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sanitation externalities, disease and sanitation externalities, disease and

sanitation externalities, disease and - PowerPoint Presentation

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sanitation externalities, disease and - PPT Presentation

childrens anemia Diane Coffey Office of Population Research Princeton University prepared for PAA session on Public Health amp Demography May 2 2014 what is anemia hemoglobin a protein in red blood cells that carries oxygen ID: 573995

open hemoglobin amp defecation hemoglobin open defecation amp anemia sanitation results effects background diseases parasites density difference kids change fixed cross link

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Slide1

sanitation externalities, disease and children’s anemia

Diane Coffey

Office of Population Research, Princeton University

prepared for PAA session on Public Health & Demography,

May 2, 2014Slide2

what is anemia?

hemoglobin

: a protein in red blood cells that carries oxygen

anemia

: lack of hemoglobin

hemoglobin concentration below 11 gm/

dL

blood (WHO, 2005) in childrenSlide3

why does anemia matter?

Scrimshaw, 2000:

increased susceptibility to infection

Grantham McGregor &

Ani

, 2001:

impaired cognitive ability

Walter et al. 1989:

impaired physical development

Stevens et al., 2011:

globally, 43% of children anemic; 58% in South AsiaSlide4

causes of anemia

diet

: iron, vitamin B12,

folate

diseases

intestinal parasites

environmental

enteropathy

malaria

blood lossSlide5

hypothesis

lack of sanitation

(open defecation)

causes disease

that contributes to anemia Slide6

outline

background

why is this link plausible?

sanitation externalities

empirical results

cross country gradient

cross sectional results from India & Nepal

fixed effects results from Nepal

policy implications

does poor sanitation make other interventions less effective?Slide7

backgroundSlide8

why is this link plausible?diseases caused by open defecation

intestinal parasites

feces on the ground spread parasites that enter kids’ bodies by the feet and mouth

(Rosenberg & Bowman, 1982)

environmental

enteropathy

bacteria in feces reduces absorptive capacity of intestines

(Walker, 2003; Humphrey, 2009)

backgroundSlide9

why is this link plausible?open defecation and height

growing literature in economics and epidemiology finds effects on

height

Bangladesh: Lin et al., 2013

Indonesia: Cameron et al., 2013

India: Hammer & Spears, 2012

international: Spears, 2012

height

and

hemoglobin

could be influenced by similar intestinal diseases

backgroundSlide10

sanitation externalities

Observations are children in India’s 2005 DHS.Slide11

empirical resultsSlide12

cross country gradientSlide13

data

hemoglobin & open defecation

:

DHS

81 surveys from 45 countries

1995 – 2012

60% of surveys are from SSA

GDP per capita & population density

:

Penn World Tables & World Bank

malaria

:

WHO incidence estimates

(

Korenromp, 2005)

cross country motivationSlide14

R

2

= 0.23

density of open defecation and hemoglobin in 81 DHS

R

2

= 0.26Slide15

open defecation

density

and hemoglobin in 81 DHS –

net of malaria

R

2

= 0.43Slide16

regression gradients: density of open defecation

& hemoglobinSlide17

fixed

effects results from NepalSlide18

dataNepal’s Demographic & Health Surveys from 2006 and 2011

2006: 4,680 kids 6-59 months

2011: 2,100 kids 6-59 months

15 percentage point drop in open defecation

2006: 50% of households

2011: 35% of households

fixed effects resultsSlide19

identification

how is change over time in open defecation within 25 regions associated with change in hemoglobin levels in those regions?

fixed effects results

Slide20

change over time in open defecation within Nepali regions predicts change in hemoglobinSlide21

policy implicationsSlide22

in India, associations between parasite medicine and hemoglobin and

iron pills and hemoglobin

are

weaker

where there is

more

open

defecation

difference

in hemoglobin levels between kids who took

parasite medicine

and those who did not

difference

in hemoglobin levels between kids who took

iron pills

and those who did not Slide23

summary

This study adds to a growing body of research that shows the

importance of sanitation for nutrition

, particularly in South Asia.Slide24

This study provides econometric evidence that open defecation may spread diseases

that cause

anemia

.

summarySlide25

It suggests that efforts to improve anemia by supplementing diets and treating parasites could be importantly complemented by

greater attention to sanitation

.

summarySlide26

questions? comments?Slide27

the association between parasite medicine and hemoglobin is greater where there is less open defecation

difference = 0.4 gm/

dL

difference = 0.2 gm/

dL

10%

90%