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
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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%