UNIVERSITY OF ECONOMICS INSTITUTE OF SOCIAL STUDIES HO CHI MINH CITY THEHUGUE VIETNAM THE NETHERLANDS VIETNAM- THE NETHERLANDS PROJECT FOR M. 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 ;; Academic Supervisor: TRUONG DH KINH TE TP. NGUYEN VAN PHUC TIIU VI~N G( ~tt\1-~ HO CHI MINH CITY, JUNE 2007 UAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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 UAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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 UAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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 UAN VAN CHAT LUONG download : add luanvanchat@agmail.com TABLE OF CONTENTS CHAPTER 1: INTRODUCTION. 4 CHAPTER 2: LITERATURE REVIEW. THEORETICAL FRAMEWORK AND EMPIRICAL STUDIES.
Household production theory.2 The material well-being theory (or nutrition based theory). The public health intervention theory (or technology-based theory). The cultural behavioral theory. 25 CHAPTER3: AN OVERVIEW OF CHILD HEALTH IN VIETNAM.
BACKGROUND ON CHILD HEALTH POLICIES AND OUTCOMES. NUTRITIONAL STATUS OF CHILDREN IN VIETNAM. 35 CHAPTER 4: EMPIRICAL ANALYSIS OF CHILD HEALTH IN LONG AN PROVINCE. OVERVIEW OF RESEARCH PLACE •.
Sampling method and sample size .Descrptive statistics ofvariables. STRENGTH AND WEAKNESS OF COLLECTED DATA. Multiple regression results .Interpretation of the results. 66 CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS.
69 iv UAN VAN CHAT LUONG download : add luanvanchat@agmail. 90 LIST OF BOXES BOX 2.1: Vietnamese adults: 25 years, gaining 2 em high .1: Child care club at Hoa Thuan 2 Village, Truong Binh, Can Giuoc District .2: A case from Phuoc Hoa Village, Truong Binh, Can Giuoc District. 66 LIST OF FIGURES FIGURE 3.1: Underweight by age and gender .2: Stunting by age and gender .3: Wasting by age and gender .4: Poor child nutrition by ethnicity and residence .5: Malnutrition rate of under five children by region and residence .6: Poor child nutrition by level of maternal education and residence .1: The distribution ofstunting .2: The distribution of underweight .3: Correlation between stunting and underweight .4: The distribution of explanatory variable "child weight at birth" .5: The distribution of explanatory variable 'Jather's education" .6: The distribution of explanatory variable "logarithm offather's education" .7: The distribution ofexplanatory variable 'Jather's height" .8: The distribution of explanatory variable "mother's education" .9: The distribution of explanatory variable "logarithm of maternal education" .10: JB Test of normal distribution of residuals in HFA regression model.11: JB Test of normal distribution of residuals in WFA regression model. 99 v UAN VAN CHAT LUONG download : add luanvanchat@agmail.com LIST OF TABLES TABLE 2.1: PIHO classification ofpoor nutrition level in the population .1: Some basic targets of the national strategy on the health care for 2001-2010 .2: Total expenditure on health for 1996-2005 .3: Actual ratio ofbasic child health indicators .4: Malnutrition rates of under five children in terns ofWFA in some Southeast Asia nations in 2004 .1: Administrative units, areas and population in Long An Province .2: Major social indicators at Can Giuoc and Can Duoc Districts .4: Coding system for flags .5: Education level ofparents .6: Maternal health knowledge .7: Maternal exposure to health knowledge providing media .9: Child weight at birth .10: Descriptive statistics ofexplanatory variables .11: Correlations between maternal education and health knowledge .12: Prevalence ofstunting by gender, district and age group .13: Prevalence of underweight by gender, district and age group .14: Stunting, underweight by maternal education .15: Stunting, underweight by maternal health knowledge .16: Correlations among dependent and independent variables .17: Child health model regression, dependent variable: Height-for-age Z-score .18: Child health model regression, dependent variable: Weight-for-age Z-score .19: Ramsey Reset Test, HFA regression model.20: White's General Heterocedasticity Test, HFA regression model .21: Ramsey Reset Test, WFA regression model .22: White's General Heterocedasticity Test, WFA regression model.
96 vi UAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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. United States VLSS Vietnam Living Standards Survey VNHS Vietnam National Health Survey VNNS Vietnam National Nutrition Survey WB World Bank vii UAN VAN CHAT LUONG download : add luanvanchat@agmail.com WFA Weight-for-Age WAZ Weight-for-Age Z-score WHO World Health Organization viii UAN VAN CHAT LUONG download : add luanvanchat@agmail.com CHAPTER! INTRODUCTION The chapter starts with the introduction of research topic and places. Their selection is rationalized in section 1. It then presents research objectives, questions, hypotheses and methodology in sections 1.
In addition, research scope is discussed in section 1. Finally, the chapter concludes with thesis structure in section 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.vn/default_en.aspx?tabid=487&ItemiD=4327 1 UAN VAN CHAT LUONG download : add luanvanchat@agmail.com maximized if their mothers are not empowered with health knowledge. Evidence is recently accumulated that an increase in female's education accounts for 43% decline in child under-nutrition while food security only contributes to 26.1% of child under- nutrition reduction (Watson, 2006). Education is one of the channels to provide mothers with health knowledge through which child health is improved (Glewwe, 1998). However, other channeJs are also important to raise maternal health knowledge.
It is obvious that health knowledge can be achieved through maternal accessing to health related information sources such as watching television, listening to the radio, reading newspapers and magazines, etc. It's worth for policy implications to examine the effect of the latter on child health improvement. This paper aims at examining the effects of maternal health knowledge perceived from various channels as mentioned above on child health at Can Giuoc and Can Duoc Districts, Long An Province It's hoped that the findings of this research are useful for the local government and key health decision makers at local and international agencies in planning and setting priorities for education strategies to improve child health at Can Giuoc and Can Duoc Districts, Long An Province in particular and child health in Vietnam in general. General objective The general objective of the paper is to examine the effects of maternal health knowledge on child health at Can Giuoc and Can Duoc Districts, Long An Province.