The impact of mothers eduction on child health bevidence from MICS4 vietnam

1.3 Research scope and data This study focus on: - The women’s education levels - Child health - Some other variables: such as the height-for-age z-score, the household income wealth in

UNIVERSITY OF ECONOMICS INSTITUTE OF SOCIAL STUDIES

HO CHI MINH CITY THE HAGUE

VIETNAM THE NETHERLANDS

VIETNAM - NETHERLANDS

PROGRAMME FOR M.A IN DEVELOPMENT ECONOMICS

THE IMPACT OF MOTHER’S EDUCATION ON

CHILD HEALTH:

EVIDENCE FROM MICS4 - VIETNAM

A Thesis Submitted in Partial Fulfilment of the Requirement for the Degree of

MASTER OF ARTS IN DEVELOPMENT ECONOMICS

By

TRAN TRUNG THU

Academic Supervisor:

Dr TRUONG DANG THUY

HO CHI MINH CITY, December 2014

DECLARATION

I would like to declare that this thesis, titled “THE IMPACT OF MOTHER’S EDUCATION ON CHILDREN HEALTH: EVIDENCE FROM MICS4 - VIETNAM”, is original, which is submitted in fulfilment of the requirements for the degree of Master of Art in Development Economic s to the Vietnam – The Netherlands Programme I ensure that this paper has not been submitted anywhere for the award of any degree

This thesis was completed with big support from my supervisor All source s

of data and information have been fully cited in the thesis

TRAN TRUNG THU

MDE19

ACKNOWLEGDEMENT

First of all, I would like to express my greatest gratitude to my respectful

supervisor, Dr Truong Dang Thuy, for his valuable knowledge in helping me

complete this study I would like to express my thanks to him, who helped and supported me through interesting courses, especially his valuable advice, guidance and inspiration, which motivate me to finish this study

I also want to express my thanks to all Professors of the MDE Programme during the past two years (2012 -2014), my friends from Class MDE 19, and administrative staffs of Economic Development Faculty, University of Economics HCMC (UEH), who provided me useful documents and materials

Finally, I would like to express my deeply appreciation to my dear family during the time I follow this grogram for their spiritual and physical supports In particular, I dedicate this thesis to my mother, who has been helping me virtually during the process of conducting my thesis

HCMC, December 2014 TRAN TRUNG THU

MDE 19

ABSTRACT

This study aims to examine the relationship between mother’s education and children health in Vietnam Data are taken from The Vietnam Multiple Indicator Cluster Survey (MICS) by the General Statistics Office of Vietnam, the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) The main finding of this study in Vietnam is consistent with other studies

in the world about mother’s education and children health The result of this study

in Vietnam showed that mother’s education is an important factor of the health of children Thus, they can provide better environment such as provid ing safe water for their house and their children The result also provides new evidence to the general literature that flushing toilet does not really affect children health in Vietnam

Table of Contents

DECLARATION 2

ACKNOWLEGDEMENT 3

ABSTRACT 4

LIST OF TABLES 7

CHAP TER 1: INTRODUCTION 8

1.1 Problem statement 8

1.2 Research objectives 11

1.3 Research scope and data 11

1.4 The structure of this study 12

CHAP TER 2: LITERATURE REVIEW 13

2.1 The relationship between mother’s education on child health 13

2.2 The impacts of all other factors 17

2.3 Conceptual framework 20

CHAP TER 3: RESEARCH METHODOLOGY 22

3.1 Model and Data 22

3.1.1 Model 22

3.1.2 Variables 23

3.2 Data 27

3.3 28

Research hypotheses 30

CHAP TER 4: EMPIRICAL RESULTS 32

4.1 Descriptive statistics 32

33

4.2 Bivariate analysis 35

4.3 The regression results 39

CHAPTER 5: CONCLUSION 43

5.1 Conclusion remarks 43

5.2 Limitations and future research of the study 44

REFERENCES 46

APPENDIX 50

LIST OF TABLES

Table 1: Variables of the study 23

Table 2: Mean, Std.dev., minimum and maximum from MICS abour HAZ z-score 32

Table 3: Percent of HAZ z-score divided five parts 33

Table 4: Percent of mother's education level 33

Table 5: Percent of wealth index quintiles 34

Table 6: Percent of households who use safe water and use flushing toilet 34

Table 7: Mother's education and HAZ 35

Table 8: Wealth index quintiles and HAZ 36

Table 9: Variables of use safe water, mother's education and HAZ 37

Table 10: Variables of use flushing toiler, mother's education and HAZ 38

Table 11: Ordinary least squares estimates of the effect of mother's education on the health of children 39

CHAPTER 1: INTRODUCTION 1.1 Problem statement

Child malnutrition is not only one of the key issues in the world but also especially pervasive in almost any low income nations and Vietnam because the poorest quintile of children usually has the highest ratio of malnutrition

What is malnutrition? When nutrients in meal are not enough or perhaps are too much, it can lead to malnutrition Children who suffer from malnutrition can have health problems such as a weakened immune system, infections, mental retardation, brain damage or even HIV/AIDS which lead to a high risk of developmental delay

Many children even can be at this damaged risk caused their mother don’t get proper nourishment Even after recovering from this issue, they still remain stunted in their lives In reality, more than 200 million children in all developing countries under age 5 years old were not provided with a good enough environment

to reach their developmental potential (Grantham-Mc Gregor et al., 2007)

There have been many efforts in many countries to bring out solutions which can reduce the number of malnourished children It is very important for national security issues in the long time for any nations about human resources and economics In particular, this serious problem is occurring in developing countries However, it varies from region to region and from country in order to country such

as in South/Southeast Asia, Latin America or perhaps Sub-Saharan Africa Therefore, many countries try to estimate which factors affect child health, particularly health and nutritional inputs, medicines, medical care or perhaps the quality of household drinking water sources, toilet facilities, and other hygienic conditions or household assets, parental schooling, community economic and health-related characteristics (Glewwe, 1999)

From many factors above, there are numerous studies found out the important role of parental schooling, especially mother’s education It is believed

that increased education of mothers may be an important means for improvement of child health or perhaps their nutrition As a result, they can provide safer environment from their earnings or beneficial food as well as health habits; thus, mothers are given chances in order to improve the nutrition of their children

However, the results of the relationship of mother’s educ ation and child health were not the same from country to country Hobcraft et al (1984) suggested that because of large socio-economic differentials among countries, the relationship between mother’s education and child survival were different amount countries This result is covered 28 World Fertility Surveys by Hobcraft et al (1984) In detail, increased education of mothers was an important factor in order to improve opportunities of child survival in larg e area of developing countries They pointe d out that because of l arge socio -economic differentials from country to country in child survival (from age one and five) , increased age of the child were widened Both mother’s and father’s levels of education also play an important role in de termining child survival The father’s occupation also related to this variable In detail, the father’s education variable increased opportunities of child survival This result improved even with a small increasing levels of education

Mensch et al (1985) also covered from 15 countries and had the same result

as Hobcraft et al (1984) They both pointed out that because of large economic differentials, the above association was weaker in sub-Saharan Africa than in Asia or particularly Latin America Furthermore, Mensch et al (1985) also suggested that the relationship between maternal education and child survival was the same in any regions (include in rural and urban areas)

socio-In Bangladesh, Lindenbaum (1990) suggested that educated women can keep greater cleanliness which explained differentials in child mortality or incidence of diarrhoeal episodes While Cleland (1990) combined the international evidence between diarrhoean episodes and maternal education The author believed that education maybe play an important role in determining health knowledge, which

leads to a more innovative attitude for women who can have more opportunities in order to have some experience of school

When comparing Bolivia, Egypt and Kenya, Stewart and Sommerfelt (1991) covered from 25 Demographic and Health Surveys They showed out that the woman’s own educational level can effect on prenatal care and mother’s education in urban was more powerful than in rural in Bolivia and Egypt while Kenya has weakly significant in this relationship after controlling urban-rural residence, a possessions index, father’s education, age, births, mother’s education, family-planning use In Kenya, at least, the urban-rural residence variable appeared to have strong significant

Malnutrition of children under five is also the key issue in Vietnam, as many low-income countries (WHO, 2007) UNICEF reported that 50 percent of Vietnamese children under 5 were stunted (abnormally low height for age) in

1993 In 2005, this figure has been improved with 25 percent of children (UNICEF, 2006) because of economic growth and sustained investment in primary healthcare

Haughton et al (1997) also showed large differences across regions and ethnic groups in malnutrition of children in Vietnam That means the greater levels of malnutrition is concentrated on families in the northern regions, rural households and ethnic families more than the rest National institute of nutrition and UNICEF (2011) mentioned that stunting of children under 5 was about 29.3 percent and the average rate reduced at 1.3 percent points per year in 5 years from 1995 to 2010

It is reported that around 60% of all under 5 dead who suffer neonatal mortality; a third of children under 5 are affected by stunting malnutrition, anaemia Moreover, the rate of overweight children is increasing year by year; and children older than 1 year old often die because of drowning and traffic accidents There are still many problems regarding children health in Vietnam remain to be settled due to the limited quality of healthcare services in mountainous areas;

neonatal conditions and diseases; stunting malnutrition and anaemia; drowning and traffic accidents (WHO, Child health in Vietnam - Fact sheet, 2010)

In summary, there have been many factors which can affect on child health in the above studies in various countries However, there have only some descriptions in Vietnamese reports about the role of mother’s education in determining their child health Therefore, whether or not this relationship persists the same in Vietnam In order to answer this question, some factors mentioned above will be applied to estimate which can explain in detail

1.2 Research objectives

This study intents to: Evaluate the relationship between mother’s education and child health in Vietnam

1.3 Research scope and data

This study focus on:

- The women’s education levels

- Child health

- Some other variables: such as the height-for-age z-score, the household income (wealth index quintile), health environment (drinking water and flushing toilet) in Vietnam from the data of MICS4

1.4 The structure of this study

Except the introduction and the references chapter, this study is divided into 4 chapters as follows:

Chapter 2: Literature review which reviews literature and empirical studies

on the relationship between mother’s education and children health This chapter discusses the results of these studies and compares the factors which can impact the relationship such as whether the difference between father’s education and mother’s education, between adopted children and own birth children, or other socio-economic dimensions such as ethnicity, geographical location, gender and assets or a wide variety of social and economic circumstances, behaviors matter and community factors Finally, it also provides the conceptual framework

Chapter 3: Research methodology This chapter presents the research

methodology, data source and regression technique Finally, hypotheses are also mentioned in

Chapter 4: Empirical results This chapter will present the statistic descriptions

of the data as well as bivariate analysis After that, it will discuss and provide evidence from the regression results on the findings of the association mother’s education and children health

Chapter 5: Conclusion This chapter will summarize the main findings of

the study from the empirical results It also present the limitations and suggests the directions for future research

CHAPTER 2: LITERATURE REVIEW

This chapter will review the literature on the relationship between mother’s education and children health The empirical studies on this association will be discussed as well as compared in detail such as the difference between father’s education and mother’s education, between adopted children and own birth children, or perhaps among other socio-economic dimensions, and then finally, between at national and individual level

2.1 The relationship between mother’s education on child health

The mother’s education has been the focus of economist There also have some papers also showed out the same result that women’s schooling appears to have an important positive impact on children’s health as well as nutrition in developing countries

The conclusion of Grossman M., (1972) suggested that an increasing in an individual’s stock of knowledge may improve an ability to process information regarding, fertility options and healthy pregnancy behaviors In detail, the more educated could have opportunities to choose a larger optimal stock of health through an improvement in wage rates This conclusion is generally about what a person’s stock of knowledge could impact on by estimating the shadow cost or the opportunity cost of the time However, education is seemly not enough to consider child health While the conclusion leads to some other questions related to father’s education or mother’s education, household income, options for houses and behaviors for child health

Mother’s income is applied to consider in study of Willis J.R (1973) This author covered from his individual data on the number of children born in America when focusing on the demand for child quality and the supply of child services The author has pointed out that the association of education and health will make an increasing in women’ permanent income which leads to their optimal choices for

taking care of their children That means the demand for child quality increased which leads to the supply of child services because of an improvement of mothers’ income when mothers’ income is associated with their education

In other studies, there have also been some evidence illustrating the effect

of mother to their children Case, A (2000) had some important information which we applied for our paper The important application of this analysis is to project the impact of mothers’ education on their children that when mother has better education as well as job, their earnings is used for influencing health through nutrition, and helped to reduce mother’s stress while taking care their children There are good reasons to expect policies from government to improve education for mothers in order to improve children’s health, education, and productivity in all their life

Why is children’s health important? To explore this question, after Currie and Stabile (2003) covered from panel data on Canadian children, they studied that health shocks of children impact on test scores and future health That means their potential development will be damaged by health shocks Thus, it is important to identify which factors can affect health of the next generation of any countries

After Currie & Moretti (2003) covered from Vital Statistics Natality data for 1970 to 1999, they found out that higher maternal education play an important role in improve infant health (measured by birth weight, gestational age) They believed that more educated mother can be able to afford more health care and have healthier behaviors as well as better earnings or even raise family income by marrying a highly educated man

However, Berhman & Wolfe (1987) found out the different result that children’s health outcomes were not improved by mother’s schooling, however it may inprove their nutrient That means this result was different with the standard estimates when they covered their cross-section data from Nicaragua They suggested that mother’s schooling generally develops children health However,

they also brought out an evidence of an indirect impact of mother’s schooling on children health through nutrition – the length of breastfeeding

The health gap between own birth child and adopted child are also concerned

in some studies, however Y.Chen & Li (2009) showed that child health is effected

by the mother’s education through the nurturing effect while the nature effect is not really necessary Because after their series of sensitivity tests and other papers, the authors could not find out an evidence in order to ensure that the different between adoptees and own birth children

Sacerdote (2000) also used three long-term panel data sets (adopted children, their adoptive parents, and their biological parents) from the British National Child Development Survey, the Colorado Adoption Project, and the National Longitudinal Survey of Youth (NLSY79) in order to examine the above problem This author found out that the association of adoptive parents’ education, income and children developmental potential In detail, adoptive parents’ education and income appeared to have a large impact on college attendance, marital status, and earnings of children’ future

Following Plug and Vijverberg (2003, 2004) and Plug (2005), they also did not show out evidence that their estimations was affected by the adoptees and own birth children variables However, adopted children’s health is believed that they are better because of the nurturing effect That means the mother’s education played an important role in determining the health of adopted children Thus, they can find information to know how to take care carefully health of children Even after controlling these variables: income, the number of siblings, health environment, and other socio-economic, the impact of education of women on adoptee sample or the own birth sample is similar Therefore, there is no difference of the effect of the mother’s education on the adoptee sample and the own birth sample However, it is doubted that parents can choose in among abandoned children which help them have children in better situation

A next question related to adopt child is whether more educated mothers select their adopt child through health Generally, it is believed that adopted children did not have their information on the birth parents or their health included

in the case of China (Y.Chen & Li (2009)) Because of one-child policy, most families in China have been trying to make sure their next generation who is boy Chinese parents only abandoned disabled or ill boys, while abandoned girls are generally normal Therefore, most of adopted children are girls (around 90 percent

of abandoned infants and around 80 percent of the adoptees) Because abandonment in China is illegal, thus these children are abandoned in very early months, in detail, most of parents have to abandon children in the first six months, therefore adoptive parents cannot select children Finally, there is no evidence to ensure that parents will choose children whose health is better Thus, after finding out about adopt children, education of parents is considered: mother’s education or father’s education?

The next question is that the association of father’s education or perhaps mother’s education and child health Whether or not the difference of the child health is when comparing father’s education and mother’s education To explore this question, Behrman (1997) believed that increasing education of women is an important means for children as well as has a greater beneficial educational than increasing men’s schooling This author also showed out that even when mothers have the same abilities, those with higher levels of schooling maybe provide a better environment for their children in order to receive potential development (such as greater academic and then labor-market performances)

Following Berhman & Rosenzweig (2002) concluded that an increase in women’ schooling would not impact on the schooling of children That means it

is difficult to ensure women help their children to study more, because it is still a decision of children for their future However, increasing mother’s education in the similar environment can improve children outcomes, such as their health

In Vietnam, generally fathers have more opportunities to attain qualified education than mothers do, thus, father’s education can be an important variable Y.Chen & Li (2009) covered their data in China and found that fathers have more education than mothers generally The tradition of China and Vietnam is similar Thus, in China, the authors also believed that father’s education may play an important role However, after testing, Y.Chen & LI (2009) stated that the mother’s education is still more important than, though the difference is small

2.2 The impacts of all other factors

There have many papers argued that health status can be explained by other socio-economic dimensions Following Gwatkin et al (2007), they applied 120 indicators as in four categories: health status (child nutritional level); use of basic health services (antenatal care, treatment of common childhood illnesses); health-related behaviors (smoking and alcohol use); and other health-status determinants (education) It is also mentioned some other indicators such as income, ethnicity, geographical location, gender and assets or perhaps a wide variety of social as well

as economic circumstances, behaviors matter and community factors (the psychological state of the primary care-giver, weaning and other feeding practices, the social norms and behaviors that govern sexual transmission of diseases, and the natural occurrence of trace minerals and vitamins available in soils and foods, water and sanitation, vaccination coverage)

From above variables, O’Donnell et al (2008) suggested that income may play an important role in determining children health They covered data from the

1993 and 1998 Vietnam Living Standards Surveys in order to estimate the association of the changes of the distribution of child nutritional status (through the distribution of child height) and the changes in the level and distribution of income Their result showed that one-half of the 15-pong fall in the ratio of children malnutrition (stunted) can be explained by changes in the distributions of income Therefore, income appears to have strong positive impact o n children health As a

result, household income help to expand opportunities to purchase not only health care but also sanitation, food and other determinants of nutrition

Case et al (2002) pointed out other evidence from income that children health is related to household income They found out that a part of this relationship can be explored by the effect and the arrival of chronic conditions Indeed in this research, they believed that children health from lower-income households are worse than those from higher-income households Therefore, higher-income families can have opportunities to provide a better environment (water and toilet) in order to take care their children who will have better health with effective child care arrangements, greater academic and performance in labor-market

In addition, it is also believed that the intergeneration transfer of economic status begins in very early life or even in the womb Thus, many researches tried to find out which factors appear to have strong positive to children’s health, as a part of the intergeneration transfer Following Case et al (2002) showed out that the impact of parents’ income on children’s health c an explain a part of this issue by transferred their income to nutrition of their children While Y.Chen & Li (2009) provided information that the mother’s education has a nurturing effect on children’s health Therefore, children health can be considered to

socio-be determined by the households’ income and mother’s education

However, Pradhan, et al (2003) argued that the determinants of health status need to be looked at national and individual level Because at national or individual level, child health can be impacted on at many levels At national level, it can be considered as health care systems of nations or growth rate And at individual level,

it can be considered as sanitation of households of household income Which are these indicator important?

At the national level, national incomes can be considered to be determined

by health status (health expenditures, social service infrastructure, education, and environmental infrastructure) O’Donnell, et al (2008), also suggested that

through improvements in commune infrastructure and reduction in negative public health externalities – the nutrition quality in community could be improved However, it is difficult to estimate the association of health care systems and health of each child in each family

Skoufias (1998) covered from cross-sectional household data from the 1994 Integrated Household Survey of Romania This author estimated the associatio n of socioeconomic, demographic or perhaps environmental factors and growth attainment of pre-school (0-5 year old) And finally they concluded that nation income does not affect child health in urban areas when estimating child health during the economic transition in Romania Thus, child health cannot be explained

by nation income based on regions Therefore, it is required to find out other monetary variables to determine the relationship

After using from household survey data from 12 countries and data on malnutrition rates in a cross-section of countries from the 1970s, Haddahs el al (2003) also found that it is required to have 6% growth in incomes per capita for

20 years to help reducing the ratio of stunted children aged 5 years old, however

in fact, the ratio of stunting in this age group was decreased 15 percent points while growth ratioin five years was close to the forecast They concluded that growth ratio can explain how malnutrition reduces, however the malnutrition variable cannot explained by only this growth income That means that the target and programmes for nutrition cannot rely on economics growth alone

At the individual level, household income can be considered to play an important variable to explain child health or malnutrition, because when families have greater incomes at the household level, they can expand more opportunities

in order to invest more in food consumption, clean water as well as good hygiene

As a result, those can help parents to afford better child care arrangements (Haddahs et al 2003)

On the other hand, O’Donnell et al (2008) pointed out that household income helped to explain 15% of the fall in the ratio of children stunted Moreover,

adding safe drinking water and sanitation variables, helped to explain 35% of the fall in this Thus, malnutrition is declined by other factors or household income rather than GDP Therefore, child health can be explained by community infrastructure variables, such as water and sanitation, drug availability or household level covariates, such as education of various members, composition

Sahn and Alderman (1997) also used data from Maputo, Mozambique in order to estimate the impact of houshold resources or health inputs They found out two conclusions First, mother’s education is a good variable to explain nutritional status of children two years of age and younger Second, an increase in household incomes affect child health of children two years of age and older

In general, the results of the studies examining the association of mother’s education and children health are not the same level among countries, however, their tendency of this relationship is closed This study is to identify the relationship between mother’s education and children health in Vietnam from MICS4

2.3 Conceptual framework

The below factors are mentioned in the above parts It is easily to realize that three points of view to identify the association of mother’s education and children health

Firstly, Berhman (1997), Sahn & Alderman (1997), Berhman & Rosenzweig (2002) and Gross M (1972) suggested that mother’s education impacts on children health directly, such as an increasing in healthy pregnancy behaviors or a good variable to explain nutritional status of children two years of age and younger

Secondly, more educated mother can have better earnings which can impact

on child health Indeed in Willis J.R (1973) suggested that mother’s income is improved which help an increasing in demand of child quality While Currie and Stabile (2003), O’Donnell et al (2008) pointed out mother’s income can afford more health care and have healthier behaviors

Thirdly, authors agreed that mother’s education have strong positive significant with their income And their income can be transferred to nutrition It is showed in studies of Case, A (2000), Case et al (2002), Y.Chen & Li (2009) and (Haddahs et al 2003) While Berhman & Wolfe (1987) pointed out in detail about the length of breastfeeding

While Sahn and Alderman (1997) found out that an increase in household incomes affect child health of children two years of age and older, O’Donnell et al (2008) showed in detail that household income helps to expand opportunities to purchase not only health care but also sanitation, food and other determinants of nutrition Case et al (2002) and Haddahs et al (2003) also pointed out higher-income families can have opportunities to provide a better environment (water and toilet) in order to take care their children who will have better health with effective child care arrangements, greater academic and performance in labor-market

Finally, this conceptual framework helps to provide an overview of all variables which used in this research

CHAPTER 3: RESEARCH METHODOLOGY

First, this chapter will present the model and data source of this study then the conceptual framework Finally, hypotheses will be mentioned and discussed the impact of each factor on the dependent variable

3.1 Model and Data

3.1.1 Model

I am interested in these variables: mother’s education, water and sanitation conditions and household income which can explain child health through HAZ z-score In detail, HAZ z-score is affected by mother’s education, safe drinking water, flushing toilet and the wealth index quintiles

This is the standard model, currently, there has no study which provide

another model for this problem (The β o , β 1 , β 2 , β 3 , β 4, β 5 , β 6, β 7 and β 8 are the

corresponding vectors of coefficients, ε is the residual.) Thus, I began by

decomposing the standard function into components related with the above variables This study uses model below to examine the effect of the mother’s education on child health (Y.Chen & Li, 2009):

HAZ i = β o + β 1 melevel 1i + β 2 melevel 2i + β 3 wiq 1i + β 4 wiq 2i + β 5 wiq 3i +

+ β 6 wiq 4i + β 7 dtoilet i + β 8 dwater i + ε i

3.1.2 Variables

dwater i = 1 if household i uses safe water

= 0 otherwise ( + )

The above variables in Table 1 are explained in detail:

HAZ

Pradhan, et al (2003) also argued that there have been some difficulties problems when trying to compare incomes or perhaps socio-economic variables to health status by time or even place Especially, constructing income as well as expenditure measures is too complex in poor countries They also agreed that standardized height should be used Because it avoids not only the measurement pitfalls of other health indicator (such as morbidity, mortality or even life expectancy) but also the measurement problems associated to using monetary variables (such as income or perhaps expenditure) Therefore, the height-for-age z-score (HAZ) is mentioned because of its widely used indicator of health and in order to prevent other measures of health unsuitable for the particular quantitative exercise (O'Donnell, Nicolas, & Doorslaer, 2008)

There also have other anthropometric indicators, such as the weight age z-score, the weight-for-height z-score, as well as the body mass index They can be used for estimating the regression in this research However they are not appropriate because more weight or perhaps too thin does not mean that they can have better health Thus, height is better to explain model (Pradhan, E.Sahn, & D.Younger, 2003)

-for-However, in the paper of Y.Chen & Li (2009), the regression found out that using weight-for-age and weight-for-height (BMI) also gave the similar results In addition, they also mentioned that even after controlling income, health environment, and other socioeconomic variables, their result still showed that the determinant of the HAZ is the mother’s education

Height is used to measure of short run and long run health status O’Donnell, Nicolas & Doorslaer (2008) covered from the 1993 and 1998 Vietnam Living standards Survey and used height-for-age z-scores as a measure of long-term nutritional status because they believed that child nutritional status could be

explained by the complete distribution of HAZ Thus, this paper only use HAZ variable to measure child health (more details in Appendix)

The height-for-age z-score is defined:

: the observed height of child i in group k (child sex and the birth month); : the median of the height in group j;

: the standard deviation of the height in group j

It is formed as the following categories

-1 < HAZ < 0 Normal -2 < HAZ < -1 Marginally stunted -3 < HAZ < -2 Moderately stunted HAZ < -3 Severely Stunted

MELEVEL

Variable melevel is the mother’s education In previous parts, the study show

out that the mother’s education can affect their children health

SAFE DRINK WATER

A dummy dwater is used for testing whether a household uses safe drink

water Water is called “safe drinking water” when it is met WHO guidelines national standards on drinking water quality and took from sources such as household connection, public standpipe, borehole, protected dug well, protected spring and rainwater (WHO)

FLUSHING TOILET

A dummy dtoilet is used for testing whether a household uses a flushing

toilet It makes sure a clean and healthful living environment for household and their neighborhood, including: public sewer connection, septic system connection, pour-flush latrine, simple pit latrine, ventilated improved pit latrine (WHO, Health

through safe drinking water and basic sanitation)

WEALTH INDEX QUINTILE

The variable wiq is the wealth index quintile Because it is difficult to collect

income and purchase data in Vietnam or in any developing countries, therefore this study used this index The wealth index is believed that it can forecast ability of household about their asset in the long term However, this index is not used for providing information about absolute poverty, current income or expenditure levels (Vietnam: Multiple Indicator Cluster Survey 2011, 2011)

The wealth index is a measure of a household’s cumulative living standard which using data on a household’s ownership of selected assets such as electricity, radio, television, refrigerator, bed, a sofa, kitchen cabinets, cable/digital TV, a computer, air conditioner, mobile telephone, motorcycle, car

or truck This index is ordered by the score, and then its score is divided into five

quintiles (20%- for each): poorest, second, middle, fourth and richest

3.2 Data

In this paper, the data is taken from The Vietnam Multiple Indicator Cluster Survey (MICS) by the General Statistics Office of Vietnam, the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) These organizations scheduled the fourth round of MICS from 2009

to 2011 which expected to be available from 2010 This data contained information on the situation of Vietnamese children as well as women which will

be used for measuring the effects and represent the relationship of the factors which was mentioned above

UNICEF has developed an international household survey program (MICS) since the mid-1990s MICS data, were collected more than 100 countries from face-to-face interviews, which is considered as one of the world’s largest sources of statistical information on children and women in the areas of health, education, child protection and HIV/AIDS

This study used information from MICS 4 (2011) of UNICEF There also have other three MICS at Vietnam which were conducted in 1996 (MICS 1),

2000 (MICS 2) as well as 2006 (MICS 3) MICS 4 is considered as the important data for the implementation of international commitments to children of the Government of Vietnam which include “End-decade review of the follow up to the World Summit for Children” and the fifth Periodic Report on the Convention

on the Rights of the Child in Vietnam

MICS 4 (2011) included three kinds of questionnaires for household, all women aged from 15 to 49 years old as well as for children aged under 5 years old (the sample’s total is 11,624 households and the sample of children aged under 5 years old is 3,559 child with 1,869 boys and 1,809 girls)

Questionnaire for household:

- List of members in family,

- Education,

- Water and sanitation,

- The characteristics of the household,

- Use of insecticide-impregnated bed nets,

- House-spraying with residual insecticides,

- Child labor,

- Child discipline,

- Wash hands,

-Use iodized salt

Questionnaire for women aged 15-49 years old:

- General information about women,

- Child mortality,

- The latest birth,

- Maternal and Infant health,

- The symptoms of disease,

- Measures to prevent pregnancy,

- Unmet demand,

- Attitudes towards family violence,

- Marriage/ Cohabitation,

- Sexual behavior,