THE IMPACT OF CHILD SURVIVAL INTERVENTIONS IN INDONESIA
Embargo until
Date
1990
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
jhu
Johns Hopkins University
Johns Hopkins University
Abstract
Health program evaluations typically are concerned with either
mortality or nutritional status as an outcome variable. Health interventions
can affect both child survival and nutritional status, therefore
an impact evaluation should consider both outcomes. If these are
to be considered simultaneously, the question is how to combine counts
of dead with observations on the living children into a unified index of
health status of a population, since the use of either mortality or nutritional
status alone may give a misleading result. The purposes of the
present study are as follows: first, to determine minimum indicator(s)
that can be used to describe the impact of child survival interventions
using survey data; second, to assess the relative contribution of child
survival interventions and other competing factors affecting health.
In 1988, we conducted a cluster survey that used a complex design
and interviewed 8054 out of 184,129 households from Timor, Indonesia.
A total of 22,440 births were reported to occur among 5,974
married women aged 15 to 49 years. Out of children ever born, 5,292
were born during the last five years, and of these, 282 children were
reported to have died. Only 4715 of these children are finally used
for the assessment of the index of health status. These had data on
nutritional status (anthropometry), child survival interventions (i.e.,
growth monitoring, oral rehydration therapy, immunization status,
antenatal care, and contraceptive use), and socioeconomic factors (i.e.,
maternal education, father’s occupation, availability of latrine, and total
family income) are available.
For all athropometric measurements, we consider under–5 children
with a NCHS/CDC’s Z–score equal to or above −1 as a grade 0
(normal), below −1 to −2 as a grade I, −2 to −3 as a grade II, and
−3 as a grade III of growth faltering. Our index of health status includes
these four grades for surviving children, while a child death
is assigned a grade IV, so that the index of health status is an ordinal
scale variable with 5 possible values. An indirect estimation method is
used to present mortality determinants at the aggregate level, while a
proportional hazard model for grouped data is used to examine determinants
of child survival at the individual level. A generalized linear
model for ordinal data (proportional odds) is used to analyze nutritional
and health status determinants.
Although the mortality level is still high, there is an obvious
trend towards mortality decline in the study area. This decline can
be attributed to adoption of child survival interventions, specifically
growth monitoring, immunization, family planning programs, but cannot
be linked with oral rehydration therapy and antenatal care programs.
More than half of under–5 years old children are underweight
or stunted, and about 16 percent are wasted. Child survival interventions
show no independent effect on the probability of becoming
underweight, stunted, and wasted. The impact of child survival interventions
on health status appears to arise primarily from the protection
of children from death. At the same time, socioeconomic factors
affect child health status primarily through the reduction of growth
faltering. In contrast with the impact of child survival interventions
on mortality, socioeconomic factors did not affect nutritional status
through the utilization of growth monitoring, oral rehydration therapy,
immunization, and family planning programs. Data show strong
evidence that the determinants of mortality do not necessarily act as
determinants of nutritional status.
Among the three indices of health status created (based on weight–
for–age, height–for–age, and height–for–age) the index that involves
weight–for–age is considered the best indicator. This study shows that
ordinary least squares can be used for the assessment of determ
Description
Keywords
New Index of Health, West Timor, Indonesia, Status-Child Survival