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Tato GL, Admassie A. Early life shock and labour market outcomes: Panel data evidence from South Africa. Heliyon 2024; 10:e33529. [PMID: 39040256 PMCID: PMC11260964 DOI: 10.1016/j.heliyon.2024.e33529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 06/01/2024] [Accepted: 06/23/2024] [Indexed: 07/24/2024] Open
Abstract
Adverse life events have short- and long-term effects on the livelihood of victims. This paper studies the effect of early life idiosyncratic shocks on labour market outcomes using five rounds of panel data from the National Income Dynamics Study (NIDS) of South Africa. Regression results from alternative panel data estimators suggest that the loss of biological parents early in life is negatively associated with the likelihood of employment and wage earnings. The association is stronger when one loses one's biological mother than one's biological father. Heterogeneity analysis reveals that the loss of a biological father among Black South Africans leads to higher wage earnings compared to other race groups who have experienced the same shock. Education level, perceived health, cognitive ability, and occupation type are strongly associated with the loss of a biological mother, while only education is associated with the loss of a father. These could be the main channels that mediate the link between early life loss of biological parents and labour market outcomes. Therefore, strengthening and aligning child support programmes to reach the victims are required.
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Affiliation(s)
| | - Assefa Admassie
- Department of Economics, Addis Ababa University, Addis Ababa, Ethiopia
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2
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Du R, Liu K, Zhao D, Fang Q. Climate Disaster and Cognitive Ability: Evidence From Wildfire. Int J Public Health 2024; 69:1607128. [PMID: 39050193 PMCID: PMC11266011 DOI: 10.3389/ijph.2024.1607128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024] Open
Abstract
Objectives We investigate the impact of wildfire disasters on cognitive health (i.e., thinking and language skills) in individuals aged 10 years and older using 2014 and 2018 wildfire and cognitive ability survey data from China. Methods We distinguished wildfires in each county at different wind directions each day by exogenous wind direction changes, and analyzed the effects of wildfires on cognitive abilities through upwind and non-upwind wildfires. Results Our analysis shows that for every 10-unit increase in upwind wildfires compared to non-upwind wildfires, respondents' scores on word and math tests decrease by 0.235 and 0.236 standard deviations, respectively. Furthermore, we find that the impact of wildfire on cognitive ability is more pronounced in younger individuals, and those with lower defensive expenditures experience more severe impacts. Additionally, wildfires negatively affect individuals' cognitive abilities by generating air pollution. Conclusion Wildfires significantly reduce individuals' cognitive abilities. Two recommendations are as follows: 1) governments should follow the principle of green development, introduce relevant regulations, and increase investment in adaptive technologies. 2) Individuals should raise awareness of climate hazards preparedness and strengthen defensive protection.
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Affiliation(s)
- Ran Du
- School of Economics, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ke Liu
- International Business School, Shaanxi Normal University, Xi’an, Shaanxi, China
| | - Dangru Zhao
- School of Economics, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiyun Fang
- School of Economics, Huazhong University of Science and Technology, Wuhan, Hubei, China
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3
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Conti G, Poupakis S, Ekamper P, Bijwaard GE, Lumey LH. Severe prenatal shocks and adolescent health: Evidence from the Dutch Hunger Winter. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101372. [PMID: 38564976 DOI: 10.1016/j.ehb.2024.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
This paper investigates health impacts at the end of adolescence of prenatal exposure to multiple shocks, by exploiting the unique natural experiment of the Dutch Hunger Winter. At the end of World War II, a famine occurred abruptly in the Western Netherlands (November 1944-May 1945), pushing the previously and subsequently well-nourished Dutch population to the brink of starvation. We link high-quality military recruits data with objective health measurements for the cohorts born in the years surrounding WWII with newly digitised historical records on calories and nutrient composition of the war rations, daily temperature, and warfare deaths. Using difference-in-differences and triple differences research designs, we first show that the cohorts exposed to the Dutch Hunger Winter since early gestation have a higher Body Mass Index and an increased probability of being obese at age 18. We then find that this effect is partly moderated by warfare exposure and a reduction in energy-adjusted protein intake. Lastly, we account for selective mortality using a copula-based approach and newly-digitised data on survival rates, and find evidence of both selection and scarring effects. These results emphasise the complexity of the mechanisms at play in studying the consequences of early conditions.
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Affiliation(s)
- Gabriella Conti
- Department of Economics and Social Research Institute, University College London, United Kingdom; Institute for Fiscal Studies, CEPR, United Kingdom; IZA, Germany.
| | - Stavros Poupakis
- Department of Economics and Finance, Brunel University London, United Kingdom
| | - Peter Ekamper
- Netherlands Interdisciplinary Demographic Institute, KNAW,, Netherlands; University of Groningen, Netherlands
| | - Govert E Bijwaard
- IZA, Germany; Netherlands Interdisciplinary Demographic Institute, KNAW,, Netherlands; University of Groningen, Netherlands
| | - L H Lumey
- Department of Epidemiology, Mailman School of Public Health, Columbia University, United States of America
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Tan CM, Tan Z, Zhang X. The intergenerational legacy of the 1959-1961 Great Chinese Famine on children's cognitive development. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101300. [PMID: 37696145 DOI: 10.1016/j.ehb.2023.101300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 09/13/2023]
Abstract
We investigate the effect of early exposure to malnutrition on the cognitive abilities of the offspring of survivors in the context of a natural experiment; i.e., the Great Chinese Famine (GCF) of 1959-61. We employ a novel dataset - the China Family Panel Studies (CFPS) - to do so. The paper finds that the cognitive abilities of children whose fathers were born in rural areas during the famine years (1959-1961) were impaired by exposure to the GCF and the negative effect was greater for girls than boys, whereas children whose mothers were born in rural areas during the famine years were not affected. The uncovered gender-specific effect is almost entirely attributable to son preference exhibited in families with male famine survivors.
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Affiliation(s)
- Chih Ming Tan
- Department of Economics & Finance, Nistler College of Business and Public Administration, University of North Dakota, Nistler Hall 330P, 3125 University Ave, Stop 8369, Grand Forks, ND 58202-8369, USA.
| | - Zhibo Tan
- International Monetary Fund, 700 19th St, NW, Washington, DC 20431, USA
| | - Xiaobo Zhang
- Guanghua School of Management, Peking University, Beijing 100871, China; International Food Policy Research Institute (IFPRI), 2033 K Street, NW, Washington, DC 20006, USA
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Wang G, Zhou Y, Duan J, Kan Q, Cheng Z, Tang S. Effects of adverse childhood health experiences on cognitive function in Chinese middle-aged and older adults: mediating role of depression. BMC Public Health 2023; 23:1293. [PMID: 37407916 DOI: 10.1186/s12889-023-16169-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Adverse childhood experiences are critical factors in depression and cognitive decrease, but the effect of adverse childhood health experiences (ACHEs) on cognitive function and the role of depression have not been fully studied. METHODS Data were taken from the China Health and Retirement Longitudinal Study (CHARLS) of 2014 and 2018. This study used indicators of situational memory ability and mental status to measure cognitive capacity. Besides analyzing the different types of ACHEs, scores for ACHEs were calculated to represent the severity of ACHEs. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depression. The analysis of this study employed two different analytical strategies in order to examine the mediated effects of depression. We used Sobel's test and Baron and Kenny's causal step approach, which utilized a generalized least squares regression model. Furthermore, a logistic regression model was used to evaluate the robustness of the Karlson-Holm-Breen (KHB) approach. RESULTS In this study, 6301 individuals who met the requirements of the study were included. We found that being confined to bed (ACHE3) (β=-0.3846, p = 0.022) in childhood had a negative impact on cognitive function. Similarly, ACHEs had a negative effect on cognitive function (β=-0.0819, p = 0.090). And after the depression had been introduced into the model, the regression coefficient of ACHEs on cognitive function was no longer significant (β=-0.0170, p = 0.727). The Sobel test showed that for ACHE3, the mediated proportion of the total effect of depression was 36.92%. While for ACHEs, the proportion of the mediated effect of depression was 70.11%. Finally, a robustness test of the mediating effect using the KHB method revealed that the mediating effect still existed. Further, based on different gender, age, and educational levels, the heterogeneity test indicated that the relationship between ACHEs and cognitive function and mediating effects of the depression were different as well as passing the robustness test of the interaction. CONCLUSION The decline in cognition had been shown to be correlated with ACHEs and depression mediated this relationship. Positive interventions might help to improve cognitive performance in individuals suffering from ACHEs and depression.
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Affiliation(s)
- Gaoling Wang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, 138 Xianlin Road, Qixia District, Nanjing, China
| | - Yuqin Zhou
- School of Health Economics and Management, Nanjing University of Chinese Medicine, 138 Xianlin Road, Qixia District, Nanjing, China
| | - Jing Duan
- School of Health Economics and Management, Nanjing University of Chinese Medicine, 138 Xianlin Road, Qixia District, Nanjing, China
| | - Qianqian Kan
- School of Health Economics and Management, Nanjing University of Chinese Medicine, 138 Xianlin Road, Qixia District, Nanjing, China
| | - Zhaopeng Cheng
- School of Health Economics and Management, Nanjing University of Chinese Medicine, 138 Xianlin Road, Qixia District, Nanjing, China
| | - Shaoliang Tang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, 138 Xianlin Road, Qixia District, Nanjing, China.
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Argaw TL, Fledderjohann J, Aurino E, Vellakkal S. Children's Educational Outcomes and Persistence and Severity of Household Food Insecurity in India: Longitudinal Evidence from Young Lives. J Nutr 2023; 153:1101-1110. [PMID: 36780944 PMCID: PMC10196702 DOI: 10.1016/j.tjnut.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/29/2022] [Accepted: 02/08/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Food insecurity is a pressing global challenge with far-reaching consequences for health and well-being. However, little attention has focused specifically on the experiences of children and adolescents over the age of 5 y in food insecure households. OBJECTIVES We examine whether the persistence and severity of household food insecurity are negatively associated with children's educational outcomes. METHODS We used data for the younger cohort of the longitudinal Young Lives data from rounds 3 (2009), 4 (2013), and 5 (2016), when children were aged 8 y, 12 y, and 15 y, respectively. Drawing on the Household Food Insecurity and Access Scale, we used descriptive statistics, graphical analysis, and multilevel regressions to document how the persistence and severity of household food insecurity are associated with children's educational outcomes (years of education, maths, and vocabulary [PPVT] test scores). We controlled for potentially confounding sociodemographic characteristics, including children's own baseline grade attained and test scores in "value-added" models, to provide robust estimates of household food insecurity in predicting children's educational outcomes. RESULTS Household food insecurity generally declined between 2009 and 2016. Fewer than 50% of households were food secure across the 3 rounds of data we examined. Our robust, multivariate, value-added models show that the persistence and severity of food insecurity are negatively associated with all 3 children's educational outcomes we examined. CONCLUSIONS We add to a small but growing literature exploring how household food insecurity is associated with children's educational outcomes in the Global South. Our findings on severity of food insecurity highlight the importance of understanding food insecurity along the severity continuum rather than as a dichotomous state, as previously done in existing literature. Addressing household food insecurity in childhood and adolescence may be a key factor to improve children's educational outcomes.
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Affiliation(s)
- Thomas Lemma Argaw
- Department of Sociology, Lancaster University, Lancaster, United Kingdom.
| | | | | | - Sukumar Vellakkal
- Department of Economic Sciences, Indian Institute of Technology Kanpur, Kanpur, India
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Choung Y, Pak TY. More than just a bad day? Traumatic life events and self-control in old age. PLoS One 2023; 18:e0266312. [PMID: 36753499 PMCID: PMC9907851 DOI: 10.1371/journal.pone.0266312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 01/26/2023] [Indexed: 02/09/2023] Open
Abstract
The behavioral economics literature suggests that exposure to traumatic events shifts preference features including risk aversion and time preference. In this study, we examined the association between traumatic life events and self-control in old age. Data were obtained from the Health and Retirement Study, which offers retrospective data on trauma exposure and early life characteristics. The results showed that experiences of serious physical attacks or assaults is associated with a 3.1% reduction in self-control, adjusted for demographic and childhood socioeconomic characteristics. The attacks or assaults were experienced approximately 30 years prior to the survey, indicating that traumatic life events exert a lasting influence on self-control. Further analyses found no difference in the association between the experience of serious physical attacks or assaults and self-control according to the timing of occurrence. Our findings are consistent with the evidence that experiences of natural disasters or armed conflicts increase impatience among survivors.
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Affiliation(s)
- Youngjoo Choung
- Department of Consumer Science, Inha University, Incheon, Republic of Korea
| | - Tae-Young Pak
- Department of Consumer Science and Convergence Program for Social Innovation, Sungkyunkwan University, Seoul, Republic of Korea
- * E-mail:
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8
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Yajnik CS, Tan CM, Bhate V, Bandyopadhyay S, Sankar A, Behere RV. Robust determinants of neurocognitive development in children: evidence from the Pune Maternal Nutrition Study. J Dev Orig Health Dis 2023; 14:110-121. [PMID: 35762407 PMCID: PMC7614085 DOI: 10.1017/s2040174422000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Neurocognitive development is a dynamic process over the life course and is influenced by intrauterine factors as well as later life environment. Using data from the Pune Maternal Nutrition Study from 1994 to 2008, we investigate the association of in utero, birth, and childhood conditions with offspring neurocognitive development in 686 participants of the cohort, at age 12 years. The life course exposure variables in the analysis include maternal pre-pregnancy size and nutrition during pregnancy, offspring birth measurements, nutrition and physical growth at age 12 years along with parental education and socio-economic status. We used the novel Bayesian Model Averaging (BMA) approach; which has been shown to have better predictive performance over traditional tests of associations. Our study employs eight standard neurocognitive tests that measure intelligence, working memory, visuo-conceptual and verbal learning, and decision-making/attention at 12 years of age. We control for nutritional-metabolic information based on blood measurements from the pregnant mothers and the children at 12 years of age. Our findings highlight the critical role of parental education and socio-economic background in determining child neurocognitive performance. Maternal characteristics (pre-pregnancy BMI, fasting insulin during pregnancy) and child height at 12 years were also robust predictors on the BMA. A range of early factors - such as maternal folate and ferritin concentrations during pregnancy, and child's head circumference at birth - remained important determinants of some dimensions of child's neurocognitive development, but their associations were not robust once we account for model uncertainty. Our results suggest that intrauterine influences on long- term neurocognitive outcomes may be potentially reversible by post-birth remediation. In addition to the current nutritional interventions, public health policy should also consider social interventions in children born into families with low socio-economic status to improve human capital.
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Affiliation(s)
| | - Chih Ming Tan
- Department of Economics & Finance, Nistler College of Business and Public Administration, University of North Dakota, Grand Forks, ND, USA
| | - Vidya Bhate
- Diabetes Unit, KEM Hospital Research Center, Pune, India
- Department of Psychology, Vishwakarma University, Pune, India
| | | | - Ashwini Sankar
- Carlson School of Management, University of Minnesota-Twin Cities, Minneapolis, MN, USA
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Bliznashka L, Jeong J, Jaacks LM. Maternal and paternal employment in agriculture and early childhood development: A cross-sectional analysis of Demographic and Health Survey data. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001116. [PMID: 36962809 PMCID: PMC10021554 DOI: 10.1371/journal.pgph.0001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023]
Abstract
Considerable literature from low- and lower-middle-income countries (LLMICs) links maternal employment to child nutritional status. However, less is known about the role of parental employment and occupation type in shaping child development outcomes. Additionally, little empirical work has examined the mechanisms through which parental occupation influences child outcomes. Our objective was to investigate the associations between maternal and paternal employment (comparing agricultural and non-agricultural employment) and child development and to examine childcare practices and women's empowerment as potential mechanisms. We pooled nine Demographic and Health Surveys (Benin, Burundi, Cambodia, Congo, Haiti, Rwanda, Senegal, Togo, and Uganda) with data on 8,516 children aged 36-59 months. We used generalised linear models to estimate associations between parental employment and child development, child stimulation (number of activities provided by the mother, father, and other household members), child supervision (not left alone or with older child for >1 hour), early childhood care and education programme (ECCE) attendance, and women's empowerment. In our sample, all fathers and 85% of mothers were employed. In 40% of families, both parents were employed in agriculture. After adjusting for child, parental and household confounders, we found that parental agricultural employment, relative to non-agricultural employment, was associated with poorer child development (relative risk (RR) 0.86 (95% CI 0.80, 0.92), more child stimulation provided by other household members (mean difference (MD) 0.26 (95% CI 0.09, 0.42)), less adequate child supervision (RR, 0.83 (95% 0.78, 0.80)), less ECCE attendance (RR 0.46 (95% CI 0.39, 0.54)), and lower women's empowerment (MD -1.01 (95% CI -1.18, -0.84)). Parental agricultural employment may be an important risk factor for early childhood development. More research using more comprehensive exposure and outcome measures is needed to unpack these complex relationships and to inform interventions and policies to support working parents in the agricultural sector with young children.
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Affiliation(s)
- Lilia Bliznashka
- International Food Policy Research Institute, Washington, DC, United States of America
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, United Kingdom
| | - Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, United Kingdom
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10
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Van VTS, Siguin CP, Lacsina AC, Yao LF, Sales ZG, Gordoncillo NP, Advincula-Lopez L, Sescon JT, Miro EDP. A Community-Led Central Kitchen Model for School Feeding Programs in the Philippines: Learnings for Multisectoral Action for Health. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100391. [PMID: 36951280 PMCID: PMC9771463 DOI: 10.9745/ghsp-d-21-00391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/02/2022] [Indexed: 12/10/2022]
Abstract
In devolved governments like the Philippines, local government units (LGUs) must be engaged to develop and coordinate responses to tackle the multisectoral problem of childhood undernutrition. However, current Philippine nutrition interventions, such as decentralized school feeding programs (SFPs), generally rely on the national government, public school teachers, or the private sector for implementation, with mixed results. The central kitchen model for SFPs was developed by 2 Philippine nongovernmental organizations and facilitated large-scale in-school feeding through community multisectoral action. This case study documented coordination processes in February 2018 for 1 urban city and 1 rural province-the model's earliest large-scale implementation sites-that contributed to its institutionalization and sustainability. Data from 24-hour dietary recalls with 308 rural and 310 urban public school students and household surveys with their caregivers showed undernutrition was an urgent problem. Enabling factors and innovative local solutions were explored in focus group discussions with 160 multisector participants and implementers in health care, education, and government, as well as volunteers, parents, and central kitchen staff. The locally led and operated central kitchens promoted community ownership by embedding volunteer pools in social networks and spurring demand for related social services from their LGU. With the LGU as the face of implementation, operations were sustained despite political leadership changes, fostering local government stewardship over nutrition. Leveraging national legislation and funding for SFPs and guided by the Department of Education's standards for SFP eligibility, LGUs had room to adapt the model to local needs. Central kitchens afforded opportunities for scale-up and flexibility that were utilized during natural disasters and the coronavirus disease (COVID-19) pandemic. The case demonstrated empowering civil society can hold volunteers, local implementers, and local governments accountable for multisectoral action in decentralized settings. The model may serve as a template for how other social services can be scaled and implemented in devolved settings.
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Affiliation(s)
- Vanessa T Siy Van
- Health Sciences Program, Ateneo de Manila University, Quezon City, Philippines.
| | - Carmina P Siguin
- Community Welfare, Wellness, and Well-being Laboratory, Ateneo de Manila University, Quezon City, Philippines
| | - Andrew C Lacsina
- Community Welfare, Wellness, and Well-being Laboratory, Ateneo de Manila University, Quezon City, Philippines
| | - Lean Franzl Yao
- Department of Mathematics, Ateneo de Manila University, Quezon City, Philippines
| | - Zarah G Sales
- Institute of Human Nutrition and Food, University of the Philippines Los Baños, Laguna, Philippines
| | - Normahitta P Gordoncillo
- Institute of Human Nutrition and Food, University of the Philippines Los Baños, Laguna, Philippines
| | | | - Joselito T Sescon
- Department of Economics, Ateneo de Manila University, Quezon City, Philippines
| | - Eden Delight P Miro
- Department of Mathematics, Ateneo de Manila University, Quezon City, Philippines
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11
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Zhang H, Ho WC. The Long-Term Effect of Famine Exposure on Cognitive Performance: Evidence from the 1959-1961 Chinese Famine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16882. [PMID: 36554762 PMCID: PMC9779583 DOI: 10.3390/ijerph192416882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
We examined the long-term impact of the 1959-1961 Chinese Famine on the survivors' cognitive performance in this study. Using data from the 2010 China Family Panel Study, our cohort comparison analysis showed that people who experienced the famine in early childhood (aged 1-3) had a lower score on a vocabulary test and that those who were exposed to the famine in utero did not differ from those born after the famine, probably due to positive selection for the in utero survivors. To deal with the problem of the lack of a comparable control group, we further applied a migrant-stayer comparison approach, with data from the 2016 China Family Panel Study and the 2017 Hong Kong Panel Study of Social Dynamics, to examine the effects of famine exposure at different life stages on adult cognition. We compared the people who stayed in Guangdong with the people who crossed the border to Hong Kong before the famine. The results showed that Guangdong stayers who experienced the famine when they were aged 1-18 had worse performance in immediate word recall. The findings suggested that exposure to malnutrition during childhood has long-term adverse effects on cognitive performance.
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Affiliation(s)
- Han Zhang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Wing Chung Ho
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong SAR, China
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12
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Aziz N, Liu T, Yang S, Zukiewicz-Sobczak W. Causal relationship between health insurance and overall health status of children: Insights from Pakistan. Front Public Health 2022; 10:934007. [PMID: 36568764 PMCID: PMC9768499 DOI: 10.3389/fpubh.2022.934007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
Evaluating the impact of health insurance always remains a methodologically challenging endeavor due to the absence of sample randomization. This paper evaluates the impact of health insurance on the health status of children in Pakistan using the data of the Multiple Indicator Cluster Survey (MICS) for Punjab, Pakistan, from 2017 to 2018. The study adopted the propensity score matching (PSM) method to address the sample selection bias. The sample is matched on potential covariates such as mother characteristics (education level), household head characteristics (gender, age, and education), and other household conditions (such as home dwelling, internet access, wealth index, migration member, number of children residing in the home, as child illness, etc.). The findings revealed that children with insurance have considerably better health than non-insured, at a 1% significance level. The results confirm that health insurance is not a luxury but a need that improves children's overall health. In this regard, governments should enhance and expand programs related to health insurance, especially for children. Health insurance programs will not only help poor people but also improve the overall infrastructure of health services in the country.
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Affiliation(s)
- Noshaba Aziz
- School of Economics, Shandong University of Technology, Zibo, China
| | - Tinghua Liu
- School of Economics, Shandong University of Technology, Zibo, China
| | - Shaoxiong Yang
- College of Economics and Management, Northwest A&F University, Xianyang, China
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13
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Ramirez D, Haas SA. Windows of Vulnerability: Consequences of Exposure Timing during the Dutch Hunger Winter. POPULATION AND DEVELOPMENT REVIEW 2022; 48:959-989. [PMID: 37063488 PMCID: PMC10087479 DOI: 10.1111/padr.12513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Prior research on early-life exposures to famine has established in utero development as a critical period of vulnerability to malnutrition. Yet, previous research tends to focus narrowly on this stage, at the expense of a more comprehensive examination of childhood. As a result, the literature has yet to compare the severity of the consequences of exposure to malnutrition across developmentally salient periods. Such comparison is crucial not only in the magnitude of effects but also in the nature of outcomes. Using a restricted population registry-linked health survey, this study examines the Dutch Hunger Winter to provide a comprehensive examination of the long-term consequences of in utero, infant, childhood, and adolescent exposure to famine. The results show malnutrition leads to heterogeneous effects depending on when the exposure occurs. In utero exposure to malnutrition leads to deleterious conditions in physical health and lower socioeconomic attainment. For older cohorts, results suggest a resilience to the effects of malnutrition on physical health in late life, but a higher vulnerability to socioeconomic stunting. Furthermore, the results suggest important gender differences in the long-term impact of malnutrition. Males consistently show stronger negative consequences across a wider array of conditions.
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14
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Liang Y, Chen X, Zhao C, Jiang S. Nutrition improvement program for rural compulsory education students and individual health. Front Public Health 2022; 10:1051810. [PMID: 36424973 PMCID: PMC9680972 DOI: 10.3389/fpubh.2022.1051810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
We use the county-by-county rollout of the program and employ the difference-in-difference (DID) methodology to identify the effects of the implementation of the nutrition improvement program for rural compulsory education students on adolescent health. The results show that the nutrition improvement program reduces the frequency and probability of illness and improves the students' health status. The heterogeneity analysis indicates that the children in western regions and children left behind have a greater marginal improvement. It finds that the nutrition improvement program for rural compulsory education students improves adolescent health through diversifying nutrition intake to alleviate malnutrition and developmental delay in impoverished areas. The program can promote adolescent health in impoverished areas, which has a role in improving regional health disparities and alleviating the intergenerational entrenchment of poverty.
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Affiliation(s)
- Yinhe Liang
- School of Economics, Central University of Finance and Economics, Beijing, China
| | - Xiyin Chen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Chenxiao Zhao
- China Export and Credit Insurance Corporation, Beijing, China
| | - Shaoxiang Jiang
- Institute for Global Health and Development, Peking University, Beijing, China,National School of Development, Peking University, Beijing, China,*Correspondence: Shaoxiang Jiang
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Does Food Insecurity in Early Life Make People More Depressed?—Evidence from CHARLS. SUSTAINABILITY 2022. [DOI: 10.3390/su14137990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Based on the China Health and Retirement Longitudinal Study (CHARLS) data, this paper estimates the long-term association between food insecurity and later adult health and health behaviors with the Probit model. The results show that food insecurity in early life significantly increases adults’ depression likelihood (measured by the CES-D scale). The food insecurity experience is also negatively and significantly associated with individual self-rated health status, memory, sleep quality, and life satisfaction. The negative association between food insecurity and cognitive ability and sleep hours is larger for females.
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16
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Siy Van VT, Antonio VA, Siguin CP, Gordoncillo NP, Sescon JT, Go CC, Miro EP. Predicting undernutrition among elementary schoolchildren in the Philippines using machine learning algorithms. Nutrition 2022; 96:111571. [DOI: 10.1016/j.nut.2021.111571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/23/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
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17
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Kämpfen F, Zahra F, Kohler HP, Kidman R. The effects of negative economic shocks at birth on adolescents’ cognitive outcomes and educational attainment in Malawi. SSM Popul Health 2022; 18:101085. [PMID: 35493407 PMCID: PMC9048075 DOI: 10.1016/j.ssmph.2022.101085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/20/2022] [Accepted: 03/26/2022] [Indexed: 11/24/2022] Open
Abstract
We provide new evidence of the association between moderate negative economic shocks in utero or shortly after birth and adolescents’ cognitive outcomes and educational attainment in Malawi. This is one of the first studies to analyze the effect of not one, but multiple moderate negative economic shocks in a sub-Saharan African (SSA) low-income country (LIC). This focus is important as multiple economic shocks in early life are more representative of the experiences of adolescents in LICs. Combining data on adolescents aged 10–16 from the Adverse Childhood Experiences (ACE) project with the Malawi Longitudinal Study on Families and Health (MLSFH) (N = 1, 559), we use linear and probit regression models to show that girls whose households experienced two or more economic shocks in their year of birth have lower cognitive scores, which are measured using working memory, reading and mathematical tests. Girls also have lower educational attainment, conditional on age. These effects are gendered, as we do not observe similar effects among boys. Overall, our results point to lasting effects of early-life adversity on adolescents, and they highlight that, even in a LIC context where early-life adversity is common, policymakers need to intervene early to alleviate the potential long-term educational impacts of in utero or early life shocks among girls.
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18
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Li Y, Sunder N. What doesn't kill her, will make her depressed. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101064. [PMID: 34601324 DOI: 10.1016/j.ehb.2021.101064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/04/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
In this paper we study the long run effects of the 1959-61 Chinese Famine on mental health outcomes. We focus on cohorts that were born during the famine and examine their mental health as adults, when they are roughly 55 years of age. We find that early-life exposure to this famine leads to a large statistically significant negative impact on women's mental health, while there is limited effect on men. This gender differential effect is observed because male fetuses experience a stronger natural selection as compared to female fetuses, which implies that in the longer run, surviving females may exhibit larger detrimental effects of early-life famine exposure. Thus, the observed effects are a composite of two well-established factors, the survival of the fittest and the Fetal Origins hypothesis.
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Affiliation(s)
- Yanan Li
- Business School, Beijing Normal University, 1720 Houzhu Building, No. 19 XinJieKouWai Street, Haidian District, Beijing 100875, China.
| | - Naveen Sunder
- Department of Economics, Bentley University, AAC Room 187, 175 Forest St., Waltham, MA, 02452, United States.
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The Mental Health Outcomes of Food Insecurity and Insufficiency in West Africa: A Systematic Narrative Review. Behav Sci (Basel) 2021; 11:bs11110146. [PMID: 34821607 PMCID: PMC8614760 DOI: 10.3390/bs11110146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Food insufficiency is a global pandemic affecting many people, especially those residing in developing countries. African countries have been affected by food insufficiency, which is mostly caused by drought or wars. Famine or food insufficiency has been reported to have an impact on the psychological health and quality of life of people affected. This review assessed the mental health outcomes of famine and food insufficiency in West Africa. (2) Methods: A search of the published literature was conducted using PubMed, PsycExtra, Medline, and PsycINFO databases. The search was limited to papers published in English between the years 2010 and 2020. Two reviewers independently screened the titles and abstracts of the retrieved papers using pre-defined inclusion and exclusion criteria and a third reviewer resolved conflicts. Data were extracted and appraised using a data extraction form and an appraisal checklist. (3) Results: A total of 81 papers were identified through the journal databases search. Out of the seven papers that met the inclusion criteria, six papers used cross-sectional designs and one paper used an experimental design. The six papers used quantitative approach for data collection, while the one paper used a qualitative technique. The evidence synthesized from this review indicated that exposure to food insecurity or insufficiency is associated with increased psychological distress including anxiety, sleeplessness, intellectual disability, general mental, and emotional instability. (4) Conclusions: This review strongly highlights the need for further research across the sub-region. It further suggests that famine and food insufficiency are associated with significant mental health problems in adults and impacts the cognitive and intellectual development of children. Although there is paucity of literature about famine and its impact on mental health in West Africa, these findings are important for developing social policy initiatives for increasing food supply and mental health interventions for all ages.
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Mwene-Batu P, Bisimwa G, Ngaboyeka G, Dramaix M, Macq J, Hermans MP, Lemogoum D, Donnen P. Severe acute malnutrition in childhood, chronic diseases, and human capital in adulthood in the Democratic Republic of Congo: the Lwiro Cohort Study. Am J Clin Nutr 2021; 114:70-79. [PMID: 33826712 PMCID: PMC8246611 DOI: 10.1093/ajcn/nqab034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/29/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Little is known about the long-term outcome of children treated for severe acute malnutrition (SAM) after nutritional rehabilitation. OBJECTIVES To explore the association between SAM in childhood, noncommunicable diseases (NCDs), and low human capital in adulthood. METHODS We identified 524 adults (median age: 22 y) who were treated for SAM during childhood in Eastern Democratic Republic of Congo between 1988 and 2007. They were compared with 407 community unexposed age- and sex-matched subjects with no history of SAM. The variables of interest were cardiometabolic risk markers for NCDs and human capital. For the comparison, we used linear and logistic regressions to estimate the association between SAM in childhood and the risk of NCDs and ordinal logistic regression for the human capital. RESULTS Compared with unexposed subjects, the exposed participants had a higher waist circumference [1.2 (0.02, 2.3) cm; P = 0.015], and a larger waist-to-height ratio [0.01 (0.01, 0.02) cm; P < 0.001]. On the other hand, they had a smaller hip circumference [-1.5 (-2.6, -0.5) cm; P = 0.021]. Regarding cardiometabolic markers for NCDs, apart from a higher glycated hemoglobin (HbA1c) [0.4 (0.2, 0.6); P < 0.001], no difference was observed in other cardiometabolic markers for NCD between the 2 groups. Compared with unexposed participants, exposed participants had a higher risk of metabolic syndrome (crude OR: 2.35; 95% CI: 1.22, 4.54; P = 0.010) and visceral obesity [adjusted OR: 1.44 (1.09, 1.89); P = 0.001]. The prevalence of hypertension, diabetes, overweight, and dyslipidaemia was similar in both groups. Last, the proportion of malnutrition survivors with higher socioeconomic status level was lower. CONCLUSION SAM during childhood was associated with a high risk of NCDs and lower human capital in adulthood. Thus, policymakers and funders seeking to fight the global spread of NCDs in adults in low-resource settings should consider the long-term benefit of reducing childhood SAM as a preventive measure to reduce the socioeconomic burden attributable to NCDs.
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Affiliation(s)
- Pacifique Mwene-Batu
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Nutritional department, Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
- Hôpital Provincial General de Reference de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Nutritional department, Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
| | - Gaylord Ngaboyeka
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Nutritional department, Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
| | - Michèle Dramaix
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Macq
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Michel P Hermans
- Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Daniel Lemogoum
- Hôpital ULB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Donnen
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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Guven C, Hoang T, Rahman MH, Ulubaşoğlu MA. Long-term effects of malnutrition on early-life famine survivors and their offspring: New evidence from the Great Vietnam Famine 1944-45. HEALTH ECONOMICS 2021; 30:1600-1627. [PMID: 33880821 DOI: 10.1002/hec.4274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/27/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
We investigate the long-term effects of the 1944-45 Great Vietnam Famine on early-life survivors and their offspring using census data, household survey data and historical administrative data. Unlike previous famine studies, we measure famine severity using a unique, more direct, and "plausibly exogenous" metric of food availability: province-level excess paddy (rice) production per capita in 1944. Our study makes two novel contributions. First, we overcome several selection problems associated with the estimation of true famine effects, given the short duration and spatial variation of the Vietnamese famine. Second, we investigate the intergenerational effects of famine, focusing specifically on the occupation of the survivors' parents and the school participation of the survivors' offspring. Our preferred specification estimates generalized triple differences that allow us to control for birth-year and birth-province fixed effects and nation-wide shocks. Our findings suggest that the Vietnamese famine reduced literacy by around 3 percent, BMI by 5.6%-8.4%, arm-length by 4.5%-6.7% (1.1-1.7 cm), height by 2.2%-3.2% (3.4-5 cm), and weight by 10%-14% (4.7-6.9 kg) among the affected cohort. These detrimental famine effects also extended to economic welfare, in the form of lower household incomes and lower non-food household expenditures in adulthood. We also document a 4.9%-7.2% reduction in school participation among survivors' offspring, which has major implications for the exogenous origins of social mobility, inequality, and poverty.
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Affiliation(s)
- Cahit Guven
- Department of Economics, Deakin University, Victoria, Australia
| | - Trung Hoang
- Institute of Theoretical and Applied Research, Duy Tan University, Hanoi, Vietnam
- TIMAS, Thang Long University, Hanoi, Vietnam
| | - Muhammad H Rahman
- School of Accounting, Economics and Finance, Faculty of Business and Law, Curtin University, Bentley, Western Australia, Australia
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Ogasawara K, Inoue T. The long-run heterogeneous effects of a cholera pandemic on stature: Evidence from industrializing Japan. ECONOMICS AND HUMAN BIOLOGY 2021; 41:100968. [PMID: 33582501 PMCID: PMC9760307 DOI: 10.1016/j.ehb.2020.100968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 06/02/2023]
Abstract
The recent COVID-19 pandemic poses the general question on how infectious diseases can persistently affect human health. A growing body of literature has found a significant amount of evidence on the long-term adverse effects of infectious diseases, such as influenza, typhoid fever, and yellow fever. However, we must be careful about the fact that little is known about the long-term consequences of the acute diarrheal disease pandemic cholera - Vibrio cholerae bacillus - which still threatens the health of the population in many developing countries. To bridge this gap in the body of knowledge, we utilized unique census-based data on army height at age 20 in early 20th-century Japan, with a difference-in-differences estimation strategy using regional variation in the intensity of cholera pandemics. We found that early-life exposure to a cholera pandemic had heterogeneous stunting effects on the final height of men; the magnitude of the stunting effects increased as the intensity of exposure increased.
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Affiliation(s)
- Kota Ogasawara
- Department of Industrial Engineering, School of Engineering, Tokyo Institute of Technology, 2-12-1, Ookayama, Meguro-ku, Tokyo 152-8552, Japan.
| | - Tatsuki Inoue
- Department of Business Economics, School of Management, Tokyo University of Science, 1-11-2, Fujimi, Chiyoda-ku, Tokyo 102-0071, Japan.
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Physical fitness and cognitive function among school-aged children in selected basic schools in the Ho Municipality of Ghana. Heliyon 2021; 7:e06324. [PMID: 33732918 PMCID: PMC7944041 DOI: 10.1016/j.heliyon.2021.e06324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/25/2020] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
Physical fitness is thought to promote cognitive function. Evidence about this is however lacking in the Ghanaian context. This study aimed to investigate the association between physical fitness and cognitive function among basic school children aged 8–13 years. A cross-sectional study involving 591 school children, recruited from 12 randomly selected public and private basic schools was conducted. Physical fitness tests were done using a five-test battery (Fifty metre run, handgrip strength, sit-up, flexibility and standing board jump) following standardized procedures. Cognitive function test using the Raven's Coloured Progressive Matrices (RCPM) were carried out. More girls (55%), children from 8-13 years old (49.1%) and public school children (66.1%) participated in the study. For fitness, boys performed better than girls in sit ups 3.4 ± 2.2 (mean ± SD), p = 0.012, handgrip 4.3 ± 2.0, p = 0.001 and overall fitness 4.3 ± 2.0, p = 0.007. Children in public schools performed significantly better in forward jump (p < 0.001) while those in private schools did better in 50m run (p < 0.001). For cognition, 46.1% of participants had less than 50% of the total score. Cognitive test score varied for forward jump and handgrip alone and not for sit ups, 50m run and overall score. Mean forward jump score was lowest in poor cognition group (4.9 ± 2.3), followed by good (5.3 ± 2.2) and highest among excellent (5.5 ± 2.3, p = 0.044) cognition group. Similar observation was made for handgrip. Cognition score and hand grip strength were positively but weakly correlated. (r = 0.132, p = 0.026). Although handgrip strength (measuring muscular strength) was significantly associated with cognitive function, this study found no significant association between overall physical fitness and cognitive function. These results indicate that only some components of physical fitness may be associated with cognitive function. This study is however correlational and one cannot infer causality.
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Long-term effects of severe acute malnutrition during childhood on adult cognitive, academic and behavioural development in African fragile countries: The Lwiro cohort study in Democratic Republic of the Congo. PLoS One 2021; 15:e0244486. [PMID: 33382748 PMCID: PMC7774943 DOI: 10.1371/journal.pone.0244486] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/11/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Little is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term effects of SAM during childhood on human capital in adulthood in terms of education, cognition, self-esteem and health-related disabilities in daily living. Methodology We traced 524 adults (median age of 22) in the eastern Democratic Republic of the Congo, who were treated for SAM during childhood at Lwiro hospital between 1988 and 2007 (median age 41 months). We compared them with 407 community controls of comparable age and sex. Our outcomes of interest were education, cognitive function [assessed using the Mini Mental State Examination (MMSE) for literate participants, or its modified version created by Ertan et al. (MMSE-I) for uneducated participants], self-esteem (measured using the Rosenberg Self-Esteem Scale) and health-related social and functional disabilities measured using the World Health Organization Disability Assessment Schedule (WHODAS). For comparison, we used the Chi-squared test along with the Student’s t-test for the proportions and means respectively. Results Compared with the community controls, malnutrition survivors had a lower probability of attaining a high level of education (p < 0.001), of reporting a high academic performance (p = 0.014) or of having high self-esteem (p = 0.003). In addition, malnutrition survivors had an overall mean score in the cognitive test that was lower compared with the community controls [25.6 compared with 27.8, p = 0.001 (MMSE) and 22.8 compared with 26.3, p < 0.001(MMSE-I)] and a lower proportion of subjects with a normal result in this test (78.0% compared with 90.1%, p < 0.001). Lastly, in terms of health-related disabilities, unlike the community controls, malnutrition survivors had less social disability (p = 0.034), but no difference was observed as regards activities of daily living (p = 0.322). Conclusion SAM during childhood exposes survivors to low human capital as regards education, cognition and behaviour in adulthood. Policy-deciders seeking to promote economic growth and to address various psychological and medico-social disorders must take into consideration the fact that appropriate investment in child health as regards SAM is an essential means to achieve this.
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Cohn-Schwartz E, Weinstein G. Early-life food deprivation and cognitive performance among older Europeans. Maturitas 2020; 141:26-32. [PMID: 33036699 DOI: 10.1016/j.maturitas.2020.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/01/2020] [Accepted: 06/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Early-life adversity, including food deprivation, has been linked with late-life cognitive function. Our aim was to explore the association between the early experience of hunger (the age at which it was experienced and its duration) and cognitive performance and decline among older Europeans. METHODS Our sample comprised dementia-free individuals aged ≥65 years who participated in waves 3 and 4 of the Survey of Health, Ageing and Retirement in Europe (SHARE). Information on periods of hunger during the life course was gathered in wave 3 (2009; SHARELIFE). Cognitive performance was assessed using tests of memory, verbal fluency and numeracy in waves 4 (2011) and 5 (2013). Regression models were used to assess the relationship between the experience of hunger at different ages and its duration and cognitive performance and decline while adjusting for age, sex, education, lifestyle and health factors. RESULTS Among a sample of 2131 individuals (mean age = 76.2 years; 50 % women), the experience of hunger when aged 0-4 years was associated with poorer immediate and delayed recall, fluency and impaired numeracy factors (B±SE=-0.58 ± 0.12; p < 0.001; B±SE=-0.74 ± 0.13; p < 0.001, B±SE=-1.60 ± 0.42; p < 0.001 and OR [95 % CI] = 0.57 [0.42-0.79], respectively). These results attenuated after controlling for duration of the experience of hunger but remained significant for immediate and delayed recall. The experience of hunger at ages 12-18 years was associated with better immediate recall, delayed recall and fluency (B±SE = 0.38 ± 0.15; p = 0.010; B±SE = 0.37 ± 0.17; p = 0.026, B±SE = 1.57 ± 0.53; p = 0.003, respectively). The associations of hunger with cognitive decline were similar but less robust. CONCLUSIONS Our findings suggest that severe nutritional deprivation in early childhood may be associated with poor cognitive function in later life, while food deprivation in later childhood and adolescence may be protective.
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Affiliation(s)
- Ella Cohn-Schwartz
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Galit Weinstein
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Israel
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Arage G, Belachew T, Abera M, Abdulhay F, Abdulahi M, Hassen Abate K. Consequences of early life exposure to the 1983-1985 Ethiopian Great Famine on cognitive function in adults: a historical cohort study. BMJ Open 2020; 10:e038977. [PMID: 32973064 PMCID: PMC7517579 DOI: 10.1136/bmjopen-2020-038977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To investigate the association between early life famine exposure and cognitive function in adults. DESIGN Historical cohort study SETTING: North Wollo Zone, Northeast Ethiopia. PARTICIPANTS We recruited 1047 adult men and women aged 30-38 years who had history of early life exposure to Ethiopian great famine. Based on self-reported age and birth date, participants were categorised into famine exposed in early life (prenatal/postnatal) and non-exposed groups. OUTCOME MEASURES The primary outcome measure of this study was cognitive function in adults after early life exposure to famine. Cognitive function was measured using Montreal Cognitive Assessment-basic. Associations between exposure and outcome variables were examined by linear regression analysis models. RESULTS Adjusted for covariates, early life exposure to famine showed 1.29 (β=-1.29; 95% CI -2.16 to -0.52) points lower cognitive function score compared with non-exposed. Based on subanalysis for timing of famine exposure, postnatal exposure to famine resulted in 2.26 (β=-2.26; 95% CI -3.12 to -1.36) points lower cognitive function score compared with non-exposed groups. Prenatal famine exposure had 1.26 (β=-1.26; 95% CI -2.35 to 0.94) points lower cognitive function score although not statistically significant. CONCLUSIONS Famine exposure in early life was associated with cognitive functions in adults. While the overall findings highlight the importance of optimal nutrition in early life for brain growth and development, the association observed between postnatal famine exposure and adult cognitive function may indicate the relative importance of learning and experience during early childhood for optimal brain development after birth. Further studies are needed to elucidate the potential mechanism behind this association.
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Affiliation(s)
- Getachew Arage
- Nutrition and Dietetics, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tefera Belachew
- Nutrition and Dietetics, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Mubarek Abera
- Psychiatry, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Fedilu Abdulhay
- Obstetrics and Gynecology, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Misra Abdulahi
- Department of Population and Family Heath, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
| | - Kalkidan Hassen Abate
- Nutrition and Dietetics, Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
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Lay MJ, Norling J. The Consequences of the 1959-1961 Chinese Famine for Educational Attainment. THE B.E. JOURNAL OF ECONOMIC ANALYSIS & POLICY 2020; 20:20190043. [PMID: 33343788 PMCID: PMC7743912 DOI: 10.1515/bejeap-2019-0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This paper finds that the Great Chinese Famine of 1959-1961 reduced lifetime educational attainment by up to 3.8 years for people who lived in areas most severely hit by the famine. Using geographical variation in famine intensity, information about place of residence during the famine, and educational attainment recorded in the China Health and Retirement Longitudinal Study, the paper demonstrates that the decline in educational attainment was particularly sharp for women. This decline interrupted substantial gains in schooling achieved in China during the middle part of the twentieth century.
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Estimating the potential effects of COVID-19 pandemic on food commodity prices and nutrition security in Nepal. J Nutr Sci 2020; 9:e51. [PMID: 33240495 PMCID: PMC7681149 DOI: 10.1017/jns.2020.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/25/2020] [Accepted: 10/07/2020] [Indexed: 12/20/2022] Open
Abstract
The objective of the paper is to analyse changes in food commodity prices and estimate the potential effects of food price change on nutrition security in Nepal in the context of COVID-19 contagion control measures. It presents a comparative intra-country observational study design looking at events before and during the pandemic (after implementation of contagion control measures). The study design includes three districts, enabling comparison between diverse agro-ecological zones and geographical contexts. The methodology consists of primary data collection, modelling and quantitative analysis. The analysis is based on actual school meal food baskets which represent culturally and nutritionally optimised food baskets, developed by the local community and notional typical household food baskets. End May/early June 2020 is the 'Post-COVID-19' reference point, the same time period in 2019 i.e. June 2019 is the 'Pre-COVID-19' reference point. The study finds a substantial increase in food commodity prices across food groups and districts with marked inter-district variation. For school meal basket, all micronutrients show large average declines ranging from 9⋅5 % for zinc to 11 % for vitamin-A. For household food baskets on average, vitamin-A reduced 37 % followed by iron at 19 %, reduction in zinc is low due to the high zinc content in whole grain cereals. COVID-19 control measures are likely to have contributed to substantial price inflation over the reference period with potentially damaging effects on nutrition security in Nepal with serious implications for vulnerable populations.
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Belesova K, Agabiirwe CN, Zou M, Phalkey R, Wilkinson P. Drought exposure as a risk factor for child undernutrition in low- and middle-income countries: A systematic review and assessment of empirical evidence. ENVIRONMENT INTERNATIONAL 2019; 131:104973. [PMID: 31400736 DOI: 10.1016/j.envint.2019.104973] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Droughts affect around 52 million people globally each year, a figure that is likely to increase under climate change. OBJECTIVES To assess the strength of empirical evidence on drought exposure as a risk factor for undernutrition in children <5 years of age in low- and middle-income countries (LMICs). METHODS Systematic review of observational studies published between 1990 and 2018 in English and reporting undernutrition outcomes in children <5 years of age in relation to droughts in LMICs. The search was performed in the Global Health, Medline, Embase, and Scopus databases. We assessed the strength of evidence following the Navigation Guide. RESULTS 27 studies met our inclusion criteria. 12 reported prevalence estimates in drought-affected conditions without comparison to unaffected conditions. These showed high prevalence of chronic and mixed undernutrition and poor to critical levels of acute undernutrition. Only two studies were judged to have low risk of bias. Overall, the strength of evidence of drought as a risk factor was found to be limited, but the two studies with low risk of bias suggested positive associations of drought exposure with children being underweight and having anaemia. CONCLUSION Published evidence suggests high levels of all types of child undernutrition in drought-affected populations in low-income settings, but the extent to which these levels are attributable to drought has not been clearly quantified and may be context specific. This review offers suggestions for enhancing the quality of future studies to strengthen evidence on the potential magnitude, timing, and modifying factors of drought impacts.
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Affiliation(s)
- Kristine Belesova
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Caroline Noel Agabiirwe
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Margaret Zou
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Revati Phalkey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany.
| | - Paul Wilkinson
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
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Rong H, Lai X, Mahmoudi E, Fang H. Early-Life Exposure to the Chinese Famine and Risk of Cognitive Decline. J Clin Med 2019; 8:jcm8040484. [PMID: 30974821 DOI: 10.3390/jcm8040484] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/25/2022] Open
Abstract
Previous studies on the Chinese famine suggested long-term effects of early-life famine exposure on health conditions. This study aims to investigate the association between exposure to the Chinese famine of 1959-1961 at different early-life stages and the risk of cognitive decline in adulthood. A total of 6417 adults born between 1952 and 1964 in the 2015 survey data of China Health and Retirement Longitudinal Study were included in this study. Cognitive performance was estimated through a series of comprehensive neuropsychological tests, including the Telephone Interview of Cognitive Status (TICS-10), word recall, and pentagon drawing. Multiple generalized linear model (GLM) was employed to detect the association between multi-stage early-life famine exposure and late-life cognitive performance. Compared with the unexposed group, respondents exposed to famine in the fetal period performed worse in the TICS (difference -0.52, 95% confidence interval (CI): -0.93 to -0.10), word recall (difference -0.46, 95% CI: -0.74 to -0.19), and general cognition (difference -1.05, 95% CI: -1.64 to -0.47). Furthermore, we also found negative effects of famine exposure on performance of word recall and pentagon drawing in the early (word recall difference -0.56, 95% CI: -1.00 to -0.11; pentagon drawing difference -0.76, 95% CI: -1.40 to -0.12), mid (word recall difference -0.46, 95% CI: -0.81 to -0.11; pentagon drawing difference -0.66, 95% CI: -1.16 to -0.16), and late (word recall difference -0.30, 95% CI: -0.55 to -0.04; pentagon drawing difference -0.75, 95% CI: -1.13 to -0.37) childhood-exposed groups. Early-life famine exposure in different stages is positively associated with late-life cognitive decline. Fetal famine exposure might affect the overall cognitive status in adulthood, and childhood famine exposure has potential adverse effects on visuospatial episodic memory.
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Affiliation(s)
- Hongguo Rong
- China Center for Health Development Studies, Peking University, Beijing 100083, China.
| | - Xiaozhen Lai
- China Center for Health Development Studies, Peking University, Beijing 100083, China.
| | - Elham Mahmoudi
- Department of Family Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing 100083, China.
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Sujan AC, Öberg AS, Quinn PD, D’Onofrio BM. Annual Research Review: Maternal antidepressant use during pregnancy and offspring neurodevelopmental problems - a critical review and recommendations for future research. J Child Psychol Psychiatry 2019; 60:356-376. [PMID: 30515808 PMCID: PMC6438736 DOI: 10.1111/jcpp.13004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
Abstract
Children of women treated with antidepressants during pregnancy are more likely to develop neurodevelopmental problems than are unexposed children. Associations between prenatal antidepressant exposure and neurodevelopmental problems could reflect a causal effect or could be partially or fully explained by other factors that differ between exposed and unexposed offspring, including having mothers with conditions requiring antidepressant treatment (e.g. depression), environmental risk factors, and/or genetic risk factors shared across disorders. This translational review aims to provide a brief overview of findings from rodent experiments and critically evaluate observational studies in humans to assess the extent to which associations between prenatal antidepressant exposure and neurodevelopmental problems are due to causal mechanisms versus other influences. We focus our review on two important neurodevelopmental outcomes - autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). In general, rodent studies have reported adverse effects of perinatal antidepressant exposure on neurodevelopment. Between-species differences raise questions about the generalizability of these findings to humans. Indeed, converging evidence from studies using multiple designs and approaches suggest that observed associations between prenatal antidepressant exposure and neurodevelopmental problems in humans are largely due to confounding factors. We also provide specific recommendations for future research. Animal research should explicitly evaluate the impact of timing of exposure and dosage of medications, as well as better map outcome measures in rodents to human neurodevelopmental problems. Observational studies should investigate specific confounding factors, specific antidepressant drugs and classes, the potential impact of timing of exposure, and a wider range of other potential offspring outcomes. The findings summarized in this review may help women and their doctors make informed decisions about antidepressant use during pregnancy by providing reassurance that use of these medications during pregnancy is unlikely to substantially increase the risk of ASD and ADHD.
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Affiliation(s)
- Ayesha C. Sujan
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - A. Sara Öberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Brian M. D’Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Zuanetti PA, Laus MF, Almeida SDS, Fukuda MTH. Early undernutrition as a cause of changes in phonological processing skills. REVISTA CEFAC 2019. [DOI: 10.1590/1982-0216/201921319018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
ABSTRACT Purpose: to determine whether undernutrition in the first years of life affects the phonological awareness skills, the phonological working memory and the school performance of children. Methods: the participants were children with a history of moderate/severe undernutrition during their first years of life (G1) who achieved nutritional recovery (n = 15). The performance of G1 in different cognitive tasks (phonological awareness at the syllable and phoneme level, phonological working memory - repetition of digits and pseudowords, and reading, writing and arithmetic activities) was compared to that of children with school difficulties (G2) (n = 15) and without school difficulties (G3) (n = 15), all eutrophic ones. Results: the performance of G1 was worse than that of the other two groups in all tasks evaluated (mean score of G1, G2 and G3 and p-values: phonological awareness: 31, 41, 57 - 0.01; repetition of direct order digits: 18, 23, 28 - 0.001; writing: 4, 10, 22 - 0.001; reading: 26, 45, 65-0.001; arithmetic: 4, 7, 11- 0.001). Conclusion: the results demonstrate that undernutrition affected the cognitive development, causing changes in important cognitive skills for the development of written language.
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Ogasawara K, Inoue T. Long-run effects of early childhood exposure to cholera on final height: Evidence from industrializing Japan. SSM Popul Health 2018; 4:66-70. [PMID: 29349274 PMCID: PMC5769111 DOI: 10.1016/j.ssmph.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 11/07/2022] Open
Abstract
Pandemic cholera is one of the most topical and urgent issues in many developing countries. However, although a growing body of research has shown the negative long-run effects of infectious disease exposure on human health, the long-run influences of early childhood exposure to cholera have thus far been understudied. To bridge this gap in the body of knowledge, we draw both on new data describing adult height from 1899 to 1910 from comprehensive official Japanese army records and on data recording the regional variation in the intensity of cholera pandemics. By using a difference-in-differences estimation strategy, we find that exposure to pandemic cholera had stunting effects on the final height of men at that time. Our estimates also suggest that early-infancy exposure to cholera seems to have a stronger long-run effect on adult height than late-infancy exposure.
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Affiliation(s)
- Kota Ogasawara
- Graduate School of Social Sciences, Chiba University, 1-33, Yayoicho, Inage-ku, Chiba 263-8522, Japan
| | - Tatsuki Inoue
- Graduate School of Economics, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Adjei MYB, Amissah JGN, Kunadu APH, Acquaah E, Colecraft E, Otoo GE, Afrifa-Anane E. Drivers-of-Liking (DOL) for Boiled Milk among Women of Reproductive Age and Children Aged between One and Five Years in Peri-Urban Communities in Ghana. ACTA ACUST UNITED AC 2018; 4:034. [PMID: 33937599 PMCID: PMC7839381 DOI: 10.24966/fsn-1076/100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/31/2018] [Indexed: 11/05/2022]
Abstract
Raw milk is heat treated in different ways to improve the safety of the milk for
consumption. The heat treatment imparts different sensory properties to the milk
that may influence its acceptance by consumers. In Ghana, fresh milk is boiled
and sold locally to consumers. Generally, consumption amongst women of
reproductive age and children under five is low. In this study, the sensory
properties that drive liking for local boiled milk and other heat-treated milks
in women of reproductive age and children between 1 and 5 years of age was
studied. External preference mapping was used to understand the sensory
properties of the milks that were liked by the two consumer groups. The sensory
properties of boiled milk that made women of reproductive age like a particular
product was its sweet and salty taste, smooth mouthfeel and artificial flavour.
For children between 1 and 5 years, the oily aftertaste, boiled egg aroma as
well as its sweet taste made them like the same product as the adults. This
product also had a cooked aroma and flavour which could have influenced liking
in the consumer groups. A small minority of adult consumers liked products that
had a smooth and runny appearance with a raw/uncooked note.
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Affiliation(s)
| | | | | | - Ezekiel Acquaah
- Office of Research, Innovation and Development, University of Ghana, Legon, Ghana
| | - Esi Colecraft
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Gloria Ethel Otoo
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Ernest Afrifa-Anane
- Regional Institute of Population Studies (RIPS), University of Ghana, Legon, Ghana
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Belesova K, Gasparrini A, Sié A, Sauerborn R, Wilkinson P. Household cereal crop harvest and children's nutritional status in rural Burkina Faso. Environ Health 2017; 16:65. [PMID: 28633653 PMCID: PMC5477741 DOI: 10.1186/s12940-017-0258-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/11/2017] [Indexed: 06/10/2023]
Abstract
BACKGROUND Reduction of child undernutrition is one of the Sustainable Development Goals for 2030. Achievement of this goal may be made more difficult in some settings by climate change through adverse impact on agricultural productivity. However, there is only limited quantitative evidence on the link between household crop harvests and child nutrition. We examined this link in a largely subsistence farming population in rural Burkina Faso. METHODS Data on the middle-upper arm circumference (MUAC) of 975 children ≤5 years of age, household crop yields, and other parameters were obtained from the Nouna Health and Demographic Surveillance System. Multilevel modelling was used to assess the relationship between MUAC and the household crop harvest in the year 2009 estimated in terms of kilocalories per adult equivalent per day (kcal/ae/d). RESULTS Fourteen percent of children had a MUAC <125 mm (a value indicative of acute undernutrition). The relationship between MUAC and annual household food energy production adjusted for age, sex, month of MUAC measurement, household wealth, whether a household member had a non-agricultural occupation, garden produce, village infrastructure and market presence, suggested a decline in MUAC below around 3000 kcal/ae/d. The mean MUAC was 2.49 (95% CI 0.45, 4.52) mm less at 1000 than at 3000 kcal/ae/d. CONCLUSIONS Low per capita household crop production is associated with poorer nutritional status of children in a rural farming population in Burkina Faso. This and similar populations may thus be vulnerable to the adverse effects of weather on agricultural harvest, especially in the context of climate change.
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Affiliation(s)
- Kristine Belesova
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Rue Namory Keïta, Nouna, Kossi province, Boucle du Mouhoun region Burkina Faso
| | - Rainer Sauerborn
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld, Heidelberg, 324 69120 Germany
| | - Paul Wilkinson
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Havari E, Peracchi F. Growing up in wartime: Evidence from the era of two world wars. ECONOMICS AND HUMAN BIOLOGY 2017; 25:9-32. [PMID: 27720584 DOI: 10.1016/j.ehb.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 06/06/2023]
Abstract
We document the association between war-related shocks in childhood and adult outcomes for Europeans born during the first half of the twentieth century. Using a variety of data, at both the macro- and the micro-level, we address the following questions: What are the patterns of mortality among Europeans born during this period? Do war-related shocks in childhood and adolescence help predict adult health, human capital and wellbeing of the survivors? Are there differences by sex, socio-economic status in childhood, and age when the shocks occurred? At the macro-level, we show that the secular trend towards lower mortality was interrupted by dramatic increases in mortality during World War I, the Spanish Flu, the Spanish Civil War, and World War II, and we quantify the size of these mortality shocks. Different patterns characterize these high-mortality episodes, with substantial variation by country, sex and age group. At the micro-level, we show that war-related hardship in childhood or adolescence, in particular exposure to war events and experience of hunger, is associated with worse physical and mental health, education, cognitive ability and subjective wellbeing at older ages. The strength of the association differs by sex and type of hardship, with war exposure being more important for females and experience of hunger for males. We also show that hardships matter more if experienced in childhood, and have stronger consequences if they last longer.
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Affiliation(s)
| | - Franco Peracchi
- Department of Economics, Georgetown University, United States; Department of Economics and Finance, University of Rome Tor Vergata, Italy.
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Peabody JW, Quimbo S, Florentino J, Shimkhada R, Javier X, Paculdo D, Jamison D, Solon O. Comparative effectiveness of two disparate policies on child health: experimental evidence from the Philippines. Health Policy Plan 2017; 32:563-571. [PMID: 28110265 PMCID: PMC5400045 DOI: 10.1093/heapol/czw179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Should health systems invest more in access to care by expanding insurance coverage or in health care services including improving the quality of care? Comparing these options experimentally would shed light on the impact and cost-effectiveness of these strategies. METHODS The Quality Improvement Demonstration Study (QIDS) was a randomized policy experiment conducted across 30 districts in the Philippines. The study had a control group and two policy intervention groups intended to improve the health of young children. The demand-side intervention in QIDS was universal health insurance coverage (UHC) for children aged 5 years or younger, and a supply-side intervention, a pay-for-performance (P4P) bonus for all providers who met pre-determined quality levels. In this paper, we compare the impacts of these policies from the QIDS experiment on childhood wasting by calculating DALYs averted per US$spent. RESULTS The direct per capita costs to implement UHC and P4P are US$4.08 and US$1.98 higher, respectively, compared to control. DALYs due to wasting were reduced by 334,862 in UHC and 1,073,185 in P4P. When adjustments are made for the efficiency of higher quality, the DALYS averted per US$ spent is similar in the two arms, 1.56 and 1.58 for UHC and P4P, respectively. Since the P4P quality improvements touches all patients seen by qualifying providers (32% in UHC versus 100% in P4P), there is a larger reduction in DALYs. With similar programmatic costs for either intervention, in this study, each US$spent under P4P yielded 1.52 DALYs averted compared to the standard program, while UHC yielded only a 0.50 DALY reduction. CONCLUSION P4P had a greater impact and was more cost-effective compared to UHC as measured by DALYs averted. While expanded insurance benefit ceilings affected only those who are covered, P4P incentivizes practice quality improvement regardless of whether children are insured or uninsured.
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Affiliation(s)
- John W Peabody
- Global Health Sciences, University of California, San Francisco, CA, USA
- QURE Healthcare, San Francisco, CA, USA
| | - Stella Quimbo
- University of the Philippines, School of Economics, Phillippines
| | | | - Riti Shimkhada
- Center for Health Policy Research, University of California, Los Angeles, CA, USA
| | - Xylee Javier
- University of the Philippines, School of Economics, Phillippines
| | | | - Dean Jamison
- Department of Global Health, University of Washington, WA, USA
| | - Orville Solon
- University of the Philippines, School of Economics, Phillippines
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Galler JR, Koethe JR, Yolken RH. Neurodevelopment: The Impact of Nutrition and Inflammation During Adolescence in Low-Resource Settings. Pediatrics 2017; 139:S72-S84. [PMID: 28562250 PMCID: PMC5374755 DOI: 10.1542/peds.2016-2828i] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 12/12/2022] Open
Abstract
Approximately 1 out of 5 children worldwide suffers from childhood malnutrition or stunting and associated health conditions, including an increased susceptibility to infections and inflammation. Due to improved early interventions, most children even in low-resource settings now survive early childhood malnutrition, yet exhibit continuing evidence of neurodevelopmental deficits, including poor school achievement and behavioral problems. These conditions are compounded in children who continue to be undernourished throughout the adolescent years. At present, these sequelae of malnutrition and infection are of major concern in the adolescent population, given that young people between the ages of 10 and 24 years represent nearly one-quarter of the world's population. Therefore, there is an urgent need to focus on the well-being of this age group and, in particular, on behavioral, cognitive, and brain disorders of adolescents who experienced malnutrition, infection, and inflammation prenatally, in early childhood, and during adolescence itself. Because one-third of all women globally become pregnant during their adolescent years, brain and behavioral disorders during this period can have an intergenerational impact, affecting the health and well-being of the next generation. This article summarizes the current state of knowledge and evidence gaps regarding childhood and adolescent malnutrition and inflammation and their impact on adolescent neurodevelopment, the limited evidence regarding nutrition and psychosocial interventions, and the role of resilience and protective factors in this age group. This overview should help to inform the development of new strategies to improve the neurodevelopmental outcomes of high risk adolescent populations.
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Affiliation(s)
- Janina R Galler
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts;
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Center on the Developing Child, Harvard University, Cambridge, Massachusetts
| | - John R Koethe
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; and
| | - Robert H Yolken
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Lee YJ, Jun JY, Park J, Kim S, Gwak AR, Lee SH, Yoo SY, Kim SJ. Effects of Psychiatric Symptoms on Attention in North Korean Refugees. Psychiatry Investig 2016; 13:480-487. [PMID: 27757125 PMCID: PMC5067341 DOI: 10.4306/pi.2016.13.5.480] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/24/2016] [Accepted: 01/28/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We investigated the performance of North Korean refugees on attention tasks, and the relationship between that performance and psychiatric symptoms. METHODS Sustained and divided attention was assessed using the computerized Comprehensive Attention Test in North Korean refugees and in South Koreans. All participants also completed the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale-Revised and the Dissociative Experiences Scale-II (DES-II). RESULTS The North Korean refugees showed slower reaction times (RTs) on the visual sustained attention task compared to the South Koreans after controlling for age and sex. North Korean refugees had a greater number of omission errors (OEs) on the divided attention task and a higher standard deviation (SD) of RT. Total DES-II scores of the North Korean refugees were associated with the number of OEs and the SD of RT on the sustained attention task, and with the number of OEs on the divided attention task. CONCLUSION North Korean refugees showed poorer performance on computerized attention tasks. In addition, attention deficit among North Korean refugees was associated with their dissociative experiences. Our results suggest that refugees may have attention deficits, which may be related to their psychiatric symptoms, particularly dissociation.
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Affiliation(s)
- Yu Jin Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Yong Jun
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soohyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ah Reum Gwak
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - So Young Yoo
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
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Wang C, An Y, Yu H, Feng L, Liu Q, Lu Y, Wang H, Xiao R. Association between Exposure to the Chinese Famine in Different Stages of Early Life and Decline in Cognitive Functioning in Adulthood. Front Behav Neurosci 2016; 10:146. [PMID: 27471454 PMCID: PMC4943926 DOI: 10.3389/fnbeh.2016.00146] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 06/29/2016] [Indexed: 12/03/2022] Open
Abstract
Objective: To investigate whether exposure to the Chinese Famine in different life stages of early life is associated with cognitive functioning decline in adulthood. Methods: We recruited 1366 adults born between 1950 and 1964 and divided them into fetal-exposed, early childhood-exposed (1–3 years old during the famine), mid childhood-exposed (4–6 years old during the famine), late childhood-exposed (7–9 years old during the famine), and non-exposed groups. A selection of cognitive tests was administered to assess their cognitive performance. Association between malnutrition in different famine exposure periods and adult cognitive performance was estimated by multivariate logistic and multiple linear regression analyses. Results: There were significant differences in cognitive performance between subjects exposed to famine during different life stages. For the general cognitive tests, fetal-exposed period was associated with decreased scores of the Mini-Mental State Examination (MMSE), and late childhood-exposed with decreased scores of the Montreal Cognitive Assessment (MoCA). We also found exposure to famine during mid and late childhood was associated with worse performance on the Stroop color and word test. Conclusion: Famine exposure in utero and during childhood is associated with overall and specific cognitive decline, affecting selective attention and response inhibition particularly.
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Affiliation(s)
- Chao Wang
- School of Public Health, Capital Medical University Beijing, China
| | - Yu An
- School of Public Health, Capital Medical University Beijing, China
| | - Huanling Yu
- School of Public Health, Capital Medical University Beijing, China
| | - Lingli Feng
- School of Public Health, Capital Medical University Beijing, China
| | - Quanri Liu
- School of Public Health, Capital Medical University Beijing, China
| | - Yanhui Lu
- School of Public Health, Capital Medical University Beijing, China
| | - Hui Wang
- School of Public Health, Capital Medical University Beijing, China
| | - Rong Xiao
- School of Public Health, Capital Medical University Beijing, China
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Fransen HP, Peeters PHM, Beulens JWJ, Boer JMA, de Wit GA, Onland-Moret NC, van der Schouw YT, Bueno-de-Mesquita HB, Hoekstra J, Elias SG, May AM. Exposure to Famine at a Young Age and Unhealthy Lifestyle Behavior Later in Life. PLoS One 2016; 11:e0156609. [PMID: 27244088 PMCID: PMC4887008 DOI: 10.1371/journal.pone.0156609] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/17/2016] [Indexed: 01/10/2023] Open
Abstract
Background A healthy diet is important for normal growth and development. Exposure to undernutrition during important developmental periods such as childhood and adolescence can have effects later in life. Inhabitants of the west of the Netherlands were exposed to severe undernutrition during the famine in the last winter of the second World War (1944–1945). Objective We investigated if exposure of women to the Dutch famine during childhood and adolescence was associated with an unhealthy lifestyle later in life. Design We studied 7,525 women from the Prospect-EPIC cohort, recruited in 1993–97 and aged 0–18 years during the Dutch famine. An individual famine score was calculated based on self-reported information about experience of hunger and weight loss. We investigated the association between famine exposure in early life and four lifestyle factors in adulthood: smoking, alcohol consumption, physical activity level and a Mediterranean-style diet. Results Of the 7,525 included women, 46% were unexposed, 38% moderately exposed and 16% severely exposed to the Dutch famine. Moderately and severely exposed women were more often former or current smokers compared to women that did not suffer from the famine: adjusted prevalence ratio 1.10 (95% CI: 1.05; 1.14) and 1.18 (1.12; 1.25), respectively. They also smoked more pack years than unexposed women. Severely exposed women were more often physically inactive than unexposed women, adjusted prevalence ratio 1.32 (1.06; 1.64). Results did not differ between exposure age categories (0–9 and 10–17 years). We found no associations of famine exposure with alcohol consumption and no dose-dependent relations with diet. Conclusions Exposure to famine early in female life may be associated with higher prevalence of smoking and physical inactivity later in life, but not with unhealthy diet and alcohol consumption.
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Affiliation(s)
- Heidi P. Fransen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Petra H. M. Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- School of Public Health, Imperial College London, London, United Kingdom
| | - Joline W. J. Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jolanda M. A. Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - G. Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - N. Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H. Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- School of Public Health, Imperial College London, London, United Kingdom
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
- Dt. of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeljer Hoekstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sjoerd G. Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne M. May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
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42
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Finlay JE, Fink G, McCoy DC, Tavárez LC, Chai J, Danaei G, Ezzati M, Fawzi W, Fawzi MCS. Stunting risk of orphans by caregiver and living arrangement in low-income and middle-income countries. J Epidemiol Community Health 2016; 70:784-90. [DOI: 10.1136/jech-2015-206346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 01/14/2016] [Indexed: 01/17/2023]
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Quansah E, Ohene LA, Norman L, Mireku MO, Karikari TK. Social Factors Influencing Child Health in Ghana. PLoS One 2016; 11:e0145401. [PMID: 26745277 PMCID: PMC4706365 DOI: 10.1371/journal.pone.0145401] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/03/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals’ target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal. Methods ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Results Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Conclusions Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother’s health knowledge is emphasised.
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Affiliation(s)
- Emmanuel Quansah
- Department of Molecular Biology and Biotechnology, School of Biological Science, University of Cape Coast, Cape Coast, Ghana
- Faculty of Health and Life Sciences, De Montfort University, Leicester LE1 9BH, United Kingdom
- * E-mail: (TKK); (EQ)
| | - Lilian Akorfa Ohene
- Faculty of Health and Life Sciences, De Montfort University, Leicester LE1 9BH, United Kingdom
- Department of Community Health, School of Nursing, University of Ghana, Accra, Ghana
| | - Linda Norman
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Michael Osei Mireku
- Département Méthodes Quantitatives en Santé Publique (METIS), Ecole des Hautes Etudes en Santeé Publique, Rennes, France
- Ecole Doctorale Pierre Louis de Santeé Publique, Universiteé Pierre et Marie Curie (UPMC- Paris VI), Paris, France
- Meère et Enfant Face aux Infections Tropicales, Institut de Recherche pour le Deéveloppement (IRD), Paris, France
| | - Thomas K. Karikari
- Neuroscience, School of Life Sciences, University of Warwick, Coventry CV4 7AL, Uunited Kingdom
- Midlands Integrative Biosciences Training Partnership, University of Warwick, Coventry CV4 7AL, United Kingdom
- * E-mail: (TKK); (EQ)
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Haydocy KE, Yotebieng M, Norris A. Restavèk children in context: Wellbeing compared to other Haitian children. CHILD ABUSE & NEGLECT 2015; 50:42-48. [PMID: 25891309 DOI: 10.1016/j.chiabu.2015.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/19/2015] [Accepted: 03/26/2015] [Indexed: 06/04/2023]
Abstract
In Haiti, large numbers of vulnerable children and the country's particular historical context has led to a unique phenomenon known as the "restavèk" system. An estimated 300,000 Haitian children are restavèks, living as unpaid domestic servants. Child-welfare advocates describe the restavèk system as modern slavery, but researchers and advocates lack information about restavèk children's circumstances, particularly vis-à-vis other children in Haiti. In a cross-sectional analysis of a nationally representative sample, we evaluated differences in well-being (school attendance, work responsibilities, physical abuse, and hunger) between restavèk children and: (a) all non-restavèk children; and (b) the poorest quintile of non-restavèk children. As compared to all Haitian children and the poorest Haitian children, restavèk children have statistically significantly lower school attendance rates and more labor responsibilities. However, restavèk children experience statistically significantly less physical abuse and less hunger than non-restavèk Haitian children. The restavèk system remains active in Haiti because poor families lack basic resources to support their children, and restavèk children are at risk for mistreatment due to their vulnerable social status. The surprising finding that restavèk children are better off in some respects than their non-restavèk peers highlights the desperate poverty in Haiti and suggests that structural changes for poverty reduction will be required before the restavèk system will end.
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Affiliation(s)
- Kelci E Haydocy
- Division of Epidemiology, College of Public Health, The Ohio State University, 250 Cunz Hall, Columbus, OH 43210, USA
| | - Marcel Yotebieng
- Division of Epidemiology, College of Public Health, The Ohio State University, 250 Cunz Hall, Columbus, OH 43210, USA
| | - Alison Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, 250 Cunz Hall, Columbus, OH 43210, USA
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Chen L, Wu Y, Coyte PC. Income-related children's health inequality and health achievement in China. Int J Equity Health 2014; 13:102. [PMID: 25359568 PMCID: PMC4229621 DOI: 10.1186/s12939-014-0102-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction This study assessed income–related health inequality and health achievement in children in China, and additionally, examined province-level variations in health achievement. Methods Longitudinal data on 19,801 children under 18 years of age were derived from the China Health and Nutrition Survey. Income–related health inequality and health achievement were measured by the Health Concentration and Health Achievement Indices, respectively. Panel data with a fixed effect multiple regression model was employed to examine province-level variations in health achievement. Results A growing trend was towards greater health inequality among Chinese children over the last two decades. Although health achievement was getting better over time, the pro-rich inequality component has lessened the associated gain in achievement. Health achievement was positively impacted by middle school enrollments, the urbanization rate, inflation-adjusted per capita gross domestic product, and per capita public health spending. Conclusion This study has provided evidence that average health status of Chinese children has improved, but inequality has widened. Widening inequality slowed the growth in health achievement for children over time. There were wide variations in health achievement throughout China.
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Affiliation(s)
- Lu Chen
- Economics School, Nankai University, 94 Weijin Road, Nankai District, Tianjin, ON, 300071, China.
| | - Ya Wu
- China Development Bank Heilongjiang Branch, 131 Xiangjiang Road, Heilongjiang, ON, 150090, China.
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 4th Floor, 155 College Street, Suite 425, Toronto, ON, M5T3M6, Canada.
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