Comparing Different Weights to Construct Composite Indicators of Maternal and Child's Basic Health Services from the Prospective of Continuum of Care:Based on Data from the National Health Services Survey 2008 and 2013 in Jilin Province.

Abstract

Objective To construct composite indicators of maternal and child's basic health services using different weights from the prospective of continuum of care and to compare them based on data from the National Health Services Survey 2008 and 2013 in Jilin Province. Methods The study selected indicators based on the countdown and the Lives Saved Tool(LiST),considering the data availability from the 2008 and 2013 National Health Surveys in Jilin.Equal weights,equal weights for different areas,epidemiology weights,and principal component weights were used to construct different composite indicators.Cronbach's alpha reliability coefficient was used to test the internal consistency.Analysis of variance of randomized block design was used to test the differences.The Spearman's correlation coefficient was calculated to compare the rank correlation.The maternal mortality,children under 5 years old mortality rate,and children under 5 years old stunting incidence were used as the outcome indicators to test the validity using correlation analysis. Results Finally 13 indicators were selected,with the Cronbach's alpha reliability coefficient value exceeding 0.7,which means acceptable internal consistency of these indicators.Analysis of variance showed that the scores were not significantly the same(F=8.14,P<0.01).The rank correlations among equal weights,principal component weights,and equal weights for different areas composite indicators were quite strong,and the Spearman's correlation coefficient between either two were all above 0.9,while the epidemiology weights composite indicator got smaller Spearman's correlation coefficient with equal weights,principal component weights,and equal weights for different areas composite indicators(0.697,0.671,and 0.818,respectively).The composite indicator using epidemiology weights showed significant negative correlation with children under 5 years old mortality rate and children under 5 years old stunting incidence(R2=0.168,P<0.05;R2=0.398,P<0.01,respectively).The composite indicators using equal weights,equal weights for different areas and principal component weights only showed significant negative correlation with children under 5 years old stunting incidence(R2=0.238,R2=0.304,R2=0.232,P<0.01 for all,respectively).Conclusion The composite indicator using epidemiology objective weights has some predictive value for maternal and child health outcomes.