Determinants of child health in krong buk district, daklak province

THE UNIVERSITY OF ECONOMICS HO CHI MINH CITY VIETNAM INSTITUE F SOCIALS TUD IES THE HAGUE THE NETHERLANDS THE VIETNAM-NETHERLANDS PROJECT FOR M.A PROGRAM IN DEVELOPMENT ECONOMICS DETERMINANTS OF CHILD HEALTH IN KRONG BUK DISTRICT, DAK LAK PROVINCE BY E>OAN TI-Q: THU HUONG IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN ECONOMICS OF DEVELOPMENT SUPERVISOR: DR HO NGQC PHUONG HO CID MINH CITY, 2003 ACKNOWLEDGEMENT I would like to thank the Vietnam - Netherlands Project for MA Program m Development Economics for offering me their scholarship to attend this program I would like to send my gratefulness to all the lecturers and the staff of the program for their helping and providing me with knowledge during my study I would like to thank Dr Ho Ngoc Phuong, my supervisor, Dr Nguyen Van Ngai and MA Nguyen Htiu Loc for their useful advice, comments, and their kindness in my thesis process I would like to thank the local government of Krong Buk district, Buon Ho town and l \ Chu Bao commtme of Dak Lak province, the Krong Buk hospital, the Representative of Ministry of Health in Ho Chi Minh City for providing me with their useful documents I would like to thank Mr Nguyen Ngoc Thinh and his family, Miss H'Brat Nie and her family for their help during my survey in Krong Buk district I would like to thank all my classmates, especially Chung Thuy, Phuong Chi, Minh Phuong, Bich Ngoc, Tan Viet and Van Dung, who are always my companions in my study Finally, my greatest gratefulness belongs to my family, especially my mother With their love and financial suppmt, I am able to overcome my two-year hard study Ho Chi Minh City, September 2003 ii 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 lrnowledge, any help received in preparing this thesis, and all sources used, have been aclrnowledged in this thesis DOAN THI THU HUONG Date: September 08 2003 ii,i ABSTRACT In 2001, Dak Lak, a province locating in Central Highlands of Vietnam, still had the highest rates of undernutrition of children under five years old in comparison with other provinces The National Institute of Nutrition concludes that one of the reasons causing child malnutrition is that child nutritional knowledge of the parents and putting this knowledge into practice within a household is not improved much Therefore, this thesis aims to study whether the improvement in parent's education influences child health status in Ede group, a native ethnic minority in Dak Lak province, or not Beside that, other characteristics of the household and the child will also be examined to find out the determinants of child malnutrition in Ede group Based on the results, this thesis suggests some policy implications as well iv TABLE OF CONTENTS CHAPTER : INTRODUCTION ; 1.1 PROBLEM STATEMENT 1.2 OBJECTIVES OF THE STUDY 1.3 RESEARCH QUESTIONS 1.4 RESEARCH HYPOTHESIS 1.5 RESEARCH METHODOLOGY 1.6 THESIS DESIGN CHAPTER : LITERATURE REVIEW 2.1 DEFINITIONS : 2.1.1 Human capital 2.1.2 Household 2.1.3 Health 2.1.4 Indices of nutritional status 2.1.4.1 Height for age 2.1.4.2 Weight for height 2.1.4.3 Weight for age 2.1.5 Nutritional conditions 2.1.5.1 Stunting : 2.1.5.2 Wasting 10 2.1.5.3 Underweight 10 2.2 HUMAN CAPITAL THEORY 10 2.3 THE ECONOMICS OF HOUSEHOLD BEHAVIOUR 12 2.4 ECONOMIC MODELS OF HOUSEHOLD BEHAVIOUR RELATING TO HEALTH 16 2.4.1 Household production functions and reduced-form demands for health and nutrients 16 2.4.2 Child health production model 20 2.4.3 Bargaining model of household behaviour 23 2.4.4 Dynamicproductionfunctions 24 2.5 EMPIRICAL STUDIES 25 2.5.1 Papua N~w Guinea 25 2.5.2 Mozambique 26 2.5.3 Vietnam 27 2.6 CONCLUSION 28 CHAPTER : OVERVIEW OF CHILD HEALTH CARE IN KRONGBUK BUK DISTRICT, DAI( LAK PROVINCE 31 v 3.1 AVERAGE POPULATION AND HEALTH BUDGET 31 3.2 MALNUTRITION RATE OF CHILDREN UNDER FIVE YEARS OLD 32 3.3 INFANT MORTALITY 33 3.4 IMMUNIZATION 33 3.5 CONCLUSION 35 CHAPTER 4: MODEL SPECIFICATION AND RESEARCH METHODOLOGY 36 4.1 MODEL SPECIFICATION 36 4.1.1 Variablejustification 36 4.1.2 Model specification 41 4.2 RESEARCH METHODOLOGY 42 4.2.1 Data requirement 42 4.2.2 Calculating height for age index 42 4.2.3 Choosing sample size 43 4.2.4 Method of sampling 44 4.2.5 Analysis methods 44 4.3 CONCLUSION 45 CHAPTER 5: EMPIRICAL ANALYSIS OF CHILD HEALTH IN KRONG BUK DISTRICT, DAK LAK PROVINCE 46 5.1 DESCRIPTIVE ANALYSIS , 46 5.1.1 Univariate analysis 46 5.1.1.1 Measures oflocation ." .46 5.1.1.2 Measures of dispersion 47 5.1.2 Bivariate analysis 48 5.1.2.1 The relationship between malnutrition and sex and age of children 51 5.1.2.2 The relationship between malnutrition and family location 54 5.1.2.3 The relationship between malnutrition and parents' education 55 5.1.2.4 The relationship between malnutrition and number of children in a household 58 5.1.2.5 The relationship between malnutrition and household's expenditure 59 5.1.2.6 The relationship between malnutrition and mother's possibility of speaking Vietnamese 60 5.1.2.7 The relationship between malnutrition and the interval between two births 61 5.2 REGRESSION ANALYSIS 62 5.2.1 Regression result 62 5.2.2 Diagnostic testing 63 5.2.2.1 Testing for omitted variables and incorrect functional form 63 5.2.2.2 Testing for heteroscedasticity 64 5.2.2.3 Testing for multicollinearity 64 5.2.2.4 Testing for normality 64 5.2.3 Interpretation of the regression results 65 vi 5.2.3.1 Effects of child's characteristics 65 5.2.3.2 Effects of household's characteristics 65 5.2.3.3 Effects of community's characteristics 67 5.3 CONCLUSION 67 CHAPTER : CONCLUSION AND RECOMMENDATION 69 6.1 CONCLUSION 69 6.2 POLICY IMPLICATIONS 69 6.3 LIMITATION OF THE STUDY 71 APPENDIX 72 BIBLIOGRAPHY 85 vii LIST OF FIGURES Figure 2.1 Parents exhibit equal concern between children 14 Figure 2.2 Parents exhibit greater concern for child A 14 Figure 3.1 Malnutrition rate of children under 5, Krong Buk district 32 Figure 3.2 Fully vaccinated coverage among children under 1, Krong Buk district 34 Figure 5.1 The distribution of residuals 65 Figure A2.1 The distribution of HAZ 79 Figure A2.2 The distribution of MOAGEBI 79 Figure A2.3 The distribution ofFAEDU 80 Figure A2.4 The distribution of MOEDU 80 Figure A2 The distribution ofFAHEI 80 Figure A2 The distribution of MOREl 81 Figure A2 The distribution ofEXPMON 81 Figure A2.8 The distribution ofNUMCHI : 81 viii LIST OF TABLES Table 2.1 Summary of empirical studies 29 I Table 3.1 Average population and Health budget, I