Access to Health Services and Early Age Mortality in Ende, Indonesia
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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.
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.
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.
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.
KeywordsIndonesia Infant mortality Socioeconomic factors Maternal-child health services
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
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.
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