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Nama : Mutiara Handaru Muti

NIM : P1337420116048
Kelas : 2A1

Potential interventions for preventing pneumonia among young children in developing countries:
promoting maternal education

This journal describe that The views of various disciplines on the role of education in
improving the health and survival of young children in developing countries are discussed, as wetl
as the factors and processes explaining this impact of education and the influence which education
could have on risk factors especially relevant to acute respiratory infections (ARI) and pneumonia.
This is by reviews of the available evidence on the impact of maternal education on mortality and
morbidity. Since there are hardly any data dealing with the impact of education on pneumonia
mortality, we focus on post-neonatal mortality, assuming that it is a suitable proxy for pneumonia
mortality. Evidence is summarized on several processes or mechanisms which could explain why
there is such an impact of education on ARI mortality (and morbidity) in children below 5. An
attempt is made to quantify the reduction in pneumonia mortality which has occurred during the
past 10—15 years as a result of improvement in women's education. This will also give an
indication of the magnitude of the potential benefits of education for health and survival in the
years ahead. Throughout this report we define maternal education as the regular schooling received
by women during their youth. Some may have followed additional adult education classes before
they became mothers.

Relevance of maternal education for child health in different disciplines

The contribution of education to child health and survival is stressed by specialists in public
health, community medicine and paediatrics. Mr. kark states that 'the education of girls and the
final standard of education attained by mothers is probably in itself a most important social factor
determining child healt.
Based on survey and anthropological data collected in India, he described 3 ways through which
maternal education exercises this influence on child survival. In the first place, education of
women alters the traditional balance of power within the family; as a result of education, decisions
concerning the child (e.g., health care) are more likely to be taken by the mother instead of the
mother-in-law. Secondly, education modifies women's knowledge and beliefs about disease
causation, prevention and cure and this has an influence on health care practices. Thirdly,
educated mothers bring their children much earlier and more frequently for treatment in health
centres and hospitals and persist much longer with the recommended treatment. This brief review
of the theoretical orientations of different disciplines makes it clear that maternal education has
an important impact on child mortality and health in developing countries. A fourth related
mechanism which has been stressed by anthropologists is that schooling introduces children to
new codes of behaviour such as insistence on cleanliness; these ideas become accepted and
socially desirable and persist into adult life without a conscious understanding of their health
implications In view of the fact that acute respiratory infections (ARI) are a major cause of death
in children below 5, it is therefore likely that this also applies to this group of diseases including
pneumonia. This review was also helpful in distilling hypotheses on how exactly schooling of the
mother influences child survival and health. One of these hypotheses deals with the consequences
of education for the level of family income and standard of living.In several of these studies
attention has been paid to the role of maternal education in ARI morbidity, but crowding and
indoor air pollution are not mentioned as factors which can explain the education—morbidity
relation. It is quite possible that crowding and indoor air pollution are determined more by
economic factors than by education.
Impact of maternal education on ARI morbidity, More data on the association between maternal
education and infant childhood mortality are available from 34 cross-sectional World Fertility
Surveys (WFS) carried out between 1975 and 1980
In these surveys several questions were asked about signs and symptoms of ARI, so that
it was possible to obtain information on percentages of children below 5 with cough and/or rapid
or difficult breathing during the past 2—4 weeks. The data obtained are not always comparable
due to changes in the wording and the length of the recall period in the various surveys. Indeed,
only one survey, that in Togo, would strictly conform to an accepted WHO before and after
adjustment for other economic and family formation variables. There are several reasons which
could explain why there were weak or no relations between mothers' schooling and signs and
symptoms of ARI morbidity. One could be the lack of precision in the measurement of the
dependent variable in these cross-sectional surveys. Another could be the existence of differences
in the quality of reporting on morbidity by level of education. A third could be that the dependent
variable includes both mild and serious cases of ARI and the relation of education with mild ARI
episodes is expected to be less strong than with respect to serious cases. Or, it could be that the
association between education and ARI morbidity is not strong in any case; the strength of the
association with ARI mortality.
In most countries medical services utilization is lowest for children of mothers without
formal education and highest for children whose mothers have at least some secondary education.
Differences are most pronounced in Togo, Bolivia, Nigeria and the Dominican Republic. Evidence
that education leads to increased use of modern medical care also comes from a large number of
surveys carried out with respect to other childhood diseases. Two more recent studies conducted
by Zeitlyn and Islam in rural Bangladesh and by Basu in New Delhi support the conclusion that
there is no or only a modest association between primary schooling and health-related knowledge.
Schooling, especially at the primary level, may have only a small effect on knowledge and beliefs
concerning diseases and disease causation, but may lead to large changes in the behaviour of
mothers when illness occurs.
Potential reduction in mortality resulting from education
In this journal, for estimation of reduction, resulting from education, in mortality, is the availability
of data on pneumonia mortality by level of education. In the section of this report on impact of
maternal education on ARI and total mortality, I saw that such data are available from only one
study conducted in southern Brazil. It is likely, however, that post-neonatal mortality rates are
representative for pneumonia mortality rates, because most of the deaths due to pneumonia take
place in the postneonatal period. And such data, by level of education of the mother, are available
from a number of WFS surveys. With these data, unadjusted relative risks of children dying in
different maternal educational groups can be calculated and from these the adjusted relative risks
can be derived. The adjusted relative risks were estimated as half the unadjusted risks. We have
chosen to calculate these risks of dying for 3 or 4 educational groups with 'some secondary and
more' or 'secondary complete and more' as the highest category.Another problem deals with the
choice of the measure to be used to calculate reductions in mortality. We have chosen here the
impact fraction (IF) or potential impact fraction (PIF) measures developed by Morgenstern and
Bursic (Kleinbaum et al. 1986). The IF is defined as 'the proportional reduction in the total number
of new cases of a certain disease resulting from a specific change in the distribution of a risk factor
in the population at risk'. This measure can be applied in our case since we consider maternal
education as the factor (and as the health intervention) and post-neonatal mortality as the outcome
variable. The potential impact fraction is in our case defined as the reduction in post-neonatal (and
pneumonia) mortality that can be expected to occur as a result of improvement in the educational
levels of women achieved in a period of 10 to 15 years in a particular country. Many countries
have projected similar increases in educational enrolment of women in the next 25 years (1990—
2015) as achieved in the past 20—25 years (UNESCO 1989). This means that it is likely that the
level of education of women between 15 and 49 years will increase at the same pace in the years
ahead as in the recent past. We can, therefore, infer a potential reduction in pneumonia mortality
as a result of education in order of magnitude of 2—11 0/0 during the next 10—15 years. These
benefits of education for survival could be much larger with faster expansion in educational
enrolment than was the case in the 8 countries in 197 5—1990. PIF would be 13-4%. An increase
in female education in Nigeria to the level of Colombia now would lead to a PIF of 6.5% and in
Indonesia 8.8%. An assumption which was made here is that the risks of dying by level of
education of the mother will remain constant. This is a reasonable assumption in view of the
findings that disparities in surVival by level of education have not changed between the 1970s and
the 1980s (Cleland et al. 1992). These calculations show that, in theory, women's education has
some potential as a child health intervention. One has to realize, however, that the benefits of
women's education for health and survival of children will be achieved only in the next generation,
that is, some 15 years after the 'intervention'. This review of the available data has shown that
maternal education may be an important determinant of infant and child mortality in children
below 5 years in developing countries. This must, therefore, also be the case with mortality due to
pneumonia occurring largely in the post-neonatal period. I could not find a consistent association
between maternal education and ARI morbidity. This does not mean that such an association does
not exist. That I did not find such a relation may be due to various design and measurement
problems in the studies which were reviewed. The association of mothers' schooling with ARI
morbidity is expected to be less strong than with respect to ARI mortality. education leads, directly
and indirectly, to a higher family income and standard of living as derived from the finding that
economic benefits explain about half of the education—mortality relation. It is also clear that
education leads to more frequent and better use of modern medical care during ARI episodes.
These two findings lend, therefore, support to the first and second hypotheses formulated in the
beginning of this report. . I could not find evidence in favour of the third hypothesis stating that
schooling of women leads to changes in beliefs and knowledge regarding diseases such as ARI. I
also did not find an impact of education on the effects of crowding and indoor air pollution on
morbidity or mortality, which leads us to conclude that education is probably not an important
factor with respect to these two risk factors of ARI.
In summary, the mother's education has a pronounced effect on the propensity to use modern
medical facilities, and it is especially through this increased use of modern medical treatment that
education may have an influence on pneumonia mortality and morbidity. The mother's schooling
has only a small or no influence on the well known risk factors of ARI. Education leads to more
appropriate responses when pneumonia occurs; it has only a minor effect on changes in exposure
to pneumonia.

Calculations were also made on the potential of maternal education as an intervention to reduce
ARI mortality. Educational statistics show that many developing countries will make gains in the
raising of educational levels of women in the next 10—20 years. It is tentatively concluded that
such improvements in women's education will lead to reductions. And in this journal says that this
research has been used to estimate the potensial for reducing mortality. Mother education is the
main of all this research. The potensial of women`s education as a child health intervention would
be much grather if the enrollment of of education could be increased more than would be