03. Journals
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These are journal articles published in World Bank journals as well as externally by World Bank authors.
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Publication
Relative Measures of Genocide Mortality: Benefits and Methodological Considerations of Using Siblings' Survival Data
(Taylor and Francis, 2019-12-31)When studying events such as the 1994 Genocide in Rwanda, for many researchers the first order question seems to be to find the best available data and methods to estimate the death toll, i.e. to provide a number of deaths in absolute terms. This makes sense since the staggering number of victims over a very short period is one of the most shocking – and defining – features of such an historical event. This short note argues that while looking for an absolute death toll number is certainly an important and worthwhile research exercise, analyzing relative mortality numbers also provides valuable insights that might not be available when focusing on absolute numbers. By relative mortality I mean comparing mortality across different population segments such as by gender, by age group or socioeconomic categories (e.g. education levels, urban/rural background). Specifically, I will use the examples of the Khmer Rouge Period in Cambodia (1975-1978) and the 1994 Genocide in Rwanda to illustrate this argument and will rely on earlier studies to show how the sibling mortality schedule – a module collecting information about the date of birth, the sex and if relevant the date of death of all siblings of the respondent – contained in most of the well-known and commonly used Demographic and Health Surveys (DHS) can be exploited to obtain reasonable and useful estimates of relative mortality. -
Publication
Challenges and Opportunities in the Continuity of Care for Hypertension: A Mixed-Methods Study Embedded in a Primary Health Care Intervention in Tajikistan
(Springer Nature, 2019-12-03)Hypertension, a significant risk factor for ischemic heart disease and other chronic conditions, is the third-highest cause of death and disability in Tajikistan. Thus, ensuring the early detection and appropriate management of hypertension is a core element of strategies to improve population health in Tajikistan. For a strategy to be successful, it should be informed by the causes of gaps in service delivery and feasible solutions to these challenges. The objective of this study was to undertake a systematic assessment of hypertension case detection and retention in care within Tajikistan’s primary health care system, and to identify challenges and appropriate solutions. We review the results for the case detection stage of the cascade of care, which had the most significant gaps. Of the half a million people with hypertension in Khatlon and Sogd Oblasts (administrative regions), about 10% have been diagnosed in Khatlon and only 5% in Sogd. Barriers to case detection include misinformation about hypertension, ambiguous protocols, and limited delivery capacity. Solutions identified to these challenges were mobilizing faith-based organizations, scaling up screening through health caravans, task-shifting to increase provider supply, and introducing job aids for providers. Translating findings on discontinuities in care for hypertension and other chronic diseases to actionable policy insights can be facilitated by collaboration with local stakeholders, triangulation of data sources, and identifying the intersection between the feasible and the effective in defining solutions to service delivery challenges. -
Publication
Quality of Care for Children with Severe Disease in the Democratic Republic of the Congo
(Springer Nature, 2019-12)Despite the almost universal adoption of Integrated Management of Childhood Illness (IMCI) guidelines for the diagnosis and treatment of sick children under the age of five in low- and middle-income countries, child mortality remains high in many settings. One possible explanation of the continued high mortality burden is lack of compliance with diagnostic and treatment protocols. We test this hypothesis in a sample of children with severe illness in the Democratic Republic of the Congo (DRC). -
Publication
The Effects of Health Insurance within Families: Experimental Evidence from Nicaragua
(Published by Oxford University Press on behalf of the World Bank, 2019-10)This paper measures the causal effects of parent enrollment into voluntary health insurance on healthcare utilization among insured and uninsured children in Nicaragua. The study utilizes a randomized trial and age-eligibility cutoff in which insurance subsidies were randomly allocated to parents that covered their dependent children under 12; children age 12 and older were not eligible for coverage. Among eligible children, the insurance increased utilization at covered providers by 0.56 visits and increased overall utilization by 1.3 visits. Ineligible children with insured parents experienced 1.7 fewer healthcare visits driven by parent, not sibling, enrollment. The results suggest complementarities across healthcare provider type and provide evidence that households reallocate resources across all members in response to changes in healthcare prices for some. -
Publication
Psychic versus Economic Barriers to Vaccine Take-Up: Evidence from a Field Experiment in Nigeria
(Published by Oxford University Press on behalf of the World Bank, 2019-10)This paper experimentally evaluates the relative importance of psychic costs of tetanus vaccination compared to monetary costs among women in rural Nigeria. We compare vaccine take-up between two conditions to receive cash incentives: clinic attendance vs. vaccine take-up. Because the only difference between these two conditions is whether a woman was required to receive a vaccine upon arrival at the clinic, the difference in clinic attendance between these two groups captures the psychic costs of vaccination. Contrary to conventional wisdom, we find no evidence for significant psychic costs. Priming about disease severity increases the perceived severity of disease, but not vaccine take-up. Monetary costs strongly affect vaccination decisions. -
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A Simple Approach to Measuring the Share of Early Childbirths Likely Due to Child Marriage in Developing Countries
(Taylor and Francis, 2019-07-10)Child marriage has large negative effects on the girls who marry early and their children, as well as communities and societies as a whole. Ending child marriage is a target under the Sustainable Development Goals, but investments to delay the age at first marriage remain limited in countries where child marriage is widespread. As part of a broader argument to make the economic case for ending child marriage, this paper provides a simple approach for measuring the share of early childbirths likely due to child marriage in developing countries. This estimation matters because many of the negative impacts of child marriage on development outcomes for the girls who marry early and their children are through early childbirths – having a child before the age of 18 (for a mother), or being born of a mother younger than 18 (for a child). The estimates provided in this paper suggest that most early childbirths in developing countries are likely due to child marriage. -
Publication
Public Mosquito Abatement: A Cluster Randomized Experiment
(Published by Oxford University Press on behalf of the World Bank, 2019-06)Mosquito abatement is a public good. A simultaneous model of mosquito abundance and abatement response is developed. We then use data from a cluster randomized controlled experiment conducted over the period 2012–2014 in urban areas of Réunion in France to study the impact of WHO-recommended mechanical elimination techniques, which involve removing sources of stagnant water around the house, on a number of outcomes, including objective entomological indices and self-declared protective behaviors. Empirical results document that households reduce their protective behavior in response to public control. This study holds implications for arboviral disease control, including Zika control. -
Publication
Cash Transfers and Health: Evidence from Tanzania
(Published by Oxford University Press on behalf of the World Bank, 2019-06)How do cash transfers conditioned on health clinic visits and school attendance impact health-related outcomes? Examining the 2010 randomized introduction of a program in Tanzania, this paper finds nuanced impacts. An initial surge in clinic visits after 1.5 years—due to more visits by those already complying with program health conditions and by non-compliers—disappeared after 2.5 years, largely due to compliers reducing above-minimal visits. The study finds significant increases in take-up of health insurance and the likelihood of seeking treatment when ill. Health improvements were concentrated among children ages 0–5 years rather than the elderly, and took time to materialize; the study finds no improvements after 1.5 years, but 0.76 fewer sick days per month after 2.5 years, suggesting the importance of looking beyond short-term impacts. Reductions in sick days were largest in villages with more baseline health workers per capita, consistent with improvements being sensitive to capacity constraints. These results are robust to adjustments for multiple hypothesis testing. -
Publication
Joint Roles of Parenting and Nutritional Status for Child Development: Evidence from Rural Cambodia
(Wiley, 2019-05-31)Substantial work has demonstrated that early nutrition and home environments, including the degree to which children receive cognitive stimulation and emotional support from parents, play a profound role in influencing early childhood development. Yet, less work has documented the joint influences of parenting and nutritional status on child development among children in the preschool years living in low‐income countries. Using panel data from 2016 to 2017 on the parenting, nutritional status, and early developmental outcomes (executive function, language, early numeracy, and socioemotional problems) of 6,508 Cambodian children ages 3–5 years, our findings demonstrate that inequities in early development associated with family wealth are evident at age 3 and increase among children ages 4 and 5 years. Using hierarchical regression analysis, a significant share of these inequalities is explained by differences in parenting and early nutritional status, measured by stunting. Better‐educated parents engage in more stimulating and supportive parenting practices. However, the positive association between parenting and language and early numeracy outcomes is 35–54% stronger for non‐stunted children, and parental activities explain only about 8–14% of the cognitive gap between the lowest and highest wealth quintiles. The results highlight the need for additional research outlining interactions between environmental factors that link family wealth and child development. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions. https://authorservices.wiley.com/author-resources/Journal-Authors/licensing/self-archiving.html -
Publication
The Impact of Monetary Incentives on Referrals by Traditional Birth Attendants for Postnatal Care in Nigeria
(World Bank, Washington, DC, 2019-05-20)Gaps in postnatal care use represent missed opportunities to prevent maternal and neonatal death in sub-Saharan Africa. As one in every three non-facility deliveries in Nigeria is assisted by a traditional birth attendant (TBA), and the TBA’s advice is often adhered to by their clients, engaging TBAs in advocacy among their clients may increase maternal and neonatal postnatal care use. This study estimates the impact of monetary incentives for maternal referrals by TBAs on early maternal and neonatal postnatal care use (within 48 h of delivery) in Nigeria. Overall, 207 TBAs participated in this study: 103 in the treatment group and 104 in the control group. The intervention increased the proportion of maternal clients of TBAs that reported attending postnatal care within 48 h of delivery by 15.4 percentage points [95% confidence interval (CI): 7.9–22.9]. The proportion of neonatal clients of TBAs that reportedly attended postnatal care within 48 h of delivery also increased by 12.6 percentage points [95% CI: 5.9–19.3]. However, providers often did not address the issues that may have led to maternal and newborn postnatal complications during these visits. We show that motivating TBAs using monetary incentives for maternal postnatal care use can increase skilled care use after delivery among their maternal and neonatal clients, who have a higher risk of mortality because of their exposure to unskilled birth attendance. However, improving the quality of care is key to ensuring maternal and neonatal health gains from postnatal care attendance.