Child Malnutrition in Indonesia: Can Education, Sanitation and Healthcare Augment the Role of Income?

Sumarto, Sudarno and de Silva, Indunil (2015): Child Malnutrition in Indonesia: Can Education, Sanitation and Healthcare Augment the Role of Income? Published in: TNP2K Working Paper Sries (9 October 2015)

Abstract

In spite of sustained economic growth and progress in poverty reduction, the status of child nutrition in Indonesia is abysmal, with chronic malnutrition rates continuing to remain at very high levels. In this backdrop, this study attempts to shed light on the channels through which various socioeconomic risk factors affect children’s nutritional status in Indonesia. We investigated the impact of child, parental, household characteristics, access and utilization of healthcare, and income effects on children’s height-for-age and on the probability of early childhood stunting. Using recent data from IFLS surveys and Indonesia’s National Health Survey, and controlling for an exhaustive set of socioeconomic factors, the study revealed that maternal education, water and sanitation conditions, household poverty and access to healthcare strongly influence chronic malnutrition in Indonesian children. Child stunting rates were surprisingly high even in the wealthiest quintile of households, implying that income growth will not automatically solve the nutritional problem. Our findings bear important policy implications and represent a further step towards an improved understanding of the complex determinants of child malnutrition. As a policy recommendation, we suggest the implementation of direct supply-side policies aimed at child malnutrition. In particular, two kinds of strategies are noteworthy. First to maximize impact, nutrition-specific interventions targeting the poorest and high burden regions in Indonesia may include, for example, breastfeeding promotion, vitamin and mineral supplements, improved sanitation facilities, public healthcare services and insurance coverage. Second, adopting nutrition-sensitive development planning across all sectors in the country will help ensure that development agendas fully utilize their potential to contribute to reductions in child malnutrition in Indonesia .

• Item Type: MPRA Paper
• Language: English
• Keywords: Child nutrition, Malnutrition, Stunting, Quantile regression, Indonesia.
• Subjects: D - Microeconomics > D0 - General > D01 - Microeconomic Behavior: Underlying Principles; D - Microeconomics > D1 - Household Behavior and Family Economics; I - Health, Education, and Welfare > I1 - Health; I - Health, Education, and Welfare > I1 - Health > I12 - Health Behavior

References

Abdulai, A. and Aubert, D. (2004). Nonparametric and parametric analysis of calorie consumption in Tanzania. Food Policy, Vol. 29: 113-129.

Alderman, Harold, Jere R. Behrman, Victor Lavy, and Rekha Menon. (2001). “Child Health and School Enrollment: A Longitudinal Analysis” The Journal of Human Resources 36(1): 185-205.

Anand, S. and C. J. Harris. (1992). “Issues in the Measurement of Undernutrition.” In Nutrition and poverty. New York: Oxford University Press Inc.

Aneweke T., and Kumar S., (2012) The effect of a vaccination program on child anthropometry: evidence from India’s Universal Immunization Program. Journal of Public Health 34(4): 489–497.

Angeles Imelda T., Werner J. Schultink, Paul Matulessi, Rainer Gross, and Soemilath Sastroamidjojo. (1993). “Decreased Rate of Stunting among Anemic Indonesian Preschool Children through Iron Supplementation.” American Journal of Clinical Nutrition 58(3): 339- 42.

Arnold, B., and J. Colford., (2007). Treating Water with Chlorine at Point-of-Use to Improve Water Quality and Reduce Diarrhea in Developing Countries: A Systematic Review and Meta-Analysis. American Journal of Tropical Medicine and Hygiene 76(2): 354–64.

Aturupane, H., A.B.Deolalikar and D.Gunewardena, (2011). “Determinants of Child Weight and Height in Sri Lanka: A Quantile Regression Approach”, Health Inequality and Development, edited by M. McGillivray, I. Dutta and D. Lawson, United Nations University.

Bhargava, Alok. (1992). “Malnutrition and the Role of Individual Variation with Evidence from the India and the Philippines. Journal of the Royal Statistical Society, Series A (Statistic in Society) 155 (2): 221- 231.

Barber, S., and P. Gertler (2002) “Child health and the quality of medical care.” Mimeo.

Becker, G. S. (1981): A Treatise on the Family. Harvard University Press, Cambridge, MA.

Behrman, Jere R and Anil B. Deolalikar (1987). “Will Developing Country Nutrition Improve with Income? A Case Study for Rural South India”, Journal of Political Economy 95(3):108-138

Behrman, J. R., and A. B. Deolalikar (1988): Health and Nutrition vol. 1 of Handbook of Development Economics, chap. 14, pp. 631–711. Elsevier Science.

Behrman, J., and B. Wolfe. 1987. “How Does Mother’s Schooling Affect Family Health, Nutrition, Medical Care Usage, and Household Sanitation?” Journal of Econometrics 36(1–2):185–204.

Borooah, V. A. (2005). ‘The height-for-age of Indian children’, Economics and Human Biology, 3, 45-65.

Bouis, H. E. (1994). The effect of income on demand for food in poor countries: Are our food consumption databases giving us reliable estimates? Journal of Development Economics Vol.44: 199-226.

Boyle, M., Y. Racine, K. Georgiades, D. Snelling, S. Hong, W. Omariba, P. Hurley, and P. Rao-Melacini. (2006). “The Influence of Economic Development Level, Household Wealth and Maternal Education on Child Health in the Developing World.” Social Science & Medicine 63:2242–54.

BROCKERHOFF, M. and L.F. DEROSE (1996): "Child survival in East Africa: The impact of preventive health care," World Development, 24, 1841-1857.

Cebu Study Team. (1992). “A Child Health Production Function Estimated from Longitudinal Data.” Journal of Development Economics 38(2): 323-51.

Christiaensen, L., and Alderman, H., (2004). Child malnutrition in Ethiopia: can maternal knowledge augment the role of income?. Economic Development and Cultural Change 52(2), 287-312.

Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC (2007) Effects of birth spacing on maternal health: a systematic review. American Journal of Obstetrics & Gynecology. 196: 297–308.

Clasen, T., W. Schmidt, T. Rabie, I. Roberts, and S. Cairncross. (2007). Interventions to Improve Water Quality for Preventing Diarrhoea: Systematic Review and Meta-Analysis. British Medical Journal 334: 782–91.

Curtis, V. & Cairncross, S. (2003). Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. The Lancet Infectious Diseases. 3(5), 275-281.

Cutler, David M., and Grant Miller (2005). "The Role of Public Health Improvements in Health Advances: The Twentieth-Century United States," Demography 42, no. 1 (February 2005): 1-22.

Dewey K. and Cohen R. (2007) “Does birth spacing affect maternal or child nutritional status? A systematic literature review”. Maternal & Child Nutrition vol.3, No.3, 151–173.

Filmer, L., and L. Pritchett (1998): “Estimating wealth effects without expenditure data – or tears : with an application to educational enrollments in states of India”, World Bank Policy Research Working Paper no. 1994.

Fiszbein, Ariel, and Norbert Schady. (2009). Conditional Cash Transfers: Reducing Present and Future Poverty. Washington, DC: World Bank.

Foster, Phillips. (1992). The world food problem: tackling the causes of undernutrition in the third world. Boulder: Lynne Rienner Publishers, Inc.

Gibson, J. and S. Rozelle (2002). How elastic is Calorie Demand? Parametric, Nonparametric, and Semi-parametric Results for Urban Papua New Guinea. Journal of Development Studies 38(6): 23-46.

Glewwe, P., (1999). Why does mother's schooling raise child health in developing countries? Evidence from Morocco. Journal of human resources 34(1), 124-159.

Gopalan, G. 1992. “Undernutrition: Measurement and Implications.” In Nutrition and poverty. New York: Oxford University Press Inc.

Guilkey, D., and R. T. Riphahn. 1998. “The Determinants of Child Mortality in the Philippines: Estimation of a Structural Model.” Journal of Development Economics 56(2):281–305.

Haddad, L., and J. Hoddinot (1994): "Woman's income and boy-girl anthropomorphic states in Cote d'Ivoire," World Development, 22, 543-553.

Haddad, L., Alderman, H., Appleton, S., Song, L., Yohannes, Y., (2003). Reducing child malnutrition: How far does income growth take us?. The World Bank Economic Review 17(1), 107.

Hien, N and, Kam S (2008) Nutritional status and the characteristics related to malnutrition in children under five years of age in Nghean, Vietnam. Journal of Preventive Medicine & Public Health 41(4): 232–240.

Hoddinott (1997). "Water, Health, and Income: A Review." Food Consumption and Nutrition Division Discussion Paper No. 25. International Food Policy Research Institute, Washington, D.C.

Howlader, A. A. and M. U. Bhuiyan (1999) "Mothers' health-seeking behaviour and infant and child mortality in Bangladesh," Asia-Pacific Population Journal, 14, 59-75.

Hodge A, Firth S, Marthias T, Jimenez-Soto E (2014) Location Matters: Trends in Inequalities in Child Mortality in Indonesia. Evidence from Repeated Cross-Sectional Surveys. PLoS ONE 9(7): e103597. doi:10.1371/journal.pone.0103597.

Hong, R., J. Banta, and J. Betancourt. 2006. “Relationship between Household Wealth Inequality and Chronic Childhood Under-nutrition in Bangladesh.” International Journal for Equity in Health 5:15.

Hong, R., and V. Mishra. 2006. “Effect of Wealth Inequality on Chronic Undernutrition in Cambodian Children.” Journal of Health Population and Nutrition 24(1):89–99.

Indonesia, Ministry of Health. (2008). Riset Kesehatan Dasar (Riskesdas) 2007: Laporan Nasional 2007. Jakarta: Badan Penelitian dan Pengembangan Kesehatan.

Keys A, Brozek J, Henschel A, Mickelsen O & Taylor HL (1950) The Biology of Human Starvation. Oxford, MN: University of Minnesota Press.

Klasen, S. (2008), “Poverty, undernutrition, and child mortality: Some interregional puzzles and their implications for research and policy,” Journal of Economic Inequality, 6, 89–115.

Koenker, R. and Bassett, G. (1978), “Regression quantiles”, Econometrica, Vol. 46, pp. 33-50.

Kremer, M., J. Leino, E. Miguel, and A. Zwane. (2009). Spring Cleaning: Rural Water Impacts, Valuation, and Institutions. NBER Working Paper, no. 5280. Cambridge, MA, USA: National Bureau of Economic Research.

Lavy, Victor, John Strauss. Duncan Thomas and Philippe de Vreyer. (1996). "Quality of Health Care, Survival and Health Outcomes in Ghana” Journal of Health Economics, 15: 333-357.

Lewis, S.A. and J.R. Britton, 1998. “Consistent effects of high socioeconomic status and low birth order, and the modifying effect of maternal smoking on the risk of allergic disease during childhood”, Respiratory Medicine, 1998 Oct, 92(10):1237-44.

Lin, A., et al. (2013). Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. American Journal of Tropical Medicine and Hygiene. 89(1), 130-137.

Mani, S. (2014), Socioeconomic Determinants of Child Health: Empirical Evidence from Indonesia. Asian Economic Journal, 28: 81–104. doi: 10.1111/asej.12026.

Masset, E. and H. White (2003): “Infant and Child Mortality in Andhra Pradesh: Analysing changes over time and between states,” Young Lives Working Paper No. 8.

Mosley, W. H., and L. C. Chen. 1984. “An Analytical Framework for the Study of Child Survival in Developing Countries.” Population and Development Review 10 (Supplement):25–45.

Myers, R. (1988). "Effects of Early Childhood Intervention on Primary School Progress and Performance in Developing Countries: An Update, 1985. The High Scope Educational Research Foundation, 1988.

Park, C. (2010), “Childrens Health Gradient in Developing Countries: Evidence From Indonesia”. Journal of Economic Development, Volume 35, Number 4, December 2010.

Peabody, J., Gertler, P. and A. Leibowitz (1998) “The policy implications of better structure and process on birth outcomes in Jamaica” Health Policy 43(1), 1-13.

Pitt, M. M., and M. R. Rosenzweig (1985): “Health and Nutrient Consumption Across and Within Farm Households,” Review of Economics and Statistics, 67(2), 212–223.

Ramalingaswami, V., Jonsson, U., and Rode, J. (1996), “The Asian enigma,” in The Progress of Nations, 1996: The Nations of the World Ranked Accordingto Their Achievements in Child Health, Nutrition, Education, Family Planning, and Progress for Women., ed. Adamson, P., New York.

Roemling, C., and M. Qaim. (2012). Obesity Trends and Determinants in Indonesia. Appetite 58 (3): 1005–13.

Sahn, D. E. (1990): "The impact of export crop production on nutritional status in Cote d'Ivoire," World Development, 18, 1635-1653.

Sahn, D.E. and D.C. Stifel (2003) Exploring Alternative Measures of Welfare in the Absence of Expenditure Data, Review of Income and Wealth, 14(4): 463–89.

Sandiford, P., J. Cassel, M. Montenegro, and G. Sanchez. 1995. “The Impact of Women’s Literacy on Child Health and its Interaction with Access to Health Services.” Population Studies 49(1):5–17.

Semba RD, de Pee S, Sun K, Sari M, Akhter N, et al. (2008) Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet 371: 322–328.

Shrimpton R. (2012). The Double Burden of Malnutrition in Indonesia. The World Bank. Jakarta, Indonesia.

Smith L.C. and Haddad L., (1999). Explaining Child malnutrition in developing countries: A cross-country analysis, FNCD Discussion paper No.6, IFPRI, Washington D.C.

Sparrow, R.; Suryahadi, A.; Widyanti, W, (2010). Social Health Insurance for the Poor: Targeting and Impact of Indonesia’s Askeskin Program; The SMERU Research Institute: Jakarta.

Ssewanyana, S.N. (2003) Food Security and Child Nutrition Status among Urban Poor Households in Uganda: Implications for Poverty Alleviation. African Economic Research Consortium, Research Paper 130

Stevens GA, Finucane MM, Paciorek CJ, Flaxman SR, White RA, Donner AJ, Ezzati M (2012), on behalf of Nutrition Impact Model Study Group (Child Growth). Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data. Lancet. 2012; 380:824 — 34.

Spears, D. (2013). How much international variation in child height can sanitation explain? Policy Research Working Paper 6351. World Bank, USA.

Subramanian, S. and Deaton, A. (1996): The Demand for Food and Calories. Journal of Political Economy, 104 (1).

Subramanyam MA, Kawachi I, Berkman LF, Subramanian SV (2011). Is economic growth associated with reduction in child undernutrition in India? PLoS Med 2011;8:e1000424. doi: http://dx.doi.org/10.1371/journal.pmed.1000424 PMID:21408084.

Strauss, J. (1990), “Households, communities and preschool child nutrition outcomes: Evidence from rural Côte d'Ivoire”, Economic Development and Cultural Change, 38(2):231-261.

Strauss, J. and D. Thomas (1995) ‘Human resources: Empirical Modeling of Household and Family Decisions’, in J. Behrman and T.N. Srinivasan (eds), Handbook of Development Economics, vol. 3. Amsterdam; North-Holland.

Strauss, J., and D. Thomas (1998): “Health, Nutrition and Economic Development,” Journal of Economic Literature, 36(2), 766–817.

Strauss, J., Beegle, K., Sikoki, B., Dwiyanto, A., Herawati,Y. andWitoelar, F. (2004). The ThirdWave of the Indonesian Family Life Survey (IFLS3): Overview and Field Report, WR-144/1-NIA/NICHD, the RAND Corporation.

Suharyo, W., and and Grede, N., (2014). “The next Indonesian government should focus on reducing stunting”, The Opinion, Jakarta Post. October 2014.

Svedberg, P. (1990). Undernutrition in Sub-Saharan Africa: Is there a gender bias?. The Journal of Development Studies 26(3), 469-486.

Thomas, D., and Strauss, J., 1993. Prices, infrastructure, household characteristics and child height. Journal of Development Economics 39, 301–331.

Thomas, D., Lavy, V., Strauss, J. (1996). Public policy and anthropometric outcomes in Cote d'Ivoire. Journal of Public Economics 61, 155–192.

Todaro, Michael P. and Stephen C. Smith. (2003). Economic development. 8th ed. Singapore: Pearson Education.

Trapp, Erin, M., and J. Menken (2005): “Assessing Child Nutrition: Problems with Anthropometric Measures as a Proxy for Child Health in Malnourished Populations,” Working Paper, Research Program on Population Processes, Institute of Behavioral Sciences, University of Colorado, Boulder.

UNICEF-United Nations Children's Fund (1990). "Strategy for Improved Nutrition of Children and Women in Developing Countries." United Nations. New York.

UNICEF - United Nations Children's Fund. (2010). Progress for Children: Achieving the MDGs with Equity. New York: United Nations. New York.

UNICEF-United Nations Children's Fund (2013). Improving Child Nutrition - The achievable imperative for global progress. United Nations. New York

UNICEF-United Nations Children's Fund (2014). Committing to Child Survival: A Promise Renewed – Progress Report 2014. United Nations. New York.

Van de Poel E, Hosseinpoor AR, Speybroeck N, Van Ourti T, Vega J (2008) Socioeconomic inequality in malnutrition in developing countries. Bulletin of the World Health Organization 86(4): 282–291.

Wagstaff, A., Van Doorslaer, E., Watanabe, N., 2003. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. Journal of Econometrics 112(1), 207-223.

WHO - World Health Organization (2008). Safer Water, Better Health: Costs, Benefits, and Sustainability of Interventions to Protect and Promote Health. Geneva.

World Bank (2008). Investing in Indonesia’s Health: Challenges and Opportunities for Future Public Spending. Health Public Expenditure Review. The World Bank. Jakarta, Indonesia.

Zere, E., and McIntyre, D. (2003). Inequities in under-five child malnutrition in South Africa. International Journal for Equity in Health 2(7).