Investigating the effects of maternal health knowledge on child health in long an province , luận văn thạc sĩ

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Investigating the effects of maternal health knowledge on child health in long an province , luận văn thạc sĩ

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UNIVERSITY OF ECONOMICS HO CHI MINH CITY VIETNAM INSTITUTE OF SOCIAL STUDIES THEHUGUE THE NETHERLANDS VIETNAM- THE NETHERLANDS PROJECT FOR M.A ON DEVELOPMENT ECONOMICS INVESTIGATING THE EFFECTS OF MATERNAL HEALTH KNOWLEDGE ON CHILD HEALTH IN LONG AN PROVINCE A thesis submitted in partial fulfillment of the requirements for the degree of MASTER OF ARTS IN DEVELOPMENT ECONOMICS BY NGUYEN LE HOANG THUY TO QUYEN BQ a tAO D~JC VA DAO TAO ;; TRUONG DH KINH TE TP.HCMl TIIU VI~N Academic Supervisor: DR NGUYEN VAN PHUC G( ~t\1HO CHI MINH CITY, JUNE 2007 ACKNOWLEDGEMENT I would like to thank my supervisor, Dr Nguyen Van Phuc for his valuable guidance, comments, advice and encouragement during my completion of this thesis Special thanks go to Dr Nguyen Trong Hoai and Dr Nguyen Hoang Bao for their comments from the start of my thesis I am grateful for Dr Arjun Singh Beddi and M.A Truong Dang Thuy for their valuable comments and advice from the initial ideas of the theme for this thesis I also send my gratefulness to my friends Thu, Vy, Quy for their supportive friendship during my study at the Vietnam - Netherlands Program for M.A in Development Economics, especially their kind help during the survey as the enumerators Many thanks are respectfully sent to my parents and my husband for providing me with the opportunity to pursue my goals and for their love and affection, which has motivated me to complete the thesis Equal gratitude goes out to my relatives in Long An Province And last but not least, I would express my deepest thank to 102 households at Can Guoc and Can Duoc Districts, Long An Province for their kind support extended to the enumerators during the survey The thesis is impossibly completed without the continuous support and help of the above people i CERTIFICATION I certify that the substance of this thesis has not already been submitted for any degree and is not being current submitted for any other degree I certify that to the best of my knowledge any help received in preparing this thesis, and all sources used, have been acknowledged in this thesis NGUYEN LE HOANG THUY TO QUYEN Date: 30 June, 2007 ii ABSTRACT Children care and protection are greatly paid attention because children are the future of a country Their health is specially important because it links to development of adult human capital and then the national economy Child health determinants have been studied by many researchers Higher parental education has been identified as a significant contributor to the improvement of child health outcomes in many studies However, the distinct functions of formal education and general health knowledge have not been clarified This paper aims to investigate the effects of maternal health knowledge on child health based on the survey of 102 households at Can Giuoc and Can Duoc Districts, Long An Province Household production theory is employed as a core theory to build up the child health model Other theories including material well-being, public health intervention and cultural behavioral theories are used to give further explanation on the child health determinants Anthropometric indicators of weight-for-age and height-for-age are used as proxies for child health The models are regressed separately for the weight-for-age and height-for-age Z-scores of under five children The research results show that: i) maternal schooling years is somehow proyed to positively impact on child anthropometric outcomes but its effect is crowded out by maternal health knowledge ii) maternal access to health information through pubic media is an important contributor to the improvement of child health iii) genetic inheritance is important but it is inferior to environmental factors such as housing sanitation, health knowledge The findings verify the feasibility of improving Vietnamese stature even under the constraints of limited access to maternal formal education Three policy implications for general education are suggested Firstly, child care attendants are targeted objects of health knowledge education Secondly, periodical training courses are proposed to ensure their acquisition of updated knowledge Thirdly, prenatal care knowledge should be emphasized In addition, the thesis has suggested efficient channels for health propaganda such as public media, child caretakers club, etc iii TABLE OF CONTENTS CHAPTER 1: INTRODUCTION 1.1 PROBLEM STATEMENT • • ••.• • .••• 1.2 RESEARCH OBJECTIVES •.•• • •• •• 1.2.1 General objectives 1.2.2 Specific objectives 1.3 RESEARCH QUESTIONS • • .• .•• • 1.4 RESEARCH HYPOTHESES •.• • •• • • •••• ••• • 1.5 METHODOLOGY .• .••.• .• ••• •.• •• ••• • •• 1.6 RESEARCH SCOPE • ; • ••••• •••• •••.• • 1.7 THESIS STRUCTURE • •• • ••.••• CHAPTER 2: LITERATURE REVIEW 2.1 INTRODUCTION • • •.• • • 2.2 DEFINITION •.•••.• •.•.•• • •.• • 2.2.1 Children 2.2.2 Child health 2.3 CHILDHEALTHMEASUREMENT • .•• .•• , 2.3.1 Mortality rates 2.3.2 Morbidity rates 2.3.3 Anthropometry 2.4 THEORETICAL FRAMEWORK AND EMPIRICAL STUDIES • • .• 14 2.4.1 Household production theory 14 2.4.2 The material well-being theory (or nutrition based theory) 17 2.4.3 The public health intervention theory (or technology-based theory) 19 2.4.4 The cultural behavioral theory 20 2.5 THEANALYTICALFRAMEWORK •• .••• .• .• •• • • 22 2.5.1 Empirical model 22 2.5.2 Variables introduction 23 2.6 SUMMARY • •• •• .• • .••.• 25 CHAPTER3: AN OVERVIEW OF CHILD HEALTH IN VIETNAM 26 3 3.3 3.4 INTRODUCTION • •.•• • • .• ••.•• • BACKGROUND ON CHILD HEALTH POLICIES AND OUTCOMES •• • •.• NUTRITIONAL STATUS OF CHILDREN IN VIETNAM •.• •• .• • • SUMMARY • •.• .• •• •• • • 26 26 29 35 CHAPTER 4: EMPIRICAL ANALYSIS OF CHILD HEALTH IN LONG AN PROVINCE 37 4.1 INTRODUCTION • •• •• • • ••• .••• •• • • • 37 4.2 OVERVIEW OF RESEARCH PLACE • • • .• • • • • • •• • •• 37 4.3 DATA DESCRIPTION • • •••• • • • 39 4.3.1 Sampling method and sample size 39 4.3.2.Description ofvariables 43 4.3.3.Descrptive statistics ofvariables 50 4.4 STRENGTH AND WEAKNESS OF COLLECTED DATA • 57 4.5 MODEL SPECIFICATION• •.•• •• • • ••• .• •• ••• •• • 58 4.6 ESTIMATION STRATEGY .• .• •• 60 4.7 ESTIMATION RESULTS • • 61 4.7.1 Multiple regression results 61 7.2.Interpretation of the results 63 4.8 SUMMARY ••••.•.•.•.•• ••••.• ••.•• • •••• •• ••• • • ••• • 66 CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS 68 5.1 CONCLUSIONS •.•• • • • .••• • •• 68 5.2 RECOMMENDATIONS • ••• •• .• • • 69 iv REFERENCES: 71 APPENDICES: 77 APPENDIX 1: 77 APPENDIX 2: 82 ' APPENDIX 3: 83 APPENDIX 4: 85 APPENDIX 5: 90 LIST OF BOXES BOX 2.1: Vietnamese adults: 25 years, gaining em high BOX 4.1: Child care club at Hoa Thuan Village, Truong Binh, Can Giuoc District 47 BOX 4.2: A case from Phuoc Hoa Village, Truong Binh, Can Giuoc District 66 LIST OF FIGURES FIGURE 3.1: Underweight by age and gender 30 , FIGURE 3.2: Stunting by age and gender 31 FIGURE 3.3: Wasting by age and gender •••.••.••.•••.•.•.• • • 32 FIGURE 3.4: Poor child nutrition by ethnicity and residence 33 FIGURE 3.5: Malnutrition rate of under five children by region and residence 34 FIGURE 3.6: Poor child nutrition by level of maternal education and residence 35 FIGURE 4.1: The distribution ofstunting 85 FIGURE 4.2: The distribution of underweight 85 FIGURE 4.3: Correlation between stunting and underweight 86 FIGURE 4.4: The distribution of explanatory variable "child weight at birth" 86 FIGURE 4.5: The distribution of explanatory variable 'Jather's education" 87 FIGURE 4.6: The distribution of explanatory variable "logarithm offather's education" 87 FIGURE 4.7: The distribution ofexplanatory variable 'Jather's height" 88 FIGURE 4.8: The distribution of explanatory variable "mother's education" 88 FIGURE 4.9: The distribution of explanatory variable "logarithm of maternal education" 89 FIGURE 4.10: JB Test of normal distribution of residuals in HFA regression model •• • 94 FIGURE 4.11: JB Test of normal distribution of residuals in WFA regression model 99 v LIST OF TABLES TABLE 2.1: PIHO classification ofpoor nutrition level in the population 13 TABLE 3.1: Some basic targets of the national strategy on the health care for 2001-2010 27 TABLE 3.2: Total expenditure on health for 1996-2005 27 TABLE 3.3: Actual ratio ofbasic child health indicators 28 TABLE 3.4: Malnutrition rates of under five children in terns ofWFA in some Southeast Asia nations in 2004 29 TABLE 4.1: Administrative units, areas and population in Long An Province 38 TABLE 4.2: Major social indicators at Can Giuoc and Can Duoc Districts 39 TABLE 4.3: Investigated objects 42 TABLE 4.4: Coding system for flags 44 TABLE 4.5: Education level ofparents 45 TABLE 4.6: Maternal health knowledge 46 TABLE 4.7: Maternal exposure to health knowledge providing media 48 TABLE 4.8: Sanitation condition 49 TABLE 4.9: Child weight at birth 50 TABLE 4.10: Descriptive statistics ofexplanatory variables 83 TABLE 4.11: Correlations between maternal education and health knowledge 83 TABLE 4.12: Prevalence ofstunting by gender, district and age group 52 TABLE 4.13: Prevalence of underweight by gender, district and age group 54 TABLE 4.14: Stunting, underweight by maternal education 55 TABLE 4.15: Stunting, underweight by maternal health knowledge 56 TABLE 4.16: Correlations among dependent and independent variables 84 TABLE 4.17: Child health model regression, dependent variable: Height-for-age Z-score 62 TABLE 4.18: Child health model regression, dependent variable: Weight-for-age Z-score 62 TABLE 4.19: Ramsey Reset Test, HFA regression model 90 TABLE 4.20: White's General Heterocedasticity Test, HFA regression model 91 TABLE 4.21: Ramsey Reset Test, WFA regression model 95 TABLE 4.22: White's General Heterocedasticity Test, WFA regression model 96 vi ACRONYMS BLUE Best Linear Unbiased Estimates CHC Commune Health Center CPCC The Committee for Protection and Care of Children CRC Convention on the Rights of the Child EPI Expanded Program of Immunization GSO General Statistics Office FAO Food and Agriculture Organization HFA Height-for-Age HAZ Height-for-Age Z-score JB Jacque-Bera LBW Low Birth Weight LHS Left Hand Side MOH Ministry of Health NCHS National Center for Health Statistics NN Neonatal PNN Post neonatal OLS Ordinary Least Square RHS Right Hand Side SD Standard Deviation usc Under five children UN United Nations UNICEF United Nations Children's Fund u.s United States VLSS Vietnam Living Standards Survey VNHS Vietnam National Health Survey VNNS Vietnam National Nutrition Survey WB World Bank vii WFA Weight-for-Age WAZ Weight-for-Age Z-score WHO World Health Organization viii CHAPTER! INTRODUCTION The chapter starts with the introduction of research topic and places Their selection is rationalized in section 1.1 It then presents research objectives, questions, hypotheses and methodology in sections 1.2, 1.3, 1.4 and 1.5 respectively In addition, research scope is discussed in section 1.6 Finally, the chapter concludes with thesis structure in section 1.1 Problem statement Under-nutrition is problematic in the world because it causes over a half of all child deaths (WB, 2006) To survived children, it impacts on their physical development and leads to underweight (a low weight-for-age), wasting (a low weight- for-height) and stunting (a low height-for-age) The consequence is their frequent disease, low labor productivity when becoming adults and therefore negatively impacts on long-term economic development (Schultz, 2003) In fact, poor nutrition of children 'is an implication of "perpetuate poverty" (WB, 2006) Like other low-income countries, under-nutrition in children under five is a key issue in Vietnam (WHO, 2007) After over a decade of impressive economic growth with yearly average rate of around 7% (GSO, 2006) (I) and government's efforts m developing the primary health care system and national public health programs m Vietnam (UNICEF, 2006), one fourth of the children are still under-nourished in 2005 (UNICEF, 2006) This figure is quite high according to WHO classification of malnutrition level (WHO, 1995) Moreover, it is still far away from what the other countries in the region have achieved For instance, under-nourished rates in China, Malaysia and Mongolia are 8%, 11% and 13% respectively (UNICEF, 2006) Child is under-nourished not only because of having too little food to eat (WB, 2006) Inappropriate child care practices and shortage of health knowledge are also critical chains of undernourished causes (Maire and Delpeuch, 2005) In addition, it's implicated by the cultural behavioral theory that children nutritional benefit may not be (I) Growth rate of GDP of some ASIAN countries, http://www.gso.gov.vn/default_en.aspx?tabid=487&ItemiD=4327 Figure 4.3 Correlation between stunting and underweight 0 0- ~ o 6'o \~Bg_'o -2- o 8o0 co~ cfP 0~ Oo N cP oOd> S0c9000 ~ ~o 0 o 0~@ oCOcP o 0 0 -4 -6 I -8 -6 -4 I -2 HAZ Figure 4.4 Distribution of explanatory variable "child weight at birth" 24 Series: BWEIGHT Sample 1124 Observations 124 20 16 12 86 Mean Median Maximum Minimum Std Dev Skewness Kurtosis 2.902016 2.900000 3.900000 2.100000 0.348889 0.421977 3.007106 Jarque-Bera Probability 3.680260 0.158797 Distribution 4.5 Figure of explanatory 24~- variable "father's Series: FEDUCATION Sample 1124 Observations 124 20 16 12 8 10 12 14 Mean Median Maximum Minimum Std Dev Skewness Kurtosis 8.733871 9.000000 16.00000 1.000000 3.436080 0.138994 2.316065 Jarque-Bera Probability 2.816062 0.244624 16 Figure 4.6 Distribution of explanatory variable "logarithm of father's education" 24 Series: LFEDUCATION Sample 1124 Observations 124 20 16 12 0.0 0.5 1.0 1.5 2.0 2.5 87 Mean Median Maximum Minimum Std Dev Skewness Kurtosis 2.074043 2.197225 2.772589 0.000000 0.467147 -1.094183 5.157510 Jarque-Bera Probability 48.79295 0.000000 education" Figure 4.7 Distribution of explanatory variable "father's height" 28 Series: FHEIGHT Sample 1124 Observations 124 24 20 16 12 Mean Median Maximum Minimum Std Dev Skewness Kurtosis 163.9355 165.0000 180.0000 150.0000 5.406623 0.026545 3.166062 Jarque-Bera Probability 0.157041 0.924483 Figure 4.8 Distribution of explanatory variable "mother's education" 24 Series: MEDUCATION Sample 1124 Observations 124 20 16 12 I !1& Mean Median Maximum Minimum Std Dev Skewness Kurtosis 7.725806 7.000000 15.00000 1.000000 3.345519 0.260946 2.371934 Jarque-Bera Probability 3.445333 0.178589 4 10 12 14 88 Figure 4.9 Distribution of variable "logarithm of maternal education" 24 Series: LMEDUCATION Sample 1124 Observations 124 20 Mean Median Maximum Minimum Std Dev Skewness Kurtosis 16 12 Jarque-Bera Probability 0.0 0.5 1.0 1.5 2.0 2.5 89 1.927501 1.945910 2.708050 0.000000 0.535087 -1.263274 5.467632 64.44204 0.000000 APPENDIX5 5.1 Diagnostic tests ofHFA regression model Ramsey's Reset Test is applied to test whether the model specified suffers from omitted variables or from the wrong functional form Regress the equation Yi =a + ~ BWEIGHT + ~ GENDRC LMEDUCATION +~ MKNOW +~ +~ + ~ FREIGHT + ~ LFEDUCATION +~ CAGE2 SANITATION+ ~ MEDIA+ ~w MHEIGHT Table 4.19 Ramsey Reset Test, HFA regression model 2.140945 7.036794 F-statistic Log likelihood ratio Probability Probability 0.099169 0.070734 Test Equation: Dependent Variable: HAZ Method: Least Squares Sample: 124 Included observations: 124 Variable Coefficient Std Error t-Statistic Prob c BWEIGHT CGENDER CAGE2 FREIGHT LFEDUCATION LMEDUCATION MKNOW SANITATION MEDIA MHEIGHT FIITED"2 FIITED"3 FIITED"4 -19.74669 0.984184 0.143659 -0.077953 0.040973 -0.035905 0.359897 0.145455 0.658359 0.892536 0.037325 0.163230 0.037272 0.006362 5.485322 0.429807 0.211138 0.046497 0.021915 0.262870 0.261031 0.059631 0.198405 0.376213 0.024522 0.120761 0.082213 0.020637 -3.599914 2.289826 0.680400 -1.676530 1.869615 -0.136590 1.378752 2.439232 3.318250 2.372425 1.522137 1.351685 0.453359 0.308273 0.0005 0.0239 0.4977 0.0965 0.0642 0.8916 0.1708 0.0163 0.0012 0.0194 0.1308 0.1792 0.6512 0.7585 R-squared Adjusted R-squared S.E of regression Sum squared resid Log likelihood Durbin-Watson stat 0.671843 0.633061 1.086490 129.8506 -178.8068 2.034747 Mean dependent var S.D dependent var Akaike info criterion Schwarz criterion F -statistic Prob(F -statistic) 90 -0.826935 1.793612 3.109787 3.428206 17.32348 0.000000 y1 y2 + p* (0.05) 3,114 = 2.6842 Wall F-test is carried out It is obvious that Fc-value is not statistically significant at 5% (Fcalculated

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