survey (NFHS-4) in India, a nationally representative cross-sectional survey. A dataset of parent-child dyads was created by merging three separate datasets (children, men, and all household members) using appropriate identifiers. The resulting dataset included information on 33,047 children aged 0-59 months with information on both parents. After further eligibility criteria, the final sample sizes for analysis varied depending on the outcome variable. Outcome variables included: any anthropometric failure (stunting, wasting, underweight); anaemia (mild-moderate and severe); and under-five mortality (neonatal and post-neonatal). Anthropometric measures were taken using standardized WHO guidelines and equipment. Anaemia was diagnosed based on hemoglobin levels measured using HemoCue Hb 201+ machines, adjusted for altitude. Mortality data were based on maternal recall. Predictor variables included parental sociodemographic characteristics (age, age at marriage, education, employment), physical characteristics (height, BMI), behavioral characteristics (tobacco and alcohol use), and the presence of NCDs (diabetes, hypertension). Additional covariates included maternal age at birth, child's age, sex, birth order, area of residence, religion, social group, wealth index, and state of residence. A chi-squared test of independence assessed sample selection bias by comparing included and excluded samples across various socioeconomic characteristics. Multi-variable logistic regression analysis (weighted, using NFHS-4 sample weights) was employed to assess associations between parental characteristics and the primary and complementary outcome measures. Three regression models were used: Model I (adjusted for paternal characteristics); Model II (adjusted for maternal characteristics); and Model III (adjusted for both parental characteristics). All models also controlled for the additional covariates mentioned earlier. Analyses were performed using Stata version 14.

The analysis revealed no significant sample selection bias. The sample distribution showed that over 50% of fathers were aged 30-39 years, while over 70% of mothers were in the 15-29 age group. Most fathers married between ages 21-25, while mothers typically married before age 18. A substantial portion of fathers (over 20%) had no or incomplete primary education, exceeding 30% for mothers. Most parents had BMIs within the 18.50-23.49 kg/m² range. Tobacco and alcohol use, as well as the prevalence of diabetes and hypertension, were higher among fathers than mothers. Key findings from Model III (adjusted for both parental characteristics) are as follows: Compared to fathers aged 15-29, children of fathers aged 30-39 had lower odds of anthropometric failure (OR=0.87, CI=0.77-0.97) and anemia (OR=0.88, CI=0.79-0.98). Children of fathers marrying between ages 18 and 25 had lower odds of under-five mortality than those whose fathers married before 18. Parental education was a protective factor for anthropometric failure, anemia, and under-five mortality. Increasing maternal height was associated with lower odds of anthropometric failure and under-five mortality. Increased paternal and maternal BMI (within certain ranges) correlated with lower odds of anthropometric failure, and maternal BMI (18.50-29.99) also correlated with lower odds of anaemia. Maternal tobacco use was associated with increased under-five mortality (OR=1.50, CI=1.17-1.91). Children of fathers with diabetes had higher odds of under-five mortality (OR=1.36, CI=1.01-1.82). Children of hypertensive mothers had lower odds of anthropometric failure (OR=0.69, CI=0.51-0.94). Supplementary tables provide further detailed analyses of specific categories within the primary outcome variables (e.g., severe stunting, severe anaemia, neonatal mortality).

This study expands on previous research by examining a wider range of parental characteristics and child health outcomes in a nationally representative sample from India. The findings largely support existing literature, demonstrating the protective effects of parental education and higher maternal height. The association between older paternal age and reduced risk of child morbidity aligns with studies showing increased paternal involvement in healthcare. The adverse impact of early paternal marriage on child mortality is a novel and significant finding, meriting further investigation. The study underscores the importance of both maternal and paternal education for improved child health. The results reinforce the negative effects of maternal tobacco use and paternal diabetes, providing further support for targeted interventions. The unexpected finding concerning maternal hypertension and reduced anthropometric failure requires additional investigation to fully understand the underlying mechanisms.

This study highlights the importance of paternal age at marriage, parental education, maternal height, maternal tobacco use, and paternal diabetes in influencing child health outcomes in India. Interventions focusing on delaying marriage for men, promoting parental education, improving maternal nutrition, implementing tobacco cessation programs, and enhancing diabetes management for men could significantly improve child health. Future research should investigate the underlying mechanisms, explore the role of other parental characteristics, and use longitudinal data to establish causal relationships.

The study's cross-sectional design limits causal inferences. Self-reported data might be subject to recall bias and social desirability bias. Potential measurement errors related to the HemoCue device for hemoglobin measurement and general anthropometric measurements should be considered. Future studies should utilize robust longitudinal cohort data to establish stronger causal links and account for potential confounding factors more comprehensively.