Sebastian Vollmer

Georg-August-Universität Göttingen | GAUG · Department of Economics

We present experimental evidence on the impact of the use of double-fortified salt in school-meals on anemia, cognition, and the learning outcomes of primary school children in rural Bihar, one of the poorest regions of India. We find that year-long intervention had statistically significant positive impacts on hemoglobin levels and reduced anemia...

We use the impact of the Dissolution of the English monasteries in 1535 to test the commercialization hypothesis about the roots of long-run English economic development. Before the Dissolution, monastic lands were relatively unencumbered by inefficient feudal land tenure, but could not be sold. The Dissolution created a market for formerly monasti...

Importance To address major causes of perinatal and maternal mortality, the World Health Organization developed the Safe Childbirth Checklist (SCC), which to our knowledge has been rigorously evaluated only in combination with high-intensity coaching. Objective To evaluate the effect of the SCC with medium-intensity coaching on health care workers...

Background The high prevalence of anemia in resource-constrained settings calls for easy-to-use, inexpensive screening tools. The Sanguina Smartphone App, an innovative tool for non-invasive hemoglobin estimation via color-sensitive, algorithm-based analysis of fingernail bed images, was validated in the United States. This study evaluates the perf...

Background: Despite ongoing debate about the health impact of probiotics, rigorous evidence assessing the use of probiotics in routine preterm newborn care is lacking. Objectives: We aimed to estimate the causal effect of routine probiotics supplementation on moderately preterm newborns' anthropometric development (weight-for-age and height-for-...

Diabetes is a leading cause of morbidity, mortality and cost of illness1,2. Health behaviours, particularly those related to nutrition and physical activity, play a key role in the development of type 2 diabetes mellitus³. Whereas behaviour change programmes (also known as lifestyle interventions or similar) have been found efficacious in controlle...

Importance Economic growth may reduce childhood malnutrition through improvements of several contributing factors, but the empirical evidence is mixed. Identifying the most important factors that contribute to child malnutrition and their associations with economic growth can inform decision-making about targeted investments to improve children’s h...

Background The global burden of diabetes is rising rapidly, yet there is little evidence on individual-level diabetes prevention activities undertaken by health systems in low-income and middle-income countries (LMICs). Here we describe the population at high risk of developing diabetes, estimate diabetes prevention activities, and explore sociodem...

Cardiovascular disease risk factors (CVDRF), in particular diabetes and hypertension, are chronic conditions which carry a substantial disease burden in Low- and Middle-Income Countries. Unlike HIV, they were neglected in the Millenium Development Goals along with the health services required to manage them. To inform the level of health service re...

Objective More than one in four adults over 40 with HIV in South Africa are unaware of their status and not receiving antiretroviral therapy (ART). HIV self-testing may offer a powerful approach to closing this gap for aging adults. Here, we report the results of a randomized comparative effectiveness trial of three different home-based HIV testing...

Background: Testing for the risk factors of cardiovascular disease, which include hypertension, diabetes, and hypercholesterolaemia, is important for timely and effective risk management. Yet few studies have quantified and analysed testing of cardiovascular risk factors in low-income and middle-income countries (LMICs) with respect to sociodemogr...

Importance: Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. Objective:...

A new approach for fortification of drinking water is presented for combating iron deficiency anemia (IDA) worldwide. The idea is to leach Fe from a bed containing granular metallic iron (Fe0), primarily using ascorbic acid (AA). AA forms very stable and bioavailable complexes with ferrous iron (FeII). Calculated amounts of the FeII-AA solution can...

This study collected evidence on the use of early sown wheat varieties and complementary zero tillage technologies in Northwest India. Detailed information on farmers’ knowledge, adoption decisions, personal experience, and perceptions of early sown wheat and zero tillage technologies were collected at the household level using different survey too...

We study the effect of the Safe Childbirth Checklist (SCC) – a tool developed by the WHO to improve the quality of delivery care – on a range of provider- and patient-level outcomes. We conducted a clustered pair-wise matched randomized controlled trial among 166 health providers in two districts of Pakistan. This included primary and secondary hea...

The World Health Organization (WHO) developed the Safe Childbirth Checklist (SCC) to increase the application of essential birth practices to ultimately reduce perinatal and maternal deaths. We study the effects of the SCC on health workers safety culture, in the framework of a cluster-randomized controlled trial (16 treatment facilities/16 control...

There remains widespread doubt among clinicians that mere lifestyle advice and counseling provided in routine care can achieve improvements in health. We aimed to determine the health effects of the largest behavior change program for pre-diabetes globally (the English Diabetes Prevention Programme) when implemented at scale in routine care. We exp...

Using a phase‐in research design, we provide experimental evidence on the impacts of early versus late initiation of iron fortification in school lunch programmes on children's health and cognitive outcomes in India. We find higher haemoglobin levels and a lower likelihood of anaemia in the early treatment group that experienced 4 years of treatmen...

Background Cardio-metabolic diseases are a major cause of death worldwide, including in Indonesia, where diabetes is one of the most critical diseases for the health system to manage. Methods We describe the characteristics, levels of control, health behavior, and diabetes-related complications of diabetes patients in Aceh, Indonesia. We use basel...

Most existing multidimensional poverty indices, like the global MPI, use the household as the unit of identification of the multi-dimensionally poor, meaning that the multidimensional poverty status of the household is equated with the multidimensional poverty status of all its members. Such an approach ignores intra-household inequalities, which a...

The Global Diabetes Compact is a WHO-driven initiative uniting stakeholders around goals of reducing diabetes risk and ensuring that people with diabetes have equitable access to comprehensive, affordable care and prevention. In this report we describe the development and scientific basis for key health metrics, coverage, and treatment targets acco...

Background Historically, the international development community has often held the view that those living in extreme poverty (at less than $1.90/day) are likely to have a low prevalence of cardiovascular disease (CVD) risk factors due to calorie scarcity, a largely plant-based diet, and physical labor. Evidence on CVD risk factor prevalence among...

The minimum dietary diversity (MDD) indicator as defined by the WHO is commonly used to assess micronutrient deficiency in young children. However, individual food item-specific consumption patterns may be overlooked when focusing solely on this indicator. We provide a comprehensive view on food item and food group consumption patterns of children...

This study investigates whether eligibility for antiretroviral therapy (ART) of HIV positive parents improved their children's educational attainment in KwaZulu-Natal, South Africa, employing a regression discontinuity design. We find that there is a positive impact of ART eligibility on paternal health, but this does not translate into general imp...

This study gathered evidence from Germany and the United States on public opinion towards fair distribution of COVID-19 vaccines across the world. Analytical Hierarchy Process and discrete choice experiments were used for this purpose. The sample is nationally representative of adults (aged 18 and above) for both countries using quotas on age, gend...

Background Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals’ socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-i...

Objectives To determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and use frequency vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and use frequency within countries. Design Sec...

There is a dearth of evidence on the epidemiology of multimorbidity in low- and middle-income countries. This study aimed to determine the prevalence of multimorbidity in India and its variation among states and population groups. We analyzed data from a nationally representative household survey conducted in 2015–2016 among individuals aged 15 to...

Background Effective equity-focused health policy for hypertension in low- and middle-income countries (LMICs) requires an understanding of the condition’s current socioeconomic gradients and how these are likely to change in the future as countries develop economically. Objectives This cross-sectional study aimed to determine how hypertension pre...

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate n...

Background: There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estim...

OBJECTIVE Diabetes prevalence is increasing rapidly in rural areas of low- and middle-income countries (LMICs), but there are limited data on the performance of health systems in delivering equitable and effective care to rural populations. We therefore assessed rural-urban differences in diabetes care and control in LMICs. RESEARCH DESIGN AND MET...

Data resource basics Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally.¹ In recent decades, a rising prevalence of major CVD risk factors including diabetes, hypertension and hyperlipidemia has been observed in many low- and middle-income countries (LMICs) where CVD was not previously considered a major health pr...

Incomplete and absent doses in routine childhood vaccinations are of major concern. Health systems in low- and middle-income countries (LMIC), in particular, often struggle to enable full vaccination of children, which affects their immunity against communicable diseases. Data on child vaccination cards from a cross-sectional primary survey with 1,...

Background In the prevention of cardiovascular disease, a WHO target is that at least 50% of eligible people use statins. Robust evidence is needed to monitor progress towards this target in low-income and middle-income countries (LMICs), where most cardiovascular disease deaths occur. The objectives of this study were to benchmark statin use in LM...

Despite ongoing calls for a more even global distribution of COVID-19 vaccines, there remains a great disparity between high- and low-income countries. We conducted representative surveys among the adult population in the United States (N=1,000) and Germany (N=1,003) in June 2021 to assess the public opinion in these countries on distributive justi...

Objective Lifestyle interventions can be efficacious in reducing cardiovascular disease risk factors and are recommended as first-line interventions in England. However, recent information on the use of these interventions in primary care is lacking. We investigated for how many patients with newly diagnosed hypertension, hyperlipidaemia or obesity...

Based on a primary survey conducted in the rural–urban interface of Bangalore, this study contributes to the understanding of the relationship between dietary diversity (DD) and anthropometric outcomes of young children (6 months – 5 years) (measured by weight-for-age (WAZ), weight-for-height (WHZ), and height-for-age (HAZ) z-scores), school-aged c...

This study used a wide range of information on parental sociodemographic, physical and behavioural characteristics as well as on the presence of non-communicable diseases among parents and examined the association of these attributes with anthropometric failure, anaemia and mortality of their children aged 0–59 months. Findings revealed that childr...

Background: The prevalence of multimorbidity in low- and middle-income countries (LMICs) is thought to be rising rapidly. Research on the state of healthcare for multimorbidity in LMICs is needed to provide an impetus for integration of care across conditions, a baseline to monitor progress, and information for targeting of interventions to those...

We propose a novel son preference measure that relates the preference to a specific child. We find child-specific son preference to be more common among later born children and in families with fewer sons. Using the novel measure and an interaction instrumental variables approach, we estimate a penalty in early mental functions for unwanted girls o...

To quantify the impact of a novel “soft” commitment intervention, we randomly allocate 1525 Indian slum dwellers to receive a zip purse and a lockbox (treatment) or a lockbox only (control). After six months, we document a 19 percent increase in total savings in the treatment arm. The effect is sustained in a sub-sample of participants we re-interv...

Grant disbursals and school-based management interventions have received growing attention from policy-makers despite their mixed success at improving educational outcomes. This paper reports results from a large-scale, cluster randomised controlled trial in Sokoto state, Nigeria. School-based management committees received a training and a grant t...

Background This study looks at the factors that can shape patients’ choice of healthcare providers. Understanding this process can help with making high quality healthcare more accessible for all. We focus on distance, patient’s health status, (perceived) quality of healthcare facility, and referrals to investigate how these factors compete in shap...

Background: For patients with type 2 diabetes in low-income and middle-income countries (LMICs), access to newer antidiabetic drugs (eg, sodium-glucose co-transporter-2 [SGLT2] inhibitors, glucagon-like peptide-1 [GLP-1] receptor agonists, and insulin analogues) could reduce the incidence of diabetes-related complications. We aimed to estimate pri...

Objective This study assessed intake of iron-and-folic-acid (IFA) tablet/syrup (grouped into none, <100 days of IFA consumption or <100 IFA, and ≥100 days of IFA consumption or ≥100 IFA) among prospective mothers and its association with various stages of low-birthweight (ELBW: extremely low-birthweight, VLBW: very low-birthweight, and LBW: low-bir...

Objective To assess how pregnancy anaemia affects the offspring’s early childhood development, child haemoglobin (Hb) levels child growth and diseases incidence 2 years after birth in a low-income setting. Furthermore, we investigate the mediating role of childhood Hb levels with disease incidences and skills. Design Prospective cohort study. Set...

Background: As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. Methods and findings: We pooled individual...

Background Mobile money—a service enabling users to receive, store, and send electronic money using mobile phones—has been widely adopted across low- and middle-income economies to pay for a variety of services, including healthcare. However, evidence on its effects on healthcare access and health outcomes are scarce and the possible implications o...

The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development as...

Immediate initiation of antiretroviral therapy (ART) for all people living with HIV has important health benefits but implications for the economic aspects of patients' lives are still largely unknown. This stepped-wedge cluster-randomized controlled trial aimed to determine the causal impact of immediate ART initiation on patients’ healthcare expe...

Lack of information about health risks may limit the adoption of improved nutrition and other new healthy behaviors. This paper studies the effect of a nutrition-information intervention on household dietary behavior, hemoglobin levels, and cognitive outcomes of children in rural India. Using experimental data and a regression discontinuity design...

Background: Given the increasing prevalence of diabetes in low-income and middle-income countries (LMICs), we aimed to estimate the health and cost implications of achieving different targets for diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among LMICs. Methods: We constructed a microsimulation mod...

We conducted representative surveys among the adult population in Germany (n=1,003) and the United States (n=1,000) with discrete choice experiments and analytical hierarchy process items to elicit opinions about global COVID-19 vaccine distribution. Results unveil a high consent towards utilitarian or egalitarian distribution principles, prioritiz...

Importance Evidence on the suitability of anthropometric failure (ie, stunting, underweight, and wasting) as a stand-alone measure of child undernutrition can inform global and national nutrition and health agendas. Objective To provide a comprehensive estimate of the prevalence of child undernutrition by evaluating both dietary and anthropometric...

Background: While the prevalence of childhood diseases and related mortality have been decreasing over the past decades, progress has been unequally distributed. The poorest households often carry the highest disease burden. As morbidity and mortality also decline most slowly among children of the poorest households, socioeconomic status may becom...

Background: Globally, health care seeking for childhood diseases seems to be on the rise. However, progress is slow and still, many cases of infectious diseases in children remain untreated, leading to preventable child mortality. A better understanding of care seeking behaviour may help to further increase the probability that a sick child is tak...

Background: The world has made considerable progress in the reduction of adolescent maternity and early marriage. However, this progress has been uneven, with many countries finding themselves far from achieving the Sustainable Development Goals in this dimension. We assessed levels and trends over time in adolescent marriage and maternity prevale...

Background: Young women in West and Central Africa have been described by the United Nations as being especially vulnerable to HIV/AIDS. Despite a consensus that increased efforts are necessary to address the needs of this particular demographic, correlates of HIV seropositivity in young West and Central African women have not been systematically...

Background Adolescence is a formative period when an individual acquires physical, cognitive, emotional, and social resources that are the foundation for later life, health, and well-being [1]. However, in West and Central African region, this trajectory is curtailed by early childbearing associated with an increased risk of undernutrition and anem...

Background: Adequate antenatal care (ANC) utilization is recognized as one of the important drivers of safe childbirth and positive birth outcomes. The usage of ANC services fluctuates with various personal, socio-economic, and cultural characteristics and in resource-poor settings, adolescent mothers are at a particularly high risk of insufficien...

Objective: Early marriage and childbearing have substantial detrimental effects on both, the affected girls and women at the micro level, as well as entire economies on the macro level. West and Central African countries have some of the highest prevalence rates of early marriage and maternity worldwide. This work attempts to quantify the long-ter...

Background: Adolescence is a highly vulnerable period of human life characterized by substantial physiological and cognitive changes for which adequate nutrition is crucial. To date, evidence on determinants, prevalence, and trends of undernutrition and anemia for the entire West and Central African region is missing. This paper provides evidence...

Background: Early marriage and maternity prevalence rates among adolescent girls remain alarmingly high in West and Central Africa (WCA). This study aims to explore the associations between socio-economic factors and the prevalence of early marriage and maternity, thus contributing to the identification of girls at risk of early pregnancy or marri...

Backgound: The global community recognizes the urgent need to end preventable child deaths, making it an essential part of the third Sustainable Development Goal. Pneumonia, diarrhoea, and malaria still remain the leading causes of deaths among children under five years, especially in one of the poorest geographic regions of the world - West and C...

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabiliti...

Background: Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilit...

We use a regression discontinuity design to estimate the causal effect of antiretroviral therapy (ART) eligibility according to national treatment guidelines of South Africa on two risk factors for cardiovascular disease, body mass index (BMI) and blood pressure. We combine survey data collected in 2010 in KwaZulu-Natal, South Africa, with clinical...