Fairlie Decomposition Research Articles

Mind the gap: what explains the rural-nonrural inequality in diarrhoea among under-five children in low and medium-income countries? A decomposition analysis

BackgroundDiarrhoea poses serious health problems among under-five children (U5C) in Low-and Medium-Income Countries (LMIC) with a higher prevalence in rural areas. A gap exists in knowledge on factors driving rural-non-rural inequalities in diarrhoea development among U5C in LMIC. This study investigates the magnitude of rural-non-rural inequalities in diarrhoea and the roles of individual-level and neighbourhood-level factors in explaining these inequalities.MethodsData of 796,150 U5C, from 63,378 neighbourhoods across 57 LMIC from the most recent Demographic and Health Survey (2010–2018) was analysed. The outcome variable was the recent experience of diarrhoea while independent variables consist of the individual- and neighbourhood-level factors. Data were analysed using multivariable Fairlie decomposition at p < 0.05 in Stata Version 16 while visualization was implemented in R Statistical Package.ResultsTwo-thirds (68.0%) of the children are from rural areas. The overall prevalence of diarrhoea was 14.2, 14.6% vs 13.4% among rural and non-rural children respectively (p < 0.001). From the analysis, the following 20 countries showed a statistically significant pro-rural inequalities with higher odds of diarrhoea in rural areas than in nonrural areas at 5% alpha level: Albania (OR = 1.769; p = 0.001), Benin (OR = 1.209; p = 0.002), Burundi (OR = 1.399; p < 0.001), Cambodia (OR = 1.201; p < 0.031), Cameroon (OR = 1.377; p < 0.001), Comoros (OR = 1.266; p = 0.029), Egypt (OR = 1.331; p < 0.001), Honduras (OR = 1.127; p = 0.027), India (OR = 1.059; p < 0.001), Indonesia (OR = 1.219; p < 0.001), Liberia (OR = 1.158; p = 0.017), Mali (OR = 1.240; p = 0.001), Myanmar (OR = 1.422; p = 0.004), Namibia (OR = 1.451; p < 0.001), Nigeria (OR = 1.492; p < 0.001), Rwanda (OR = 1.261; p = 0.010), South Africa (OR = 1.420; p = 0.002), Togo (OR = 1.729; p < 0.001), Uganda (OR = 1.214; p < 0.001), and Yemen (OR = 1.249; p < 0.001); and pro-non-rural inequalities in 9 countries. Variations exist in factors associated with pro-rural inequalities across the 20 countries. Overall main contributors to pro-rural inequality were neighbourhood socioeconomic status, household wealth status, media access, toilet types, maternal age and education.ConclusionsThe gaps in the odds of diarrhoea among rural children than nonrural children were explained by individual-level and neighbourhood-level factors. Sustainable intervention measures that are tailored to country-specific needs could offer a better approach to closing rural-non-rural gaps in having diarrhoea among U5C in LMIC.

Decomposition analysis of the compositional and contextual factors associated with poor-non-poor inequality in diarrhoea among under-five children in low- and middle-income countries

ObjectivesThe aim of the study was to assess the magnitude of wealth inequalities in the development of diarrhoea among under-five children in low- and middle-income countries (LMICs) and to identify and quantify contextual and compositional factors' contribution to the inequalities. DesignThis is a cross-sectional study. MethodsWe used cross-sectional data from 57 Demographic and Health Surveys conducted between 2010 and 2018 in LMICs. Descriptive statistics were used to understand the gap in having diarrhoea between the children from poor and non-poor households and across the selected covariates using Fairlie decomposition techniques with multivariable binary logistic regressions at P = 0.05. ResultsOf the 57 countries, we found a statistically significant pro-poor odds ratio in only 29 countries, 7 countries showed pro-non-poor inequality and others showed no statistically significant inequality. Among the countries with statistically significant pro-poor inequality, the risk difference was largest in Cameroon (94.61/1000), whereas the largest pro-non-poor risk difference in diarrhoea was widest in Timor-Leste (−41.80/1000). Important factors responsible for pro-poor inequality varied across countries. The largest contributors to the pro-poor inequalities in having diarrhoea are maternal education, access to media, neighbourhood socio-economic status, place of residence, birth order and maternal age. ConclusionDiarrhoea remains a major challenge in most LMICs, with a wide range of pro-poor inequalities. These disparities were explained by both compositional and contextual factors, which varied widely across the countries. Thus, multifaceted geographically specific economic alleviation intervention may prove to be a potent approach for addressing the poor and non-poor differentials in the risk of diarrhoea with policies tailored to country-specific risk factors. There is a need for further investigation of factors that drive pro-non-poor inequalities found in 9 of the LMICs.

Impact of socio-economic inequity in access to maternal health benefits in India: Evidence from Janani Suraksha Yojanausing NFHS data.

BackgroundCaste plays a significant role in Indian society and it influences women to health care access in the community. The implementation of the maternal health benefits scheme in India is biased due to caste identity. In this context, the paper investigates access to Janani Suraksha Yojana (JSY) among social groups to establish that caste still plays a pivotal role in Indian society. Also, this paper aims to quantify the discrimination against Scheduled Castes/Scheduled Tribes (SCs/STs) in accessing JSY.MethodsThis paper uses a national-level data set of both NFHS-3 (2005–06) and NFHS-4 (2015–16). Both descriptive statistics and the Fairlie decomposition econometric model have been used to measure the explained and unexplained differences in access to JSY between SCs/STs and non-SCs/STs groups.ResultsOverall, the total coverage of JSY in India is still, 36.4%. Further, it is found that 72% of access to JSY is explained by endowment variables. The remaining unexplained percentage (28%) indicates that there is caste discrimination (inequity associated social-discrimination) against SCs/STs in access to JSY. The highest difference (54%) between SCs/STs and non-SCs/STs in access to JSY comes from the wealth quintile, with the positive sign indicating that the gap between the two social groups is widening.Discussion and conclusionIt is necessary for the government to implement a better way to counter the caste-based discrimination in access to maternal health benefits scheme. In this regard, ASHA and Anganwadi workers must be trained to reduce the influence of dominant caste groups as well as they must be recruited from the same community to identify the right beneficiaries of JSY and in order to reduce inequity associated with social-discrimination.

Contribution of Education to Infant and Under-Five Mortality Disparities among Caste Groups in India

The level of infant and under-five mortality is high among scheduled castes (SCs) and scheduled tribes (STs) in India. This study intends to quantify the contribution of education in explaining the gap in infant and under-five mortality between SCs/STs and non-SC/ST population in India with a special focus on the effect of maternal education. We used data from three rounds of National Family Health Survey (NFHS): 1992–93, 1998–99 and 2005–06. The synthetic cohort probability approach using full birth histories was used to estimate childhood mortality. We performed binary logistic regression analysis to examine the association of infant mortality (IM) and under-five mortality (U5M) with maternal education and selected other covariates. Further, we applied Fairlie's decomposition technique to understand the relative contribution of maternal education and other covariates on IM and U5M risk between the caste groups. The IM rate (IMR) among children born to illiterate mothers is about 3 times higher than those born to mothers with higher education across all caste groups. Similarly, the U5M rate (U5MR) is 5 times higher among ST population and 3 times higher among SC population during the 14-year observation period (1992–2006). The proportions of secondary and higher educated SC and ST mothers are relatively lower than among non-SC/ST mothers. The regression analysis shows that mother’s education has a statistically significant effect on reducing IM and U5M. A number of socio-economic covariates are found associated with IM and U5M; such as father’s education, mother’s age at first birth, mother’s work status, household wealth, exposure to media and socio-economic empowerment of the mother. A decomposition analysis shows that more than 90 percent of the gap in IM and U5M between social groups is explained by the differences in the distribution of maternal education and household wealth. The findings of this study emphasise the need to provide education to disadvantaged girls and health counselling to women, particularly among SC/STs with more focus on backward regions or states, to further reduce IM and U5M in India.

A Comparative Analysis of the Effects of Fertility on Women’s Employment in Urban and Rural Areas of Cameroon

This paper compares the effects of fertility on women’s employment in Urban and Rural areas of Cameroon using pulled data from the 1991, 1998, 2004, 2011 and 2018 Demographic Health Survey (DHS) for Cameroon. The Logistic Regression, Fairlie and Multivariate decomposition models were used for analyses. The logistics regression results showed that fertility has a positive and statistically significant effect on women’s employment in Cameroon. The fairlie decomposition results showed that fertility, primary education, being in the richer and richest wealth level, husband’s being in primary education, being a Muslim and husband being in agricultural-self-employment all significantly reduced the differences in women’s employment in urban and rural areas. On the other hand, secondary and tertiary educational level for husband and wife, poorer and middle-income wealth group, being a Catholic, husband’s working in the agricultural sector, marriage, age at first cohabitation and being resident in urban areas all significantly increased the differences between women’s employment in the urban and rural areas. The Multivariate decomposition results showed that the largest significant contributor to differences in women’s employment in urban and rural areas of Cameroon was fertility. Fertility significantly increased the differences in women’s employment in urban and rural zones by 19.2%. The promotion of women’s employment in the urban areas through the subsidization of day-care, services and the provision of start up capital is recommended.

A decomposition of the gender gap in financial inclusion : evidence from Namibia

This paper investigated the determinants of the gender gap in financial inclusion in Namibia, a country where women are more financially included than men. We employed the probit model to identify the determinants of financial inclusion and the Fairlie decomposition to examine the contribution of these factors to the gender gap in financial inclusion. The results suggest that the observed gender gap in financially included is insignificant. We found that individual characteristics such as financial literacy, educational attainment and proximity to financial institutions, contribute positively and significantly to the observed gender gap. Thus, any policy action geared towards improving the level of financial inclusion of disadvantaged women should focus on enhancing their level of education, financial knowledge and access (proximity) to financial institutions. However, the contribution of other individual and household characteristics cannot be completely ignored.

Bargaining Power or Specialization? Determinants of Household Decision Making in Chinese Rural Migrant Families

Family migration is a common integration process for rural migrants in contemporary China. However, discussions on intra-household decision making in dual-earner migrant families are limited. This study aims to address this gap. The data set from the Rural Urban Migration in China (RUMiC2008–2010) is employed to explore the determinants of household decision making. In addition, logit regression is performed to estimate the probability of wives acting as head of the household under different specifications, and the Blinder–Oaxaca–Fairlie decomposition is utilized to discuss gender differentials in decision-making responsibilities. Income and migration duration differentials between a wife and husband have important influences on the probability of being responsible for household decision making. The squared terms of wives’ and husbands’ income have inverted effects. The gender gap between household decision makers can be largely attributed to structural factors rather than observable characteristics, though bargaining power acts as the main contributor in explained parts. Bargaining theory can account for the probability of wives becoming the household decision maker, and the claim of the specialization approach is also confirmed. Gender inequality among household decision makers is largely attributed to structural factors, such as cultural/social norms, obstacles, or gender discrimination. The establishment of long-term effective mechanisms to improve employment quality for female migrants, the supply of basic public services, and protection of women’s legal rights in the household should be strengthened in the future to elevate the status of female migrants.

Information asymmetry and self denial in gender participation in commercial banks’ credit markets in emerging economies in Ghana

Micro and small women entrepreneurs’ participation in commercial banks’ credit markets remains a huge challenge even after the liberalization of the financial sector. The present study sought to examine factors that influence gender participation in the credit markets of commercial banks. The sample size comprised 678 respondents to questionnaires for the study. At the individual level, the study tested that no significant relationship exists between a borrower’s individual characteristics and credit participation, and that no significant relationship exists between individual’s gender and credit participation. Also, at the firm level, the study tested that no significant relationship occurs between credit market conditions and credit market participation, and that no significant relationship occurs between individual’s firm characteristics and credit market participation. However, the findings reject all these null hypotheses for the alternates. Using the Heckman two-step model, we observed that participation increases for male and the young, entrepreneurs in the commerce sector, those closer to the bank and those who have previously participated in the market. Yet, participation reduces for entrepreneurs with secondary education and those with larger household size. Also, the likelihood to participate is influenced by being a male, having larger assets value and easiness of loan processing. Moreover, the Fairlie decomposition analysis shows a credit participation gap between men and women entrepreneurs that is largely influenced by differences in their individual and firm characteristics. The major implication is that male entrepreneurs have more favorable individual, firm and credit market conditions than female entrepreneurs for credit market participation. Thus, government policies to empower women are desirable.

Decomposing of Urban Poor / Non-Poor Differential in Childhood Malnutrition and Mortality in India, 2015-16

Background The high level of childhood malnutrition due to mortality in India is a major hurdle impeding the achievement of the Sustainable Development Goals–3 (SDG–3). The present study aims to quantify the contribution of factors that explain the poor/non-poor gap in malnutrition and mortality status of children 0-5 years in urban India using data from 2015-16 of fourth round National Family Health Survey (NFHS-4). Methods For understand the gap in child health between the urban poor and non-poor, and across the selected covariate were used the descriptive statistics. Furthermore Blinder–Oaxaca decomposition and non-liner Fairlie decomposition technique both were used to explain the factors contributing to the average gap in under nutrition between poor and non-poor children in urban India. Result The result suggested that explained the gap urban poor/non-poor in nutritional indicator stunting and underweight were 40 and 46 percentage and childhood infant and under-five mortality were 40 and 48 percentage respectively. The maternal factor mainly for lower education contributed much more changed in child health status those are living in urban poverty. Conclusion The overall finding indicate that children living poor household higher level malnutrition and mortality due to poor health status and poor education of mother, lower health care service and less exposed to mass media. This finding help to policy maker reducing the gap of child undernutrition between urban poor and the non-poor and low coverage of health services among the urban poor.

Determinants of Rural–Urban Differentials in Under-Five Child Mortality in Ethiopia

This paper examines the factors behind the rural–urban differentials in under‑five child mortality in Ethiopia. It employs Fairlie's decomposition technique to analyse data from three Ethiopian Demographic and Health Surveys conducted by the Central Statistics Agency in 2005, 2011 and 2016. The findings indicate that the child's birth weight, mother’s maternal education, household size, and mother’s exposure to mass media contribute to narrowing the disparity in child mortality rate. On the other hand, antenatal healthcare services and share of women's use of modern contraceptives contribute to widening the rural–urban variations. Hence, we suggest that substantial efforts to do away with rural–urban differentials in under‑five child mortality must focus more on child's birth size disparity and women's education across different population subgroups of the country.

Dynamics of chronic diseases in metro and non-metro regions of India: evidence from India Human Development Survey I and II

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The growth of metropolitan cities had significantly contributed to the process of urbanization in India. About two-fifth of the urban population, out of total India’s urban population, live in 35 metropolitan cities. It is important to look into the disease dynamics in the population of metro and non-metro regions of India. The study aims to find the differences in the distribution of chronic diseases in metro and non-metro regions of India and depicts the contributions of background factors causing a change in the prevalence of chronic diseases in metro and non-metro regions of India.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Data from India Human Development Survey (IHDS) I and II conducted in 2004 and 2012 respectively have been used. Bivariate analysis has been performed to find the association between independent variables and chronic diseases, and logistic regression has been used to find the effect of predictor variables on chronic diseases by metro and non-metro regions. Fairlie decomposition technique has been used to find the contribution of each predictor variable accounting for differences in chronic diseases between metro and non-metro regions. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Age, sex, socio-economic status (education and wealth), alcohol consumption, tobacco consumption, and body mass index status are significantly associated with chronic conditions in metro regions of India. Age, wealth, and developed regions contributed most to the differences in chronic diseases between metro and non-metro areas.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Metro regions in India suffers from a massive burden of chronic conditions. Metro regions should be given a special focus to tackle the menace of chronic diseases.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Transgender labour market outcomes: Evidence from the United States

Alternative labour market outcomes for men and women have been studied extensively in past literature. However, existing studies fail to directly compare labour market differences between transgender and non‐transgender people. We utilize data from the 2015 Behavioral Risk Factor Surveillance System in the United States to examine employment and wage differentials between transgender persons and non‐transgender people using the Fairlie decomposition method of 2005. Our findings suggest that transgender people are less likely than non‐transgender people to be employed, and are more likely than non‐transgender people to receive lower wages. While some of the difference in employment and wage gaps is explained by sociodemographic characteristics, part of the gap remains unexplained. Approximately 64 per cent of the employment differential and 43 per cent of the wage differential is unexplained and may be due to discrimination. Therefore, our findings highlight the importance of appropriate anti‐discrimination policy.

Gender differences and new venture performance

PurposeThis study compares the performance of female majority-owned new ventures (FNV) vs. male majority-owned new ventures (MNV). It analyzes the differences in levels of variables such as education, the same industry work experience of owners, and other venture level attributes between FNVs and MNVs. More importantly, this study employs decomposition techniques to determine the individual contribution from the intergender difference of each attribute on the performance of the new venture. For example, the study finds that, on average, the owners of an MNV possessed 3.4 years more of the same industry work experience than their FNV counterparts. This difference in work experience accounted for 47% of the “explained” gap [1] in Net Profits between the FNVs and MNVs.Design/methodology/approachThis paper utilizes the Kauffman Firm Survey, a longitudinal dataset of 4,928 new ventures started in the USA in 2004. It employs Blinder-Oaxaca and Fairlie decomposition techniques in conjunction with OLS and Logit regressions. Both methods provide point estimates of contributions to the performance gap due to the heterogeneity in each attribute across the groups (FNV and MNV). This approach has a significant advantage over OLS or mediation analysis, which can only provide a directional analysis of the contributions of differences in attributes to performance.FindingsThe paper finds no performance gap between MNVs and FNVs. It further investigates whether the heterogeneous characteristics of MNVs vs FNVs are related to different effects on survival and performance. It finds that characteristics such as owners’ work experience in the same industry, average hours worked by owners in the new venture, the technology level of the venture, and its incorporation status are related with a differential impact on new venture survival and performance.Research limitations/implicationsAll firms in the dataset belonged to a single cohort (2004) of new ventures started in the US. Future studies are encouraged to develop a dataset from multiple geographies and founding over several years so that the results may be more generalizable.Practical implicationsThe paper provides crucial practical guidance to policymakers, investors, and entrepreneurs. In general, policies that enhance the work experience of women entrepreneurs and provide access to infrastructure such as daycares, which may allow them to work more hours, would probably improve the performance of FNVs.Originality/valueThe paper furthers the literature on women entrepreneurship by analyzing point estimates of differential contribution of disparate variables to performance. From a methodological perspective, the study reconciles the results between regression and decomposition analyses.

Decomposing the Gaps in Access to LPG across Socio-Religious Groups in Rural India

This article investigates the patterns of household cooking fuel choice and its determining factors for various socio-religious groups in rural India using NSS 68th Consumption Expenditure round. The article also studies how the inter-household gaps result in many levels of Liquefied Petroleum Gas (LPG) access for households belonging to various socio-religious groups. In this regard, the application of a logistic model for the considered socio-religious groups highlights the importance of income and the education level of different members of the households. Further, the differences in the probability of access to LPG among various socio-religious groups, with respect to upper caste Hindus, are decomposed using Fairlie decomposition method. The gap in income determines a major proportion of the gap, followed by the education level of the members. We also find that the Scheduled Tribes (STs) face the problem of availability of LPG, while other socio-religious groups, when compared to upper caste Hindus, either face affordability issues or possess a taste for traditional fuel.

Gender gap in financial inclusion: Evidence from MENA

This study aims to analyze the gender dimension of financial inclusion in MENA countries. Using the World Bank’s 2017 Global Findex Database, it explores the underlying factors of gender differences in formal financial services usage via Fairlie decomposition method. The findings of the study indicate that a significant portion of the disparity in financial inclusion is attributable to employment, while age and tertiary education are also found as contributing factors to the financial inclusion gap. Another notable finding is that upper income quintiles contribute positively to the gender gap, indeed to a greater extent compared to lower income groups.

The persistent influence of caste on under-five mortality: Factors that explain the caste-based gap in high focus Indian states.

ObjectiveAlthough under-five mortality rate (U5MR) is declining in India, it is still high in a few selected states and among the scheduled caste (SC) and scheduled tribe (ST) population of the country. This study re-examines the association between caste and under-five deaths in high focus Indian states following the implementation of the country’s National Rural Health Mission (NRHM) program. In addition, we aim to quantify the contribution of socioeconomic determinants in explaining the gap in under-five death risk between the SC/ST population and non-SC/ST population in high focus states in India.Data and methodUsing data from the National Family Health Survey (NFHS), we calculated the U5MR by applying a synthetic cohort probability approach. We applied a binary logistic regression model to examine the association of under-five deaths with the selected covariates. Further, we used Fairlie's decomposition technique to understand the relative contribution of socioeconomic variables on under-five death risk between the caste groups.FindingsIn high focus Indian states, the under-five mortality risk between well-off and deprived caste children has declined in the post-NRHM period, indicating a positive impact in terms of reducing caste-based inequalities in the high focus states. Despite the reduction in under-five death risk, children belonging to the SC population experience higher mortality rates than children belonging to the non-SC/ST population from 1992 to 2016. Both macro level (district level mortality rates) and individual (regression analysis) analyses showed that children belonging to SCs experience the highest likelihood of dying before their fifth birthday. A decomposition analysis revealed that 83% of the caste-based gap in the under-five deaths is due to the distribution of women’s level of educational attainment and household wealth between the SC/ST and non-SC/ST population. Program indicators such as place of birth and number of antenatal care (ANC) visit also contributed significantly to widening caste-based gaps in U5MR.ConclusionThe study indicates that there is still room to improve access to health facilities for mothers and children belonging to deprived caste groups in India. Continuous efforts to raise the level of maternal education and the economic status of people belonging to deprived caste groups should be pursued simultaneously.

Disentangling the rural-urban immunization coverage disparity in The Gambia: A Fairlie decomposition

IntroductionExploring factors underlying disparities in immunization uptake is highly relevant and can contribute to improved immunization interventions globally. The Gambia is an interesting case, since higher immunization coverage in rural areas has been shown for many years, yet the factors explaining this unexpected rural-urban disparity have not been studied. The aim of our study was to quantify the rural-urban disparity in immunization coverage and identify factors that contribute to explaining it. MethodsData from the nationally representative Demographic and Health Survey 2013 was used to select children aged 12–23 months (Weighted n = 1644) for the study. The outcome measure was full immunization status, the grouping variable was area of residence. Descriptive statistics were used to analyze the proportions of full immunization and rural-urban residence across the exposure variables. The Fairlie decomposition technique was used to decompose factors contributing to explaining the coverage disparity. ResultsThe findings show that there is a disparity of 16.06 percentage points to the advantage of the rural areas and the exposure variables explained 76.49% of the disparity. Material factors explained 92.03% of the explained disparity with maternal occupation and household wealth quintile being the only significant individual material variable contributors to the explained disparity. Lower household wealth quintile and working especially in agriculture were associated with higher immunization coverage and they were more common in rural areas. Religion and mother’s age group e each contributed somewhat to the explained inequality. ConclusionsThere was a large immunization coverage disparity between rural and urban areas in The Gambia. This disparity was mainly explained by mothers working in agriculture and living in the poorest households, being more likely to immunize their children – unexpected findings. Our study showed that the drivers of healthcare disparities differ by setting and deserve more research.

Decomposing disparity in adult individual's mental health in Tehran among lower and higher economic groups; an Oaxaca- Blinder analysis on urban HEART Survey- round 2.

Mental health is one of the main aspects of social well-being. Tehran -capital of Iran- is metropolitan, where the mental health status of citizens is not prioritized effectively. The purpose of this study was identifying contributors of mental health inequality between lower and higher economic groups in Tehran through Oaxaca- Blinder method. The study was conducted by the data of Tehran's Urban Heart Survey- Round 2 (2012). Through a three- stage stratified and clustered sampling method, 34,700 were selected as samples. The mental health status was measured by the General Health Questionnaire 28- items (GHQ- 28) and the quantity of the inequality in mental health was measured by corrected concentration index. The Fairlie's decomposition approach was performed in STATA 14. The corrected concentration index were: -0.0967 and -0.1004 by Erreyger's and Wagstaff 's approaches. Being of the Iranian origin, disability conditions, employment status and smoking were identified as the main contributors of inequality in mental health among lower and higher economic groups. Thus, re-organizing strategies and plans on promoting the socio- economic status of non-Iranian residents, improving employment opportunities, developing well-designed environment for disabled individuals and supporting plans to reduce smoking is recommended to the urban policy makers.

Risk factors of psychotropic polypharmacy in the treatment of children and adolescents with psychiatric disorders.

To examine patient and provider characteristics associated with the use of pediatric psychotropic polypharmacy. A retrospective study was conducted on children with psychiatric disorder diagnosis and treatment using the 2013-2015 claims data from a Pediatric Medicaid Managed Care Plan. Psychotropic polypharmacy was defined as the receipt of ≥2 psychotropic medications from different drug classes concurrently for ≥60 days. Stratified logistic regression analyses based on the number of prescribers involved in the treatment, i.e. single prescriber (SP) and multiple prescribers (MP) were conducted to determine the risk factors associated with multiclass psychotropic polypharmacy. The Fairlie decomposition method was used to test the difference in receipt of psychotropic polypharmacy between patients with and without a psychiatrist visit. A total of 24,147 children and adolescents met the inclusion criteria. The prevalence of psychotropic polypharmacy was 20.09%. In addition to patients' demographics, diagnoses, number of comorbid psychiatric disorders (MP only), and the number of prescribers involved in the treatment (MP only), patients with a psychiatrist involved in the treatment had 5.3 times and 3.6 times higher odds of receiving psychotropic polypharmacy in SP and MP groups respectively (SP: OR = 5.32; 95% CI 4.62-6.14 & MP: OR = 3.57; 95% CI 3.20-3.99). Only a quarter of the prescribing practice variation between psychiatrists and PCPs was explained by the observed need factors. Pediatric psychotropic polypharmacy may be necessary and justified as it is mainly prescribed by the best-trained providers.

‘I Wish I Had 100 Dollars a Month …’ The Determinants of Poverty in Mongolia

We consider extreme household poverty to be a risk factor in youth poverty in Mongolia, one of the 50 poorest countries in the world. The emphasis is placed on the identification of poverty trap mechanisms generated through selective access to education. We use a unique, nationally representative School-to-Work Transition survey. A young person born in a household living on US$1 a day has a ceteris paribus probability of school dropout that is four times higher than a contemporary born into a family living on more than $3 a day. Parental educational background is a good proxy of household poverty. Fairlie decomposition suggests that differences in characteristics expound only one-third of the gap. School dropout results in twice the probability of working poverty. It reduces the chances of women being employed and increases those of men, as women drop out of school to attend to domestic chores, while men pursue child labour in herding.