Child health and utilisation of health services in Northeast Thailand : socio-economic correlates and cultural explanations

This study examines the patterns and importance of maternal and child health care services utilisation and the extent of the use of health services which influence child health in the Northeast of Thailand. Quantitative and qualitative methods were used to analyse two main sources of data: the cross-sectional data of the 1987 Thailand Demographic and Health Survey and the field research conducted in 1992 in one village in Khonkaen province. The modification of the malnutrition-infection syndrome model developed by van Norren and van Vianen was used as a conceptual basis for the study, and logistic regression was used to examine the predictive power of several sets of explanatory variables for child health status. Nutritional status and diarrhoea morbidity were two measures of child health used in this study. Two nutritional status indicators for children aged 6-36 months identified stunting and underweight. Diarrhoeal morbidity was taken to refer to all children aged 0-59 months who experienced diarrhoea in the two weeks prior to the survey. The study findings indicate that women's use of preventive health services in the Northeast was relatively low. Twenty-two per cent of women did not receive prenatal care, 26 per cent were not given tetanus toxoid injections, 42 per cent of childbirths were assisted by non-modern health providers, and 33 per cent of children aged under five did not possess health record cards. The following conditions were found to reduce the likelihood of using all forms of preventive health service: illiteracy (of the women or their husbands), longer travel time to, longer distance from, and lack of previous contact with health providers, holding place of residence constant. The results also suggested that the local health facilities were under-utilised and that traditional health providers continue to play a major role in providing health care. The results from the case study also revealed dual utilisation of both modern and traditional health services in one Northeast village. Reluctance to use the health centre there was due partly to the perceived inefficiency of the centre, inconvenience, the perceived ineffectiveness of treatment received there, perceived low quality of care, and a negative attitudes towards the local health providers. The use of health services was utilised in the thesis as an interesting variable for child nutritional status and diarrhoea. Malnutrition was moderately prevalent, based on the international standard: 27 per cent of children aged 6-36 months were chronically malnourished and 35 per cent were underweight. Growth retardation and diarrhoea began at very young ages. At ages 3-6 months, 12 per cent of children were already stunted, five per cent were underweight, and 14 per cent had diarrhoea. Logistic regression analysis indicated that, controlling for age of child and place of residence, both chronic malnutrition and underweight were significantly influenced by ownership of radio, maternal height, education (of the mother for stunting and of the father for underweight), and utilisation of preventive health services. The strong influence of utilisation of health services supports the view that preventive health measures are useful predictors of child health. The prevalence of diarrhoea in the Northeast was highly influenced by community variables, place of residence and type of public health services in locations (place of residence was hold constant). This suggests that the improved social and physical environment in urban settings has been instrumental in preventing diarrhoea. Socio-economic variables such as ownership of a refrigerator, radio, and current occupation of mother also had a significant impact on diarrhoea among children under five years of age. Diarrhoea was not always treated or managed in medically appropriate ways. For those who were treated, self-medication was common. In contrast to the TDHS figures, diarrhoeal morbidity was very low in the case study village. The case study found that other infectious diseases, such as fever and cough, were the most prevalent illnesses. The study strongly suggests the complexity of factors influencing child health and nutritional status. Poor health and low nutritional status must be tackled by addressing the several factors intertwined with the direct causes and consequences of diarrhoea and malnutrition. These include socio-economic and environmental factors, hygienic practices, and the provision and use of health services. Current health intervention to improve the health of the children have placed heavy emphasis on the participation of women. However, the case study found that other family members also played important role in childcare and in decision-making about nutrition and the treatment of illness. Among measures to improve the health of children, maternal and child health intervention should be flexible and take into account the practicalities of local daily activities in order to increase effectiveness and place less of a burden on mothers.