Chapter 19 Child health in developed countries

Maternal education and child health: Causal evidence from Denmark

This study examines how maternal education shapes the life and health of their children. Causal effects are identified from a Danish school reform that increased minimum compulsory schooling from 7 to 9 years in 1972 and estimates are based on large administrative registers. We find that the reform as well as maternal education when instrumented by it, has significant, positive effects on mothers' age at first birth and maternal health. Nevertheless, maternal education has no systematic causal effects on child health, neither at birth, during childhood, or in adolescence. This null finding is robust to a wide range of model specifications.

Evaluating the effects of a targeted home visiting program on maternal and child health outcomes

We evaluate the effects of home visiting targeted towards disadvantaged first-time mothers on maternal and child health outcomes. Our analysis exploits a randomized controlled trial and combines rich longitudinal survey data with unique administrative health data. In a context in which the target group has comprehensive health care access, we find no effects of home visiting on most types of health utilization, health behaviors, and physical health measures. However, the intervention has a positive effect on some maternal mental health outcomes, reducing depression reported in the survey data by eleven percentage points and prescription of psycholeptics recorded in the administrative data by seven percentage points.

Geostatistical modelling of the association between malaria and child growth in Africa

Background

Undernutrition among children under 5 years of age continues to be a public health challenge in many low- and middle-income countries and can lead to growth stunting. Infectious diseases may also affect child growth, however their actual impact on the latter can be difficult to quantify. In this paper, we analyse data from 20 Demographic and Health Surveys (DHS) conducted in 13 African countries to investigate the relationship between malaria and stunting. Our objective is to make inference on the association between malaria incidence during the first year of life and height-for-age Z-scores (HAZs).

Methods

We develop a geostatistical model for HAZs as a function of both measured and unmeasured child-specific and spatial risk factors. We visualize stunting risk in each of the 20 analysed surveys by mapping the predictive probability that HAZ is below − 2. Finally, we carry out a meta-analysis by modelling the estimated effects of malaria incidence on HAZ from each DHS as a linear regression on national development indicators from the World Bank.

Results

A non-spatial univariate linear regression of HAZ on malaria incidence showed a negative association in 18 out of 20 surveys. However, after adjusting for spatial risk factors and controlling for confounding effects, we found a weaker association between HAZ and malaria, with a mix of positive and negative estimates, of which 3 out of 20 are significantly different from zero at the conventional 5% level. The meta-analysis showed that this variation in the estimated effect of malaria incidence on HAZ is significantly associated with the amount of arable land.

Conclusion

Confounding effects on the association between malaria and stunting vary both by country and over time. Geostatistical analysis provides a useful framework that allows to account for unmeasured spatial confounders. Establishing whether the association between malaria and stunting is causal would require longitudinal follow-up data on individual children.

Electronic supplementary material

The online version of this article (10.1186/s12942-018-0127-y) contains supplementary material, which is available to authorized users.

Determinants and the impact of the National Health Insurance on neonatal mortality in Ghana

The national health insurance was established to increase access to health care services and the maternal component was later introduced to improve the health outcomes of both mother and child. The main objectives of this study are to investigate the factors that affect neonatal deaths as well as examine the effect of the Ghana Health Insurance on neonatal deaths in Ghana. Using the most recent round of the Ghana Demographic and Health Survey, the study estimates the probit model with interaction effects to account for the heterogeneity in outcomes. Additionally, the study employs the propensity score matching approach to account for the possible endogeneity in the insurance enrolment decision. Results from the estimations, after controlling for relevant individual and household characteristics suggest that the national health insurance significantly reduces the likelihood of neonatal deaths. Estimates remain consistent even after more robust estimators are employed. Estimates from the interaction between place of residence and health insurance indicate that health insurance beneficiaries who reside in urban areas are at a higher risk of neonatal deaths compared to other women. Access to medical facilities proxied by distance to the nearest health post emerged as an important predictor of neonatal death. The study also suggests significant regional differences in neonatal deaths. We, therefore, conclude that the national health insurance may have the potential to substantially improve the health outcomes of neonates and have policy implications for increasing coverage to more mothers and their neonates, as well as coverage in critical neonatal services and drugs.

Socioeconomic gradients in early childhood health: evidence from Bangladesh and Nepal

Background

A large literature has developed researching the origins of socioeconomic gradients in child health in developed countries. Particularly, this research examines the age at which these gradient effects emerge and how they change across different stages of childhood. However, similar research on developing countries is limited.

Methods

This paper examines the socioeconomic gradients in early childhood health in two developing countries, Bangladesh and Nepal using the 2011 Demographic and Health Surveys. The paper separately studies two measures of household socioeconomic status: household wealth and maternal educational attainment. Two anthropometric measures of early childhood health, height-for-age and weight-for-age Z scores for 0–59 months of children, are used for our empirical exercise. The paper uses both non-parametric and multivariate ordinary least squares approaches to examine at what age socioeconomic disparities in health emerge, and investigates if these disparities increase with age in early childhood.

Results

The paper provides significant evidence of age-specific socioeconomic gradients in early childhood health in both countries. Health disparities in household wealth exist in both countries. This disparity emerges in the first 11 months of life, and is particularly severe for children from the poorest quintile. On the other hand, while the emergence of maternal education gradients during the first 11 months is sensitive to the choice of childhood health measure, the study finds the children of mothers with higher education to enjoy significantly higher health outcomes in comparison to those with lower education. However, controlling for father’s education weakens the effects of maternal education on child health in both countries. Further, the paper does not find statistically significant evidence where socioeconomic gradients in health increase with age in early childhood.

Conclusions

Our study concludes that socioeconomic disparities in health outcomes exist even in very early childhood in Bangladesh and Nepal. This has important implications for targeted policy interventions in the form of food security and nutrition supplement programs, free provision of health care, and maternal education in both countries.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-016-0364-2) contains supplementary material, which is available to authorized users.

Television and the behaviour of adolescents: does socio-economic status moderate the link?

This paper examines the relationship between adolescent behaviour, television viewing and family socio-economic status (SES) using the Canadian National Longitudinal Survey of Children and Youth (NLSCY). The effect of television viewing on adolescents' behaviour, ranging from pro-social to aggressive, and whether this effect is moderated by family socio-economic status is investigated. An adolescent fixed effects model is used to estimate the effect of television viewing on behaviour. The results indicate that the effect of television viewing varies between males and females. Family SES has a role in the effect of television on adolescents' behaviour, although the results do not distinguish between the two proposed hypotheses.

The family as the health producer--when spouses act strategically

The Grossman model has been extended recently in order to take account of the fact that most people lead their lives in a family--using frameworks in which family members, respectively, (a) have common preferences and (b) are Nash-bargainers. These models, however, do not consider individual incentives for behaving strategically. In the model presented in this paper, spouses interact strategically both in the production of own health and in the production of health of other family members. We analyse, inter alia, the impact on the distribution of health of changes in family policies, such as child allowance and custody rules.