PEMANFAATAN PELAYANAN KESEHATAN DAN KELANGSUNGAN HIDUP BAYI PADA RUMAH TANGGA MISKIN DI INDONESIA (ANALISIS DATA SDKI 2002-2003 DAN 2007)

Background: The infant mortality rate becomes an important indicator of the health sector development of a country. Infant survival gaps between rich and poor families make poverty become one of the factors that affects infant survival. The low status of health and infant survival in poor communities are due to limitations in the utilization of basic health services and lack of understanding of healthy behavior. Objective: To assess the impact of poverty on infant survival in Indonesia. Methods: This study used retrospective cohort design on the data of Indonesia Demographic and Health Survey (IDHS) in 2002-2003 and 2007. Study sample was households with children under five and born alive, amounting to 18,886 (IDHS in 2002-2003) and 20,810 households (IDHS in 2007). The dependent variable in this study was the survival of infants calculated from the age of infants from birth to death (in days). Family economic status became the independent variable and utilization of health services was the intervening variable. Other variables taken into account were maternal age, education, parity, and area of residence. Analysis of data was in the form of descriptive analysis, Kaplan-Meier curves and log rank test, and multivariable analysis using Cox's regression. Results: The results of the bivariable analysis with Kaplan-Meier curve showed a significant relationship between the economic status of families and infant survival. The probability of survival was higher in infants with a family's wealthy economic status compared with those with the poor economic status (97.4%: 94.5% for 2002-2003 IDHS and 97.1%: 94.7% for 2007 IDHS). The risk of infant mortality in poor families had decreased from 1.4 to 1.1 for 2007 IDHS. The existence of health insurance for poor families did not affect health care utilization and infant survival (HR: 1.2, 95% CI :1,08-1, 44). After including the other variables, the risk of infant mortality from the poor family had remained with HR of 1.2 (95% CI:1,04- 1, 41). Conclusion: Family economic factors were associated with risk of infant mortality. The policy of health insurance for the poor was related to the utilization of health services and infant survival. The other variable that affected infant survival was maternal education