Health in Developing Countries
Long-Term Double Fortiﬁed Salt Usage for Child Health in Rural Bihar
Liza von Grafenstein , Georg-August Universität Göttingen
Many existing nutrition interventions evaluate the short-term effects on child health focusing on whether a treatment matters for child health. To what degree timing and duration of exposure to a long-term nutrition intervention matter for child development is hardly considered. We want to provide evidence by examining the effectiveness of a hardly implemented government directive in India that postulates all government run schools to improve children's diets by using iron and iodine fortified salt called double-fortified salt [DFS] in the school feeding program. Facilitating the availability of DFS at 107 randomly selected governmental schools in two blocks of the district Jehanabad in the state of Bihar, India, we want to examine how timing and duration of the use of DFS effect child health, cognition, and school outcomes. We contribute to the literature by considering one of the longest treatment periods of DFS in a school feeding program so far: almost 4 years. Due to variation in onset and duration of DFS treatment, we include four exposure groups in our study to examine the effectiveness of DFS across different treatment periods. Further, we observe how a childhood intervention unfolds in outcomes for young adolescents.
Using three waves of panel data of about 1,000 school children, we analyze the difference in means of the health, cognition, and education outcome variables of four exposure groups with ANCOVA estimation techniques considering endline and midline separately.
Our results show on average higher hemoglobin levels for children who receive DFS at least in early childhood. Early childhood exposure seems to matter in particular because the likelihood of suffering from moderate and severe anemia in early adolescence (at endline) is 8.6 percentage points lower compared to children who are hardly exposed to DFS. The magnitude of this effect has increased from midline to endline indicating health benefits beyond the period of DFS exposure.
The results have high policy relevance as they show the potential of fortified foods in school feeding programs to increase health of female and male adolescents without crowding out other interventions. The results highlight that early childhood exposure is long-lasting and so could benefit children even when schools are closed.
Abhijeet Kumar, Georg-August Universität Göttingen
Santosh Kumar, Sam Houston State University
Sebastian Vollmer, Georg-August Universität Göttingen
Did you know? The effect of SMS reminders on health screening uptake in Indonesia
Maja Marcus, Georg-August-Universität Göttingen
The past decades brought massive improvements in living standards and life expectancy in many low- and middle-income countries, but was accompanied by an upsurge of the burden of non-communicable diseases. In many cases, these are “invisible” until severe, but preventable complications develop. Regular testing for these diseases can increase earlier detection and help to mitigate their negative economic and health impacts, but is often under-utilized. We conducted a community-based RCT in Indonesia using personalized and targeted text messages aiming to increase the demand for existing public screening services for diabetes and hypertension. We find that this low-touch intervention increased screening uptake by approximately 7 percentage points compared to the pure control group. This effect does not appear to work through gains in knowledge, but rather as reminder. We conclude that text messages can be a cheap and easily scalable tool to reduce screening gaps in a middle-income country setting.
Anna Reuter, Georg-August-Universität Göttingen
Lisa Rogge, Georg-August-Universität Göttingen
Sebastian Vollmer, Georg-August-Universität Göttingen
The Effects of Secondhand Smoke Exposure on Child Development in the Short and Long Run: Evidence from Indonesia
Anne Simon, Leibniz Universität Hannover/ Universität Passau
Secondhand smoke (SHS) is known for its adverse effects on children’s respiratory and immune systems. The causal effects of SHS exposure have however been sparsely studied in the empirical literature. In the context of Indonesia, exposure to SHS is a common threat to the health of children, with three out of four men smoking tobacco. Simultaneously, one third of children below the age of five still suffers from stunted growth despite the country’s thriving economy. Therefore, I empirically analyze how SHS affects children’s height-for-age, stunting, lung capacity and asthma in Indonesia in the short and long run, using rich longitudinal data from three Indonesian Family Life Survey waves.
The main empirical strategy of this study combines propensity-score weighting with a difference-in-differences (DiD) regression for the main outcomes height-for-age and stunting to construct a setting that comes close to a natural experiment. This method is used to analyse how the main outcomes of children exposed to SHS in the short (1997-2000) and long run (1997-2014) are affected compared to the outcomes of children who were not exposed. The outcome variables lung capacity and asthma are only available for 2014 and I thus use reweighted OLS and logit regressions to analyze potential effects of SHS exposure.
Overall, I find that SHS exposure does not have a statistically significant effect on either of these outcomes in the short and long run. When disaggregating the results however, some interesting heterogeneity of the effects can be uncovered. In particular, girls experience some adverse health effects of SHS exposure. The height-for-age in girls who were exposed to SHS in 1997 drops by 0.26 standard deviations in the short run compared to their female counterparts with no exposure. In the long run, the effect vanishes. Additionally, SHS exposure increases the stunting prevalence among girls in the long run by 11.5 ppt. For the subsamples of boys as well as children from urban and rural areas, no statistically significant effect of SHS exposure is found. Only in the robustness checks, some effects of marginal statistical significance can be found that are however not very robust. With regard to the respiratory outcomes of children in 2014, some puzzling effects of SHS exposure are found. SHS exposure substantially increases the lung capacity for the full sample of children as well as for the subsamples of rural residence and lower SES. Additionally, it is found to have a huge positive effect on the prevalence of asthma for children living in rural areas. However, these effects do partly not make a lot of sense and seem unrealistically large. As the OLS/logit model seems less reliable, the results for the respiratory outcomes are probably not causal.
Michael Grimm, Universität Passau
Anne Simon, Leibniz Universität Hannover/ Universität Passau
Climate shocks, coping strategies and health: evidence from rural Thailand
Soschia Karimi, Institut für Gesundheitsökonomie, LUH
In the last 20 years, humanity faced over 7000 natural catastrophes, 40% of them occurring in Asia and affecting over 4 billion individuals. Research shows that the frequency, intensity and related losses of such climate disasters remain increasing. Climate shocks have even more severe consequences regarding income and well-being for poorer households in less developed areas. To reduce the consequences it is relevant to understand how households deal with these shocks choosing strategies such as selling assets and borrowing money, and the health effects given the specific coping strategies. While there is evidence showing mostly negative impacts of different weather shocks on health and positive impacts on health care expenses, there is no evidence yet linking coping strategies induced by climate shocks to these outcomes. This paper measures the a) causal effect of climate shocks on health (& -expenses) b) probability to choose a specific coping strategy for a given climate shock c) effect of different coping strategies on health (& -expenses).
The analysis is based on Data from the Thailand Vietnam Socio Economic Panel. To exclude ex-ante self-selection into affectedness we only include households with farming-activities. Our sample covers 1491 households, 443 female- and 1048 male lead, over a timeframe of 11 years (2008-19). 42% of them had been affected at least once. The aim of this study is first to show the causal effect of climate shocks on health and health expenses via a differences-in-differences approach comparing households in affected villages with unaffected villages in Thailand. Second, we analyse the impact of climate shocks and household characteristics (such as the gender of the household head) on the probability to choose a specific coping strategy. Third, we examine the different health outcomes of households depending on the coping strategy they use.
We expect to find negative impacts of climate shocks on human health and on the household income, further we expect to find rising health expenses based on related research. We believe climate shocks to trigger coping behaviour. Furthermore, we expect to find significant correlations suggesting that specific coping strategies have different impact on health, e.g. lending money from an NGO will help to get through shocks better than selling assets.
There is a gap of research regarding the effect of climate shock induced coping strategies on health. Our aim is to fill that gap. We analyse three aspects of climate shock events: the causal effect on health, the choice of coping strategies and their effect on health given climate shocks. This research can help decision-makers to intervene with the most health-promoting measures.