Investment In Child Health Research Articles

In the Aftermath of the National Children's Study.

In the Aftermath of the National Children's Study.

Gender‐Biased Breastfeeding in Egypt: Examining the Fertility Preference Hypotheses of Jayachandran and Kuziemko (2011)

SummaryJayachandran and Kuziemko (Why do mothers breastfeed girls less than boys? Evidence and implications for child health in India. Quarterly Journal of Economics 2011; 126(3): 1485–1538) develop and empirically validate a theory showing son preference in India generates ‘passive’ parental bias against girls in breastfeeding due to gender‐differentiated birth spacing and fertility stopping. I scientifically replicate their empirical exercises to test the validity of the theory in Egypt, where there is also high prevailing son preference, but little research on its implications for child health investments. I additionally examine whether using the exclusive breastfeeding rate as an alternative outcome yields supportive evidence for the theory. I find the theory is strongly supported by empirical results from Egyptian data, bolstering its policy relevance for developing countries besides India. Copyright © 2015 John Wiley & Sons, Ltd.

Addressing the Challenges and Cost of Health Care for At-Risk Children in Roanoke, Virginia, USA

The Child Health Investment Partnership of the Roanoke Valley (CHIP-RV), Virginia, USA, has been helping at risk children and families for the past 24 years. CHIP-RV began as a grassroots effort involving local pediatricians, social service agencies, and the public health department. Working together these professionals have developed and implemented a comprehensive program that provides for health care coordination, family strengthening services, and mental health services all directed at the mission of promoting health of medically under-served children within the greater Roanoke Valley. CHIP services are directed at low-income pregnant women and children from birth to kindergarten entry. Services include home visits with an RN, medical records reviews, in-home comprehensive assessments, health education, preparation for kindergarten, support for management of difficult behaviors, skill development, home and child safety, dental varnish application, and transportation to health and social services. Evaluations of the CHIP-RV model has shown CHIP-RV to be successful at meeting selected health and social needs of at-risk children and families. It is a model that should successfully interface with the Affordable Care Act as well as private/public efforts to reduce the cost of health care, help families to utilize the health care system and keep children well.

FAMILY PLANNING, GROWTH, INCOME DISTRIBUTION: GRAPH-THEORETIC PATH ANALYSIS OF RWANDA

This paper explores macroeconomic linkages among family planning, human capital and economic growth in Rwanda. Based on a disaggregated social accounting matrix (SAM), welfare effects of alternative exogenous injections are investigated, and the high and low-income pathways are identified by graph-theoretic path analysis. Three important findings follow from the analysis. First, rural income gains spread over the entire economy, while urban income gains are largely contained within urban areas. This suggests a relatively larger income multiplier effect of rural investments. Second, investing in family planning and health promotes agricultural production, with a considerable rural employment effect. Thus, targeted rural investment should yield economic growth followed by an improvement in income equality. Third, a unit increase in the consumption of family planning and health commodities is respectively associated with 1.3 unit, 1.2 unit and 0.74 unit increase in the agricultural, service and manufacturing production; It further generates 60% more income for the urban-Kigali households than rural households. To sum up, benefits of investing in family planning-health should not be overlooked in terms of improvement in rural employment, agricultural production and poverty reduction.Keywords: Family Planning, Fertility, Human Capital, Growth, Income Distribution, Graph-Theory, Path Analysis, SAM Multiplier, RwandaJEL classification: I15, I25, I38, J13, O15, O21(ProQuest: ... denotes formulae omitted.)1. BACKGROUND AND INTRODUCTIONFamily planning has long been a central component of population policies and programs and is an integral part of reproductive health.1 It provides couples with methods of preventing unplanned pregnancies not only to reduce fertility and child mortality but also augment investment in child health. Since the 1960s, the use of family planning has been steadily increasing in the developing world. For Europe and the United States, for example, it took a century to reduce their average family size from around 6 to 3 children. For the developing world, however, a comparable decline in family size took only about four decades during 1960-2000. Despite the convergence in family size across the two worlds, unmet need for family planning in the developing world still remains about one-fifth of the currently married women.Rwanda is no exception to high unmet need for family planning. Relative to other African countries, it is leading with its low contraceptive prevalence (36% in 2008), high fertility rate (5 children in 2009) and high unmet need for family planning (32% in 2008).2 Data obtained from the 2008 DHS paint a picture of a rather unstable pattern of contraceptive use among married women. The contraceptive use sharply fell after the 1994 genocide, from 21.2% in 1992 to only 13.2% in 2000 and thereafter it slowly increased until 2005 to the point where 17.4% of married women were using modern contraception. By 2008, the contraceptive use has leveled around 36% - which can largely be attributed to the recent surge of investment in family planning services and increasing flow of donor funds targeting population programs.3 At present, the main concern is the adverse effect of high unmet need and high fertility on per child human capital investment (i.e., education, health and nutrition) and economic growth through declining productivity.Recognizing the link between fertility and development outcomes, the Rwandan government views family planning as an important instrument for targeting poverty and raising per child resource allocation at the household level. However, poverty is multi-sectoral in its cause, and decreasing family size can reduce it only partially. The creation of new employment opportunities is necessary for households to benefit from their investment in child quality because employment, sectoral productivity and household family size decision are interlinked at the meso level through economic and demographic policies. …

Empirical examination of the indicator ‘pediatric gastroenteritis hospitalization rate’ based on administrative hospital data in Italy

BackgroundAwareness of the importance of strengthening investments in child health and monitoring the quality of services in the pediatric field is increasing. The Pediatric Quality Indicators developed by the US Agency for Healthcare Research and Quality (AHRQ), use hospital administrative data to identify admissions that could be avoided through high-quality outpatient care. Building on this approach, the purpose of this study is to perform an empirical examination of the ‘pediatric gastroenteritis admission rate’ indicator in Italy, under the assumption that lower admission rates are associated with better management at the primary care level and with overall better quality of care for children.MethodsFollowing the AHRQ process for evaluating quality indicators, we examined age exclusion/inclusion criteria, selection of diagnostic codes, hospitalization type, and methodological issues for the ‘pediatric gastroenteritis admission rate’. The regional variability of hospitalizations was analyzed for Italian children aged 0–17 years discharged between January 1, 2009 and December 31, 2011. We considered hospitalizations for the following diagnoses: non-bacterial gastroenteritis, bacterial gastroenteritis and dehydration (along with a secondary diagnosis of gastroenteritis). The data source was the hospital discharge records database. All rates were stratified by age.ResultsIn the study period, there were 61,130 pediatric hospitalizations for non-bacterial gastroenteritis, 5,940 for bacterial gastroenteritis, and 38,820 for dehydration. In <1-year group, the relative risk of hospitalization for non-bacterial gastroenteritis was 24 times higher than in adolescents, then it dropped to 14.5 in 1- to 4-year-olds and to 3.2 in 5- to 9-year-olds. At the national level, the percentage of admissions for bacterial gastroenteritis was small compared with non-bacterial, while including admissions for dehydration revealed a significant variability in diagnostic coding among regions that affected the regional performance of the indicator.ConclusionsFor broadest application, we propose a ‘pediatric gastroenteritis admission rate’ that consists of including bacterial gastroenteritis and dehydration diagnoses in the numerator, as well as infants aged <3 months. We also suggest adjusting for age and including day hospital admissions. Future evaluation by a clinical panel at the national level might be helpful to determine appropriate application for such measures, and make recommendations to policy makers.

The impact of a home visiting program on children's utilization of dental services.

Child Health Investment Partnership (CHIP) of Roanoke Valley is a home visiting program that promotes children's health and family self-sufficiency. CHIP's Begin With a Grin program provides preventive dental services in the home (oral health anticipatory guidance and fluoride varnish) for children aged 0 to 6 years. The purpose of this study was to compare the dental utilization of Medicaid-enrolled children in CHIP versus Medicaid-enrolled children not in CHIP. Using the propensity score method, control subjects were selected from the statewide Medicaid database by using a caliper-matching algorithm. A vector of chosen covariates was used to match control subjects; these covariates included risk factors, estimated propensity score, age, race, gender, and days of Medicaid eligibility. Propensity scores were developed by using a logistic regression. Differences in dental utilization outcomes were tested: ≥1 dental claim (logistic regression) and number of dental claims (Poisson regression) for each subject within the test period. When CHIP children were compared with Medicaid-only children, the CHIP child was 3 times more likely to have at least 1 dental visit (odds ratio: 3.0 [95% confidence interval: 1.9-4.7]) and have a higher number of dental claims (ratio of estimated average number of dental claims [cases/control]: 8.60/3.05 = 2.82 [95% confidence interval: 2.56-3.12]). A home visiting model can introduce children and their families to dental prevention, improve dental health literacy, establish a dental home, and provide application of fluoride varnish.

Growing Up Together: Cohort Composition and Child Investment

In sub-Saharan Africa, 60 % of child deaths are preventable by investments in child health as simple as immunizations, bed nets, or water purification. This article investigates how a household's decisions regarding such investments are affected by the size and gender composition of a child's cohort. I focus on a previously overlooked type of investment: nonrival, child-specific goods (club goods). I empirically estimate the response of immunization status to cohort characteristics. I carefully address the problem of endogenous fertility, which is common in cohort studies. Because most rural Senegalese households are composed of multiple nuclear families, a child's cohort is composed of both siblings and nonsibling children. Estimating within households, I instrument cohort characteristics with those of the nonsibling (exogenous) portion. I find that children with larger (or more predominantly male) cohorts of vaccine-eligible age are significantly more likely to receive immunization. These findings suggest that children with larger cohorts may be better off in terms of club investments; this is a significant finding for child health given that many illness prevention methods are of a club good nature.

Social Inequality in Early Childhood Health – Participation in the Preventive Health Care Program for Children

This paper asks how far socioeconomic differences in parental child health investments can be explained by personal and social resources within the family. Using SOEP data from the 2003 to 2008 newborn questionnaire, we estimate multiple logistic regressions to determine the effects of migration status, education, time resources, coping competencies, and social resources (in terms of shared parenthood and childcare support by the partner and relatives) on participation in the national German preventive health care program for children (U-Untersuchungen). First, our analyses reveal strong influences of maternal education and migration status, whereas social class plays no significant role for participation in preventive health checkups for children. Second, the likelihood of participation is higher the better mothers cope with motherhood and the more time they spend with their offspring. Finally, we find mixed effects of social resources ranging from a positive influence of parents living together, over no effect of childcare support provided by the father of the child, to a seemingly negative impact of support from further kin relations. All in all, personal and social resources do not seem to play a crucial role in explaining participation in child health programs in terms of social disparities between educational and ethnic groups. JEL Classification: I10

Is Sex-Selective Abortion Associated With a Reduction in Gender Differentials in Child Health Investments? Evidence from India

India has experienced an imbalance in sex ratios due to the rapid diffusion of sex-selective abortions. This paper tests whether sex-selective abortions have substituted for postnatal discrimination against girls after birth. I identify the demographic groups that exhibit the greatest take up of sex-selective abortions and then check whether these same groups experienced increases in girls' health investments and outcomes. Since sex selection allows parents to choose the gender of their child, the ‘substitution hypothesis' predicts that girls who would have experienced the greatest postnatal discrimination will be terminated prenatally instead and so we should observe more equitable investments in male and female children (Goodkind 1996). Data from the National Family and Health Survey indicates that wealthy urban households exhibit the largest sex ratio imbalance. This same group exhibits a relative increase in the duration of breastfeeding for girls. In contrast, the largest reduction in the female disadvantage in postneonatal mortality is observed in poorer rural households who are less likely to practice sex selection. This result could be attributed to falling family sizes which frees up household resources which has allowed investments in girls to increase. Overall, the results suggest that sex selection and postnatal gender discrimination are practiced by different socioeconomic groups.

Supply Shocks and Gender Bias in Child Health Investments: Evidence from the ICDS Programme in India

Abstract This paper examines whether a permanent increase in the supply of immunisations reduces or intensifies the gender bias in immunisation against female children in India. It also investigates the effect of duration of exposure to the supply shock on gender bias. The variation in the implementation of the Integrated Child Development Services (ICDS) programme across both regions and time is exploited for the analysis. Estimations use data from the 2005-06 Measure DHS survey in India. We find that the increased supply of vaccinations due to the programme initially increases the gender inequality in immunisation but that this increase disappears over time. Our results indicate that the programme has saved approximately 1.72-1.84 million children, of which about 70% are boys.

Disparities in Academic Achievement and Health: The Intersection of Child Education and Health Policy

Recent data suggest that that the United States is failing to make significant progress toward the Healthy People 2010 goal of eliminating health disparities. One missing element from the US strategy for achieving this goal is a focus on gaps in child development and achievement. Academic achievement and education seem to be critical determinants of health across the life span and disparities in one contribute to disparities in the other. Despite these linkages, national policy treats child education and health as separate. Landmark education legislation, the No Child Left Behind Act of 2001, is due for Congressional reauthorization. It seeks to eliminate gaps in academic child achievement by 2014. It does so by introducing accountability for states, school districts, and schools. In this special article, we review health disparities and contributors to child achievement gaps. We review changes in achievement gaps over time and potential contributors to the limited success of the No Child Left Behind Act of 2001, including its unfunded mandates and unfounded assumptions. We conclude with key reforms, which include addressing gaps in child school readiness through adequate investment in child health and early education and reductions in child poverty; closing the gap in child achievement by ensuring equity in school accountability standards; and, importantly, ensuring equity in school funding so that resources are allocated on the basis of the needs of the students. This will ensure that schools, particularly those serving large numbers of poor and minority children, have the resources necessary to promote optimal learning.

Estimating average inpatient and outpatient costs and childhood pneumonia and diarrhoea treatment costs in an urban health centre in Zambia

BackgroundMillions of children die every year in developing countries, from preventable diseases such as pneumonia and diarrhoea, owing to low levels of investment in child health. Investment efforts are hampered by a general lack of adequate information that is necessary for priority setting in this sector. This paper measures the health system costs of providing inpatient and outpatient services, and also the costs associated with treating pneumonia and diarrhoea in under-five children at a health centre in Zambia.MethodsAnnual economic and financial cost data were collected in 2005-2006. Data were summarized in a Microsoft excel spreadsheet to obtain total department costs and average disease treatment costs.ResultsThe total annual cost of operating the health centre was US$1,731,661 of which US$1 284 306 and US$447,355 were patient care and overhead departments costs, respectively. The average cost of providing out-patient services was US$3 per visit, while the cost of in-patient treatment was US$18 per bed day. The cost of providing dental services was highest at US$20 per visit, and the cost of VCT services was lowest, with US$1 per visit. The cost per out-patient visit for under-five pneumonia was US$48, while the cost per bed day was US$215. The cost per outpatient visit attributed to under-five diarrhoea was US$26, and the cost per bed day was US$78.ConclusionIn the face of insufficient data, a cost analysis exercise is a difficult but feasible undertaking. The study findings are useful and applicable in similar settings, and can be used in cost effectiveness analyses of health interventions.

Does increased access increase equality? Gender and child health investments in India

Increases in access to social services are often thought to decrease inequality in the level of these services between advantaged and disadvantaged groups. This is an issue in the developing world, where policy-makers often argue that increasing the level of health care, for example, will decrease gender inequality. However, increases in access to services often have empirically ambiguous effects on inequality, increasing it in some cases and decreasing it in others. This paper argues that this is not surprising, and simple economic theory suggests that we should expect a non-monotonic relationship between access and inequality. At low levels of access to investments, there is no investment for either the advantaged or disadvantaged group, producing equality. Increases in access increase investment for the advantaged group first, generating inequality. Further increases in access increase investment in the disadvantaged group, decreasing inequality. I test the predictions of this theory using data on the availability of health camps (or distance to health centers) and gender differences in vaccinations in India. I find strong support for a non-monotonic relationship between access and gender equality.

Social affiliation and the demand for health services: Caste and child health in South India

This paper assesses the role of social affiliation, measured by caste, in shaping investments in child health. The special setting that we have chosen for the analysis – tea estates in the South Indian High Range – allows us to control nonparametrically for differences in income, access to health services, and patterns of morbidity across low caste and high caste households. In this controlled setting, low caste households spend more on their children's health than high caste households, reversing the pattern we would expect to find elsewhere in India. Moreover, health expenditures do not vary by gender within either caste group, in contrast once again with the male preference documented throughout the country. A simple explanation, based on differences in the returns to human capital across castes in the tea estates, is proposed to explain these striking results.

Growth Status of Male Children in Rural Haryana

Investments in child health and welfare are made for the future. Planning for child health is essentially long-term prospective and futureoriented. Alva (1979) aptly describes When infants die although medical knowledge knows how to prevent it the technical dimension of a civilization has most cruelly outdistanced its humanitarian development. There is a two-way interaction between health and other factors such as income housing water supply sanitation culture education etc. For our country the issue is still more crucial with nearly 42 percent of a population being in the 0-14 age group. Such a large percentage of child population does not contribute to production and increases one dependency load of the country. A realistic picture of their health status become important because they constitute the labor force of the future what they are today will determine their tomorrow. (excerpt)

Interrelations between Child Education, Health, and Family Size: Evidence from a Developing Country

The objectives of this study are first to examine whether small families have a higher propensity for child investment in education and health than do larger families. An economic model is developed as the basis for empirical investigation of the hypothesis that larger family size and lower average per child investment are simultaneously determined. Second by incorporating child health as another measure of child quality it is possible to explore the determinants of child mortality a vital index of the current socioeconomic welfare of a country. Further this approach also permits examination of the interrelations with investment in child health and fertility....The aim...was to design a model that tests the empirical applicability of the New Home Economics postulated by Becker and Lewis in a rural setting of a less developed country. Data from Bangladesh were used.... (EXCERPT)