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Maternal Agency Influences the Prevalence of Diarrhea and Acute Respiratory Tract Infections Among Young Indonesian children

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Abstract

To examine the relationship between measures of mother’s caretaking, practice and individual agency on acute diarrhea and respiratory tract infections (ARTIs) of Indonesian children. Using population-based household data from the Indonesian Demographic Health Surveys for 2002–2003 (n = 9,151 children) and 2007 (n = 9,714 children), we selected 28 indicators related to mother’ caretaking, and applied principal component analysis to derive indices for access to care, practice and experience, and agency. The association between index quartiles (level 1–4) and the prevalence of diarrhea and ARTIs in the youngest child <5 years of age was assessed with multivariate logistic regression adjusting for socioeconomic status, residence type, mother’s age and education, family size, child’s age and sex, immunization status and received vitamin A supplementation. Moderate levels (level 3) of practice and experience were associated with decreased diarrheal risk (adjusted OR 0.86, 95 % CI 0.75–0.98), but not for ARTIs. Children of mothers with higher levels (level 4) of agency were protected against both diarrhea (adjusted OR 0.68, 95 % CI 0.60–0.77) and ARTIs (adjusted OR 0.77, 95 % CI 0.66–0.91). Stratified analyses with child’s age and mother’s education, and tests of interaction, showed that agency had a stronger effect on diarrhea and ARTIs prevalence in children <2 years of age. Maternal caretaking, especially agency, is strongly associated with lower prevalence of diarrhea and ARTIs in younger children. Interventions specifically designed to promote maternal autonomy and decision-making may lead to improved child health.

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Acknowledgments

RA received a scholarship to attend the course and workshop at the Harvard School of Public Health entitled ‘Analysis of Health and Nutrition Data from Low-Income Countries’, and support for manuscript preparation and analysis, from the Higher Education Network Ring Initiative (HENRI) Program, a partnership supported by a grant from the United States Agency for International Development-Indonesia (Cooperative Agreement AID-497-A-11-00002) to the Harvard School of Public Health in partnership with, and with in-kind contributions from, the SEAMEO Regional Centre for Food and Nutrition, University of Mataram, Andalas University, the Summit Institute of Development, and Helen Keller International, with additional contributions from the Rajawali Foundation and Harvard Kennedy School Indonesia Program.

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

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Authors and Affiliations

  1. SEAMEO RECFON (Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition), University of Indonesia, P.O. Box 3852, Jakarta, 10038, Indonesia

    Rina Agustina

  2. Department of Nutrition, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia

    Rina Agustina

  3. Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Anita V. Shankar

  4. Department of Epidemiology, Harvard School of Public Health, Harvard University, Boston, MA, USA

    Azalea Ayuningtyas

  5. Faculty of Public Health, University of Indonesia, Depok, West Java, Indonesia

    Endang L. Achadi

  6. Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, MA, USA

    Anuraj H. Shankar

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  1. Rina Agustina
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Correspondence to Rina Agustina.

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Agustina, R., Shankar, A.V., Ayuningtyas, A. et al. Maternal Agency Influences the Prevalence of Diarrhea and Acute Respiratory Tract Infections Among Young Indonesian children. Matern Child Health J 19, 1033–1046 (2015). https://doi.org/10.1007/s10995-014-1603-z

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