Relation between Social Determinants of Maternal Health and Child Development: A Path Analysis

Authors

1 Professor, MD, Pediatrician, MPH, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences. Tehran, Iran.

2 PhD, Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Associate Professor, Community Medicine, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

4 Professor, Biostatistician, Department of Biostatistics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background: Since several factors, rather than a single cause, contribute to developmental delay in children, identification of the condition's risk factors and their pathway of effects are critical to the design and implementation of appropriate intervention .This study aimed to determine the relation between social determinants of maternal health and child development in Iranian mothers and their children.
Materials and Methods: In this analytical cross-sectional study, the subjects were recruited from mother-child health clinics located at general hospitals affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran). A total of 950 mothers and their children were selected using cluster sampling. Based on the WHO conceptual framework of Social determinants of health (SDH) and review of literature, this model was proposed. The questionnaires used for data gathering were: Beck’s Depression Inventory II (BDI-II), Spiel Berger's State-Trait Anxiety Inventory (STAI), the 12-item MSPSS questionnaire for social support, Cohen’s measure of perceived stress, the Ages and Stages Questionnaires (ASQ) of infant developmental status, and socio-economic status questionnaire. The data and theoretical Path Model were analyzed using SPSS software version 19.0 and Lizrel 8.8 software.
Results: The mean of Mother’s age was 28.05±4.22 years old.The percentage of children with suspected delay was 12.2%. The final path model fitted well (RMSEA=0.049 GFI=1). Maternal Socioeconomic status had the greatest direct, indirect, and total effects on child development (βTotal=0.35377), and maternal depression had the second most significant direct effects on child development (β= -0.17).
Conclusion: The proposed path model regarding the effects of maternal socioeconomic status, perceived social support, perceived stress, anxiety and depression, on the developmental status of 6 to 18 month-old children, fitted well.

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