Educating girls for a healthier Cambodia: The impact of education on girls' health knowledge, attitudes, and practices

Abstract

Introduction In recent decades, studies from developing countries have shown that maternal education is strongly correlated with child health. Many government agencies and non-governmental organisations have used this evidence to emphasise the importance of educating girls and women as an effective means of improving population health in the long-term.

The relationship between maternal education and child health, though evident in many studies, is still not clearly understood. The differences between educated women and non-educated women are also indicative of wider socio-economic, cultural, and environmental differences that suggest that educated and non-educated women may be more influenced by other factors besides whether or not they have been to school.

Furthermore, the immediate impact of education on girls' health knowledge, attitudes, and behaviours, which may eventually affect both maternal and child health, has often been overlooked by researchers. An investigation of health knowledge and practices of young women may offer further insight into the mechanisms which determine their future children's health.

As a developing country, Cambodia's leading causes of mortality and morbidity are from communicable diseases. Many of the country's inhabitants have limited access to adequate sanitation and water, health facilities, and schools. Although many humanitarian organisations and government and non-government agencies are working to improve the situation in Cambodia, little research has been conducted to determine effective strategies to improve the present and future health and well-being of young Cambodians.

Purpose The purposes of this study were to evaluate the impact of schooling on young Cambodian women's health knowledge, attitudes, and practices, as well as to evaluate the health impact of a specific programme of the Cambodian Arts and Scholarship Foundation (CASF) that provides scholarships to young women.

Methods Qualitative and quantitative data were collected using face-to-face interviews following a piloted, structured questionnaire. Three comparison groups were identified: CASF scholarship recipients, non-CASF students, and out-of-school participants. Eligible participants were selected by local informants and interviewed in Khmer or Bunong. Additional information was collected during focus groups with local villagers and interviews with village chiefs.

Results Between April and August 2005, data were collected from 82 face-to-face interviews, nine village focus groups, and four interviews with village chiefs, in three Cambodian provinces and Phnom Penh.

In-school and out-of-school participants lived in substantially different environments, primarily because in-school participants were more likely to live in rural areas (94.0%) than out-of-school participants (30.0%). Residence was an important determinant for access to hygiene and sanitation facilities, which would affect health practices and outcomes.

Health practices improved among in-school participants, both CASF and non-CASF, although in CASF students, these improved practices were not reflected in health outcomes. Despite being in school, CASF students had similar health outcomes to out-of-school participants as regards self-reported health state and recent diarrhoeal disease incidence.

Health knowledge of out-of-school participants was better than in-school participants, particularly for tuberculosis transmission and prevention methods. However, better health knowledge did not necessarily lead to improved health practices.

Conclusion Although hand washing and other health practices were better and more consistent in the in-school groups, the poor health of CASF students suggests that education and improved health practices may not be sufficient in improving young people's health. Any benefits that may arise from educating girls may be overshadowed by an unhealthy physical environment, such as lack of toilets in communities and schools, inadequate access to safe water, and poor air quality. Socio-economic status also plays a huge role in the health status of young women, which, in the short term, at least is not mitigated by schooling.