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Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India*
Abstract
This paper has an empirical and overtly methodological goal. The authors propose and defend a method for estimating the effect of household economic status on educational outcomes without direct survey information on income or expenditures. They construct an index based on indicators of household assets, solving the vexing problem of choosing the appropriate weights by allowing them to be determined by the statistical procedure of principal components. While the data for India cannot be used to compare alternative approaches they use data from Indonesia, Nepal, and Pakistan which have both expenditures and asset variables for the same households. With these data the authors show that not only is there a correspondence between a classification of households based on the asset index and consumption expenditures but also that the evidence is consistent with the asset index being a better proxy for predicting enrollments--apparently less subject to measurement error for this purpose--than consumption expenditures. The relationship between household wealth and educational enrollment of children can be estimated without expenditure data. A method for doing so - which uses an index based on household asset ownership indicators- is proposed and defended in this paper. In India, children from the wealthiest households are over 30 percentage points more likely to be in school than those from the poorest households.
... We assess wealth-related inequality in tetanus immunization coverage using countryspecific household wealth quintiles. Household wealth is derived from household asset indices and is directly provided in DHS and MICS datasets [12]. The households, weighted by size, are divided into five equal groups, or wealth quintiles, each representing 20% of the population. ...
... Vaccines 2024, 12, 431 Conflicts of Interest: Author Cauane Blumenberg was employed by the company Causale Consulting. The remaining authors declare that they have no conflict of interest. ...
Immunization of pregnant women against tetanus is a key strategy for reducing tetanus morbidity and mortality while also achieving the goal of maternal and neonatal tetanus elimination. Despite substantial progress in improving newborn protection from tetanus at birth through maternal immunization, umbilical cord practices and sterilized and safe deliveries, inequitable gaps in protection remain. Notably, an infant’s tetanus protection at birth is comprised of immunization received by the mother during and before the pregnancy (e.g., through childhood vaccination, booster doses, mass vaccination campaigns, or during prior pregnancies). In this work, we examine wealth-related inequalities in maternal tetanus toxoid containing vaccination coverage before pregnancy, during pregnancy, and at birth for 72 low- and middle-income countries with a recent Demographic and Health Survey or Multiple Indicator Cluster Survey (between 2013 and 2022). We summarize coverage levels and absolute and relative inequalities at each time point; compare the relative contributions of inequalities before and during pregnancy to inequalities at birth; and examine associations between inequalities and coverage levels. We present the findings for countries individually and on aggregate, by World Bank country income grouping, as well as by maternal and neonatal tetanus elimination status, finding that most of the inequality in tetanus immunization coverage at birth is introduced during pregnancy. Inequalities in coverage during pregnancy are most pronounced in low- and lower-middle-income countries, and even more so in countries which have not achieved maternal and neonatal tetanus elimination. These findings suggest that pregnancy is a key time of opportunity for equity-oriented interventions to improve maternal tetanus immunization coverage.
... The analyst can aggregate such proxy measures through various methods. The earliest and most influential study, that constructed socioeconomic indices by using Principle Component Analysis (PCA), is developed a few years ago (Filmer & Pritchett 2001), got attention in the field of development economics. Similarly, the wealth index can also be constructed by using data on durable goods and assets owned by households. ...
... The data used on household assets is of primary importance from the glance of durable goods such as ownership of vehicle, TV, refrigerator, access to hygiene facilities, source of drinking water, types of toilets, number of rooms in the house, source of heat for cooking and material used for flooring etc. Some of the reported work (Filmer & Pritchett 2001) have confronted the criticism against using PCA although it is a suitable technique for continuous data that satisfies multivariate normal distribution (Anderson 2003;Hotelling 1933;Mandia 1980). Variables used to construct WEI are in binary and categorical form so polychoric method of correlation is adopted (Olsson 1979). ...
Child malnutrition is one of the major causes of child morbidity and mortality around the globe especially in developing countries. The current study attempts to investigate the factors that contribute to malnutrition captured through WAZ (weight for age) among children in the Cholistan desert area of Punjab, Pakistan. Out of 900 households surveyed, 584 households were identified, having a sample of 1059 children aged between 0 and 59 months. The logit, multilevel logit, generalized linear mixed model, and generalized linear latent and mixed model approaches were employed to analyze the collected data. The findings reveal that the wealth index of households, mother’s age at birth of a child, birth order of the child, duration of breastfeeding, distance to the basic health unit, and use of protected/clean water significantly affect children for being underweight. The policy recommendations are made in line with the study findings to suggest ways that can reduce prevalance of underweight children in the area.
... The intensity of infection was expressed as EPG of feces. Infection intensities were also classified into light, moderate, and heavy infections according to WHO guidelines [11] . Asset ownership variables were used to generate a wealth index based on principal component analysis [11] , which was then divided into two groups (poor and less poor) based on the median score. ...
... Infection intensities were also classified into light, moderate, and heavy infections according to WHO guidelines [11] . Asset ownership variables were used to generate a wealth index based on principal component analysis [11] , which was then divided into two groups (poor and less poor) based on the median score. Latrine cleanliness indicators collected included presence of visible feces, excessive smell, and excessive flies, which were combined by principal component analysis. ...
Objectives
Kenya has implemented a national school-based deworming program, which has led to substantial decline in the prevalence of soil-transmitted helminths (STHs), although some pockets of infections remain. To effectively design an STH control program that leads to significant reductions of Trichuris trichiura, there is a need to understand the drivers of persistent infection despite ongoing treatment programs.
Methods
This study was conducted between July and September 2019 at the south coast of Kenya, using a two-stage sampling design. First, a school-based cross-sectional survey was conducted in 2265 randomly selected school children from selected schools in areas known to be endemic for T. trichiura. After this, we conducted a nested case-control study wherein all children positive for T. trichiura (142) were matched to 148 negative controls based on age and village. A household survey was then conducted with all household members of cases and controls. In addition, a subsample of 116 children found to be infected with T. trichiura were followed up to assess the efficacy of albendazole at day 21 post-treatment. The predictors of presence of T. trichiura were investigated through multilevel logistic regression, considering clustering of infection.
Results
Overall, 34.4% of the children were infected with at least one STH species; T. trichiura was the most common (28.3%), 89.1% of those with T. trichiura had light-intensity infections. The prevalence of T. trichiura was significantly higher in male children and was positively associated with younger age and number of people infected with T. trichiura in a household. The parasitological cure rate and egg reduction rate of T. trichiura were 35% and 51%, respectively. Other STHs identified were hookworm (9.6%) and Ascaris lumbricoides (5.7%).
Conclusions
T. trichiura remains a significant public health challenge in the study area with albendazole treatment efficacy against the parasite, remaining lower than the World Health Organization–recommended thresholds. Because of the observed focal transmission of T. trichiura in the current area, control efforts tailored to local conditions and targeting lower implementation units should be used to achieve optimal results on transmission.
... In practice, however, household expenditure data usually takes at least an hour to collect, resulting in lengthy and expensive surveys, and even then, may be affected by recall bias, observer bias, and high attrition rates 5,8 . In response to these challenges, a method of quantifying a household's assets into a single SES index was developed using household assets widely available in standardized household surveys in a seminal work by Filmer and Pritchett 9 . Asset indices are now the most widely used method to quantify SES in global health household surveys of LMICs because assets can be quickly and objectively measured by surveyors, remain relatively stable over time, and pre-calculated indices are now included in the most widely used health surveys including Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) 5,10,11 . ...
... Asset indices are now the most widely used method to quantify SES in global health household surveys of LMICs because assets can be quickly and objectively measured by surveyors, remain relatively stable over time, and pre-calculated indices are now included in the most widely used health surveys including Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) 5,10,11 . Despite their relative speed and ease of collection, there has been considerable debate over how best to calculate asset indices [12][13][14][15] and the resulting measures can be difficult to interpret due to the lack a meaningful interval scale 9,16 . Because they do not have an interval scale, asset indices can only be used to compare relative orderings of households across contexts and over time, and only if care is taken to account for changes in the social value of household assets such as smartphones or access to sanitation 17,18 . ...
There has been no systematic comparison of how the three most common measures to quantify household SES—income, consumption, and asset indices—could impact the magnitude of health inequalities. Microdata from 22 Living Standards Measurement Study surveys were compiled and concentration indices, relative indices of inequality, and slope indices of inequality were calculated for underweight, stunting, and child deaths using income, consumption, asset indices, and hybrid predicted income. Meta-analyses of survey year subgroups (pre-1995, 1995–2004, and post-2004), outcomes (child deaths, stunting, and underweight), and World Bank country-income status (low, low-middle, and upper-middle) were then conducted. Asset indices and the related hybrid income proxy result in the largest magnitudes of health inequalities for all 12 overall outcomes, as well as most country-income and survey year subgroupings. There is no clear trend of health inequality magnitudes changing over time, but magnitudes of health inequality may increase as country-income levels increase. There is no significant difference between relative and absolute inequality measures, but the hybrid predicted income measure behaves more similarly to asset indices than the household income it is supposed to model. Health inequality magnitudes may be affected by the choice of household SES measure and should be studied in further detail.
... To develop the SES indicator, we employed the Filmer and Pritchett's method (22), which utilizes principal components analysis to reduce multidimensional datasets on household asset ownership to fewer dimensions. This approach allowed us to divide the participants into 5 wealth quintiles, ranging from the lowest (1st quintile) to the highest (5th quintile) groups. ...
... The household-level factors consisted of ethnicity and household wealth index of the participants. We applied the principal components analysis (PCA) method [37] to represent the household wealth index as a score of household assets. We assigned each de jure household member with scores after computing the index. ...
Micronutrient deficiencies remain a public health burden among non-pregnant women in developing countries, including Nepal. Hence, this study examined micronutrient deficiencies among non-pregnant Nepalese women aged 15-49 using the 2016 Nepal National Micronutrient Status Survey (NNMSS). Data on 2143 non-pregnant women was extracted from the 2016 NNMSS. The study analysed ferritin, soluble transferrin receptor (sTfR), red blood cell (RBC) folate and zinc. Multivariable logistic analysis was carried out to assess factors associated with micronutrient deficiencies. Prevalence of ferritin, sTfR, folate, and zinc were 19%, 13%, 16% and 21%, respectively. Non-pregnant women from the Janajati region were significantly less prone to ferritin [adjusted odds ratio (AOR): 0.45; 95% confidence interval (CI): 0.25, 0.80], and those who had body mass index (BMI) of 25 kg/m2 or higher had significantly higher odds of ferritin [AOR: 2.69; 95% CI: 1.01, 7.17]. Non-pregnant women aged 35-49 years were significantly less predisposed to folate deficiency [AOR: 0.58; 95% CI: 0.40, 0.83], and the likelihood of zinc deficiency was significantly lower among non-pregnant women from richer households [AOR: 0.48; 95% CI: 0.31, 0.76]. The study provides further insight into screening high-risk subgroups and instituting public health interventions to address the prevailing micronutrient deficiencies among non-pregnant Nepalese women.
... Socioeconomic status (SES) of the family of the respondent was estimated using a wealth index (or asset index) based on measures of housing (constructing materials used for flooring), number of rooms, type of toilet, electricity, and ownership of assets (water-heater, TV, computer, radio, stove, washing machine, microwave, and vacuum cleaner). To generate the index, we used principal component analysis as described elsewhere [18][19][20]. Scores from the first component, which explained 39.2% of the total variance, were used to create the wealth variable. We included those assets and services recommended in the literature and that were available in our questionnaire [19,21]. ...
Background
The COVID-19 pandemic has not only caused tremendous loss of life and health but has also greatly disrupted the world economy. The impact of this disruption has been especially harsh in urban settings of developing countries. We estimated the impact of the pandemic on the occurrence of food insecurity in a cohort of women living in Mexico City, and the socioeconomic characteristics associated with food insecurity severity.
Methods
We analyzed data longitudinally from 685 women in the Mexico City-based ELEMENT cohort. Food insecurity at the household level was gathered using the Latin American and Caribbean Food Security Scale and measured in-person during 2015 to 2019 before the pandemic and by telephone during 2020–2021, in the midst of the pandemic. Fluctuations in the average of food insecurity as a function of calendar time were modeled using kernel-weighted local polynomial regression. Fixed and random-effects ordinal logistic regression models of food insecurity were fitted, with timing of data collection (pre-pandemic vs. during pandemic) as the main predictor.
Results
Food insecurity (at any level) increased from 41.6% during the pre-pandemic period to 53.8% in the pandemic stage. This increase was higher in the combined severe-moderate food insecurity levels: from 1.6% pre-pandemic to 16.8% during the pandemic. The odds of severe food insecurity were 3.4 times higher during the pandemic relative to pre-pandemic levels (p<0.01). Socioeconomic status quintile (Q) was significantly related to food insecurity (Q2 OR = 0.35 p<0.1, Q3 OR = 0.48 p = 0.014, Q4 OR = 0.24 p<0.01, and Q5 OR = 0.17 p<0.01), as well as lack of access to social security (OR = 1.69, p = 0.01), and schooling (OR = 0.37, p<0.01).
Conclusions
Food insecurity increased in Mexico City households in the ELEMENT cohort as a result of the COVID-19 pandemic. These results contribute to the body of evidence suggesting that governments should implement well-designed, focalized programs in the context of economic crisis such as the one caused by COVID-19 to prevent families from the expected adverse health and well-being consequences associated to food insecurity, especially for the most vulnerable.
... By adhering to these standards, the study ensures alignment with global data, enabling a more thorough analysis of child malnutrition trends in Nepal and facilitating comparisons on a global scale. Household asset holding served as a proxy for economic status, derived using Principal Component Analysis (PCA) on binary response variables of household assets, following Rustein & Johnson (2004) [65][66][67]. ...
Background
Child stunting, child underweight, and child wasting in Nepal decreased from 48%, 47%, and 11% to 25%, 19%, and 9%, respectively, between 1996 and 2022. Despite an overall reduction in prevalence rates, economically poor and geographically backward regions in Nepal have not seen equivalent improvement in child undernutrition similar to their richer and developed regions, leading to increased differences in undernutrition prevalence across the wealth quintiles. This study aimed to assess time trends in the average and inequality of child nutritional status by household wealth across Nepal's geographical spaces from 1996 to 2022.
Methods
This study utilized data from four rounds (1996, 2006, 2016, and 2022) of the Nepal Demographics and Health Survey (NDHS). The nutritional status of children below three years of age, measured by stunting, wasting, and underweight, served as the main dependent variable. Household wealth status, determined by binary responses regarding possession of household assets, acted as a proxy for economic status. The study employed point prevalence for average, Concentration Index (CI), Poorest-Richest-Ratio (P-R-R), and Poorer-Richer-Ratio (Pr-Rr-R) to analyze trends in child nutritional status by wealth quintiles.
Results
From 1996 to 2022, Nepal exhibited an increasing Concentration Index and an upward trend in P-R-R measures of inequality in child stunting. The P-R-R increased from 1.77 in 1996 to 2.51 in 2022, However, results show a concurrent decrease in Pr-Rr-R from 1.19 to 1.18, assessing the prevalence of stunting among children. In the prevalence of child underweight, the P-R-R and Pr-Rr-R were 1.88 and 1.19 in 1996, decreasing to 1.47 and 1.10, respectively, in 2022.
Conclusion
The results indicated that inequalities in child nutrition across wealth status show an increase in stunting but marginal decline in underweight and wasting. Therefore, the study underscores the need for inclusive policy and program interventions to achieve equitable improvement in child stunting in Nepal, ensuring that progress extends to children in the poorest wealth quintile households. However, the progress is equitable in child underweight and wasting.
... Most agricultural households (57%) live in rural areas, where they cultivate an average of 3 acres of land, while 43% live in urban areas. The household's wealth index is determined through principal component analysis [40], which combines all household assets to create an index that is then classified into five groups, from poor to wealthy. The household ownership of physical assets such as motorcycles, bicycles, radios, televisions, refrigerators, mobile phones, and livestock is considered. ...
Farm crop diversity is often overlooked, predominantly indigenous crops’ role in this diversity. The main concentration has been on the contribution or role of exotic crops to household crop diversification. At the same time, the role played by both types of crops in household food security has only been aggregated, failing to show how indigenous crops play a key role in household food security. This research paper uses Tanzanian Panel data from waves 4 and 5 to study the factors influencing indigenous and exotic crop diversification and the role of this diversity in household food security. Using a random effect model, the author found that various factors are crucial in determining household crop diversification. Gender, household size, marital status, and expected harvest quantity are among the key factors influencing indigenous crop diversification. On the other hand, age, education, access to markets, access to irrigation services, and soil quality are the primary factors that affect the diversification of exotic crops. Moreover, the findings show that indigenous and exotic crop diversity significantly influences household food consumption. Thus, policies to increase the production of indigenous crops in order to improve household food consumption should be considered.
... Principal component analysis was used in this process. [16] The wealth index is divided into five quintiles: poorest, poor, middle, rich and richest. ...
Background. Despite global strides to reduce child morbidity and mortality, the number of infant and child deaths from preventable causes in low-and middle-income countries remains unacceptably high. A cost-effective strategy to improve child health outcomes is through child vaccination and subsequent immunisation. Despite free child vaccination in the public healthcare sector in Tanzania, the country’s vaccination rates have plateaued and remain concentrated among children from wealthier households. Objective. To identify the factors contributing to inequality in childhood vaccination in Tanzania.Methods. This retrospective study used secondary data from the Tanzania Demographic and Health Survey for 2004/05, 2010 and 2015/16. Inequalities were measured using the Erreygers’ corrected concentration indices. These inequalities were then decomposed to gain a deeper understanding of the contributing factors. Results. Child vaccinations are higher among children from wealthier households in Tanzania, andthis disparity has intensified over time. Socioeconomic differences in wealth, residential locations, mass media exposure and maternal education have become increasingly important drivers of these inequalities among Tanzanians. Conclusions. Socioeconomic divisions in Tanzania threaten to perpetuate inequalities in access to healthcare and subsequent health. Child vaccination should be provided equitably to all children regardless of their household’s socioeconomic background. Moreover, efforts should be made to address these gaps between the vulnerable and the more privileged groups in society
... were computed through principal component analysis (PCA), which generated three equal groups -rich, middle and poor (see also Filmer and Pritchett (2001) for details on the method used). Dummies are included for the rich and poor, and the middle class is the reference category. ...
Rapid urbanisation in developing countries has often resulted in slums with minimal public goods provision, where the poor rely on clientelist networks to provide for their basic needs. Using household‐level data, this paper is the first to empirically document how political clientelism operates in Pakistani slums. It finds that urban brokers, unlike their rural counterparts, are unable to claim credit for public goods provision. Instead, they provide personalised and highly targeted services – such as dispute resolution and assistance with documentation. Moreover, unlike traditional clientelism, urban networks are found to be problem‐solving and welfare‐enhancing for slum dwellers.
... The wealth index was then converted into five wealth quintiles, which were used in the final analysis. 23 Household distance to the nearest PHC was determined using orthodromic (great-circle) distance estimates between family compound and PHC Global Positioning System coordinates. ...
Objective
The vast majority of the 300 000 pregnancy-related deaths every year occur in South Asia and sub-Saharan Africa. Increased access to quality antepartum and intrapartum care can reduce pregnancy-related morbidity and mortality worldwide. We used a population-based cross-sectional cohort design to: (1) examine the sociodemographic risk factors and structural barriers associated with pregnancy care-seeking and institutional delivery, and (2) investigate the influence of residential distance to the nearest primary health facility in a rural population in Mali.
Methods
A baseline household survey of Malian women aged 15–49 years was conducted between December 2016 and January 2017, and those who delivereda baby in the 5 years preceding the survey were included. This study leverages the baseline survey data from a cluster-randomised controlled trial to conduct a secondary analysis. The outcomes were percentage of women who received any antenatal care (ANC) and institutional delivery; total number of ANC visits; four or more ANC visits; first ANC visit in the first trimester.
Results
Of the 8575 women in the study, two-thirds received any ANC in their last pregnancy, one in 10 had four or more ANC visits and among those that received any ANC, about one-quarter received it in the first trimester. For every kilometre increase in distance to the nearest facility, the likelihood of the outcomes reduced by 5 percentage points (0.95; 95% CI 0.91 to 0.98) for any ANC; 4 percentage points (0.96; 95% CI 0.94 to 0.98) for an additional ANC visit; 10 percentage points (0.90; 95% CI 0.86 to 0.95) for four or more ANC visits; 6 percentage points (0.94; 95% CI 0.94 to 0.98) for first ANC in the first trimester. In addition, there was a 35 percentage points (0.65; 95% CI 0.56 to 0.76) decrease in likelihood of institutional delivery if the residence was within 6.5 km to the nearest facility, beyond which there was no association with the place of delivery. We also found evidence of increase in likelihood of receiving any ANC care and its intensity increased with having some education or owning a business.
Conclusion
The findings suggest that education, occupation and distance are important determinants of pregnancy and delivery care in a rural Malian context.
Trial registration number
NCT02694055.
... From adolescents and their parents, we collected information on demographic characteristics, socioeconomic status, nutrition knowledge, WASH practices, dietary intake (measured using a food frequency questionnaire), and food insecurity. The household wealth quartile was constructed based on household asset ownership (17 assets such as electricity, radio, television, and refrigerator) using principal component analysis [31]. For adolescents, we also collected information on physical activity and food preferences. ...
... To assess their wealth, we created an asset index. We use principal component analysis (PCA), dividing the sample into five categories ranging from 1 (poorest) to 5 (richest), as outlined by Filmer and Pritchett (2001). Both asset and mechanization indexes were constructed and categorized according to low-to-high rankings. ...
Climate-induced increase in temperature and rainfall variability severely threaten the agricultural sector and food security in the Indian state of Odisha. Climate-smart agricultural (CSA) practices, such as crop rotation and integrated soil management, help farmers adapt to climate risk and contribute to a reduction in greenhouse gas (GHG) emissions. Therefore, this paper examines the impact of CSA practices on yield and income in vulnerable semi-arid districts of Odisha—Balangir, Kendrapara, and Mayurbhanj. We use primary survey data from 494 households collected in 2019–2020, using a multi-stage stratified sampling approach and structured questionnaire. Propensity score matching (PSM) and the two-stage least square method (2SLS) have been used to analyze the impact of CSA on income and productivity. Two instrument variables, namely distance to the extension office and percentage of adopters in a village, are used to control self-selection bias and endogeneity in our model. Both models show a positive and significant impact of the adoption of CSA on farmers’ productivity and income. The study sheds light on the significant contribution of CSA practices in fostering sustainable income growth amid environmental challenges. Overall, our results suggest that small and marginal farmers of Eastern India, a highly environmentally vulnerable area, can significantly improve their income and productivity by adopting CSA technology. Hence, policymakers should scale the adoption of CSA technology through effective extension programs.
... In the second example (the blue polygon in Figure 3 for PLoS Neglected Tropical disease), we observe life science publications on parasitic infections such as Helminth or Schistosoma mansoni are citing social science publications with keywords such as school children, educational enrollments, and wealth effects. One frequently cited publication in this cluster is from Demography, titled "Estimating wealth effects without expenditure data-or tears: An application to educational enrollments in states of India" (Filmer & Pritchett, 2001). Seventy percent of citations from this journal to this paper are found in this cluster. ...
Social sciences are increasingly recognized as significant for building a sustainable world since the social perspective can assist researchers in other fields in navigating public controversy and designing more responsible interaction mechanisms between the natural and social systems. However, the question arises: to what extent do natural sciences rely on social science research in their studies? Examining life science publications from seven PLoS journals, this paper attempts to characterize the volume and trajectory of citations from life sciences to social sciences. We explore three core questions: To what extent do life sciences cite social sciences? What actors in the life sciences are citing social sciences? Which actors in the social sciences are being cited? Our analysis estimates social sciences influence 15%–19% of life science publications, contributing to 1.1%–1.5% of references in 2018. Social science citers are found across peripheral and central topics of life science disciplines. Cited social science publications exhibit various levels of interdisciplinarity and achieve the greatest citation impact among peers. Citations to social sciences are prevalent in both theoretically and methodologically oriented sections. We show empirically the increasing impact of social sciences on the development of the life sciences.
... Outcomes include time delays to accessing care (timeliness, using questions on time taken to travel to facility), effectiveness of care received (using data on death and disability), and patient centredness of care received (using data from I-PAHC and O-PAHC). Equity will be assessed by comparing outcomes by age, sex, rural or urban location, wealth index (quintiles derived from household assets variables using the principal component analysis method [39]), and education status. Additionally OOP and impoverishing or catastrophic expenditure will be calculated using methods as previously used in Sierra Leone, using national household expenditure data and poverty lines to calculate impoverishing and catastrophic expenditure from local and international sources [36,40,41]. ...
Background
Equitable access to quality care after injury is an essential step for improved health outcomes in low- and middle-income countries (LMICs). We introduce the Equi-Injury project, in which we will use integrated frameworks to understand how to improve equitable access to quality care after injury in four LMICs: Ghana, Pakistan, Rwanda and South Africa.
Methods
This project has 5 work packages (WPs) as well as essential cross-cutting pillars of community engagement, capacity building and cross-country learning. In WP1, we will identify needs, barriers, and facilitators to impactful stakeholder engagement in developing and prioritising policy solutions. In WP2, we will collect data on patient care and outcomes after injuries. In WP3, we will develop an injury pathway model to understand which elements in the pathway of injury response, care and treatment have the biggest impact on health and economic outcomes. In WP4, we will work with stakeholders to gain consensus on solutions to address identified issues; these solutions will be implemented and tested in future research. In WP5, in order to ascertain where learning is transferable across contexts, we will identify which outcomes are shared across countries. The study has received approval from ethical review boards (ERBs) of all partner countries in South Africa, Rwanda, Ghana, Pakistan and the University of Birmingham.
Discussion
This health system evaluation project aims to provide a deeper understanding of injury care and develop evidence-based interventions within and across partner countries in four diverse LMICs. Strong partnership with multiple stakeholders will facilitate utilisation of the results for the co-development of sustainable interventions.
... This study employes three categories to assess dietary diversity for households: low dietary diversity category (≤3 food groups), medium diversity category (4-6 food groups) and high diversity category (≥7 food groups), as used by different authors [127,128] (see Fig. 2). The Principal Component Analysis (PCA) method was employed to construct the household asset index; a similar approach was employed in different studies [131]. The authors incorporated asset ownership and household characteristics to create an asset index that serves as a proxy for long-term household welfare. ...
Food and nutrition security is a major global challenge especially in developing countries. Agriculture is main means of livelihoods and hunger is drastically increasing from time to time especially due to effects of climate change, conflict and other manmade and natural calamities in these countries. Similarly, the Tigray Region is one of the Ethiopia’s most food and nutrition insecure regions with agriculture serving as the main source of income and employment. This study was therefore conducted to fill the gap in understanding the socioeconomic situation, bio-physical environment, institutional setting and policy landscape by analysing the existing circumstances in Tigray Region. This research employed quantitative data sets collected from 300 randomly selected Productive Safety Net Program (PSNP) beneficiarieries and Non-PSNP households using probability
proportional to size. The Household Dietary Diversity Score (HDDS) used as a proxy measure to nutrition security as our data is 24 h recall and food gap months as proxy to food security. Besides, Principal Component Analysis (PCA) method is used to construct household asset index. The results of the study revealed that there are clear and significant differences of the PSNP and Non-PSNP households, and gender in land holding (p<0.01%), asset ownership(p<0.01%), food gap months(p<0.01%), dietary diversity(p<0.01%), exposure to hazards and risks, copping strategies, yield, access to agricultural extension services, access to improved varieties (varietal diversification). The male headed households, and Non-PSNP households are better off than the female headed and PSNP households’ counterparts. Thus, provision of practical training, conducting farmer’s participatory
research, field days, promoting and creating access to farmers’ preferred high yielding improved varieties and management practices available in the research and extension consortium, support in research and development that develops and disseminate appropriate technologies to help farmers to
lower their food gap months is highly important. In addition, sustainable intensification, off-farm employment alternatives, and engaging in agribusiness activities that create resilient livelihood options to those resource poor farm households, strengthening the formal and informal seed system would help to reduce food gap months, improve HDDS, build resilience of the food and nutrition insecure households. Therefore, customized
extension services and packages are important for addressing the food and nutrition security gaps by setting goal, outcome and output indicators for future interventions in the research and development arena in filling food gap months, dietary diversity and household asset building through collaboration among relevant stakeholders in the food system.
... Prominent examples are research into intergenerational mobility, where annual income or income averages are used as a proxy for permanent income, and research into the effect of wealth on school enrolment, where different types of physical asset holdings and household conditions collected from demographic and health surveys are used as a proxy for wealth, e.g. Filmer and Pritchett (2001). Lam et al. (2020) discuss several other proxy variables for household wealth. ...
Prior to 2011, individual life expectancy played no role in the Norwegian old-age pension system. However, after the 2011 reform, life expectancy became a central factor for early pension take-up. Asymmetric information is crucial in most insurance markets, including the new pension system, where employees can flexible claim a public pension from the age of 62. Individuals who expect to live longer than the average for their birth cohort can maximize their pension wealth by deferring pension claiming, while those with a shorter life expectancy should draw their pension as early as possible. This raises concerns that adverse selection may pose a risk to the sustainability of the new pension system. To investigate this issue, we use chronic disease as a proxy for life expectancy and examine its relationship with employment and pension decisions. Our findings show that individuals with a chronic health condition are more likely to draw a pension and continue working when they reach 62 years of age compared to those without a chronic health condition. This suggests potential adverse selection issues in the pension system, although our results suggest small effects after adjusting for unobservables.
... Principal component analysis was used to construct the wealth index to classify SES [24,25]. All considered variables were first recoded to be binary. ...
There is limited research on how a cervical cancer diagnosis financially impacts women and their families in Uganda. This analysis aimed to describe the economic impact of cervical cancer treatment, including how it differs by socio-economic status (SES) in Uganda. We conducted a cross-sectional study from September 19, 2022 to January 17, 2023. Women were recruited from the Uganda Cancer Institute and Jinja Regional Referral Hospital, and were eligible if they were ≥ of 18 years and being treated for cervical cancer. Participants completed a survey that included questions about their out-of-pocket costs, unpaid labor, and family’s economic situation. A wealth index was constructed to determine their SES. Descriptive statistics were reported. Of the 338 participants, 183 were from the lower SES. Women from the lower SES were significantly more likely to be older, have ≤ primary school education, and have a more advanced stage of cervical cancer. Over 90% of participants in both groups reported paying out-of-pocket for cervical cancer. Only 15 participants stopped treatment because they could not afford it. Women of a lower SES were significantly more likely to report borrowing money (higher SES n = 47, 30.5%; lower SES n = 84, 46.4%; p-value = 0.004) and selling possessions (higher SES n = 47, 30.5%; lower SES n = 90, 49.7%; p-value = 0.006) to pay for care. Both SES groups reported a decrease in the amount of time that they spent caring for their children since their cervical cancer diagnosis (higher SES n = 34, 31.2%; lower SES n = 36, 29.8%). Regardless of their SES, women in Uganda incur out-of-pocket costs related to their cervical cancer treatment. However, there are inequities as women from the lower SES groups were more likely to borrow funds to afford treatment. Alternative payment models and further economic support could help alleviate the financial burden of cervical cancer care in Uganda.
... Additional demographic information included education and wealth, which was assessed as years of full-time schooling for education status and using 37 asset ownership indicators and dwelling characteristics such as livestock, bank account, and distance to a water source for wealth status. A wealth index was created based on principal component analysis as described in the previous study [22], and the original sample was divided into quintiles of wealth levels. ...
Background
Over- and undernutrition coexist in many African countries and pose a threat to metabolic health. This study assessed the associations between relationship satisfaction and Body Mass Index (BMI), waist circumference (WC), and glycated hemoglobin (HbA1c), in a rural population of older adults in Burkina Faso. It also explored potential gender differences and the mediating role of depressive symptoms.
Methods
Data from the “Centre de Recherche en Santé de Nouna (CRSN) Heidelberg Aging Study (CHAS),” a cross-sectional population-based study conducted in 2018 in Burkina Faso, were used in our study. Hierarchical linear regression models were applied for each of the three outcome variables. Among 2291 participants aged 40 years or older who provided data on relationship satisfaction, 2221, 2223, and 2145 participants had BMI, waist circumference (WC), and HbA1c values respectively.
Results
Higher relationship satisfaction (CSI-4 score) was associated with increased BMI (β = 0.05, p = 0.031) and WC (β = 0.12, p = 0.039). However, the association of CSI-4 and BMI became non-significant after controlling for depressive symptoms (PHQ-9 score) and physical inactivity (BMI: β = 0.04, p = 0.073). Depressive symptoms fully mediated the relationship between relationship satisfaction and BMI (β = -0.07, p = 0.005). There was no significant association between relationship satisfaction and HbA1c. These results were consistent across genders and age groups.
Conclusion
Higher relationship satisfaction may lead to increased body weight among Burkinabe adults aged 40 years and older, and depressive symptoms may be a mediator in this association.
... .,Victora, Mushi, De Savigni, Schellemberg, D., Mishinda y Bryce, 2003;Filmer y Pritchett, 2001). Montgomery, Gragnolati, Burke y Paredes (2000) señalan la ausencia de una sola manera de seleccionar variables como proxy de las condiciones de vida y muchas veces el criterio es "ad hoc". ...
Este artículo presenta la aplicación de la técnica Análisis de Componentes Principales (ACP) en la construcción de estratos socioeconómicos. Generalmente, las medidas de bienestar de los hogares pueden captarse a través de información sobre el ingreso, el consumo o el gasto. Sin embargo, la información detallada sobre estas variables resulta problemática y la utilización de indicadores sobre los activos que tiene el hogar constituye una opción en la medición de la desigualdad. Se discute cómo los índices socioeconómicos son construidos, cómo pueden utilizarse y sus limitaciones. Se tratan de manera específica temas relativos a la elección de las variables y la preparación de los datos.
... Fourth, provincial differences may be a more significant determinant of macro-level socioeconomic status as "within-region" differences may still vary greatly, nevertheless, weighted regional estimates may still determine area-specific differences to some extent. Fifth, household wealth may seem to be a less accurate measure of one's ability-to-pay however, studies have shown that the DHS wealth index is similar to other indicators of socioeconomic status and is adequate in the assessment of "absolute economic status" [51,91]. Lastly, due to the cross-sectional nature of the study, associations found in the study do not assume causality. ...
Background The study uncovers micro and macro socioeconomic disparities in terms of health behavior, disease
perception, and reception of information. Furthermore, findings shed light on the possible role of health insurance on
access to information, disease perception and the adoption of preventive behaviors in the context of a public health
emergency such as the COVID-19 pandemic.
Methods This study employed a cross-sectional design using the Philippine Demographic and Health Survey
(DHS). With a total of 29,809 respondents, it evaluated the individual or household and systemwide socioeconomic
determinants of four different outcomes: receipt of information, disease perception, uptake of free preventive
services, and treatment-seeking behavior. In addition to logistic regression models with the socioeconomic variables
as the independent variables, models for the evaluation of the moderating effect of insurance ownership were fitted.
Predicted probabilities were reported for the analysis of moderating effects.
Results Findings show that individual and householdsocioeconomic determinants affected health-behavior and
access to or receipt of information pertinent to the COVID-19 pandemic. Both education and wealth affected the
receipt of information such that individuals in more advantaged socioeconomic positions were at least 30% more
likely to have received information on COVID-19. Wealth was also associated to treatment-seeking behavior. Regional
differences were seen across all dependent variables. Moreover, the study provides evidence that ownership of
insurance can close education-based gaps in the uptake of free vaccination and COVID-19 testing.
Conclusion It is imperative that targeted efforts be maximized by utilizing existing strategies and mechanisms to
reach the marginalized and disadvantaged segments of the population. Health insurance may give off added benefits
... This index is estimated through principal components analysis and is adjusted for urban or rural residence. Households are then categorized into quintiles of the resulting score, Q1 including the 20% poorest households up to Q5 with the 20% richest households [16]. ...
... This index is estimated through principal components analysis and is adjusted for urban or rural residence. Households are then categorized into quintiles of the resulting score, Q1 including the 20% poorest households up to Q5 with the 20% richest households [16]. ...
... The individual-level factors included the child's age, gender and relationship to the carer; household-level factors included the household wealth index and ethnicity. The household wealth index was represented as a score of household assets through the principal components analysis (PCA) method [22]. The index was categorised into three classes, namely, poor, middle and rich. ...
Developmental impairment remains an important public health problem among children in many developing countries, including Nepal. Iron deficiency in children may affect development and lead to anaemia. This study on 1702 children aged 6–59 months aimed to assess the association between nutritional anthropometric indices and iron deficiencies. Data for this study were extracted from the 2016 Nepal National Micronutrient Status Survey. Three nutritional anthropometric indices (stunting, wasting and underweight) and their association with anaemia and iron deficiencies (ferritin and sTfR biomarkers) were assessed by conducting multivariate statistical analyses. The prevalence of stunting, wasting and underweight among children aged 6–59 months was 35.6%, 11.7% and 29.0%, respectively. Most of the children were not stunted (64.4%), not wasted (71.0%) and not underweight (88.3%). Belonging to castes other than the Janajati, Dalit and Brahmin castes increased the odds of anaemia and iron deficiency (ferritin biomarker). Children in the age group 6–23 months were significantly at higher odds of having anaemia and iron deficiency (ferritin and sTfR biomarkers). Stunting significantly increased the odds of anaemia [adjusted odds ratio (OR): 1.55; 95% confidence interval (CI): (1.11, 2.17)], iron deficiency (ferritin biomarker [OR: 1.56; 95% CI: (1.16, 2.08)] and sTfR biomarker [OR: 1.60; 95% CI: (1.18, 2.15)]). Further, underweight significantly increased the odds of anaemia [OR: 1.69; 95% CI: (1.12, 2.54)] and iron deficiency (sTfR biomarker [OR: 1.48; 95% CI: (1.14, 1.93)]). Interventions to minimise the occurrence of anaemia and iron deficiencies among children in Nepal should focus on providing appropriate healthcare services that would reduce the burden of stunting and underweight.
... El ejemplo desarrollado por (Filmer & Pritchett, 2000) del modelo fue: = 1 1 + 2 2 + ⋯ + donde es el índice de activos de un hogar ⅈ , son indicadores o variables de posesión de activos y de calidad de la vivienda. son las ponderaciones, obtenidas del primer componente principal, utilizado para agregar los indicadores en un índice (son datos binarios y es bueno usar la técnica de mínimos cuadrados ordinarios entre componentes y luego ver los valores cardinales. ...
Although the Bioeconomy emerged as an economic and productive paradigm more than 50 years ago, today it has gained unusual importance, affecting agriculture, industry, and all other productive sectors, as a real alternative to face post-COVID-19 challenges, reactivating economies. and taking into account the great ecological and environmental imbalances that are taking their toll on humanity. It also affects food security and helps mitigate the effects of climate change.
To this must be added the philosophy of “Living Well, Good Living or Wellbeing” constitutionally embodied in some Andean-Amazonian countries and other latitudes, to integrate into different economic models. The Ande Amazonian Bioeconomy is the bridge that allows us to replace imports of fossil fuels and others, relieving the care of Mother Earth, through the convergence of modern sciences and technologies with ancestral knowledge, entering Bioculture, Bioinformation and Territoriality, forgotten files that we return in our proposal. The basis of everything is the balance that must occur between time and space, as well as between matter and spirit (which is energy), which were deliberately separated. We call all of this THE ECONOMY OF LIFE.
This study examined the demographic, socioeconomic, health, and well-being of rural-dwelling older Cambodians and identified differentials based on age and gender. The goal is to understand disparities in wealth, health, well-being, and support systems among older adults within the context of Cambodia’s history of civil unrest and socio-cultural norms. A regionally representative sample from three northwestern Cambodian provinces was used to evaluate household wealth, economic satisfaction, health, psychological well-being, social support, and a government welfare program. Analysis was conducted to document how these factors differed by age and gender. Significant gender differentials in demographics, well-being, and support systems were observed. Older women outnumbered men and reported lower levels of social support and psychological well-being, potentially influenced by high widowhood rates and gender-linked cultural norms. Education levels were generally low, possibly due to disruption from wars and conflicts. Relative to neighboring countries, the health status of older Cambodians was poor, though no significant gender-based health disparities were identified. There were differences in debt and wealth accumulation among age groups but no variation in welfare support by age or gender. These findings underline the significance of addressing gender disparities and socio-cultural factors affecting older Cambodians. They underscore the need for policy attention toward older women’s psychological well-being and support systems, as well as health and social support interventions for the oldest age groups. Future research should investigate these observed patterns, accounting for regional variations and survivor selection bias.
Background
Micronutrient deficiencies are widespread in India. Soil-transmitted helminth (STH) infections are acquired by interaction with soil and water contaminated by human feces and lead to blood loss and poor micronutrient absorption. The current recommendation for control of STH-related morbidity is targeted deworming, yet little is known about the effectiveness of deworming on micronutrient status in varying sanitation contexts. Ranging between 1% and 40% prevalence across Indian states, open defecation (OD) remains high despite India’s investments at elimination by promoting community-wide sanitation. This variation provides an opportunity to study the relationship between deworming, micronutrient status, and OD at-scale.
Methods and findings
Cross-sectional datasets that were representative for India were obtained the Comprehensive National Nutrition Survey in 2016 to 2018 ( n = 105,060 individuals aged 1 to 19 years). Consumption of deworming medication was described by age and community OD level. Logistic regression models were used to examine the relationship between deworming, cluster OD, and their interactions, with anemia and micronutrient deficiencies (iron, zinc, vitamin A, folate, and vitamin B12), controlling for age, sex, wealth, diet, and seasonality. These regression models further allowed us to identify a minimum OD rate after which deworming becomes ineffective. In sensitivity analyses, the association between deworming and deficiencies were tested in subsamples of communities classified into 3 OD levels based on statistical tertiles: OD free (0% of households in the community practicing OD), moderate OD (>0% and <30%), or high OD (at least 30%).
Average deworming coverage and OD prevalence in the sample were 43.4% [IQR 26.0, 59.0] and 19.1% [IQR 0, 28.5], respectively. Controlling for other determinants of nutritional status, adolescents living in communities with higher OD levels had lower coverage of deworming and higher prevalence of anemia, zinc, vitamin A, and B12 deficiencies. Compared to those who were not dewormed, dewormed children and adolescents had lower odds of anemia (adjusted odds ratio 0.72, (95% CI [0.67, 0.78], p < 0.001) and deficiencies of iron 0.78, (95% CI [0.74, 0.82], p < 0.001) and folate 0.69, (95% CI [0.64,0.74], p <0.001)) in OD free communities. These protective effects remained significant for anemia but diminished for other micronutrient deficiencies in communities with moderate or high OD. Analysis of community OD indicated a threshold range of 30% to 60%, above which targeted deworming was no longer significantly associated with lower anemia, iron, and folate deficiency. The primary limitations of the study included potential for omitted variables bias and inability to capture longitudinal effects.
Conclusions
Moderate to high rates of OD significantly modify the association between deworming and micronutrient status in India. Public health policy could involve sequencing interventions, with focus on improving deworming coverage in communities that have achieved minimum thresholds of OD and re- triggering sanitation interventions in high OD communities prior to deworming days, ensuring high coverage for both. The efficacy of micronutrient supplementation as a complementary strategy to improve nutritional outcomes alongside deworming and OD elimination in this age group needs further study.
This paper adopts a micro‐level analysis to assess the effect of aid from China and the World Bank on the wealth of locals residing near aid project sites. We match geospatial data on aid projects financed by China and the World Bank in 35 African countries between 2008 and 2014 to respondents from rounds 5 and 6 of the Afrobarometer survey. The results indicate that aid from these two donors increases the wealth of the local population. Our transmission mechanism test suggests that aid impacts wealth by promoting employment opportunities.
We rely on Permanent Income to define a socioeconomic stratification system based on a latent trait measurement model using objective and widely available socioeconomic variables as reflective indicators, with an official panel of households
spanning 2006-2020 in Spain. We obtain an objective and transparent stratification of Spanish society for these 15 years, and track social mobility at the household level between consecutive years that included economic expansion, a major recession,
economic recovery and a major pandemic.
We have quantified social mobility (greater in the extreme strata) in each of the periods of growth, crisis and economic recovery. Crisis derived from COVID-19 has been more drastic and has affected more the consumption of households under 65 years of age or
with few members.
In Spain, measures adopted against the effects of the COVID crisis
have generated less inequality than those adopted during the Big Recession of 2008.
Background and Objectives
Alcohol causes more than 3 million deaths a year globally and contributes to over 5% of global disease and injury. Heavy drinking and alcohol use disorders among older adults have increased in the last 10–15 years. For individuals living in low-income countries, where wages are low and unemployment is high, old age pensions may provide a significant increase in household income. In turn, the receipt of supplementary income may increase spending on alcohol. Earlier life factors and socioeconomic status may affect alcohol consumption, making it difficult to directly assess the impact of income on alcohol consumption. This study reduces the potential for endogeneity with other life factors by exploiting an exogenous increase in income from old age pensions to isolate the impact of extra income on alcohol consumption for older adults.
Research Design and Methods
We used a regression discontinuity design to assess changes in drinking patterns among rural, low-income adults who were 3 years below and 3 years above South Africa’s Old Age Pension Grant eligibility threshold (age 60). We assessed this relationship separately by gender and for employed and unemployed individuals.
Results
We observed a significantly increased alcohol use associated with the Old Age Pension Grant eligibility for employed men (β = 4.57, 95% confidence interval: 1.72–12.14). We did not observe this same trend for unemployed men or for women.
Discussion and Implications
The analysis in this study indicates that increased income from reaching the pension eligibility age may contribute to an increase in alcohol consumption for employed men. Interventions, such as informational campaigns on the risks of alcohol consumption for older adults or age-appropriate health interventions to help individuals reduce alcohol consumption, targeted around the time of pension eligibility age for employed men may help to reduce alcohol-related harms in low-income, rural sub-Saharan African settings.
The Integrated Child Development Services (ICDS) programme has been the central focus of the POSHAN Abhiyaan to combat maternal and child malnutrition under the national nutrition mission in India. This paper examined the linkages between utilization of ICDS and underweight among children aged 6–59 months. The study utilized data from two recent rounds of the National Family Health Survey (NFHS‐4 [2015–2016] and NFHS‐5 [2019–2021]). Descriptive analyses were used to assess the change in utilization of ICDS and the prevalence of underweight at the national and state levels. Multivariable logistic regressions were performed to examine factors associated with the utilization of ICDS and underweight. Linkages between utilization of ICDS and underweight were examined using the difference‐in‐differences (DID) approach. Utilization of ICDS increased from 58% in 2015–2016 to 71% in 2019–2021. The prevalence of underweight decreased from 37% to 32% in the same period. Changes in ICDS utilization and underweight prevalence varied considerably across states, socioeconomic and demographic characteristics. Results from decomposition of DID models suggest that improvements in ICDS explained 9%–12% of the observed reduction in underweight children between 2016 and 2021, suggesting that ICDS made a modest but meaningful contribution in addressing undernutrition among children aged 6–59 months in this period.
Introduction:
Young newly married women and first-time parents (FTPs), particularly those living in slum settlements, have a high unmet need for modern contraceptive methods to limit and space births. We describe an intervention in which adolescents and youth sexual and reproductive health (AYSRH) services tailored to FTPs were incorporated into the government's existing family planning (FP) program in 5 cities of Uttar Pradesh. We examined the effect of this intervention on modern contraceptive use among FTPs aged 15-24 years.
Methods:
To assess the effect of this pilot, in 2019, 1 year after the implementation of the program, we analyzed community-based output tracking survey data on 549 married women who are FTPs in the pilot cities. These FTPs were compared with 253 women who were FTPs from other cities where the program was implemented without a specific focus on FTPs. Descriptive statistics and multivariate logistic regression analysis were applied to understand the association between exposure to FP information, either through accredited social health activists or through service delivery points, and use of modern contraceptives.
Results:
Use of modern contraceptives was higher among FTPs in the 5 pilot cities than non-pilot cities (39% vs. 32%; P<.05). The interaction effect of city type and exposure to the information showed a positive association between modern contraceptive use and program exposure, greater in pilot cities than non-pilot cities.
Conclusions:
Higher uptake of modern contraceptives among young women may be achieved when an FTP-focused intervention is layered on the government's existing FP programs. Future studies with a longer duration of implementation, in a wider geography, and with longitudinal design are recommended to provide more robust measures of high impact intervention/practices in urban areas.
Ensuring basic literacy and numeracy is the primary objective of India’s education policy. With the right to education (RTE) Act, India has universalized physical access. However, with little improvement in infrastructure, human resources and pedagogy, learning remains a concern, particularly for first-generation learners. First-generation learners are children from deprived sections with limited learning opportunities. Using the probit model for 3 years spanned over the decade post-RTE, the paper estimates the magnitude of the learning gap between first-generation learners and other students. The study further analyses the role of school resources to enhance the performance of first-generation learners and reduce the learning gap. The results demonstrate that substantial learning gaps are present, which have increased over the years. Simultaneously, the findings show a positive effect of libraries, smaller class sizes and female teachers on overall learning performance. Further, smaller class sizes and private schools are effective in reducing the learning gaps.
This paper explores the impact of livelihood strategies and place on mental well‐being. Identifying different socioeconomic factors that impact mental well‐being across contexts is pressing given the global rise in mental health disorders. Numerous studies in the population and social sciences have emphasized the protective role of material wealth on human health and well‐being; however, scholars frequently assess wealth as a one‐dimensional variable, which may fail to capture diverse forms of wealth. Acknowledging different forms of wealth may be particularly important in settings where agricultural economies coexist with cash economies. Using data from the 2013 Namibia Demographic Health Survey ( n = 13 377), we use a newly developed measure of success in agricultural activities, an agricultural wealth index, or AWI, generated by Hackman et al., (2021). To examine the role of different forms of wealth on mental health symptoms. We find mental well‐being, assessed through three survey questions, is lower among urban dwellers and females and shows varied associations with wealth type and sex/gender. In general, success in agricultural activities is associated with better mental well‐being, while the association with market success is null or and conditional upon sex/gender and place. This study adds to recent work on the value of using multidimensional measures of wealth and raises important questions about why wealth type and sex/gender differentially impact mental well‐being.
Children with severe acute malnutrition (SAM) are at high risk of impaired development. Contributing causes include the inadequate intake of specific nutrients such as polyunsaturated fatty acids (PUFAs) and a lack of adequate stimulation. We conducted a pilot study assessing developmental and nutritional changes in children with SAM provided with a modified ready-to-use therapeutic food and context-specific psychosocial intervention in Mwanza, Tanzania. We recruited 82 children with SAM (6–36 months) and 88 sex- and age-matched non-malnourished children. We measured child development, using the Malawi Development Assessment Tool (MDAT), measures of family and maternal care for children, and whole-blood PUFA levels. At baseline, the mean total MDAT z-score of children with SAM was lower than non-malnourished children; −2.37 (95% confidence interval: −2.92; −1.82), as were their total n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) levels. After 8 weeks of intervention, MDAT z-scores improved in all domains, especially fine motor, among children with SAM. Total n-3 and EPA levels increased, total n-6 fatty acids decreased, and DHA remained unchanged. Family and maternal care also improved. The suggested benefits of the combined interventions on the developmental and nutritional status of children with SAM will be tested in a future trial.
Background: To ensure resources invested into services are commensurate with benefit, economists utilise various methods to assess value of life. Understanding the performance of these methods in older populations is crucial, particularly in low-and-middle-income countries (LMICs), where the majority of older people will live by 2030. Value of Statistical Life Years (VSLY) is widely used in cost-benefit analyses but rarely been in LMICs or in older people.
Objective: This study aimed to investigate the hypothesis that frailty would be associated with a lower VSLY in participants in rural Burkina Faso, when controlling for factors found in other studies likely to affect VSLY, such as socio-demographics, multimorbidity, quality of life, and disability.
Methods: The study included 3,988 adults aged 40 years and older from a population-representative household survey done in Nouna, Burkina Faso. Data were collected on sociodemographic characteristics, chronic medical conditions, quality of life, disability, physical performance, and VSLY. Frailty status was derived using Fried's frailty phenotype. Bivariate analyses investigated the association between quintiles of VSLY and frailty. To explore modification of associations by other variables, we built sequential binary logistic regression models comparing each quintile of VSLY with the first (lowest) quintile. Models included frailty category, age, sex, marital status, educational attainment, and wealth. We sequentially added quality of life, multimorbidity, and disability.
Results: Of 2,761 survey participants included in this analysis, 51.4% were female. Average age was 54.5 years (with 70.0% aged 40-59 years), 24.8% of respondents reported being alone, and 84.5% had not completed education. In bivariate analyses, we found a significant negative association between higher VSLY and frailty, increasing age, disability, and quality of life. Conversely, being male, married, and educated were positively associated with higher VSLY. The negative association between VSLY and frailty remained significant after adjusting for age, gender, education, wealth, quality of life, disability, and multimorbidity (odds of being frail for VSLY quintile 5 vs quintile 1 was 0.48, 95% CI 0.37-0.64 for the fully adjusted model). Furthermore, effect of age, education, and wealth on VSLY became non-significant once frailty was included in the model.
Conclusion: There is a strong relationship between the value that older people place on their lives and their frailty status. Frailty status is important to consider when assessing VSLY, especially in LMICs in which there is a rapidly growing older population.
Background: The aim of this study is to estimate the factors at both the individual and community levels related to the adequacy of iodized salt in households in Bangladesh. Methods: For this study we utilized the 2019 Multiple Indicator Cluster Survey data. A total of 61 242 households were chosen as samples from Bangladesh. In our study of socioeconomic disparities, we applied a concentration indexing method. To identify the factors associated with the adequacy of iodine in salt at both the individual and community levels, we employed multilevel logistic regression. Aside from the multilevel regression used in the study, we also applied spatial analysis. Results: The results indicated that the prevalence of iodine adequacy in household salt was found to be 57.8% (95% confidence interval 57.4 to 58.2). Rural areas have a higher concentration of iodine than urban areas. According to the multilevel model, younger women (adjusted odds ratio [aOR] 0.70), Muslim women (aOR 0.89), illiterate women (aOR 0.80) and those from poor households (aOR 0.33) were found to be less likely to consume iodine in concentrated salt compared with their counterparts. Disabled women and those with low media exposure have a lower likelihood of iodine adequacy in salt compared to their reference group. Furthermore, households in urban areas exhibited higher odds of having iodine adequacy in salt compared with households in rural areas. Barisal, Chattogram, Dhaka, Khulna, Mymensingh, Rajshahi and Rangpur Divisions have lower iodine adequacy in salt compared with Sylhet Division. Conclusions: The findings reveal that religion, physical disability and exposure to media exert an equal influence on the presence of iodized salt intake. Moreover, women's age, wealth status, education level and the educational background of the household head positively contribute to the adequacy of iodine in household salt. In light of these results, policymakers are advised to prioritize efforts aimed at enhancing iodine concentration, with a particular focus on mass media advertising, especially in rural areas (excluding Sylhet Division).
Most of the research on ethnicity in Central America looks at two groups: indigenous and nonindigenous populations. While indigenous people are disadvantaged relative to the nonindigenous group, the many groups that make up the indigenous population are often times not very similar in terms of personal and group characteristics. But the differences within these groups are important for public policy. Ethnic groups' experience depends on many factors besides education and skill levels. These additional factors may include what has come to be known as “ethnic capital.” That is, the socioeconomic performance of today's workers depends not only on parental skills, but also on the average skills of the ethnic group in the parent's generation. In the United States, when data on ethnic groups is broken down, the black-white comparison may be too simple a characterization. It is argued here that the indigenous-nonindigenous comparison in Guatemala is too simple. Guatemala's household survey, which utilizes two questions to determine an individual's ethnicity (self-perception and language), is used here to examine the question of ethnicity in terms of schooling attainment, earnings and the returns to schooling. The following hypothesis is tested: do higher levels of schooling correspond to higher returns to schooling? Dividing the indigenous sample into the main ethnic groups produces widely different and dramatic results in terms of schooling, earnings and the returns to schooling. Higher levels of schooling correspond to higher returns to schooling by ethnic group. Thus there may be a need to target interventions appropriately to the specific ethnic group in question.
Schooling is widely seen as critical for income generation in all types of economies. A growing concern among many has been the possibility of increasing inequality in part due to children from higher-income households obtaining more schooling and reaping greater gains from schooling than children from lower-income households. There are many empirical studies for various societies that tend to find significantly positive, but small associations between household income and schooling. But these studies generally have three major limitations for the purpose of characterizing the degree of association between household income and schooling-related investments: (1) use of income indicators that may be contaminated by relatively large measurement errors and endogeneity, (2) inclusion of other household, community and schooling variables that may represent part of the association with income in empirical estimates, and (3) use of limited indicators of schooling. This paper uses a rich new household survey-commune-school facility survey from Viet Nam to illustrate how important these limitations may be. The estimates suggest: (1) predicted income (expenditure) tends to yield estimates of much stronger associations than does current income or expenditures, (2) controlling for variables such as in most previous studies reduces the estimated associations with income substantially, and (3) including a wide range of schooling-related variables leads to more nuanced understanding of income-schooling associations, with some benefits for children from poorer households but a dominant tendency for school and private behaviors to favor significantly and in many cases substantially children from higher-income households.
The widely held view that larger families tend to be poorer in developing countries has influenced research and policies. But the basis for this"stylized fact"is questionable, the authors argue. Widely cited evidence of a strong negative correlation between size and consumption per person is unconvincing, given that even poor households face economies of size in consumption. The authors find that the correlation between poverty and household size vanishes in Pakistan when the size elasticity of the cost of living is about 0.6. This turns out to be the elasticity implied by a modified version of the food-share method of setting scales. By contrast, some measures of child nutritional status indicate an elasticity closer to unity. Consideration of the weight attached to child versus adult welfare may help resolve the nonrobustness of demographic profiles of poverty. The authors show that the incidence of severe child stunting is more elastic to household size than their Engel curve estimate suggests, although the latter is still a fair predictor of child wasting. A consideration of the purpose of measuring poverty - notably the extent to which it is used to inform policies aimed at promoting child welfare - may go some way toward resolving the issues.
In a new, relatively high-quality, panel-data set on household consumptions for postreform rural China we find that consumption variability accounts for a large share of observed poverty and is likely to be a severe constraint on efforts to reach the long-term poor. Half of the mean squared poverty gap and over a third of the mean poverty gap is transient, in that it is directly attributable to year-to-year fluctuations in consumption. There is enough transient poverty to treble the cost of eliminating chronic poverty when targeting transfers according to current consumptions and to tilt the balance in favor of untargeted transfers. Anti-poverty policies in China may have to give greater emphasis to the problem of transient poverty.J. Comp. Econom., June 1998,26(2), pp. 338–357. World Bank Washington, DC.
This book is about the analysis of household survey data from developing countries and about how such data can be used to cast light on a range of policy issues. Much of the analysis works with household budget data, collected from income and expenditure surveys, though I shall occasionally address topics that require wider information. I shall use data from several different economies to illustrate the analysis, drawing examples of policy issues from economies as diverse as Cote d'Ivoire, India, Pakistan, South Africa, Taiwan (China), and Thailand. I shall be concerned with methodology as well as substance, and one of the aims of the book is to bring together the relevant statistical and econometric methods that are useful for building the bridge between data and policy.
This section will offer a description of a data source that may be of interest to economists. The purpose is to describe what data are available from that source or in that subject area, what questions can be addressed because of the unique features of the data, and how an interested reader can gain access to the data.
The idea of duality has proved to be a powerful device in modern work on the economics of consumer behaviour. The authors have used duality to provide an integrated and accessible treatment of this subject. The book focuses on applications of the theory to welfare economics and econometric analysis. The book begins with four chapters that provide a self-contained presentation of the basic theory and its use in applied econometrics. These chapters also include elementary extensions of the theory to labour supply, durable goods, the consumption function, and rationing. The rest of the book is divided into three parts. In the first of these the authors discuss restrictions on choice and aggregation problems. The next part consists of chapters on consumer index numbers; household characteristics, demand, and household welfare comparisons; and social welfare and inequality. The last part extends the coverage of consumer behaviour to include the quality of goods and household production theory, labour supply and human capital theory, the consumption function and intertemporal choice, the demand for durable goods, and choice under uncertainty.
This paper examines the relationship between widowhood and poverty in rural India, based on National Sample Survey data on consumer expenditure. In terms of standard poverty indices based on household per-capita expenditure, there is no evidence of widows being disproportionately concentrated in poor households, or of female-headed households being poorer than male-headed households. These findings also apply in terms of adult-equivalent consumption for any reasonable choice of equivalence scales. Poverty indices for different household types, however, are quite sensitive to the level of economies of scale. Even relatively small economies of scale imply that the incidence of poverty among single widows, widows living with unmarried children, and female household heads (all of whom tend to live in relatively small households) is higher than in the population as a whole.
Zoubida Allaoua: Team leader. Incl. annexes, bibl., abstract, executive summary, list of abbreviations
This paper uses a new survey to contrast the wages of genetically identical twins with different schooling levels. Multiple measurements of schooling levels were also collected to assess the effect of reporting error on the estimated economic returns to schooling. The data indicate that omitted ability variables do not bias the estimated return to schooling upward, but that measurement error does bias it downward. Adjustment for measurement error indicates that an additional year of schooling increases wages by 16%, a higher estimate of the economic returns to schooling than has been previously found.
The stronger are the associations between household income and child schooling, the lower is intergenerational social mobility and the less equal is opportunity. This study estimates the associations between household income and children's school success in Vietnam. The estimates indicate that these associations are considerable. For example, the income elasticity of completed grades is five times the median estimate of earlier studies. Moreover, this association is strongest for grades completed per year of school, not for completed grades, on which most of the previous literature has focused. There are some gender differences, the most important being a smaller association between income and grades completed per year of school for boys than for girls. This difference implies that schooling of girls is treated as more of a luxury (less of a necessity) than is schooling of boys. This article also investigates some ways in which policies relate to household incomes. School fees are progressive, but school fees are only about one-third of what households pay directly to schools and are a much smaller proportion of a household's total school-related expenditures. Total household expenditures paid directly to schools increase with household income less proportionately than do school fees alone, so the overall structure of such payments is less progressive than is the structure of school fees. Because school enrollment is positively related to household income, moreover, the structure of school fees is less progressive for the entire population than for the selected subset that has children enrolled in school. Further, the two school quality measures that have the strongest positive association with children's school success are much more available to higher-income households, meaning that higher-income households have greater school expenditures in part because they are obtaining higher-quality schooling and not because charges for the same quality schooling are progressive across income classes. Copyright 1999 by Oxford University Press.
This paper attempts to answer the question: Who is most vulnerable to declines in welfare during a macroeconomic shock? After clarifying the difference between poverty and vulnerability, an analytical framework is presented and then applied to household panel data from Peru. Major findings are: (a) households with better educated heads are less vulnerable; (b) female headed households are not more vulnerable to declines than male headed households; (c) households with more children are more vulnerable to macroeconomic shocks; and (d) transfer networks that may assist the poor in relatively stable periods do not appear to protect them during a major shock, with the exception of transfers that originate from outside Peru.
An analyst using household survey data to construct a welfare metric is often confronted with a number of theoretical and practical problems. What components should be included in the overall welfare measure? Should differences in tastes be taking into account when making comparisons across people and households? How best should differences in cost-of-living and household composition be taken into consideration? Starting with a brief review of the theoretical framework underpinning typical welfare analysis undertaken based on household survey data, this paper provides some practical guidelines and advice on how best to tackle such problems. It outlines a three-part procedure for constructing a consumption-based measure of individual welfare: (i) aggregation of different components of household consumption to construct a nominal consumption aggregate, (ii) construction of price indices to adjust for differences in prices faced by households, and (iii) adjustment of the real consumption aggregate for differences in household composition. Examples based on survey data from eight countries-Ghana, Vietnam, Nepal, the Kyrgyz Republic, Ecuador, South Africa, Panama, and Brazil - are used to illustrate the various steps involved in constructing the welfare measure, and the STATA programs used for this purpose are provided in the appendix. The paper also includes examples of some analytic techniques that can be used to examine the robustness of the estimated welfare measure to underlying assumptions.
This paper uses a new survey to contrast the wages of genetically identical twins with different schooling levels. Multiple measurements of schooling levels were also collected to assess the effect of reporting error on the estimated economic returns to schooling. The data indicate that omitted ability variables do not bias the estimated return to schooling upward but that measurement error does bias it downward. Adjustment for measurement error indicates that an additional year of schooling increases wages by 12 to 16 percent, a higher estimate of the economic returns to schooling than has been previously found. Copyright 1994 by American Economic Association.
The widely held view that larger families tend to be poorer in developing countries has influenced research and policy. The scope for size economies in consumption cautions against this view. We find that the correlation between poverty and size vanishes in Pakistan when the size elasticity of the cost of living is about 0-6. This turns out to be the elasticity implied by a modified version of the food share method of setting scales. By contrast, some measures of child nutritional status indicate an elasticity of unity. Considerations of the weight attached to child versus adult welfare may help resolve the non-robustness of demographic profiles of poverty. Copyright 1995 by Royal Economic Society.
The authors use household survey data from the Demographic and Health Surveys (DHS) from 44 surveys (in 35 countries) to document different patterns in the enrollment and attainment of children from rich and poor households. They overcome the lack of income or expenditure data in the DHS by constructing a proxy for long-run wealth of the household from the asset information in the surveys, using the statistical technique of principal components. There are three major findings. First, the enrollment profiles of the poor differ across countries but fall into distinctive regional patterns: in some regions the poor reach nearly universal enrollment in first grade, but then drop out in large numbers leading to low attainment (typical of South America), while in other regions the poor never enroll in school (typical of South Asia and Western/Central Africa). Second, there are enormous differences across countries in the "wealth gap," the difference in enrollment and educational attainment of the rich and poor. While in some countries the difference in the median years of school completed of the rich and poor is only a year or two, in other countries the wealth gap in attainment is 9 or 10 years. Third, the attainment profiles can be used as diagnostic tools to suggest issues in the educational system, such as the extent to which low attainment is attributable to physical unavailability of schools. Copyright 1999 by The Population Council, Inc..
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