The Indian Journal of Pediatrics

, Volume 79, Issue 5, pp 612–618 | Cite as

Access to Health Services and Early Age Mortality in Ende, Indonesia

  • T. Adair
  • J. F. Pardosi
  • C. Rao
  • S. Kosen
  • I. U. Tarigan
Original Article

Abstract

Objective

Improvements in child survival to achieve Millennium Development Goal 4 require highly accessible and effective maternal and child health (MCH) services. This article seeks to fill the gap in information for local government in Indonesia about early age mortality and access to appropriate care to inform the evaluation and planning of MCH services.

Methods

The Ende Child Mortality Survey (ECMS) was conducted in the district of Ende in Nusa Tenggara Timur (NTT), one of the poorest provinces in Indonesia. The ECMS is a cross-sectional household survey, providing information on child survival, MCH service utilisation, and socio-economic characteristics of the population. Multivariate logistic regression was conducted to examine the association of mortality, health service utilisation and socio-economic variables.

Results

Use of an unskilled birth attendant (45% of births) and giving birth at home are most common among the poorest and least educated women. The children of these women have the highest risk of infant mortality. The infant mortality rate differs greatly by region within Ende. Time to the preferred provider of child health care is longest in regions with the highest under-five mortality risk.

Conclusions

Many women in Ende do not receive vital interventions during labour to reduce infant mortality. The ECMS demonstrates the feasibility in implementing a low cost survey to provide evidence for MCH investments to improve accessibility to appropriate health services and reduce mortality risk.

Keywords

Indonesia Infant mortality Socioeconomic factors Maternal-child health services 

Notes

Contributions

TA: manuscript writing, the data analysis and research design; JP: design of the survey, training of interviewers, planned and coordinated field work, data analysis and manuscript writing; CR: research design, data analysis and manuscript writing; SK: research and survey design, and field work logistics; IT: training of field interviewers, and planning and coordination of field work.

Conflict of Interest

None.

Role of Funding Source

The field research conducted in Ende was supported by a research grant from the Australian Agency for International Development (ROU 45918), which included support to the University of Queensland staff (TA and CR); as well as a travel scholarship for Jerico Pardosi. SK and IT are government employees of the Ministry of Health in Indonesia.

References

  1. 1.
    UN. The Millennium development goals report 2010. New York: United Nations; 2000.Google Scholar
  2. 2.
    Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, the Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet. 2003;362:65–71.PubMedCrossRefGoogle Scholar
  3. 3.
    Burke L, Suswardany DL, Michener K, et al. Utility of local health registers in measuring perinatal mortality: A case study in rural Indonesia. BMC Pregnancy Childbirth. 2011;11:20.PubMedCrossRefGoogle Scholar
  4. 4.
    Black RE, Cousens S, Johnson HL, et al. Global, regional and national causes of child mortality. Lancet. 2010;375:1969–87.PubMedCrossRefGoogle Scholar
  5. 5.
    Gwatkin D, Rutstein S, Johnson K, Wagstaff A. Socio-economic differences in health, nutrition and population in Indonesia. Washington, DC: HNP/Poverty Thematic Group of the World Bank; 2003.Google Scholar
  6. 6.
    BPS. Laporan bulanan: data sosial ekonomi, Februari 2011 (Monthly report: socio-economic data, February 2011), Edition 9. Jakarta: Badan Pusat Statistik; 2011.Google Scholar
  7. 7.
    Statistics Indonesia, Macro International. Indonesia Demographic and Health Survey 2007. Calverton: BPS and Macro International; 2008.Google Scholar
  8. 8.
    BPS, ORC Macro. Indonesia Demographic and Health Survey 2002–2003. Calverton: Badan Pusat Statistik-Statistics Indonesia and ORC Macro; 2003.Google Scholar
  9. 9.
    Australia Indonesia Partnership. Australia Indonesia Partnership for Maternal and Neonatal Health (AIPMNH). Canberra: AusAID; 2011. http://www.aipmnh.org Date accessed: 23 February 2011.
  10. 10.
    MEASURE DHS. Demographic and Health Surveys: about DHS. Calverton, MD: ICF Macro; 2011. http://www.measuredhs.com/aboutdhs/ Date accessed: 30 July, 2011
  11. 11.
    Rutstein SO, Johnson K. The DHS wealth index. DHS Comparative Reports no. 6. Calverton: MEASSURE DHS; 2004.Google Scholar
  12. 12.
    MEASURE DHS. Early childhood mortality rates. Calverton, MD: ICF Macro; 2011. http://www.measuredhs.com/help/Datasets/Methodology_of_DHS_Mortality_Rates_Estimation.htm Date accessed: 5 January 2011.
  13. 13.
    Kirkwood B, Sterne J. Essential medical statistics. 2nd ed. Malden: Blackwell Science Ltd; 2003. pp. 237.Google Scholar
  14. 14.
    Vittinghoff E, Glidden DV, Shiboksi SC, McCulloch CE. Regression methods in biostatistics: linear, logistic, survival, and repeated measures models. New York: Springer; 2005. pp. 312.Google Scholar
  15. 15.
    Mosley WH, Chen LC. An analytical framework for the study of child survival in developing countries. Popul Dev Rev. 1984;10:25–45.CrossRefGoogle Scholar
  16. 16.
    StataCorp. Stata 11. College Station: StataCorp; 2009.Google Scholar
  17. 17.
    Bhutta ZA, Ahmed T, Black RE, et al. Maternal and child undernutrition: What works? Interventions to affect maternal and child undernutrition and survival globally. Lancet. 2008;371:417–40.PubMedCrossRefGoogle Scholar
  18. 18.
    Niehof A. Mediating roles of the traditional birth attendant in Indonesia. In: van Bemmelen S, Djajadiningrat-Nieuwenhuis M, Locher-Scholten E, Touwen-Bouwsma E, eds. Women and Mediation in Indonesia. Leiden: KITLV Press; 1992. pp. 167–86.Google Scholar
  19. 19.
    Caldwell JC. Education as a factor in mortality decline: An analysis of Nigerian data. Popul Stud. 1979;33:395–413.CrossRefGoogle Scholar
  20. 20.
    Pebley AR, Goldman N, Rodriguez G. Prenatal and delivery care and childhood immunization in Guatemala: Do family and community matter? Demography. 1996;33:231–47.PubMedCrossRefGoogle Scholar
  21. 21.
    de Souza AC Terra, Petersen KE, Andrade FMA, et al. Circumstances of post-neonatal deaths in Ceara, Northeast Brazil: Mothers’ health care-seeking behaviors during their infants’ fatal illness. Soc Sci Med. 2000;51:1675–93.CrossRefGoogle Scholar
  22. 22.
    Kristiansen S, Santoso P. Surviving decentralisation? Impacts of regional autonomy on health service provision in Indonesia. Health Policy. 2006;77:247–59.PubMedCrossRefGoogle Scholar
  23. 23.
    Thouw J. Delegation of obstetric care in Indonesia. Int J Gynecol Obstet. 1992;38:S45–7.CrossRefGoogle Scholar
  24. 24.
    Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361:2226–34.PubMedCrossRefGoogle Scholar
  25. 25.
    Pelletier D. Relationship between child anthropometry and mortality in developing countries: implications for policy, programs and future research. J Nutr. 1993;124:2047–81.Google Scholar
  26. 26.
    Shah NM, Shah MA. Socioeconomic and health care determinants of child survival in Kuwait. J Biosoc Sci. 1990;22:239–53.PubMedCrossRefGoogle Scholar
  27. 27.
    Adair T. Child outpatient care utilisation in the mega-urban regions of Jabotabek, Bandung and Surabaya. J Population. 2006;12:21–57.Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2011

Authors and Affiliations

  • T. Adair
    • 1
  • J. F. Pardosi
    • 1
    • 2
  • C. Rao
    • 1
  • S. Kosen
    • 2
  • I. U. Tarigan
    • 2
  1. 1.School of Population HealthUniversity of QueenslandHerstonAustralia
  2. 2.National Institute of Health Research and Development, Ministry of HealthJakartaIndonesia

Personalised recommendations