Selected Publications

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Author:
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Theme:
Year:
Nolan M KavanaghNoora MarcusRisper BosireBrian OtienoElizabeth F. BairKawango AgotHarsha Thirumurthy

(2021). Health and Economic Outcomes Associated With COVID-19 in Women at High Risk of HIV Infection in Rural Kenya. JAMA Network Open. 4(6):e2113787.

PDRI Co-Director, Harsha Thirumurthy, coauthored an article inJAMA Network Open exploring how COVID-19 lockdowns influenced the economic well-being, food security, and sexual behavior of vulnerable populations in low- and middle-income countries. Findings from a survey in Kenya show lockdowns were associated with declines in employment, income, and numbers of sexual partners, suggesting negative economic impacts and temporarily reduced HIV risk in vulnerable populations.

Linda H. AikenMarta SimonettiDouglas M SloaneConsuelo CerónDavid BravoAlejandra GalianoPaz SotoJere R. BehrmanHerbert L SmithMatthew D McHughEileen T Lake

(2021). “Hospital nurse staffing and patient outcomes in Chile: a multilevel cross-sectional study”, The Lancet Global Health, In Press.

 

Background

Unrest in Chile over inequalities has underscored the need to improve public hospitals. Nursing has been overlooked as a solution to quality and access concerns, and nurse staffing is poor by international standards. Using Chile’s new diagnosis-related groups system and surveys of nurses and patients, we provide information to policy makers on feasibility, net costs, and estimated improved outcomes associated with increasing nursing resources in public hospitals.

Methods

For this multilevel cross-sectional study, we used data from surveys of hospital nurses to measure staffing and work environments in public and private Chilean adult high-complexity hospitals, which were linked with patient satisfaction survey and discharge data from the national diagnosis-related groups database for inpatients. All adult patients on medical and surgical units whose conditions permitted and who had been hospitalised for more than 48 h were invited to participate in the patient experience survey until 50 responses were obtained in each hospital. We estimated associations between nurse staffing and work environment quality with inpatient 30-day mortality, 30-day readmission, length of stay (LOS), patient experience, and care quality using multilevel random-effects logistic regression models and zero-truncated negative binomial regression models, with clustering of patients within hospitals.

Findings

We collected and analysed surveys of 1652 hospital nurses from 40 hospitals (34 public and six private), satisfaction surveys of 2013 patients, and discharge data for 761 948 inpatients. Nurse staffing was significantly related to all outcomes, including mortality, after adjusting for patient characteristics, and the work environment was related to patient experience and nurses’ quality assessments. Each patient added to nurses’ workloads increased mortality (odds ratio 1·04, 95% CI 1·01–1·07, p<0·01), readmissions (1·02, 1·01–1·03, p<0·01), and LOS (incident rate ratio 1·04, 95% CI 1·01–1·06, p<0·05). Nurse workloads across hospitals varied from six to 24 patients per nurse. Patients in hospitals with 18 patients per nurse, compared with those in hospitals with eight patients per nurse, had 41% higher odds of dying, 20% higher odds of being readmitted, 41% higher odds of staying longer, and 68% lower odds of rating their hospital highly. We estimated that savings from reduced readmissions and shorter stays would exceed the costs of adding nurses by US$1·2 million and $5·4 million if the additional nurses resulted in average workloads of 12 or ten patients per nurse, respectively.

Interpretation

Improved hospital nurse staffing in Chile was associated with lower inpatient mortality, higher patient satisfaction, fewer readmissions, and shorter hospital stays, suggesting that greater investments in nurses could return higher quality of care and greater value.

Funding

Sigma Theta Tau International, University of Pennsylvania Global Engagement Fund, University of Pennsylvania School of Nursing’s Center for Health Outcomes, and Policy Research and Population Research Center.
Philip SmithAlison ButtenheimLaura SchmuckerLinda-Gail BekkerHarsha ThirumurthyDvora L. Joseph Davey
(2021). Undetectable = Untransmittable (U = U) Messaging Increases Uptake of HIV Testing Among Men: Results from a Pilot Cluster Randomized Trial. AIDS Behav. 31:1–9.  Epub ahead of print.

HIV testing coverage in sub-Saharan Africa is lower among men than women. We investigated the impact of a peer-delivered U = U (undetectable equals untransmittable) message on men’s HIV testing uptake through a cluster randomized trial with individual mobile clinic days as a unit of randomisation.

On standard of care (SOC) days, peer promoters informed men about the availability of HIV testing at the mobile clinic. On intervention days, peer promoters delivered U = U messages. We used logistic regression adjusting for mobile clinic location, clustering by study day, to determine the percentage of invited men who tested for HIV at the mobile clinic.

Peer promoters delivered 1048 invitations over 12 days. In the SOC group, 68 (13%) of 544 men invited tested for HIV (3, 4.4% HIV-positive). In the U = U group, 112 (22%) of 504 men invited tested for HIV (7, 6.3% HIV-positive). Men in the U = U group had greater odds of testing for HIV (adjusted odds ratio = 1.89, 95% CI 1.21-2.95; p = 0.01).

Tailored, peer-delivered messages that explain the benefits of HIV treatment in reducing HIV transmission can increase men’s HIV testing uptake.

Susanna Berkouwer (2021) Promoting Accountability in Public Projects: Donors, Audits, and Rural Electrification

Many low-income country governments hire contractors to carry out large infrastructure projects, as they often lack the capacity to implement these themselves. At 14.5% of GDP, low-income countries have the highest share of public procurement in their economies (World Bank 2017). At the same time, low-income countries often have limited capacity to oversee public projects, which can result in low-quality infrastructure and leakage of public funds.

In 2015, Kenya’s President Kenyatta launched the Last Mile Connectivity Project (LMCP), whose goal was “to connect one million new customers to electricity each year” and achieve universal household electricity access by 2020. The USD 500 million program — one of Kenya’s largest public programs, financed largely by international aid agencies — would extend Kenya’s low voltage network to every household located within 600 meters of more than 13,000 sites nationwide. The program also sought to reduce red tape. The old process of applying for electricity — often requiring months of paperwork — would be replaced by a system where Kenya Power contractors initiate connections, with minimal effort from households.

Concerns around corruption are widely thought to threaten the quality, cost, timeliness, and equity of the construction process, and contribute to significant leakage The LMCP is just one example of many infrastructure projects financed by international agencies. To prevent corruption and improve construction quality, such projects are often accompanied by stringent conditions over how local implementing agencies are to use these funds. But do donor conditions actually improve infrastructure quality on the ground? And, could additional independent monitoring improve accountability?

Valentina Assenova

(2021). “How Incubators Help Entrepreneurs Succeed.” Knowledge@Wharton.

Becoming a successful entrepreneur requires the right combination of factors, impeccable timing, and often sheer luck. In her latest research, Wharton management professor Valentina Assenova examines what it takes to help entrepreneurs who need more luck than most — those who live in places where inequality is institutionalized and the obstacles to success are even higher to hurdle.

Inspired by a trip to South Africa, Assenova tracked the improvement rates for small businesses in Soweto whose owners received help through an incubator. She found that entrepreneurs who were paired with mentors learned the kind of expertise that enabled them to grow their businesses significantly.

Gabriel ChamieDalsone KwarisiimaAlex NdyabakiraKara MarsonCarol S. CamlinDiane V. HavlirMoses R. KamyaHarsha Thirumurthy

(2021).  “Financial incentives and deposit contracts to promote HIV retesting in Uganda: A randomized trial.” PLOS Medicine

 

Frequent retesting for HIV among persons at increased risk of HIV infection is critical to early HIV diagnosis of persons and delivery of combination HIV prevention services. There are few evidence-based interventions for promoting frequent retesting for HIV. We sought to determine the effectiveness of financial incentives and deposit contracts in promoting quarterly HIV retesting among adults at increased risk of HIV.

Maureen M BlackJere R. BehrmanBernadette Daelmans
et al (2021). “The principles of Nurturing Care promote human capital and mitigate adversities from preconception through adolescence.”

A comprehensive evidence-based framework is needed to guide policies and programmes that enable children and adolescents to accrue the human capital required to meet the Sustainable Development Goals (SDGs).

This paper proposes a comprehensive, multisectoral, multilevel life-course conceptualization of human capital development by building on the Nurturing Care Framework (NCF), originally developed for the foundational period of growth and development through the age 3 years. Nurturing care (NC) comprises stable environments that promote children’s health and nutrition, protect from threats, and provide opportunities for learning and responsive, emotionally supportive, and developmentally enriching relationships. NC is fostered by families, communities, services, national policies, and beyond.

The principles apply across the life course, endorse equity and human rights, and promote long-term human capital. This paper presents an evidence-based argument for the extension of the NCF from preconception through adolescence (0–20 years), organised into six developmental periods: preconception/prenatal, newborn/birth, infancy/toddlerhood, preschool, middle childhood, and adolescence.

The proposed framework advances human capital within each developmental period by promoting resilience and adaptive developmental trajectories while mitigating the negative consequences of adversities.

Attaining the SDGs depends on strengthening human capital formation, extending throughout childhood and adolescence and supported by NC. Embedded in enabling laws, policies, and services, the dynamic NCF components can mitigate adversities, enhance resilience and promote the well-being of marginalised groups. The life-course extension of the NCF is strategically positioned to enhance human capital, attain the SDGs, and to ensure that children or adolescents are not left behind in reaching their developmental potential.

Gabriel ChamieSue NapieralaKawango AgotHarsha Thirumurthy

(Apr 2021). “HIV testing approaches to reach the first UNAIDS 95% target in sub-Saharan Africa”. (Review). The Lancet. 8(4) E225-E236.

HIV testing is a crucial first step to accessing HIV prevention and treatment services and to achieving the UNAIDS target of 95% of people living with HIV being aware of their status by 2030. Combined implementation of facility-based and community-based approaches has helped to achieve high levels of HIV testing coverage in many countries including those in sub-Saharan Africa.

Approaches such as index testing and self-testing help to reach individuals at higher risk of acquiring HIV, men, and those less likely to use health facilities or community-based services. However, as the proportion of people living with HIV who are aware of their HIV status has risen, the challenge of reaching those who remain undiagnosed or those who are at high risk of acquiring HIV has grown.

Demand generation and novel testing approaches will be necessary to reach undiagnosed people living with HIV and to promote frequent retesting among key and priority populations.

Michael AlbertusGuy Grossman

(2021). “The Americas: When Do Voters Support Power Grabs?” Journal of Democracy 32(2) 116–31.

This article examines the nature of democratic fragilities in the Americas through survey experiments in Argentina, Brazil, Mexico, and the United States. Encouragingly, strong majorities of citizens recognize violations of democratic principles, laws, and norms. Moreover, how incumbents justify anti-democratic actions has little impact on how citizens view them.

Yet there are minorities, ranging from 10 to 35 percent of the population, who support efforts to erode democracy. And partisanship matters: Many individuals are seemingly “conditional democrats” who support anti-democratic actions if they voted for the incumbent. People are also reluctant to support impeachment for democratic violations, which creates an opening that would-be authoritarians can exploit.

Pedro BessoneGautam RaoFrank SchilbachHeather SchofieldMattie Toma

(2021). “The Economic Consequences of Increasing Sleep Among the Urban Poor.”  Accepted into Quarterly Journal of Economics

The urban poor in developing countries face challenging living environments, which may interfere with good sleep. Using actigraphy to measure sleep objectively, we find that low-income adults in Chennai, India sleep only 5.5 hours per night on average despite spending 8 hours in bed.

Their sleep is highly interrupted, with sleep efficiency—sleep per time in bed—comparable to those with disorders such as sleep apnea or insomnia. A randomized three-week treatment providing information, encouragement, and improvements to home sleep environments increased sleep duration by 27 minutes per night by inducing more time in bed.

Contrary to expert predictions and a large body of sleep research, increased nighttime sleep had no detectable effects on cognition, productivity, decision-making, or well-being, and led to small decreases in labor supply.

In contrast, short afternoon naps at the workplace improved an overall index of outcomes by 0.12 standard deviations, with significant increases in productivity, psychological well-being, and cognition, but a decrease in work time.

Gemma DipoppaGuy GrossmanStephanie Zonszein

(2021). “Locked Down, Lashing Out: Situational Triggers and Hateful Behavior Towards Minority Ethnic Immigrant.” Empirical Studies of Conflict Project (ESOC) Working Papers 23, Empirical Studies of Conflict Project.

COVID-19 caused a significant health and economic crisis, a condition identified as conducive to stigmatization and hateful behavior against minority groups. It is however unclear whether the threat of infection triggers violence in addition to stigmatization, and whether a violent reaction can happen at the onset of an unexpected economic shock before social hierarchies can be disrupted.

Using a novel database of hate crimes across Italy, we show that (i) hate crimes against Asians increased substantially at the pandemic onset, and that (ii) the increase was concentrated in cities with higher expected unemployment, but not higher mortality. We then examine individual, local and national mobilization as mechanisms. We find that (iii) local far-right institutions motivate hate crimes, while we find no support for the role of individual prejudice and national discourse.

Our study identifies new conditions triggering hateful behavior, advancing our understanding of factors hindering migrant integration.

Alberto CiancioFabrice KämpfenHans-Peter KohlerIliana Kohler

(2021) Health screening for emerging non-communicable disease burdens among the global poor: Evidence from sub-Saharan Africa, Journal of Health Economics, Volume 75

PDRI affiliates Hans-Peter Kohler and Iliana Kohler recently co-authored a study, published in the Journal of Health Economics that investigates the effectiveness of health screenings to reduce the burden of non-communicable diseases in Malawi.

Evidence for the effectiveness of population health screenings to reduce the burden of non-communicable diseases in low-income countries remains very limited. We investigate the sustained effects of a health screening in Malawi where individuals received a referral letter if they had elevated blood pressure. Using a regression discontinuity design and a matching estimator, we find that receiving a referral letter reduced blood pressure and the probability of being hypertensive by about 22 percentage points four years later.

These lasting effects are explained by a 20 percentage point increase in the probability of being diagnosed with hypertension. There is also evidence of an increase in the uptake of medication, while we do not identify improvements in hypertension-related knowledge or risk behaviors. On the contrary, we find an increase in sugar intake and a decrease in physical activity both of which are considered risky behaviors in Western contexts.

The health screening had some positive effects on mental health. Overall, this study suggests that population-based hypertension screening interventions are an effective tool to improve health in low-income contexts.

Morgan PeeleSharon Wolf

(2021). Depressive and anxiety symptoms in early-childhood education teachers: Relations to professional well-being and absenteeism. Early Childhood Research Quarterly. 55;  275-283

 

 

This study investigated how early childhood education teachers’ (N = 444) depressive and anxiety symptoms predicted their professional well-being outcomes and absenteeism over the course of one school year in Ghana. Higher anxiety and depressive symptoms predicted lower job motivation and job satisfaction and higher levels of emotional exhaustion at the end of the school year. Increased depressive symptoms were further associated with more days absent over the course of the school year. Findings point to the importance of considering teachers’ mental health for early educational quality. Implications for policy and practice are discussed.

Jere R. Behrman

(2021). “Social Mobility and Human Capital in Low- and Middle-Income Countries,” in Social Mobility in Developing Countries: Concepts, Methods, and Determinants, edited by Vegard Iversen, Anirudh Krishna, and Kunal Sen, Oxford, UK: Oxford University Press, 2021, in Press.

Parental human capital and endowments may affect children’s human capital, which in turn may affect children’s earning and occupations and thus affect social mobility.

This paper focuses on what we know about these possible links in low- and middle-income countries. It starts with definitions of human capital and endowments and simple frameworks for guiding the summary of what we know and do not know about these links in low- and middle-income countries.

It discusses determinants of children’s human capital in the form of cognitive skills, socioemotional skills, and health, which pertain directly to some indicators of social mobility; reviews estimates of the impacts of these forms of human capital, which pertain to some other indicators of social mobility, such as incomes and earnings; and concludes with a summary suggesting some positive impacts of parental human capital and endowments on social mobility in low- and middle-income countries and a discussion of gaps in the literature pertaining to both data and methodology.

Andreas GeorgiadisJere R. BehrmanLiza Benny

(2021). “Maternal Undernutrition in Adolescence and Child Human Capital Formation over the Life-Course: Evidence from an International Cohort Study”, Economica, in press.

Maternal undernutrition and adolescent childbearing are prevalent in low- and middle-income countries and have harmful consequences for children. However, less is known on whether these implications persist throughout the offspring’s life course. Moreover, although adult nutritional status has been suggested to largely reflect conditions during the period from conception to 2 years old (“the first 1,000 days”), others have argued that adolescence is an equally important period for nutrition. This is not well established, however, and there is less evidence on the relative importance of conditions during the first 1,000 days of a girl’s life, versus during adolescence, for her nutritional status during pregnancy.

This working paper addresses these gaps through two interrelated investigations. First, we document associations of mothers’ stunting and adolescent childbearing with their children’s developmental outcomes from infancy through early adolescence, using data on a cohort of children and their mothers from Ethiopia, India, Peru, and Vietnam. Second, in order to infer whether maternal adult undernutrition may reflect undernutrition during adolescence, we use data from another cohort of girls in each of these countries who were surveyed throughout adolescence to estimate the extent of catch-up growth during adolescence.

The results suggest that maternal stunting and adolescent childbearing are both associated with offspring stunting at infancy, that the association between the mother’s and offspring’s stunting persists through the offspring’s early adolescence, and that the two maternal outcomes are not systematically associated with offspring cognitive achievement.

Angela TrudeLinda RichterJere R. BehrmanAryeh D. SteinAna M. B. MenezesMaureen M Black

(2021). “Mitigating effects of responsive caregiving and learning opportunities during preschool ages on the association of early adversities on adolescent IQ: evidence from birth cohorts in two middle-income countries”, The Lancet Child & Adolescent Health 5: 37-46.

Background

Millions of children globally are at risk of not reaching their developmental potential because of early adversities. We hypothesized that responsive caregiving and learning opportunities, components of nurturing care, at pre-school ages might mitigate the effects of adversities.

Methods

We analyzed longitudinal birth cohort data from Brazil (1993 Pelotas Birth Cohort, n=632) and South Africa (Birth to Twenty Plus [Bt20+] Birth Cohort, n=1130) to assess whether responsive caregiving and learning opportunities at pre-school ages (2–4 years) modified associations between cumulative early adversities and adolescent human capital. The cumulative adversities score (range 0–9) included household wealth and crowding; mothers’ schooling, height, age, and mental health; and children’s birth weight, gestational age, and length at age 12 months. We extracted data on responsive caregiving and learning opportunities from the Early Childhood Home Observation for Measurement of the Environment Inventory, assessed at age 4 years (1993 Pelotas cohort) and 2 years (Bt20+ cohort). We examined three human capital indicators: intelligence quotient (IQ) assessed at age 18 years (1993 Pelotas cohort) and 16 years (Bt20+ cohort); psychosocial adjustment assessed at age 15 years and 14 years, respectively; and height assessed at age 18 years and 16 years, respectively. We used linear models with interaction terms between cumulative adversities, and responsive caregiving and learning opportunities, to predict adolescent human capital.

Findings

For each additional Z score of total cumulative adversity, adolescent IQ decreased by 5·89 (95% CI −7·29 to −4·50) points in the 1993 Pelotas cohort (p<0·0001) and 2·69 (–4·52 to −0·86) points in the Bt20+ cohort (p=0·0039). After adjusting for total cumulative adversities, adolescent IQ points increased by 5·47 (95% CI 4·20 to 6·74) with each additional Z score of learning opportunities and by 2·26 (0·93 to 3·59) with each additional Z score of responsive caregiving in the 1993 Pelotas cohort, but not in the Bt20+ cohort (0·86 [–0·12 to 1·83] and 0·65 [–0·32 to 1·61], respectively). Associations between early adversities and IQ were modified by learning opportunities in the 1993 Pelotas cohort (beta coefficient for interaction 1·74, 95% CI 0·43 to 3·04; p=0·0092) and by responsive caregiving in the Bt20+ cohort (2·24, 0·94 to 3·54; p=0·0075). A high nurturing environment attenuated the negative effects of early cumulative adversities on IQ.
Christopher BlairGuy GrossmanJeremy Weinstein

(2020). “Liberal Displacement Policies Attract Forced Migrants in the Global South.” Working Paper

Most forced migrants around the world are displaced within the Global South. We study whether and how de jure policies on forced displacement effect where the developing world forced migrants to flee. Recent evidence from the developed world suggests migrants gravitate toward liberal policy environments.

However, existing analyses presume de jure policies have little effect in the developing world, given strong presumptions that policy enforcement is poor and policy knowledge is low. Using original data on de jure displacement policies for 92 developing countries, we document a robust association between liberal de jure policies and forced migrant flows.

The gravitation toward liberal environments is conditional on factors that facilitate the diffusion of policy knowledge, such as transnational ethnic kin. Policies for free movement, services, and livelihoods are especially attractive. Utility-maximizing models of migrant decision-making must take de jure policy provisions into account.

Xiaoying LiuJere R. BehrmanEmily HannumFan WangQingguo Zhao

(2021). “Same environment, stratified impacts? Air pollution, extreme temperatures, and birth weight in Southeast China,”  SSRN.

Ambient air pollution and extreme temperatures have been associated in a number of settings with adverse birth outcomes. However, some newborns may be more vulnerable than others. First, the pathway from ambient conditions to adverse birth outcomes could vary according to indicators of socioeconomic status such as maternal education. For example, less-educated mothers may be more vulnerable than more-educated mothers if they lack access to living, work, transportation, and leisure spaces with indoor air filtration and temperature regulation, or if they lack knowledge of or resources for mitigation strategies. Second, overall effect modifications associaed with maternal education may mask another source of heterogeneity: babies’ underlying innate health. Protective effects of maternal education may be more pronounced for the most physically vulnerable babies.

Linking 54,828 singleton live birth records from a district in Guangzhou, China to ambient air pollution (PM10 and a composite measure) and extreme temperature data, we test whether, overall, maternal education is an “effect modifier” in the relationships between ambient air pollution, extreme temperature, and birth weight. Via conditional quantile regressions, we then test for effect heterogeneity according to the underlying physical vulnerability of babies–those further to the left in the conditional distribution of birth weight–after conditioning on other confounders. Results show that the protection associated with a college-educated mother with respect to pollution and extreme heat is substantial: up to 0.31 standard deviations of birth weight. Importantly, this protection is amplified under more extreme ambient conditions and for physically vulnerable infants, after conditioning on other confounders.

Susan MeffertThomas C. NeylanCharles E. McCullochKelly BlumCraig R. CohenElizabeth A. BukuskiHelen VerdeliJohn C. MarkowitzJames G. KahnDavid BukuskiHarsha ThirumurthyGrace RotaRay RotaGrace OketchElizabeth OpiyoLinnet Ongeri

(Jan 2021). Interpersonal psychotherapy delivered by nonspecialists for depression and posttraumatic stress disorder among Kenyan HIV-positive women affected by gender-based violence: Randomized controlled trial. PLOS Medicine 18: e1003468.

Background: HIV-positive women suffer a high burden of mental disorders due in part to gender-based violence (GBV). Comorbid depression and posttraumatic stress disorder (PTSD) are typical psychiatric consequences of GBV. Despite attention to the HIV-GBV syndemic, few HIV clinics offer formal mental healthcare. This problem is acute in sub-Saharan Africa, where the world’s majority of HIV-positive women live and prevalence of GBV is high.

Methods and findings: We conducted a randomized controlled trial at an HIV clinic in Kisumu, Kenya. GBV-affected HIV-positive women with both major depressive disorder (MDD) and PTSD were randomized to 12 sessions of interpersonal psychotherapy (IPT) plus treatment as usual (TAU) or Wait List+TAU. Nonspecialists were trained to deliver IPT inside the clinic. After 3 months, participants were reassessed, and those assigned to Wait List+TAU were given IPT. The primary outcomes were diagnosis of MDD and PTSD (Mini International Neuropsychiatric Interview) at 3 months.

Secondary outcomes included symptom measures of depression and PTSD, intimate partner violence (IPV), and disability. A total of 256 participants enrolled between May 2015 and July 2016. At baseline, the mean age of the women in this study was 37 years; 61% reported physical IPV in the past week; 91% reported 2 or more lifetime traumatic events and monthly income was 18USD. Multilevel mixed-effects logistic regression showed that participants randomized to IPT+TAU had lower odds of MDD (odds ratio [OR] 0.26, 95% CI [0.11 to 0.60], p = 0.002) and lower odds of PTSD (OR 0.35, [0.14 to 0.86], p = 0.02) than controls. IPT+TAU participants had lower odds of MDD-PTSD comorbidity than controls (OR 0.36, 95% CI [0.15 to 0.90], p = 0.03).

Linear mixed models were used to assess secondary outcomes: IPT+TAU participants had reduced disability (-6.9 [-12.2, -1.5], p = 0.01), and nonsignificantly reduced work absenteeism (-3.35 [-6.83, 0.14], p = 0.06); partnered IPT+TAU participants had a reduction of IPV (-2.79 [-5.42, -0.16], p = 0.04). Gains were maintained across 6-month follow-up. Treatment group differences were observed only at month 3, the time point at which the groups differed in IPT status (before cross over). Study limitations included 35% attrition inclusive of follow-up assessments, generalizability to populations not in HIV care, and data not collected on TAU resources accessed.

Conclusions: IPT for MDD and PTSD delivered by nonspecialists in the context of HIV care yielded significant improvements in HIV-positive women’s mental health, functioning, and GBV (IPV) exposure, compared to controls.

Tulia G. FalletiSantiago CunialSelene Bonczok Sotelo

(2020). Invisible to Political Science: Indigenous Politics in a World in Flux. The Journal of Politics

 

 

Coproduction between state and civil society for the delivery of public services raises a host of questions that go from the capture of the state, to cooptation of civil society, and efficiencies or accountability in the delivery of public services. Moreover, when this cooperation focuses on vulnerable and historically marginalized indigenous populations, ethical concerns arise about intercultural health and sensitive care.

We are working with two health care non-governmental organizations that deliver mobile health services to pregnant women and children in the tri-border area of Argentina, Bolivia, and Paraguay. The main goal of our research is to assess the impact of the medical intervention and study the individual, community, institutional, and country level determinants of health outcomes.

Ricardo PiqueMario CannellaAlexey Makarin

(2020). The Political Legacy of Nazi Annexation, Working Paper

This paper uses the case of Nazi Operational Zones (OZ) in Italy during WWII to shed light on the legacy of foreign state repression. While the rest of Northern Italy was placed under Fascist rule, the OZ were de facto annexed by Nazi Germany. Using a spatial regression discontinuity design, we show that the OZ experienced harsher political persecution and violence. After the war, OZ areas exhibited greater support for radical opposition and lower political participation. Voters in affected areas showed lower political trust and less support for laws suppressing dissent. Foreign repression, even if temporary, has enduring political consequences.

Private: Sumitra Badrinathan

(2020). Educative Interventions to Combat Misinformation: Evidence from A Field Experiment in India. Forthcoming.

Misinformation makes democratic governance harder, especially in developing countries. Despite its real-world import, little is known about how to combat fake news outside of the U.S., particularly in places with low education, accelerating Internet access, and encrypted information sharing.

This study uses a field experiment in India to test the efficacy of a pedagogical intervention on respondents’ ability to identify fake news during the 2019 elections (N=1224). Treated respondents received in-person media literacy training in which enumerators demonstrated two tools to identify fake news: reverse image searching and navigating a fact-checking website.

Receiving this hour-long media literacy intervention did not significantly increase respondents’ ability to identify fake news on average. However, treated respondents who support the ruling party became significantly less able to identify pro-attitudinal fake news. These findings point to the resilience of misinformation in India and the presence of motivated reasoning in a traditionally non-ideological party system.

Karen AustrianErica Soler-HampejsekJere R. BehrmanJean DigitaleMaximillian BweupePaul C. Hewett

(2020). “The impact of the Adolescent Girls Empowerment Program (AGEP) on short and long term social, economic, education and fertility outcomes: a cluster randomized controlled trial in Zambia.” BMC Public Health. 20, 349.

Background

Adolescent girls in Zambia face risks and vulnerabilities that challenge their healthy development into young women: early marriage and childbearing, sexual and gender-based violence, unintended pregnancy and HIV. The Adolescent Girls Empowerment Program (AGEP) was designed to address these challenges by building girls’ social, health and economic assets in the short term and improving sexual behavior, early marriage, pregnancy and education in the longer term. The two-year intervention included weekly, mentor-led, girls group meetings on health, life skills and financial education. Additional intervention components included a health voucher redeemable for general wellness and reproductive health services and an adolescent-friendly savings account.

Methods

A cluster-randomized-controlled trial with longitudinal observations evaluated the impact of AGEP on key indicators immediately and two years after program end. Baseline data were collected from never-married adolescent girls in 120 intervention clusters (3515 girls) and 40 control clusters (1146 girls) and again two and four years later. An intent-to-treat analysis assessed the impact of AGEP on girls’ social, health and economic assets, sexual behaviors, education and fertility outcomes. A treatment-on-the-treated analysis using two-stage, instrumental variables regression was also conducted to assess program impact for those who participated.

Results

The intervention had modest, positive impacts on sexual and reproductive health knowledge after two and four years, financial literacy after two years, savings behavior after two and four years, self-efficacy after four years and transactional sex after two and four years. There was no effect of AGEP on the primary education or fertility outcomes, nor on norms regarding gender equity, acceptability of intimate partner violence and HIV knowledge.

Conclusions

Although the intervention led to sustained change in a small number of individual outcomes, overall, the intervention did not lead to girls acquiring a comprehensive set of social, health and economic assets, or change their educational and fertility outcomes. It is important to explore additional interventions that may be needed for the most vulnerable girls, particularly those that address household economic conditions. Additional attention should be given to the social and economic environment in which girls are living.

Nolan M KavanaghElisabeth M. SchafferAlex NdyabakiraKara MarsonDiane V. HavlirMoses R. KamyaDalsone KwarisiimaGabriel ChamieHarsha Thirumurthy

(Nov 2020). “Planning prompts to promote uptake of HIV services among men: a randomised trial in rural Uganda”,

Introduction Interventions informed by behavioural economics, such as planning prompts, have the potential to increase HIV testing at minimal or no cost. Planning prompts have not been previously evaluated for HIV testing uptake. We conducted a randomised clinical trial to evaluate the effectiveness of low-cost planning prompts to promote HIV testing among men.

Methods We randomised adult men in rural Ugandan parishes to receive a calendar planning prompt that gave them the opportunity to make a plan to get tested for HIV at health campaigns held in their communities. Participants received either a calendar showing the dates when the community health campaign would be held (control group) or a calendar showing the dates and prompting them to select a date and time when they planned to attend (planning prompt group). Participants were not required to select a date and time or to share their selection with study staff. The primary outcome was HIV testing uptake at the community health campaign.

 

Arindam NandiJere R. BehrmanRamanan Laxminarayan

(2020). “The Impact of a National Early Childhood Development Program on Future Schooling Attainment: Evidence from ICDS in India”, Economic Development and Cultural Change. 69:1, 291-316.

Evidence on the long-term benefits of early-life interventions remains inadequate in developing countries. In this paper, we evaluate the effect of India’s Integrated Child Development Services (ICDS), a national program of supplementary nutrition and health services, on schooling.

Using national survey data and employing age-state and village or city ward fixed-effect regression, we find that non-migrant 15- to 54-year-old men and 15- to 49-year-old women who were exposed to an ICDS center during the first three years of life completed 0.1–0.3 more grades of schooling than those who were not exposed. The effect is stronger among women than men.

Kara MarsonAlex NdyabakiraDalsone KwarisiimaCarol S. CamlinMoses R. KamyaDiane V. HavlirHarsha ThirumurthyGabriel Chamie

(Nov 2020) HIV Retesting and Risk Behaviors among High-risk, HIV-uninfected Adults in Uganda. AIDS Care Page: 1-7.

There are limited data characterizing HIV retesting among high-risk adults in sub-Saharan Africa. From October-December 2018, we distributed recruitment cards offering health evaluations with HIV testing at venues frequented by individuals at-risk of HIV infection in Southwest Uganda. Those who attended were asked about their HIV testing history and risk factors: having >1 sexual partner, an HIV+ partner, STIs, and/or transactional sex.

We defined “highest risk” as ≥3 risk factors and “frequent testing” as ≥3 tests within the past year. Of 1,777 cards distributed, 1,482 (83%) adults came to clinic: median age was 26(IQR: 22-31), 598 (40%) were men, and 334 (23%) were HIV+. Of 1,148 HIV-negative adults, 338 (29%) were highest risk and 205 (18%) were frequent testers. Frequent testing was similar in women (19%) and men (16%, p = 0.22). Among women, those at highest risk were more likely to report any testing (90% vs. 81%, p = 0.01) and frequent testing (25% vs. 18%, p = 0.06) than those at lower risk. Among men, any testing and frequent testing were similar between risk levels.

Among adults recruited from high-risk venues in peri-urban Uganda, HIV risk behaviors were commonly reported, yet frequent retesting remained low. Interventions to promote retesting are needed, particularly among men.

Sally Grantham-McGregorAkanksha AdyaOrazio AttanasioBritta AugsburgJere R. BehrmanBet CaeyersMonimalika DayPamela JervisReema KocharPrerna MakkarCostas MeghirAngus PhimisterMarta Rubio-CodinaKarishma Vats

(2020). “Group Sessions or Home Visits for Early Childhood Development in India: A Cluster RCT”, Pediatrics. 146 (6) e2020002725

OBJECTIVES: Poor early childhood development in low- and middle-income countries is a major public health problem. Efficacy trials have shown the potential of early childhood development interventions but scaling up is costly and challenging. Guidance on effective interventions’ delivery is needed. In an open-label cluster-randomized control trial, we compared the effectiveness of weekly home visits and weekly mother-child group sessions. Both included nutritional education, whose effectiveness was tested separately.

METHODS: In Odisha, India, 192 villages were randomly assigned to control, nutritional education, nutritional education and home visiting, or nutritional education and group sessions. Mothers with children aged 7 to 16 months were enrolled (n = 1449). Trained local women ran the two-year interventions, which comprised demonstrations and interactions and targeted improved play and nutrition. Primary outcomes, measured at baseline, midline (12 months), and endline (24 months), were child cognition, language, motor development, growth and morbidity.

RESULTS: Home visiting and group sessions had similar positive average (intention-to-treat) impacts on cognition (home visiting: 0.324 SD, 95% confidence interval [CI]: 0.152 to 0.496, P = .001; group sessions: 0.281 SD, 95% CI: 0.100 to 0.463, P = .007) and language (home visiting: 0.239 SD, 95% CI: 0.072 to 0.407, P = .009; group sessions: 0.302 SD, 95% CI: 0.136 to 0.468, P = .001). Most benefits occurred in the first year. Nutrition-education had no benefit. There were no consistent effects on any other primary outcomes.

CONCLUSIONS: Group sessions cost $38 per child per year and were as effective on average as home visiting, which cost $135, implying an increase by a factor of 3.5 in the returns to investment with group sessions, offering a more scalable model. Impacts materialize in the first year, having important design implications.

Shing-Yi WangJing Cai

(2020). “Firms & Trade Improving management through worker feedback: Auto-manufacturing in China.” VoxDev

 

 

 

Letting workers provide feedback on their managers leads to significant reductions in worker turnover and increases in team productivity

There are large differences in firm productivity between developing and developed countries (Bloom and Reenen 2007), and prior research has demonstrated that management practices may be key to explaining these differences (Bloom et al. 2013). This may be driven by the fact that firms differ widely in the relationships between low-level managers and upper-level management.

On one hand, economic theory suggests that financial incentives for low-level managers may be key to aligning the interests of these managers with upper-level management (Grossman and Hart 1983, Holmstrom and Milgrom 1987). However, recent randomised controlled studies have shown that financial incentives are not the only thing that is important: providing managers with training, feedback, or consulting may be effective in improving managerial performance (Bruhn et al. 2018, Schoar 2013, Kelly et al. 2014, Bloom et al. 2013).

Private: Sumitra BadrinathanDevesh KapurMilan Vaishnav (2020) How Will Indian Americans Vote? Results From the 2020 Indian American Attitudes Survey

Even though Indian Americans comprise slightly more than 1 percent of the total U.S. population—and less than 1 percent of all registered voters—both major parties are leaving no stone unturned in reaching out to this community. Yet, despite the rising political profile of Indian Americans, their political attitudes are woefully under-studied.

As the 2020 presidential election in the United States approaches, Indian Americans are unexpectedly in the spotlight thanks to their growing affluence and influence in political circles and Democratic candidate Joe Biden’s selection of Kamala Harris (who is of partial Indian origin) as his running mate.

But significant attention is also being paid to Indian Americans because a narrative is emerging that the apparent courtship between U.S. President Donald Trump and Indian Prime Minister Narendra Modi, compounded by concerns over how a Biden administration might manage U.S.-India ties, will push Indian Americans to abandon the Democratic Party in droves.

This study finds no empirical evidence to support either of these claims. The analysis is based on a nationally representative online survey of 936 Indian American citizens—the Indian American Attitudes Survey (IAAS)—conducted between September 1 and September 20, 2020, in partnership with the research and analytics firm YouGov. The survey has an overall margin of error of +/- 3.2 percent.
Private: Sumitra BadrinathanDevesh KapurMilan Vaishnav
(2020). “Why Indian Americans are not becoming Republicans any time soon.” The Washington Post

 

In 2005, writing in the National Review, conservative columnist Jay Nordlinger speculated that a “group of American superachievers” was “ripe” for the Republican Party. They were “entrepreneurial, hard-working, striving, traditionalist, family-oriented, religious, assimilationist, patriotic.” What’s more, he wrote, this group’s principal “‘issues” — “tax reform and regulation … free trade … tort reform” — were also dear to the GOP.

Nordlinger was wrong. The group he was writing about — Indian Americans — has remained loyal to the Democratic Party. Some observers have begun wondering again whether Indian Americans will depart for the Republicans. Last September, President Trump and Indian Prime Minister Narendra Modi shared the stage at a “Howdy, Modi!” rally in Houston, with about 50,000 cheering Indian Americans in the audience. Meanwhile, Democratic leaders have been critical of Modi’s domestic policies. Will Indian Americans switch sides over this?

In short, no. We find that Indian Americans remain solidly with the Democrats, for several reasons.

Guy GrossmanMacartan HumphreysGabriella Sacramone-Lutz
(2020). “Information Technology and Political Engagement: Mixed Evidence from Uganda.” The Journal of Politics. 82:41321-1336.

PDRI’s Academic Director Guy Grossman’s recent co-authored study, published in The Journal of Politics, analyzes how information communications technology (ICT) innovations have an effect on who communicates with politicians in Uganda.

This study integrates three related field experiments to learn about how information communications technology (ICT) innovations can affect who communicates with politicians. We implemented a nationwide experiment in Uganda following a smaller-scale framed field experiment that suggested that ICTs can lead to significant “flattening”: marginalized populations used short message service (SMS) based communication at relatively higher rates compared to existing political communication channels.

We find no evidence for these effects in the national experiment. Instead, participation rates are extremely low, and marginalized populations engage at especially low rates. We examine possible reasons for these differences between the more controlled and the scaled-up experiments. The evidence suggests that even when citizens have issues they want to raise, technological fixes to communication deficits can be easily undercut by structural weaknesses in political systems.

 

Arindam NandiAnita ShetJere R. BehrmanMaureen M BlackDavid E BloomRamanan Laxminarayan

(July 2020). Anthropometric, Cognitive, and Schooling Benefits of Measles Vaccination: Longitudinal Cohort Analysis in Ethiopia, India, and Vietnam. Vaccine, 37(31), 4336-4343. 

Objective

To estimate the associations between measles vaccination and child anthropometry, cognition, and schooling outcomes in Ethiopia, India, and Vietnam.

Methods

Longitudinal survey data from Young Lives were used to compare outcomes at ages 7–8 and 11–12 years between children who reported receipt or non-receipt of measles vaccine at 6–18 months-of-life (n = ∼2000/country). Z-scores of height-for-age (HAZ), BMI-for-age (BMIZ), weight-for-age (WAZ), Peabody Picture Vocabulary Test (PPVT), early grade reading assessment (EGRA), language and mathematics tests, and attained schooling grade were examined. Propensity score matching was used to control for systematic differences between measles-vaccinated and measles-unvaccinated children.

Findings

Using age- and country-matched measles-unvaccinated children as comparisons, measles-vaccinated children had better anthropometrics, cognition, and schooling. Measles-vaccinated children had 0.1 higher HAZ in India and 0.2 higher BMIZ and WAZ in Vietnam at age 7–8 years, and 0.2 higher BMIZ at age 11–12 years in Vietnam. At ages 7–8 years, they scored 4.5 and 2.9 percentage points (pp) more on PPVT and mathematics, and 2.3 points more on EGRA in Ethiopia, 2.5 points more on EGRA in India, and 2.6 pp, 4 pp, and 2.7 points more respectively on PPVT, mathematics, and EGRA in Vietnam. At ages 11–12 years, they scored 3 pp more on English and PPVT in India, and 1.7 pp more on PPVT in Vietnam. They also attained 0.2–0.3 additional schooling grades across all ages and countries.

Conclusion

Our findings suggest that measles vaccination may have benefits on cognitive gains and school-grade attainment that can have broad educational and economic consequences that extend beyond early childhood.

Valentina Assenova

(2020). Early-Stage Venture Incubation and Mentoring Promote Learning, Scaling, and Profitability among Disadvantaged Entrepreneurs. Organization Science, forthcoming.

Do founders learn during early-stage venture incubation? If so, what role does learning play in subsequent performance? To answer these questions, I use data from 2,153 applicants to an incubator in Johannesburg, South Africa, and study the relationship between changes in founders’ learning during incubation and their ventures’ post-incubation revenues and profits.

Further, I examine how founders’ random assignment to coaches in the incubator affected learning and compare changes in revenues, costs, employment, and rates of business registration within incubated and non-incubated ventures using a differences-in-differences design. I find that learning during incubation among founders was associated with profitability and revenue growth post-incubation. Every one standard-deviation increase in learning, as measured by changes in entrepreneurs’ mid-point and final exam scores, was associated with a 109% increase in monthly profits and a 136% increase in monthly revenues during the 11 months after venture incubation.

Further, coach centrality moderated the observed benefits of incubation, with a one unit increase in a coach’s centrality being associated with up to 25% increase in founders’ learning during incubation. These findings suggest that early-stage venture incubation promotes learning and that learning contributes to greater scaling and profitability among incubated ventures.

Valentina Assenova

(2020). Institutional Change and Early-Stage Startup Selection: Evidence from Applicants to Venture Accelerators. Organization Science, forthcoming.

Existing research at the nexus of institutional theory and entrepreneurship suggests that lowering institutional barriers to forming, growing, and exiting new firms through legal and regulatory reforms can affect the types of startups that entrepreneurs found in a region. These institutional changes could affect entrepreneurs’ willingness to partner with organizational sponsors to develop high-growth startups and potentially enhance these sponsors’ ability to select high-growth startups to fund and develop.

This study evaluates these ideas by developing and testing three hypotheses, that institutional reforms (a) improve entrepreneurs’ perceived benefits of the resources that organizational sponsors provide, (b) increase the number, quality, and diversity of applicants for these resources within sponsors’ local ecosystems, and (c) enhance sponsors’ capacity to select high-growth startups into their cohorts.

To evaluate these hypotheses, I analyze data from 13,770 applicants to venture accelerators over multiple application cycles between 2016-2018 in 170 countries, using a difference-in-differences design that exploits institutional reforms that aimed to reduce the time and procedures to start new firms, obtain credit, and resolve bankruptcy for entrepreneurs.

The findings have important implications for how institutional reforms affect early-stage entrepreneurship and the capacity of organizational sponsors to select high-growth early-stage startups to fund and develop within their local ecosystems.

Yue HouPeichun Wang

(September 2020). Unpolluted decisions: Air quality and judicial outcomes in China. Economics Letters, 194, 109369.

Judicial outcomes should not be influenced by factors that have no bearing on legal decisions, but studies have shown that judges can be affected by extraneous variables such as weather, sports events, and food consumption. Employing the universe of drug offense court decisions in five major Chinese cities between 2014 and 2015, we study whether air pollution and temperature affect sentencing outcomes in China, where air pollution is severe and judges have considerable discretion in sentencing drug cases.

We find that Chinese criminal judges are not at all affected by pollution or temperature changes. One standard deviation change in air pollutant PM2.5 level may change the sentence length by no more than 2% of its standard deviation with over 95% probability. Further analysis shows that our results are robust to a variety of specifications and a battery of robustness checks.

Our findings suggest that judicial rulings are not always swayed by extraneous factors, and we discuss conditions under which public officials are more likely to be shielded from these non-legal factors.

Whitney SchottElisabetta AurinoMary PennyJere R. Behrman

(May 2020). Time use and Sexual Maturity−related Indicators Differentially Predict Youth Body Mass Indices, Peruvian Girls Versus Boys. Annals of the New York Academy of Sciences, 1468(1), 55-73. 

Rapid development in Latin America has been accompanied by lifestyle shifts, including changes in time use and social environments. Overweight/obesity has also emerged as a public health challenge. We examined whether lifestyle changes and sexual maturity−related indicators (early pubertal development and having a child) predict increases in adiposity among Peruvian youth.

Using longitudinal data from Young Lives, we examined changes in adiposity between ages 8 and 15 years old for the younger cohort and ages 15 and 22 years old for the older cohort. Boys and girls in both cohorts demonstrated substantial increases in age‐adjusted adiposity measures, but predictors were different for boys versus girls.

For boys, increases in time spent in work and domestic chores predicted increases in adiposity body mass index and BMI‐for‐age Z‐score, and increases in time spent sleeping were associated with decreases in adiposity (waist circumference and waist‐to‐height ratio). For girls, sexual maturity−related indicators (early menarche and childbearing) predicted increases in adiposity, regardless of time use.

Potential mechanisms for these results may include diet, physical activity, wealth, and urban−rural residence. Time use among youth was associated with diet quality and physical activity, but in different ways for boys versus girls. Strategies for dealing with rising overweight and obesity should incorporate sex‐based specificities.

Yuan HuJunsen ZhangJere R. Behrman

(2020). “The Causal Effects of Parents’ Schooling on Children’s Schooling in Urban China”, Journal of Comparative Economics.

Parental schooling is widely thought to improve child outcomes. But most studies on parental-child relations are associative, without control for estimation problems, such as unobserved intergenerationally-correlated endowments, if causality is of interest. The few exceptions are relatively recent studies that focus on high-income countries (HICs), with their much different contexts than the low- and middle-income countries (LMICs) in which the vast majority of children globally are growing up.

This paper estimates the causal (conditional on the assumptions for the model) relationships between parents’ schooling and their children’s schooling in the most populous LMIC, using adult identical (monozygotic, MZ) twins data from urban China. Our ordinary least-squares estimates show that one-year increases in maternal and paternal schooling are associated, respectively, with 0.4 and 0.5 more years of children’s schooling.

However, if we control for genetic and other endowment effects by using within-MZ fixed effects, the results indicate that mothers’ and fathers’ schooling have no significant effects on children’s schooling. Our main results remain with various robustness checks, including controlling for measurement error.

These results suggest that the positive associations between children’s and parents’ schooling in standard cross-sectional estimates in this major LMIC are mainly due to the correlation between parents’ unobserved endowments and their schooling and not the effects of their schooling per se.

Juan Camilo CastilloDorothy Kronick

(August 2020). The Logic of Violence in Drug War. The American Political Science Review, 114(3), 1-14.

Drug traffickers sometimes share profits peacefully. Other times they fight. We propose a model to investigate this variation, focusing on the role of the state. Seizing illegal goods can paradoxically increase traffickers’ profits, and higher profits fuel violence.

Killing kingpins makes crime bosses short-sighted, also fueling conflict. Only by targeting the most violent traffickers can the state reduce violence without increasing supply. These results help explain empirical patterns of violence in drug war, which is less studied than interstate or civil war but often as deadly.

Sarah E. WeingartenKirk A. DeardenBenjamin T. CrookstonMary PennyJere R. BehrmanDebbie L. Humphries

(July 2020). Are Household Expenditures on Food Groups Associated with Children’s Future Heights in Ethiopia, India, Peru, and Vietnam? International Journal of Environmental Research and Public Health, 17(13), 4739. 

Household expenditure surveys, routinely conducted in low—and middle-income countries (LMICs), usually include questions pertaining to recent household expenditures on key food groups. When child anthropometrics are also available, such expenditure data can provide insights into household food purchasing patterns that are associated with subsequent child growth measures.

We used data from 6993 children, born around 2001, from Ethiopia, India, Peru, and Vietnam, from the Young Lives younger cohort. We compared associations between two weeks of household food expenditures (in PPP—Purchasing Power Parity adjusted dollars) on food groups and child height-for-age-Z score (HAZ) at subsequent time points to assess longitudinal associations. Total food expenditures, rural/urban residence, maternal and paternal schooling, and child sex were included in our adjusted models because they may affect the relations between household food group expenditures and future child HAZ.

In Ethiopia, India, and Peru every extra PPP$ spent on fats was associated with 0.02–0.07 higher future HAZ. In Vietnam, every extra PPP$ spent on starches, was significantly associated with a 0.01 lower future HAZ. Across countries, different patterns of food expenditure and procurement may be differentially critical for predicting child HAZ. Our results demonstrate how expenditures on specific food groups can be associated with children’s linear growth. This study provides additional evidence of the utility of longitudinal household food expenditure data in understanding child nutritional status.

Syeda Farwa FatimaSharon Wolf

(June 2020). Cumulative Risk and Newly Qualified Teachers’ Professional Well-being: Evidence from Rural Ghana. SAGE Journals, 1745-4999.

The transition from student-teaching to full-time teaching is an understudied period in teachers’ careers. This paper uses a cumulative risk (CR) framework to assess personal and professional risks experienced by 135 student-teachers in rural Ghana during pre-service training and later as newly qualified teachers and examines how risks relate to their professional well-being and learning outcomes of children in their classrooms. Higher CR was associated with lower teacher motivation and personal accomplishment. Furthermore, higher CR predicted lower child numeracy skills and socioemotional development over the school year. Implications for teacher professional development and improving educational quality are discussed.

Paul C. HewettAmanda L. WilligJean DigitaleErica Soler-HampejsekJere R. BehrmanKaren Austrian

(July 2020). Assessment of an adolescent-girl-focused nutritional educational intervention within a girls’ empowerment programme: a cluster randomised evaluation in Zambia. Public Health Nutrition, 1-14. 

Objective:

Adolescent girls are at risk for both macro- and micronutrient deficiencies affecting growth, maternal and child health. This study assessed the impact of an adolescent-girl-tailored nutritional education curriculum on nutritional outcomes, including knowledge, dietary behaviour, anthropometry and anaemia.

Design:

A cluster-randomised evaluation was conducted with two study arms: girls in mentor-led weekly girls’ groups receiving sexual and reproductive health and life-skills training assigned to an age-appropriate nutritional curriculum and control girls in the weekly girls’ groups without the nutritional education. The primary analysis was intent-to-treat (ITT) generalised least squares regression. Secondary analysis using two-stage, instrumental-variables estimation was also conducted.

Setting:

The intervention and evaluation were conducted in urban and rural areas across four of ten provinces in Zambia.

Participants:

In total, 2660 girl adolescents aged 10–19 years were interviewed in 2013 (baseline) and annually through 2017.

Results:

ITT results indicate that exposure to the nutritional educational programme did not meaningfully change outcomes for adolescents or their children. Intervention adolescents were no more likely to correctly identify healthy foods (P = 0·51) or proper infant-feeding practices (P = 0·92); were no less likely to be stunted (P = 0·30) or underweight (P = 0·87) and no less likely to be anaemic (P = 0·38). Outcomes for children of intervention participants were not improved, including being breastfed (P = 0·42), stunted (P = 0·21), wasted (P = 0·77) or anaemic (P = 0·51).

Conclusions:

Even a high-quality nutritional educational intervention tailored to adolescents within an empowerment programme does not assure improved nutritional outcomes; adolescent preferences, resource control and household dynamics require consideration in the context of nutritional educational programmes.

Jere R. BehrmanJohn HoddinottJohn Maluccio

(June 2020). Nutrition, Adult Cognitive Skills, and Productivity: Results and Influence of the INCAP Longitudinal Study. Food and Nutrition Bulletin, 41(1), S41-S49. 

This article summarizes research based on the INCAP Longitudinal Study that demonstrates the positive effects of the atole intervention on prime-age adult cognitive skills and productivities.

The findings are interpreted in the context of a life-cycle stage model in which various factors and investments at each stage of life influence outcomes not only in that stage but in subsequent ones. The results point to the likely importance of improvements in adult cognitive skills due to better early-life nutrition on adult male labor market outcomes as well as on women’s “home productivity” in terms of anthropometrics for the next generation.

Possible mechanisms are also explored, including the impacts of early-life exposure to atole on children’s height when starting school, on grades of schooling attainment, and on the extent of experience with higher-skilled jobs, as well as the impacts of improved cognitive skills on wages. Not only are investments in early-life nutrition important for immediate welfare but also they have significant productivity payoffs in adulthood.

Yue HouChuyu LiuCharles Crabtree

(June 2020). Anti-muslim bias in the Chinese labor market. Journal of Comparative Economics. 48(2), 235-250.

Is there a Muslim disadvantage in economic integration to the Chinese economy? Do political mandates from the government help reduce disparities? To answer these questions, we conducted a large-scale audit study and submitted over 4,000 fictitious resumes to job advertisements for accounting and administrative positions posted by private firms, state-owned firms, and foreign firms.

We randomized the ethnic identities of job applicants, their academic merits, and requested salaries. Our results show that a Muslim job seeker is at least 50 percent less likely to receive a callback than a Han job seeker, and higher academic merit does not compensate for this bias.

Importantly, we find that state-owned enterprises are equally likely to discriminate against Muslim job seekers, despite their political mandate to increase diversity. Interview evidence suggests that besides outright hostility towards outgroups, there exist operational costs to diversity-related to building infrastructure that accommodates religious and cultural needs.

Susanna BerkouwerJoshua Dean

(June 2020). Credit and attention in the adoption of profitable energy efficient technologies in Kenya, forthcoming.

What roles do credit constraints and inattention play in the under-adoption of high-return technologies? We study this question in the case of energy efficient cookstoves in Nairobi. Using a randomized field experiment with 1,000 households, we estimate a 300% average annual rate of return to investing in this technology, or $120 per year in fuel savings—around one month of income.

Despite this, adoption rates are low: eliciting preferences using an incentive-compatible Becker-DeGroot-Marschak mechanism, we find that average willingness-to-pay (WTP) is only $12. To investigate what drives this puzzling pattern, we cross-randomize access to credit with two interventions designed to increase attention to the costs and benefits of adoption.

Our first main finding is that credit doubles WTP and closes the energy efficiency gap over the period of the loan. Second, credit works in part through psychological mechanisms: around one-third of the total impact of credit is caused by inattention to loan payments. We find no evidence of inattention to energy savings. Private benefits and avoided environmental damages generate average benefits of $600 for each stove adopted and used for two years.

Subha ManiJere R. BehrmanSheikh GalabPrudhvikar Reddy

(May 2020). Impact of the NREGS on Children’s Intellectual Human Capital. The Journal of Development Studies, 56(5), 929-945. 

This paper uses panel data from the Young Lives Survey to examine the effect of the world’s largest public works program and India’s flagship social protection program, the National Rural Employment Guarantee Scheme (NREGS), on children’s learning outcomes such as grade progression, reading comprehension test scores, writing test scores, math test scores, and Peabody Picture Vocabulary Test (PPVT) scores.

We find that the program has strong positive effects on these outcomes in both the short-and-medium run. Finally, the impact estimates reported here are robust to a number of econometric concerns such as – program placement, selective attrition, and type I error.

Morgan PeeleSharon Wolf

(May 2020). Predictors of anxiety and depressive symptoms among teachers in Ghana: Evidence from a randomized controlled trial. Social Science & Medicine, 253, 112957.

Rationale

While teachers are heralded as key drivers of student learning outcomes, little attention has been paid to teachers’ mental health, especially in less-developed countries such as Ghana. Professional background, workplace environment, and personal life stressors may threaten teachers’ mental health and subsequent effectiveness in the classroom.


Objectives

The objectives of this study were to investigate 1) whether and how professional background, workplace environment, and personal life stressors predicted teachers’ anxiety and depressive symptoms, and 2) whether participation in a professional development intervention predicted change in teachers’ symptoms over the course of one school year in Ghana.


Method

We used multilevel models to examine predictors of depressive and anxiety symptoms among 444 kindergarten teachers (98% female; age range: 18-69) who participated in the Quality Preschool for Ghana (QP4G) Study. QP4G was a school-randomized control trial (n = 108 public schools; n = 132 private schools) evaluating a one-year teacher professional development intervention program implemented with and without parental-awareness meetings. Teacher depressive and anxiety symptoms were assessed at baseline before the intervention and at the end of the school year.


Results

Poor workplace environment was associated with increased anxiety and depressive symptoms. Social support also predicted symptoms, with a lack of support from students’ parents and being new to the local community associated with more anxiety symptoms. Within teachers’ personal lives, household food insecurity predicted more depressive symptoms. Finally, anxiety and depressive symptoms increased for all teachers over the school year. However, randomization to either intervention was linked to a significantly smaller increase in symptoms over the school year.


Conclusions

Results suggest that teachers’ personal and professional lives are consequential for their mental health and that professional development interventions that provide training and in-class coaching and parent engagement may benefit teachers’ mental health.

Amalavoyal ChariElaine LuiShing-Yi WangYongxiang Wang

(May 2020). Property Rights, Land Misallocation and Agricultural Efficiency in China. The Review of Economic Studies.

 

This paper examines the impact of a property rights reform in rural China that allowed farmers to lease out their land. We find the reform led to increases in land rental activity in rural households.

Consistent with a model of transaction costs in land markets, our results indicate that the formalization of leasing rights resulted in a redistribution of land toward more productive farmers. Consequently, the aggregate productivity of land increased significantly.

We also find that the reform increased the responsiveness of land allocation across crops to changes in crop prices.

Arindam NandiJere R. BehrmanMaureen M BlackSanjay KinraRamanan Laxminarayan

(2020). “Relationship between Early-Life Nutrition and Ages at Menarche and First Pregnancy, and Childbirth Rates of Young Adults: Evidence from Apcaps in India.” Maternal & Child Nutrition. 16(1) e12854.

India’s Integrated Child Development Services (ICDS) provides daily supplementary nutrition and other public health services to women and children. We estimated associations between exposure to early-childhood ICDS nutrition and adult reproductive outcomes.

During 1987-1990, a balanced protein-calorie supplement called “upma”-made from locally available corn-soya ingredients-was rolled out by subdistricts near Hyderabad and offered to pregnant women and children under age 6 years. In a controlled trial, 15 villages received the supplement and 14 did not. We used data from a 2010-2012 resurvey of adults born during the trial (n = 715 in intervention and n = 645 in control arms). We used propensity score matching methods to estimate the associations between birth in an intervention village and menarcheal age, age at first pregnancy, and fertility of adults.

We found that women born in the intervention group during the trial, as compared with the control group, had menarche 0.45 (95% confidence interval [CI: 0.22, 0.68]; p < .001) years later and first pregnancy 0.53 (95% CI [0.04, 1.02]; p < .05) years later. Married women from the intervention group had menarche 0.36 (95% CI [0.09, 0.64]; p < .01) years later, first cohabitation with partner 0.8 (95% CI [0.27, 1.33]; p < .01) years later, and first pregnancy 0.53 (95% CI [0.04, 1.02]; p < .05) years later than married women in the control group.

There was no significant difference between intervention and control group women regarding whether they had at least one childbirth or the total number of children born. The findings were similar when we employed inverse propensity score weighted regression models.

Alan SánchezGuido MeléndezJere R. Behrman

 (April 2020). Impact of the Juntos Conditional Cash Transfer Program on Nutritional and Cognitive Outcomes in Peru: Comparison between Younger and Older Initial Exposure. Economic Development and Cultural Change, 68(3), 865-897. 

We evaluate whether the Juntos conditional cash transfer program in Peru has a larger effect on children who benefited initially from the program during the first 4 years of life compared with those children who benefited initially between ages 5 and 8. The former group was exposed during early-life sensitive periods, received the program for a longer period, and received more growth monitoring sessions and vaccinations.

We find that exposure to Juntos led to an improvement in nutritional status and in cognitive achievement, both of which were greater, but only the latter was significant for those initially exposed during the first 4 years of life.

Dorothy Kronick

(April 2020). Profits and Violence in Illegal Markets: Evidence from Venezuela. Journal of Conflict Resolution, 64(7-8), 1499-1523. 

Some theories predict that profits facilitate peace in illegal markets, while others predict that profits fuel violence. I provide empirical evidence from drug trafficking in Venezuela. Using original data, I compare lethal violence trends in municipalities near a major trafficking route to trends elsewhere, both before and after counternarcotics policy in neighboring Colombia increased the use of Venezuelan transport routes.

For thirty years prior to this policy change, lethal violence trends were similar; afterward, outcomes diverged: violence increased more along the trafficking route than elsewhere. Together with qualitative accounts, these findings illuminate the conditions under which profits fuel violence in illegal markets.

Guy GrossmanSoojong KimPrivate: Jonah RexerHarsha Thirumurthy

(April 2020). Political Partisanship Influences Behavioral Responses to Governors’ Recommendations for COVID-19 Prevention in the United States. Social Science Research Network, 253, 112957.

Voluntary physical distancing is essential for preventing the spread of COVID-19. Political partisanship may influence individuals’ responsiveness to recommendations from political leaders.

Daily mobility during March 2020 was measured using location information from a sample of mobile phones in 3,100 US counties across 49 states. Governors’ Twitter communications were used to determine the timing of messaging about COVID-19 prevention.

Regression analyses examined how political preferences influenced the association between governors’ COVID-19 communications and residents’ mobility patterns. Governors’ recommendations for residents to stay at home preceded stay-at-home orders and led to a significant reduction in mobility that was comparable to the effect of the orders themselves.

Effects were larger in Democratic than Republican-leaning counties, a pattern more pronounced under Republican governors. Democratic-leaning counties also responded more to recommendations from Republican than Democratic governors.

Political partisanship influences citizens’ decisions to voluntarily engage in physical distancing in response to communications by their governor.

Emily HannumXiaoying LiuFan Wang

(April 2020). Estimating the Effects of Educational System Contraction: The Case of China’s Rural School Closure Initiative. Economic Development and Cultural Change.

Global trends of fertility decline, population aging, and rural outmigration are creating pressures to consolidate school systems, with the rationale that economies of scale will enable higher quality education to be delivered in an efficient manner, despite longer travel distances for students. Yet, few studies have considered the implications of system consolidation for educational access and inequality, outside of the context of developed countries.

We estimate the impact of educational infrastructure consolidation on educational attainment using the case of China’s rural primary school closure policies in the early 2000s. We use data from a large household survey covering 728 villages in 7 provinces, and exploit variation in villages’ year of school closure and children’s ages at closure to identify the causal impact of school closure.

For girls exposed to closure during their primary school ages, we find an average decrease of 0.60 years of schooling by 2011, when children were, on average, 17 years old. Negative effects strengthen with time since closure. For boys, there is no corresponding significant effect. Different effects by gender may be related to the greater sensitivity of girls’ enrollment to distance and greater responsiveness of boys’ enrollment to quality

Elisabetta AurinoSharon WolfEdward Tsinigo

(April 2020). Household food insecurity and early childhood development: Longitudinal evidence from Ghana. Plos One, 15(4).

The burden of food insecurity is large in Sub-Saharan Africa, yet the evidence-base on the relation between household food insecurity and early child development is extremely limited. Furthermore, available research mostly relies on cross-sectional data, limiting the quality of existing evidence. We use longitudinal data on preschool-aged children and their households in Ghana to investigate how being in a food insecure household was associated with early child development outcomes across three years.

Household food insecurity was measured over three years using the Household Hunger Score. Households were first classified as “ever food insecure” if they were food insecure at any round. We also assessed the persistence of household food insecurity by classifying households into three categories: (i) never food insecure; (ii) transitory food insecurity, if the household was food insecure only in one wave; and (iii) persistent food insecurity, if the household was food insecure in two or all waves.

Child development was assessed across literacy, numeracy, social-emotional, short-term memory, and self-regulation domains. Controlling for baseline values of each respective outcome and child and household characteristics, children from ever food insecure households had lower literacy, numeracy, and short-term memory.

When we distinguished between transitory and persistent food insecurity, transitory spells of food insecurity predicted decreased numeracy (β = -0.176, 95% CI: -0.317; -0.035), short-term memory (β = -0.237, 95% CI: -0.382; -0.092), and self-regulation (β = -0.154, 95% CI: -0.326; 0.017) compared with children from never food insecure households. By contrast, children residing in persistently food insecure households had lower literacy scores (β = -0.243, 95% CI: -0.496; 0.009).

No gender differences were detected. Results were broadly robust to the inclusion of additional controls. This novel evidence from a Sub-Saharan African country highlights the need for multi-sectoral approaches including social protection and nutrition to support early child development.

Luca Maria PesandoSharon WolfJere R. BehrmanEdward Tsinigo

 (February 2020). Are Private Kindergartens really Better? Examining Preschool Choices, Parental Resources, and Children’s School Readiness in Ghana. Comparative Education Review, 64(1), 107-136. 

Low-cost private schools are expanding across sub-Saharan Africa and are often perceived by parents to be of better quality than public schools. This article assesses the interplay between kindergarten (or preschool) choice, household resources, and children’s school readiness in Ghana. We examine how child, household, and school characteristics predict private versus public kindergarten attendance and whether household characteristics are associated with school readiness beyond preschool selection.

Using a geospatial-identification strategy to account for observed and unobserved determinants of preschool choice, we find that parental investments—including the number of books at home and caregiver help with homework—predict both private-preschool selection and start-of-year child outcomes beyond their influence on preschool choice. We take this evidence as suggesting that investments in children support learning beyond simply selecting the presumed best preschool type.

We also find independent associations between attending private preschool and one-year changes in early literacy scores. The findings contribute knowledge to the literature on the recent expansion of preschool education in sub-Saharan Africa and globally and shed new light on the role of private-preschool attendance in early academic skill development.

Christopher WimerSharon Wolf

(2020). Family income and young children’s development. The Future of Children, 30(2), 191-211.

Is income during children’s earliest years a key determinant of long-term child and adult success in the long run? The research to date, Christopher Wimer and Sharon Wolf write, suggests that it is. Wimer and Wolf review substantial descriptive evidence that income can enhance child development and later adult outcomes, and that it does so most strongly during children’s earliest years.

Next, they wrestle with the question of whether this relationship is causal. After outlining the challenges in identifying such causal relationships, they describe a number of studies that purport to overcome these challenges through quasi- or natural experiments. Among other topics, the authors examine how family income affects the outcomes of young children compared to those of older children, and how its effects vary among poor, low-income, and higher-income families. They also look at the evidence around other dimensions of income, including nonlinear relationships between income and key outcomes, instability in income versus the absolute level of income, and various forms of income, and they review the evidence for impacts of in-kind or near-cash income supports.

Finally, Wimer and Wolf highlight some recently launched studies that will shed further light on the relationship between income and development in children’s earliest years, and they suggest how policy might better provide income support to low-income families and their children.

Nicolás IdroboDorothy KronickFrancisco Rodríguez

(2020). Do Shifts in Late-Counted Votes Signal Fraud? Evidence From Bolivia.  SSRN

 

 

Surprising trends in late-counted votes can spark conflict. When late-counted votes led to a narrow incumbent victory in Bolivia last year, fraud accusations followed—with dramatic political consequences. We study the pro-incumbent shift in vote share as the tally progressed, finding that we can explain it without invoking fraud. Two observable characteristics, rurality and region, account for most of the trend. And what looked like a late-breaking surge in the incumbent’s vote share—which electoral observers presented as evidence of foul play—was actually an artifact of methodological and coding errors. Our findings underscore the importance of documenting innocuous explanations for differences between early- and late-counted votes.

Elisabetta AurinoWhitney SchottJere R. BehrmanMary Penny

(2020).”Nutritional Status from 1 to 15 and Adolescent Learning for Boys and Girls in Ethiopia, India, Peru and Vietnam,” Population Research and Policy Review. 38, pages 899–931.

There has been little examination of (1) associations of early-life nutrition and adolescent cognitive skills, (2) if they vary by gender, (3) if they differ by diverse contexts, and (4) contributions of post-infancy growth to adolescent cognitive attainment. We use Young Lives data on 7687 children from Ethiopia, India, Peru, and Vietnam to undertake ordinary least squares estimates of associations between age-1 height-for-age z-score (HAZ) and age-15 cognitive outcomes (math, reading, vocabulary), controlling for child and household factors. Age-1 HAZ is positively associated with cognitive scores in all countries.

Child gender-specific estimates for these coefficients either do not differ (math, reading) or favor girls (vocabulary). Augmenting models to include growth in HAZ between ages 1 and 15 years that was not predicted by HAZ at age 1 reveals that such improvements are associated with higher cognitive scores, but that sex-specific coefficients for this predictor favor boys in India and Peru.

The results suggest that nutritional indicators at age 1 have gender-neutral associations with math and reading and favor girls for vocabulary achievement at age 15, but unpredicted improvements in HAZ by adolescence are associated with higher cognitive scores for boys than for girls. This evidence enriches our understanding of relationships between children’s nutritional trajectories during childhood and adolescent cognitive development, and how these associations vary by gender in some contexts to the possible disadvantage of girls.

Morgan PeeleElisabetta AurinoSharon Wolf

(2020). Depressive and anxiety symptoms in early-childhood education teachers: Relations to professional well-being and absenteeism, Early Childhood Research Quarterly.

This household-level intervention is designed by Movva Technologies to improve school-aged children’s learning outcomes during and after the COVID-19 pandemic. Parents will receive text messages in simple English with behavioral nudges targeting parental engagement in children’s learning across grades and ages for in-school and remote learning.

The treatment will include two variations by duration of message receipt and promotion of gender-equitable outcomes in education and broader development. Households will be randomly assigned to one of five groups: 1. Standard messages for (3 months); 2. Messages with a “gender-parity boost” (3 months): 3. Standard messages of longer duration (6 months); into the first term of the next academic year). 4. Messages with a “gender-parity boost” of longer duration: (6 months, into the first term of the next academic year). 5. Comparison group: No messages during the study period.

M. Farhan MajidJere R. Behrman

(2020). “Early Life Health and Economic Success in Adulthood” in Klaus F. Zimmermann, ed., Handbook of Labor, Human Resources and Population Economics, New York, New York: Springer Publishing Co.

This handbook provides an integrated picture of knowledge about the economic and social behaviors and interactions of human beings on markets, in households, in companies and in societies. With a core basis in labor economics, human resources, demography and econometrics, it contains a large and complete summary and evaluation of the scientific state of the art.

It relates to relevant fields in law, behavioral science, psychology, health, biology, sociology and political science, among others, where basic human processes are considered. Long survey chapters on core knowledge are combined with shorter frontier research chapters and those with a clear policy perspective.

Nandi A, Behrman JR, Black MM, Kinra S, Laxminarayan R. (2020). Relationship between early-life nutrition and ages at menarche and first pregnancy, and childbirth rates of young adults: Evidence from APCAPS in India. Matern Child Nutr. 16(1):e12854.

PDRI’s affiliate Jere R. Behrman has recently co-authored a study in Maternal & Child Nutrition. The article analyzes the associations between exposure to early-childhood nutrition services and adult reproductive outcomes in India.

India’s Integrated Child Development Services (ICDS) provides daily supplementary nutrition and other public health services to women and children. We estimated associations between exposure to early-childhood ICDS nutrition and adult reproductive outcomes. During 1987-1990, a balanced protein-calorie supplement called “upma”-made from locally available corn-soya ingredients-was rolled out by subdistricts near Hyderabad and offered to pregnant women and children under age 6 years. In a controlled trial, 15 villages received the supplement and 14 did not. We used data from a 2010-2012 resurvey of adults born during the trial (n = 715 in intervention and n = 645 in control arms).

We used propensity score matching methods to estimate the associations between birth in an intervention village and menarcheal age, age at first pregnancy, and fertility of adults. We found that women born in the intervention group during the trial, as compared with the control group, had menarche 0.45 (95% confidence interval [CI: 0.22, 0.68]; p < .001) years later and first pregnancy 0.53 (95% CI [0.04, 1.02]; p < .05) years later. Married women from the intervention group had menarche 0.36 (95% CI [0.09, 0.64]; p < .01) years later, first cohabitation with partner 0.8 (95% CI [0.27, 1.33]; p < .01) years later, and first pregnancy 0.53 (95% CI [0.04, 1.02]; p < .05) years later than married women in the control group.

There was no significant difference between intervention and control group women regarding whether they had at least one childbirth or the total number of children born. The findings were similar when we employed inverse propensity score weighted regression models.

Jacob BorHarsha Thirumurthy

(December 2019). Bridging the Efficacy–Effectiveness Gap in HIV Programs: Lessons from Economics. Journal of Acquired Immune Deficiency Syndromes. 82, S183-S191.

Background: Bridging the efficacy-effectiveness gap in HIV prevention and treatment requires policies that account for human behavior.

Setting: Worldwide.

Methods: We conducted a narrative review of the literature on HIV in the field of economics, identified common themes within the literature, and identified lessons for implementation science.

Results: The reviewed studies illustrate how behaviors are shaped by perceived costs and benefits across a wide range of health and non-health domains, how structural constraints shape decision-making, how information interventions can still be effective in the epidemic’s fourth decade, and how lessons from behavioral economics can be used to improve intervention effectiveness.

Conclusion: Economics provides theoretical insights and empirical methods that can guide HIV implementation science.

Slawa RokickiBrian MwesigwaLaura SchmuckerJessica Cohen

(December 2019). Shedding light on quality of care: A study protocol for a randomized trial evaluating the impact of the Solar Suitcase in rural health facilities on maternal and newborn care quality in Uganda. BMC Pregnancy and Childbirth, 19(1).

Background: Continued progress in reducing maternal and newborn morbidity and mortality in low-income countries requires a renewed focus on the quality of delivery care. Reliable electricity and lighting are a cornerstone of a well-equipped health system, but most primary maternity care facilities in sub-Saharan Africa are either not connected to the electrical grid or suffer frequent blackouts.

Lack of reliable electricity and light in maternity facilities may contribute to poor quality of both routine and emergency obstetric and newborn care, by hindering infection control, increasing delays in providing care, and reducing health worker morale. The “Solar Suitcase” is a solar electric system designed specifically for maternity care facilities in low-resource environments. The purpose of this trial is to evaluate the impact of the Solar Suitcase on the reliability of light, quality of obstetric and newborn care, and health worker satisfaction.

Methods: We are conducting a study with 30 maternity care facilities in rural Uganda that lack access to a reliable, bright light source. The study is a stepped wedge cluster randomized controlled trial. Study facilities are identified according to predefined eligibility criteria and randomized by blocking on baseline covariates. The intervention is a “Solar Suitcase”, a complete solar electric system that provides essential lighting and power for charging phones and small medical devices.

The primary outcomes are the reliability and quality of light during intrapartum care, the process quality of obstetric and newborn care, and health worker satisfaction. Outcomes will be assessed via direct clinical observation by trained enumerators (estimated n = 1980 birth observations), as well as interviews with health workers and facility managers. Lighting and blackouts will be captured through direct observation and via light sensors installed in facilities.

Discussion: A key feature of a high-quality health system is an appropriate infrastructure, including reliable, bright lighting, and electricity. Rigorous evidence on the role of a reliable light source in maternal and newborn care is needed to accelerate the “electrification” of maternity facilities across sub-Saharan Africa. This study will be the first to rigorously assess the extent to which reliable light is an important driver of the quality of care experienced by women and newborns.

Elisabetta AurinoWhitney SchottJere R. BehrmanMary Penny

(October 2019). Nutritional Status from 1 to 15 Years and Adolescent Learning for Boys and Girls in Ethiopia, India, Peru, and Vietnam. Population Research and Policy Review, 38(6), 899-931. 

There has been little examination of (1) associations of early-life nutrition and adolescent cognitive skills, (2) if they vary by gender, (3) if they differ by diverse contexts, and (4) contributions of post-infancy growth to adolescent cognitive attainment. We use Young Lives data on 7687 children from Ethiopia, India, Peru, and Vietnam to undertake ordinary least squares estimates of associations between age-1 height-for-age z-score (HAZ) and age-15 cognitive outcomes (math, reading, vocabulary), controlling for child and household factors. Age-1 HAZ is positively associated with cognitive scores in all countries.

Child gender-specific estimates for these coefficients either do not differ (math, reading) or favor girls (vocabulary). Augmenting models to include growth in HAZ between ages 1 and 15 years that was not predicted by HAZ at age 1 reveals that such improvements are associated with higher cognitive scores, but that sex-specific coefficients for this predictor favor boys in India and Peru.

The results suggest that nutritional indicators at age 1 have gender-neutral associations with math and reading and favor girls for vocabulary achievement at age 15, but unpredicted improvements in HAZ by adolescence are associated with higher cognitive scores for boys than for girls. This evidence enriches our understanding of relationships between children’s nutritional trajectories during childhood and adolescent cognitive development, and how these associations vary by gender in some contexts to the possible disadvantage of girls.

Romain FerraliGuy GrossmanMelina R. PlatasJonathan Rodden

(October 2019). It Takes a Village: Peer Effects and Externalities in Technology Adoption. American Journal of Political Science, 64(3), 536-553. 

Do social networks matter for the adoption of new forms of political participation? We develop a formal model showing that the quality of communication that takes place in social networks is central to understanding whether a community will adopt forms of political participation where benefits are uncertain and where there are positive externalities associated with participation. Early adopters may exaggerate benefits, leading others to discount information about the technology’s value.

Thus, peer effects are likely to emerge only when informal institutions support truthful communication. We collect social network data for 16 Ugandan villages where an innovative mobile‐based reporting platform was introduced. Consistent with our model, we find variation across villages in the extent of peer effects on technology adoption, as well as evidence supporting additional observable implications. Impediments to social diffusion may help explain the varied uptake of new and increasingly common political communication technologies around the world.

Alison ButtenheimMichael Z. LevyRicardo Castillo-NeyraMolly McGuireAmparo M. Toledo VizcarraLina M. Mollesaca RiverosJulio MezaKatty Borrini-MayoriCesar NaquiraJere R. BehrmanValerie A. Paz-Soldan

(September 2019). A behavioral design approach to improving a Chagas disease vector control campaign in Peru. BMC Public Health. 19(1272).

Background

Individual behavior change is a critical ingredient in efforts to improve global health. Central to the focus on behavior has been a growing understanding of how the human brain makes decisions, from motivations and mindsets to unconscious biases and cognitive shortcuts. Recent work in the field of behavioral economics and related fields has contributed to a rich menu of insights and principles that can be engineered into global health programs to increase impact and reach. However, there is little research on the process of designing and testing interventions informed by behavioral insights.

Methods

In a study focused on increasing household participation in a Chagas disease vector control campaign in Arequipa, Peru, we applied Datta and Mullainathan’s “behavioral design” approach to formulate and test specific interventions. In this Technical Advance article we describe the behavioral design approach in detail, including the Define, Diagnosis, Design, and Test phases. We also show how the interventions designed through the behavioral design process were adapted for a pragmatic randomized controlled field trial.

Results

The behavioral design framework provided a systematic methodology for defining the behavior of interest, diagnosing reasons for household reluctance or refusal to participate, designing interventions to address actionable bottlenecks, and then testing those interventions in a rigorous counterfactual context. The behavioral design offered us a broader range of strategies and approaches that are typically used in vector control campaigns.

Conclusions

Careful attention to how behavioral design may affect the internal and external validity of evaluations and the scalability of interventions is needed going forward. We recommend behavioral design as a useful complement to other intervention design and evaluation approaches in global health programs.

Ellen MoscoeKawango AgotHarsha Thirumurthy

(September 2019). Effect of a Prize-Linked Savings Intervention on Savings and Healthy Behaviors among Men in Kenya: A Randomized Clinical Trial. JAMA Network Open, 2(9), e1911162. 

Importance  Interventions to reduce men’s alcohol use and risky sexual behaviors are essential for reducing new HIV infections in high-prevalence settings in sub-Saharan Africa. Prize-linked savings accounts can motivate savings and may decrease expenditures on risky behaviors, but few studies have examined the HIV prevention potential of such savings interventions among men.

Objective  To evaluate the effect of prize-linked savings accounts on savings behavior and expenditures on alcohol, gambling, and transactional sex among men in Kenya.

Design, Setting, and Participants  Randomized clinical trial among communities in Siaya County, Kenya. Participants were men 21 years or older who owned a mobile phone were engaged in fishing or transportation sector work, and were willing to open an account with a local bank; they were screened for eligibility between September 3 and October 5, 2018.

Interventions  Eligible participants were offered savings accounts endowed with 1000 Kenya shillings (US $10) and randomized (1:1) to receive weekly lottery-based rewards contingent on growth in savings balance or to a control group that received standard interest.

Main Outcomes and Measures  The primary outcome was an indicator of whether a participant saved any money in the bank account (intent-to-treat analysis) during the study period. Secondary outcomes included the total amount saved in the bank account, the total amount saved in all sources, and expenditures on alcohol, gambling, and transactional sex.

Results  A total of 425 men were screened, 329 (77.4%) met eligibility criteria, 300 (70.6%) were enrolled (with 152 randomized to the intervention group and 148 to the control group), and 270 of 300 (90.0%) opened bank accounts. Participants’ mean age was 33.7 years (interquartile range, 13.5 years), 84.3% (253 of 300) were married, and the mean weekly earnings were US $30 (interquartile range, US $23). During a mean (SD) follow-up of 9 (2) weeks, 37.3% (50 of 134) in the intervention group saved money in a bank account vs 27.2% (37 of 136) in the control group, although the difference was not statistically significant (odds ratio, 1.62; 95% CI, 0.96-2.74). The intervention group had higher growth in bank savings balances (US $10.26; 95% CI, US $5.00-US $58.20 vs US $4.87; 95% CI, US $0.67-US $9.00) and higher total savings from all sources (US $201; 95% CI, US $133-US $269 vs US $145; 95% CI, US $88-US $202), but neither difference was statistically significant. The intervention did not have a significant effect on alcohol, gambling, and transactional sex expenditures.

Conclusions and Relevance  Prize-linked savings accounts modestly increased savings among high-risk men in Kenya over a 9-week period, but the difference compared with standard-interest savings accounts was not significant. Testing of more powerful savings products is needed to assess whether such savings-led interventions can reduce men’s expenditures on alcohol, gambling, and transactional sex.

Ran LiuAndrea Alvarado-UrbinaEmily Hannum

(September 2019). Differences at the Extremes? Gender, National Contexts, and Math Performance in Latin America. American Educational Research Journal, 57(3), 1290-1322. 

Studies of gender disparities in STEM (science, technology, engineering, and mathematics) performance have generally focused on average differences. However, the extremes could also be important because disparities at the top may shape stratification in access to STEM careers, while disparities at the bottom can shape stratification in dropout.

This article investigates determinants of gender disparities in math across the performance distribution in Latin American countries, where there is a persistent boys’ advantage in STEM performance. Findings reveal disparate national patterns in gender gaps across the performance distribution. Furthermore, while certain national characteristics are linked to gender gaps at the low- and middle-ranges of the performance distribution, female representation in education is the only characteristic associated with a reduced gender gap at the top level.

Wei ChangPrimrose MatambanadzoAlbert TakaruzaKarin HatzoldFrances M. CowanEuphemia SibandaHarsha Thirumurthy

(August 2019). Effect of Prices, Distribution Strategies, and Marketing on Demand for HIV Self-Testing in Zimbabwe: A Randomized Clinical Trial. JAMA Network Open, 2(8), e199818. 

Greater awareness of HIV status and more frequent testing in high-risk populations are essential for realizing the promise of treatment as prevention and achieving the 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS (that by 2020, 90% of people living with HIV will know their HIV status, 90% of people with diagnosed HIV will be on antiretroviral therapy [ART], and 90% of people receiving ART will be virally suppressed).1 Yet in sub-Saharan Africa, nearly 20% of people living with HIV were unaware of their status in 2017.2 Despite the scale-up of a clinic- and community-based models for providing HIV testing services, testing coverage remains suboptimal, particularly among men and other key populations.3 To close the testing gap and advance HIV prevention objectives, innovative approaches are needed to increase the uptake of HIV testing in sub-Saharan Africa.

A self-administered test for HIV allows individuals to collect their own sample and to perform a simple, rapid HIV antibody test in the absence of a health care practitioner.4 Several oral fluid-based or blood-based HIV tests have received prequalification from the World Health Organization and showed high sensitivity and specificity among lay users.4 Existing research shows high interest in and acceptability of HIV self-testing across a wide range of populations.512 After the 2016 World Health Organization guidelines that recommended large-scale implementation of HIV self-testing, self-tests are becoming more widely available in governmental health facilities and retail outlets in several countries in sub-Saharan Africa with high HIV prevalence.4

Donor agencies and governments have heavily subsidized HIV self-tests for distribution in some countries, and private sector availability is emerging in parallel.13 However, the cost of self-tests and the price for consumers represent important obstacles to large-scale implementation of HIV self-testing. As countries seek to scale up HIV self-testing for priority populations, little evidence exists on the effect of alternative pricing and marketing strategies on self-testing demand. A growing body of evidence from low-income countries shows that demand for prevention technologies, such as antimalarial bed nets and water filtration solutions, is highly price sensitive.1419 Knowing the self-testing demand at various prices in the general population and key subgroups is important for setting appropriate subsidy levels for these self-tests and for understanding the demand for HIV prevention technologies in general. Moreover, with HIV self-testing, information is limited about the optimal distribution approaches for reaching untested individuals and messaging strategies for promoting the adoption of such new technologies. Estimating how demand is affected not only by prices but also by various distribution approaches and types of information provided to consumers can further inform HIV self-testing scale-up efforts.

We conducted a large community-based randomized clinical trial to examine the optimal pricing policies and distribution strategies for HIV self-testing in Zimbabwe.

Nicholas EubankGuy GrossmanMelina R. PlatasJonathan Rodden

(July 2019). Viral Voting: Social Networks and Political Participation. Quarterly Journal of Political Science.

Social context theory suggests that an important driver of political participation is the behavior of family, friends, co-workers, and neighbors. How do social ties between individuals shape equilibrium behavior in larger populations? Despite theoretical inroads into this question, direct empirical tests remain scarce due to data limitations.

We fill this gap using full social network data from 15 villages in rural Uganda, where village-level turnout is the outcome of interest. We find that levels of participation predicted by structural features of village networks are strongly associated with actual village-level turnout in low-salience local elections, and weakly associated in high-salience presidential elections. We also find these features predict other forms of political participation, including attending village meetings and contributing to village projects.

In addition to demonstrating that networks help explain political participation, we provide evidence that the mechanism of influence is that proposed by social context theory rather than alternative mechanisms like the presence of central brokers or the ability of networks to diffuse information.

Harsha ThirumurthyDavid A. AschKevin G. Volpp

(March 2019). The Uncertain Effect of Financial Incentives to Improve Health Behaviors. JAMA: The Journal of the American Medical Association, 321(15), 1451-1452. 

If intrinsic motivations alone were enough to influence health behaviors, individuals would not smoke, all drivers would wear seat belts, and patients with chronic conditions would take their medications. Yet approximately half of patients prescribed single-drug therapy for hypertension discontinue their medications within a year,¹ even though presumably they want to avoid strokes and hopefully know that taking their medication is one way to reduce health risks.

To supplement the intrinsic motivations apparently insufficient to the task, economists and others have long proposed extrinsic motivations in the form of financial rewards. These rewards offer the added benefit of being immediate rather than the typically delayed intrinsic rewards of better health sometime in the future. Studies in varied health domains have revealed that financial incentives work well.

For example, a 2015 systematic review determined that to reduce smoking during pregnancy, financial or material incentives were more effective than other medical or behavioral strategies.² The use of incentives is also widespread. In 2018, 86% of US employers offered some financial incentives for healthy behavior,³ and in lower-income countries, conditional cash transfer programs rewarded utilization of preventive services.

Susanna Berkouwer

(February 2019). Electric Heating and the Effects of Temperature on Household Electricity Consumption in South Africa. The Energy Journal, 41(4).

How does temperature affect household energy demand in low-income countries? I use 132,375,282 hourly electricity consumption observations from 5,975 households in South Africa to estimate the causal effects of short-term temperature changes on household electricity consumption. The estimates flexibly identify a constant log-linear temperature response – for every 1°C increase in temperature, electricity consumption decreases by 4.1% among temperatures below the heating threshold but increases by 8.1% among temperatures above the cooling threshold.

This relationship is driven more strongly by seasonal than hourly temperature changes. Holding all else constant, a 3.25°C increase in temperatures would reduce electricity consumption by 1,093.4 kWh (6.2%) per year per household. Widespread use of electric heating due to limited residential gas heating infrastructure likely drives this. These results point to important regional heterogeneity in how temperature increases may affect household energy demand in the coming decades.

Gabriel ChamieElisabeth M. SchafferAlex NdyabakiraDevy M. EmperadorDalsone KwarisiimaCarol S. CamlinDiane V. HavlirJames G. KahnMoses R. KamyaHarsha Thirumurthy

(July 2018). Comparative Effectiveness of Novel Nonmonetary Incentives to Promote HIV Testing. AIDs, 32(11).

 

 

 

Objective:

To assess the comparative effectiveness of alternative incentive-based interventions to promote HIV testing among men.

Design:

Randomized clinical trial.

Methods:

We enumerated four Ugandan parishes and enrolled men at least 18 years. Participants were randomized to six groups that received incentives of varying types and amount for HIV testing at a 13-day community health campaign. Incentive types were: gain-framed (control): participants were told they would receive a prize for testing; loss-framed: participants were told they had won a prize, shown several prizes, asked to select one, then told they would lose the prize if they did not test; lotteries: those who tested had a chance to win larger prizes. Each incentive type had a low and high amount (∼US$1 and US$5/participant). The primary outcome was HIV-testing uptake at the community health campaign.

Results:

Of 2532 participants, 1924 (76%) tested for HIV; 7.6% of those tested were HIV-positive. There was no significant difference in testing uptake in the two lottery groups (78%; P = 0.076) or two loss-framed groups (77%; P = 0.235) vs. two gain-framed groups (74%). Across incentive types, testing did not differ significantly in high-cost (76%) vs. low-cost (75%; P = 0.416) groups. Within low-cost groups, testing uptake was significantly higher in the lottery (80%) vs. gain-framed (72%; P = 0.009) group.

Conclusion:

Overall, neither offering incentives via lotteries nor framing incentives as losses resulted in significant increases in HIV testing compared with standard gain-framed incentives. However, when offering low-cost incentives to promote HIV testing, providing lottery-based rewards may be a better strategy than gain-framed incentive

Nancy R. BuchanGianluca GrimaldaRick WilsonMarilynn BrewerEnrique FatasMargaret Foddy

(2009). “Globalization and human cooperation.” Proceedings of the National Academy of Sciences, 106(11), 4138-4142.

 

 

Globalization magnifies the problems that affect all people and that require large-scale human cooperation, for example, the overharvesting of natural resources and human-induced global warming. However, what does globalization imply for the cooperation needed to address such global social dilemmas? Two competing hypotheses are offered. One hypothesis is that globalization prompts reactionary movements that reinforce parochial distinctions among people.

Large-scale cooperation then focuses on favoring one’s own ethnic, racial, or language group. The alternative hypothesis suggests that globalization strengthens cosmopolitan attitudes by weakening the relevance of ethnicity, locality, or nationhood as sources of identification. In essence, globalization, the increasing interconnectedness of people worldwide, broadens the group boundaries within which individuals perceive they belong. We test these hypotheses by measuring globalization at both the country and individual levels and analyzing the relationship between globalization and individual cooperation with distal others in multilevel sequential cooperation experiments in which players can contribute to individual, local, and/or global accounts.

Our samples were drawn from the general populations of the United States, Italy, Russia, Argentina, South Africa, and Iran. We find that as a country and individual levels of globalization increase, so too does individual cooperation at the global level vis-à-vis the local level. In essence, “globalized” individuals draw broader group boundaries than others, eschewing parochial motivations in favor of cosmopolitan ones. Globalization may thus be fundamental in shaping contemporary large-scale cooperation and maybe a positive force toward the provision of global public goods.

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