Mother's social capital and child health in Indonesia

"People are now working together for a common good": The effect on social capital of participatory design for community-level sanitation infrastructure in urban informal settlements

Communities with higher levels of social capital perform better than communities with lower social capital in community-level water and sanitation interventions and have better health outcomes. Although research recommends bolstering social capital to improve intervention outcomes, few studies provide empirical evidence on the effect of intervention activities on social capital. This study aimed to evaluate the effect of participatory design and community engagement activities on social capital among urban informal settlements in Suva, Fiji and Makassar, Indonesia enrolled in the Revitalizing Informal Settlements and their Environments trial using the Short Adapted Social Capital Assessment Tool. We performed confirmatory factor analyses (CFA) to test tool performance and built structural equation models to assess intervention effect on CFA-informed, sub-scale scores for cognitive and structural social capital. Qualitative in-depth interviews in Fiji and Indonesia and focus group discussions in Fiji provided nuanced understanding of intervention effects on social capital from residents' perspectives. Results confirmed the hypothesized two-factor solution but revealed differences by country and by gender in Indonesia. The intervention appeared positively related to cognitive social capital among men and women in Indonesia and negatively related to cognitive and structural social capital among men and women in Fiji. While effect sizes were small and cluster-adjustment for a small number of settlements yielded non-significant effects, trends were consistent across models and bivariate analyses and were corroborated by qualitative findings. Several contextual factors may explain these results, including timing and duration of intervention activities and influence of COVID-19. Qualitative data suggested that the relationship between participatory design and social capital may be bidirectional, helping to explain why certain settlements appeared to be better equipped to benefit from intervention activities. Practitioners and program designers should carefully consider the social pre-conditions of communities in which they intend to work to optimize program outcomes and avoid unintended consequences.

Number of Siblings and Social Capital Among Parents Rearing Schoolchildren: Results From the A-CHILD Study

BACKGROUND

Having siblings may foster sociality; however, little is known about whether sibling number determines social capital, the resources obtained through social networks. We examined the association between sibling number and social capital among Japanese parents rearing schoolchildren.

METHODS

We used cross-sectional data from the 2018 and 2019 Adachi Child Health Impact of Living Difficulty (A-CHILD) study, targeting all primary and junior high school students and their parents in Adachi, Tokyo, Japan (n = 8,082). Individual-level social capital was evaluated by assessing caregivers' social cohesion, social support, and group affiliation. All analyses were adjusted for age and sex.

RESULTS

An inverse U-shaped association was found between sibling number and social capital. Adults who grew up with one or two, but not three or more siblings had greater social support (coefficient = 0.23; 95% confidence interval [CI], 0.06-0.40 and coefficient = 0.46; 95% CI, 0.29-0.64, respectively) than those who grew up as an only child, after covariate adjustment. Adults who grew up with two or three, but not one or four or more siblings had greater group affiliation (coefficient = 0.09; 95% CI, 0.03-0.16 and coefficient = 0.09; 95% CI, 0.01-0.18, respectively) than those who grew up as an only child, after covariate adjustment. Sibling number was not associated with social cohesion.

CONCLUSION

Growing up with one to three siblings was associated with higher social capital in adulthood than being an only child. Having siblings may provide an opportunity to foster social capital.

Does social capital aid in leveling the income gradient in child mental health? A structural analysis of the left-behind and not-left-behind Chinese children

BACKGROUND

Few prior studies have investigated the income gradient in child mental health from a socio-environmental perspective. In an age when child mental health problems in a rapidly changing social environment have become a worldwide issue, an understanding of the socio-environmental mechanisms of the income disparities in child mental health outcomes is imperative and cost-effective.

METHODS

By conducting structural equation analyses with Chinese nationally representative survey data, this study explored the family income gradient in child depression and its potential socio-environmental pathways at the neighborhood, family and school levels, differentiating left-behind and not-left-behind children.

RESULTS

We found a robust family income gradient in depressive symptoms. Neighborhood cohesion mitigated the income gradient in depressive symptoms by playing a suppression role. School social capital acted as a mediator. Neighborhood trust, neighborhood safety and family social capital played no significant impact. The mitigating and mediating roles of social capital components were significant among only the not-left-behind children.

CONCLUSIONS

To reduce income-related inequalities in child mental health in the long run, integrating policies that directly reduce poverty with policies that improve distal socio-environments is necessary.

Effects of types and levels of social capital on emotional well-being for older people in Indonesia: A longitudinal study

OBJECTIVES

The purpose of this study was to examine the effects of different types and levels of social capital and emotional well-being in older adults in Indonesia by a longitudinal data.

METHODS

The fourth and the fifth waves of Indonesian Family Life Survey data were used for this study. The participants aged 60 years or older who participated in both waves were included for analysis (n = 1374). Depressive symptoms and happiness were used to assess emotional well-being. Cognitive social capital (neighborhood trust) and structural social capital (participating in arisan, community meetings, volunteers, village improvement programs, and religious activities) were the main independent variables. The generalized estimating equations model was used for analysis.

RESULTS

Participation in arisan (B = -0.534) and attending religious activities (B = -0.591) were related to lower depressive symptoms, but the effect of religious activities would offset over time. Both a low or high social participation showed protective effects on depressive symptoms at the intercept and the time slope. Having higher neighborhood trust was related to more chance of feeling very happy (OR = 1.518).

CONCLUSION

Structural social capital is protective from depressive symptoms, while cognitive social capital contributes to happiness. Facilitating social participation and improving neighborhood trust through policies and programs is suggested to promote emotional well-being for older people.

Does social capital influence community health worker knowledge, attitude and practices towards COVID-19? Findings from a cross-sectional study in Malang district, Indonesia

Community health workers (CHWs) are the first point of contact with the primary health care system in many low- and middle-income countries and are situated to play a critical role in the public health response to the COVID-19 pandemic. The knowledge, attitude and practices of CHWs regarding COVID-19 may be influenced by their level of trust and participation in the community, collectively defined as their level of social capital. To assess whether social capital influences CHWs’ knowledge, attitude and practices related to COVID-19, we conducted a web-based survey of CHWs (n = 478) in Malang district, Indonesia between October 2020 and January 2021. CHW social capital was measured using the Shortened Adapted Social Capital Assessment Tool. Multiple logistic regression results show that cognitive social capital was associated with higher self-reported knowledge of COVID-19, more confidence in answering COVID-related questions from the community and feeling safe from COVID-19 when working. Membership of community organisations was associated with a higher number of COVID-related tasks conducted. Thus, CHWs in Malang district with higher levels of cognitive social capital were more likely to be confident in their knowledge and ability to respond to COVID-19, and CHWs embedded in their community were more likely to be engaged in pandemic response duties. Our findings suggest that policies aimed at promoting CHW embeddedness, targeted recruitment and addressing training needs hold promise in strengthening the positive contribution of the community health workforce to the COVID-19 response.

•

We conducted a survey to examine how social capital influences CHW knowledge, attitudes and practices re COVID-19 in Malang district, Indonesia.

•

Structural social capital was associated with a higher number of COVID-related tasks conducted.

•

Cognitive social capital was associated with higher knowledge of COVID-19 and higher confidence in answering COVID-related questions.

•

Promoting CHW embeddedness and targeted recruitment may strengthen the contribution of CHWs to future public health crises in Malang district.

Sociodemographic characteristics and health access associated with COVID-19 infection and death: a cross-sectional study in Malang District, Indonesia

OBJECTIVES

This study aims to examine sociodemographic characteristics and health access associated with COVID-19 infection and death in Malang District, Indonesia.

DESIGN

A non-random cross-sectional study.

SETTING

Population in 390 villages in Malang District, East Java Province, Indonesia.

PARTICIPANTS

We used Malang District government COVID-19 contact tracing data from 14 264 individuals, spanning from 1 March 2020 to 29 July 2020.

PRIMARY OUTCOME MEASURES

The outcome variables in this study are COVID-19 infections and COVID-19 deaths. The associations between sociodemographic characteristics and health access of COVID-19 infection and death were analysed using multilevel logistic regression.

RESULTS

Among the 14 264 samples, 551 individuals were confirmed as being infected with COVID-19; 62 individuals died of COVID-19. Women, individuals with direct contact with confirmed COVID-19 cases and individuals with hypertension constituted the groups most vulnerable to COVID-19 infection. Among respondents with confirmed COVID-19 cases, men, individuals aged 61 years and older, individuals with hypertension, and those diagnosed with pneumonia and respiratory failure were at higher risk of death. The number of community-based healthcare interventions was significantly associated with lower COVID-19 infection and COVID-19 mortality. Greater distance to a COVID-19 referral hospital increased risk of COVID-19 mortality.

CONCLUSIONS

COVID-19 infection and death were related not only to sociodemographic characteristics of individuals but also to the presence of community-based healthcare interventions and access to hospital care. Strategies in public health, including improving healthcare access, are required to reduce COVID-19 infections among the most susceptible groups in Indonesia.

Maternal and child social support and food availability in relation to child growth in four low- and middle-income countries

Previous studies showed positive associations between specific types of social capital and child nutritional status. Our study examined whether improved food availability mediates the impact of maternal and child social support on child nutritional status in four low- and middle-income countries. We used data from the Young Lives cohort study, comprising 1,000 children aged 8 and 12 in Vietnam and Ethiopia, 1008 in India, and 714 in Peru. The outcome variables were the z-scores for height for age and body mass index (HAZ and BAZ, respectively). The causal mediation analysis framework was used. In Peru, above-median values of maternal social support and receiving child financial support were positively associated with HAZ at age 12. The level of maternal financial support was positively associated with BAZ among 12-year-old children in India. Peru was the only country where a positive association was found between food availability and maternal financial support among children aged 12. However, food availability did not mediate the effect of maternal financial support on HAZ at age 12. Strengthening social support to improve child nutritional status, especially by improving food availability, may not be a sufficient intervention in resource-poor settings because sources of support may lack sufficient food resources to share. However, more comprehensive measurements of social support and food security are necessary to better understand the mechanism of social support and child nutritional status.

Women's employment and Children's education: Longitudinal evidence from Nepal

This study examines how maternal employment is related to children's school enrollment in rural Nepal. Using the Chitwan Valley Family Study we combine over 30 years (1974-2008) of yearly data on mother's employment and their children's education. Results reveal heterogeneity by gender, social status, and type of work. Children from historically disadvantaged social groups were more likely to be in school when their mothers started working. This was largely driven by mothers with jobs that allowed them to more easily combine work and family tasks (i.e., those self-employed in the home). In fact, maternal self-employment outside the home was associated with boys dropping out of school. Additionally, we find evidence that some of the observed relationship between maternal wage labor and children's school enrollment is due to household-level selection effects on mother's work.

Promoting Subjective Well-Being among Rural and Urban Residents in Indonesia: Does Social Capital Matter?

There has been growing research on the link between social capital and subjective well-being. However, to date, research investigating the impact of social capital on subjective well-being based on urban and rural typology is limited. Therefore, to fill this gap, this study aims to examine the effects of social capital on subjective well-being, based on urban and rural typology, using large-scale data from 29,341 Indonesian residents, comprising 17,155 urban residents and 12,186 rural residents. A two-stage predictor substitution (2SPS) approach is applied to address the endogeneity issue in estimating the impact of social capital. The empirical findings indicate that social capital significantly increases subjective well-being, i.e., happiness and life satisfaction. However, based on the urban–rural model, we found that the impact of social capital on subjective well-being is different. In the urban model, social capital increases happiness and life satisfaction significantly. However, the rural model indicates that social capital significantly increases happiness, not life satisfaction. These findings imply that subjective well-being impacts urban residents more than rural residents. The main reason is social capital in urban areas is well-developed (i.e., management and infrastructure for community association). Therefore, we suggest developing social capital in rural areas to expand its role in improving well-being.

Sleep Disturbance in Indonesia: How Much Does Smoking Contribute?

Objective: To examine the linkage between smoking and sleep disturbance in Indonesia Methods: This study used data from the 2014 Indonesia Family Life Survey (IFLS), drawn from a sample of 38,879 individuals from 15,067 households living in 262 communities. Sleep disturbance was measured by ten validated indicators of sleep quality and sleep deprivation adopted from the PROMIS (Patient Recorded Outcomes Measurement Information System), developed by the USC Center for Economic and Social Research (CESR), USA. Hierarchical ordered logistic regression was used to account for unobserved factors in village communities. Results: In 2014, the prevalence of smoking in Indonesia remained high at thirty-two percent of the population, or about ninety million active smokers. Nearly half of smokers were young adult males. Eight of every ten males who reported sleep disturbance were smokers. Current smokers' odds of facing sleep disturbance were almost one-and-one-half times higher than those of nonsmokers (OR = 1.39, p-value < 0.01), and among heavy smokers, the odds were almost double (OR = 1.91, p-value < 0.01). These findings were controlled for stressors, chronic diseases, social support and sociodemographic characteristics as well as unobserved factors in village communities. Conclusion: The substantial relationship between smoking and sleep disturbance suggests that policies that address the issue of sleep disturbance through preventing tobacco use among young adults should be a public health priority in Indonesia.

Maternal education and the multidimensionality of child health outcomes in India

Maternal education plays a central role in children's health, but there has been little research comparing the role of maternal education across health outcomes. It is important to distinguish child health outcomes from medical care outcomes. Health outcomes such as short-term morbidity and stunting are multifactorial in origin and determined by a range of factors not necessarily under a mother's control. Mother's education, given the necessary structural factors such as medical centres, is likely to lead to increased access to, and uptake of, medical services. Using data from the 2004-05 India Human Development Survey, eight separate logistic regressions were carried out on 11,026 women of reproductive age and their last-born child under five years of age. The results showed that maternal education had the strongest association with medical care, immunization (except polio) and iron supplementation for pregnant mothers, moderate association with underweight and weak association with short-term diseases and stunting. In addition, the study investigated whether maternal education impacts child health and medical care outcomes through the intervening roles of empowerment and human, social and cultural capital. These intervening linkages were found to be missing for short-term diseases and stunting, bolstering the argument that the influence of maternal education is limited for these outcomes.

Family Health Clinics as a Source of Social Capital

PURPOSE

To examine the extent to which Family Health Clinics (FHCs) contribute to the formation of social capital among mothers, and determine whether it is influenced by socioeconomic factors. In FHCs, social capital can be gained by relationships between mothers (bonding social capital), by relationships between mothers and FHCs team, or between mothers of different origins/culture (bridging social capital) and health services institutional bodies (linking social capital).

DESIGN

This is a mixed method study. For the quantitative part, data were collected from 673 mothers using a questionnaire. The qualitative part was conducted with six focus groups.

RESULTS

The FHC constitutes a source of social capital in all dimensions. Bridging social capital was most prominent and is formed by interactions between mothers and FHC nurses. The factors that explain the formation of social capital were: mothers' spoken language being Arabic, participation in group training, and lower level of education. The focus groups revealed that participation in group training increased the social capital. Mothers noted that FHC nurses supplied updated information about their children's care. Regarding linking social capital, mothers perceive FHC nurses as mediators between them and the local and national health services.

CONCLUSIONS

FHC clinics are a source for gaining social capital. The FHC services should be adapted to mother's needs.

IMPLICATIONS

FHC nurses should try to create conditions for mothers to meet to create bonding social capital, relate to mother's needs for the creation of bridging social capital, and provide culturally adapted care for the formation of linking social capital.

Maternal employment and child health in Nepal: The importance of job type and timing across the child's first five years

The increase in female labor force participation (FLFP) in the paid labor market since the mid-1900s is one of the most pronounced family transitions and increasingly a global phenomenon. While this may improve income and bargaining power of the women, it may also increase stress and decrease time with children. Using the Chitwan Valley Family Study in Nepal, we explore the consequences of this transition for children's health by combining newly collected data on child health outcomes, quarterly data on women's employment, and data on households and neighborhoods. Regression models were used to estimate the relationship between FLFP and child health, exploring both the type (wage, salary, or own business) and timing of work across the child's first five years for 860 children born to 793 mothers. After adjusting for a robust set of individual, household, and community factors, FLFP is associated with worse child health. We find evidence this is largely due to wage labor, the more common but "lower quality" and lower paying type of work women do. Measures of current work are generally inadequate at capturing this negative relationship. Breastfeeding may be an important piece of this story as mothers that worked during the first six months of a child's life were less likely to exclusively breastfeed during this period. Recognizing the challenges faced by working mothers in LMICs and paying attention to the quality of work will be critical as more women enter the workforce.

Social capital and child nutrition in India: The moderating role of development

Empirical studies of social capital rarely take into account the socioeconomic context of the region in which it operates, indeed as most of this research has been located in high income countries. It is imperative to investigate how development may influence the impact of social capital, especially in developing countries. This paper examines the relationship between social capital and child nutrition using the India Human Development Survey, 2005-2006. Using a multilevel framework and a sample of 6770 rural children under the age of five, it finds that household based bridging social capital, expressed as connections with development based organizations, is positively associated with child nutrition. Bonding social capital, expressed as ties with caste and religious based organizations, has the opposite impact. At the village level, contextual measures of social capital are associated with nutritional status of children, but their influence is conditional on local development.

WOMEN’S EMPOWERMENT AND GENDER INEQUALITY IN ADOLESCENT NUTRITIONAL STATUS: EVIDENCE FROM THE INDONESIAN FAMILY LIFE SURVEY

In contrast to the extensive knowledge on the association between women’s empowerment and the nutritional status of children under the age of five, relatively little is known about the influence of women’s empowerment on adolescents’ nutritional status. This study aimed to assess the association between women’s empowerment and gender inequalities in adolescent nutritional status. Data were from the Indonesian Family Life Survey (IFLS) covering the period 1997 to 2015, and consisted of 16,683 observations from 13,396 adolescents between the ages of 10 and 19 years born in 6781 families. Three indicators of women’s empowerment were used: mother’s education, mother’s bargaining power and mother’s working status. Multivariate linear regression with robust standard errors was used to examine whether and how these indicators of women’s empowerment influenced adolescent nutritional status. Interaction terms were added to analyse how the association between women’s empowerment and adolescent nutritional status differed by gender. The results showed that mother’s education and mother’s working status were significantly associated with adolescent nutritional status, particularly with height-for-age. Adolescents of well-educated mothers had a higher height-for-age while those who were raised by mothers with a blue-collar job had a lower height-for-age. Although no gender differences were found for height-for-age, gender differences for BMI-for-age were obvious, with boys having a lower BMI-for-age than girls. Interactions between indicators of mother’s empowerment and gender showed that the gender gap in BMI-for-age was smaller for adolescents of more educated mothers. However, further analyses of food consumption patterns showed that boys whose mothers were more educated consumed more fast food and had higher instant noodle consumption than girls, thus suggesting gender bias in new disguise.

Social Capital and Well-Being: Structural Analyses of Latina Mothers by Nativity

Objective This study examined the direct and mediating effects of maternal social capital on health and well-being for native- and foreign-born Latina mothers and their children. Methods Data were drawn from the baseline and nine-year follow up waves of the Fragile Families and Child Well-being Study. The study included a sample of 874 Latina mothers. Mplus7 was used to perform structural equation modeling to determine whether exogenous indicators (age, education, and economic well-being) predicted social capital, whether social capital predicted mother and child well-being, and whether mediating effects helped explain each relationship. Results For native-born Latinas (n = 540), social capital did not predict maternal or child well-being. However, social capital significantly mediated the effects of age, education, and economic well-being on maternal well-being. For foreign-born Latinas (n = 334), social capital was a significant predictor of maternal well-being. Social capital also mediated the effects of age, education, and economic well-being on maternal, but not child well-being. Younger and foreign-born Latinas who report higher educational attainment and economic well-being have greater social capital, and thus better self-reported health. Conclusion Findings suggest that social capital is particularly relevant to the health of foreign-born Latinas. For all Latina mothers, social capital may serve as a protective mitigating factor to better health. Health service providers should evaluate the potential to integrate programs that promote social capital accumulation for Latinas. Further research should examine factors to improve the health of Latinas' children.

Investigating the determinants of Chinese adult children's intention to use online health information for their aged parents

BACKGROUND

The increasing number of older people and the dissemination of health information via the Internet have emerged and both are challenging to Chinese society. Available online health information highlights the importance of decision making processes, specially in relation to the elderly who almost have no online presence and depend on their adult children's help. The researchers mostly focus on parents' health information search for their children, however, they overlook the adult children's intention to use online health information for their aged parents.

OBJECTIVE

This study fills this gap by extending the Theory of Planned Behavior (TPB) to identify the determinants of adult children's intention to use online health information for their aged parents.

METHOD

Relying on survey method, the data were collected from teachers and students at different participating Universities in Wuhan, China. The Partial Least Squares (PLS), a structural equation modeling technique, was employed to test the research model.

RESULTS

This study found that attitude, subjective norm, perceived behavioral control and risk (p<0.05) were the predictors of intention to use online health information, whereas, trust (p>0.05) was not listed among the predictors.

CONCLUSIONS

This study is a significant addition to the literature, in that it confirms the utility of the TPB with additional variables in predicting adults' children intention to use online health information for their aged parents.

Millennium development goal four and child health inequities in indonesia: a systematic review of the literature

Introduction

Millennium Development Goal (MDG) 4 calls for reducing mortality of children under-five years by two-thirds by 2015. Indonesia is on track to officially meet the MDG 4 targets by 2015 but progress has been far from universal. It has been argued that national level statistics, on which MDG 4 relies, obscure persistent health inequities within the country. Particularly inequities in child health are a major global public health challenge both for achieving MDG 4 in 2015 and beyond. This review aims to map out the situation of MDG 4 with respect to disadvantaged populations in Indonesia applying the Social Determinants of Health (SDH) framework. The specific objectives are to answer: Who are the disadvantaged populations? Where do they live? And why and how is the inequitable distribution of health explained in terms of the SDH framework?

Methods and Findings

We retrieved studies through a systematic review of peer-reviewed and gray literature published in 1995-2014. The PRISMA-Equity 2012 statement was adapted to guide the methods of this review. The dependent variables were MDG 4-related indicators; the independent variable “disadvantaged populations” was defined by different categories of social differentiation using PROGRESS. Included texts were analyzed following the guidelines for deductive content analysis operationalized on the basis of the SDH framework. We identified 83 studies establishing evidence on more than 40 different determinants hindering an equitable distribution of child health in Indonesia. The most prominent determinants arise from the shortcomings within the rural health care system, the repercussions of food poverty coupled with low health literacy among parents, the impact of low household decision-making power of mothers, and the consequences of high persistent use of traditional birth attendants among ethnic minorities.

Conclusion

This review calls for enhanced understanding of the determinants and pathways that create, detain, and overcome inequities in child health in resource constraint settings like Indonesia and the promotion of actionable health policy recommendations and tailored investments.