Person:
de Walque, Damien

Development Research Group
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Education, Macroeconomic and Structural Policies, Health
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Last updated: October 24, 2023
Biography
Damien de Walque is a Lead Economist in the Development Research Group (Human Development Team) at the World Bank. He received his Ph.D.in Economics from the University of Chicago in 2003. His research interests include health and education and the interactions between them. His current work is focused on evaluating the impact of financial incentives on health and education outcomes. He is currently evaluating the education and health outcomes of conditional cash transfers linked to school attendance and health center visits in Burkina Faso. He is also working on evaluating the impact of HIV/AIDS interventions and policies in several African countries. He is leading two evaluations of the impact of short-term financial incentives on the prevention of HIV/AIDS and other sexually transmitted infections (STIs): individuals who test negatively for a set of STIs receive regular cash payment in Tanzania, while in Lesotho they receive lottery tickets. On the supply side of health services, he is managing a large portfolio of impact evaluations of results-based financing in the health sector. He has also edited a book on risky behaviors for health (smoking, drugs, alcohol, obesity, risky sex) in the developing world.
Citations 594 Scopus

Publication Search Results

Now showing 1 - 7 of 7
  • Publication
    Incentivising Safe Sex : A Randomised Trial of Conditional Cash Transfers for HIV and Sexually Transmitted Infection Prevention in Rural Tanzania
    (2012-02-08) de Walque, Damien; Nathan, Rose; Abdul, Ramadhani; Abilahi, Faraji; Gong, Erick; Isdahl, Zachary; Jamison, Julian; Jullu, Boniphace; Krishnan, Suneeta; Majura, Albert; Migue, Edward; Moncada, Jeanne; Mtenga, Sally; Mwanyangala, Mathew Alexander; Packel, Laura; Schachter, Julius; Shirima, Kizito; Medlin, Carol A.
    Objective The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex. Design An unblinded, individually randomised and controlled trial. Setting 10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania. Participants The authors enrolled 2399 participants, aged 18–30 years, including adult spouses. Interventions Participants were randomly assigned to either a control arm (n=1124) or one of two intervention arms: low-value conditional cash transfer (eligible for $10 per testing round, n=660) and high-value conditional cash transfer (eligible for $20 per testing round, n=615). The authors tested participants every 4 months over a 12-month period for the presence of common sexually transmitted infections. In the intervention arms, conditional cash transfer payments were tied to negative sexually transmitted infection test results. Anyone testing positive for a sexually transmitted infection was offered free treatment, and all received counselling. Main outcome measures The primary study end point was combined prevalence of the four sexually transmitted infections, which were tested and reported to subjects every 4 months: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. The authors also tested for HIV, herpes simplex virus 2 and syphilis at baseline and month 12. Results At the end of the 12-month period, for the combined prevalence of any of the four sexually transmitted infections, which were tested and reported every 4 months (C trachomatis, N gonorrhoeae, T vaginalis and M genitalium), unadjusted RR for the high-value conditional cash transfer arm compared to controls was 0.80 (95% CI 0.54 to 1.06) and the adjusted RR was 0.73 (95% CI 0.47 to 0.99). Unadjusted RR for the high-value conditional cash transfer arm compared to the low-value conditional cash transfer arm was 0.76 (95% CI 0.49 to 1.03) and the adjusted RR was 0.69 (95% CI 0.45 to 0.92). No harm was reported. Conclusions Conditional cash transfers used to incentivise safer sexual practices are a potentially promising new tool in HIV and sexually transmitted infections prevention. Additional larger study would be useful to clarify the effect size, to calibrate the size of the incentive and to determine whether the intervention can be delivered cost effectively. Trial registration number NCT00922038 ClinicalTrials.gov.
  • Publication
    Education, Information, and Smoking Decisions : Evidence from Smoking Histories in the United States, 1940-2000
    (2010) de Walque, Damien
    This paper tests the hypothesis that education improves health and increases life expectancy. The analysis of smoking histories shows that after 1950, when information about the dangers of tobacco started to diffuse, the prevalence of smoking declined earlier and most dramatically for college graduates. I construct panels based on smoking histories in an attempt to isolate the causal effect of smoking from the influence of time-invariant unobservable characteristics. The results suggest that, at least among women, college education has a negative effect on smoking prevalence and that more educated individuals responded faster to the diffusion of information on the dangers of smoking.
  • Publication
    Parental Education and Children's Schooling Outcomes: Evidence from Recomposed Families in Rwanda
    (2009) de Walque, Damien
    In this article, I investigate how educational outcomes of orphans are affected by the education of the family members in their new family. The study uses household survey data from Rwanda that contain a large proportion of children living in households without their biological parents. The data also allow controlling for the educational attainment of the absent biological parents and the type of relationship that links the children to their adoptive families. The results of the analysis suggest that the education of the adoptive parents has a positive impact on the children's schooling. Interestingly, mothers' education matters more for girls, while fathers' education is more important for boys. The results also indicate that placing orphans with their relatives has a positive impact on their schooling. This finding has obvious policy implications for African countries with a large proportion of orphans due to the HIV/AIDS epidemic or to conflicts.
  • Publication
    The Demographic and Socio-economic Distribution of Excess Mortality during the 1994 Genocide in Rwanda
    (2010) de Walque, D.
    This paper studies the demographic consequences of the Rwandan genocide and how the excess mortality due to the conflict was distributed in the population. Data collected by the 2000 Demographic and Health Survey indicate that although there were more deaths across the entire population, adult males were the most likely to die. Using the characteristics of the survey respondent as a proxy for the socio-economic status of the victims' family, the results also show that individuals with an urban or more educated background were more likely to die. The country's loss of human capital is a long-term cost of the genocide that compounds the human tragedies.
  • Publication
    HIV Status in Discordant Couples in Sub-Saharan Africa : A Systematic Review and Meta-Analysis
    (2010) Eyawo, O.; de Walque, D.; Ford, N.; Gakii, G.; Lester, R. T.; Mills, E. J.
    Background Most couples affected by HIV/AIDS in sub-Saharan Africa live in discordant relationships. Men are thought to be the index case in most relationships, and most social marketing and awareness campaigns are focused on men. We investigated serodiscordance in stable relationships to establish the gender balance of index-case infections. Methods We did a systematic review, random-effects meta-analysis, and meta-regression of published and unpublished studies enrolling discordant couples and assessed the proportion of men and women that were index cases. We repeated the analysis with data from demographic and health surveys (DHS) from the 14 countries that have documented the HIV status of couples. Our primary outcome was the total number of HIV discordant couples, including the proportion of HIV-positive women. Findings We included data from 27 cohorts of 13 061 couples and DHS data from 14 countries of 1145 couples. The proportion of HIV-positive women in stable heterosexual serodiscordant relationships was 47% (95% CI 43-52), which shows that women are as likely as men to be the index partner in a discordant couple. DHS data (46%, 41-51) and our sensitivity analysis (47%, 43-52) showed similar findings. Meta-regression showed that urban versus rural residence (odds ratio 0.31, 95% CI 0.22-0.39), latitude (beta coefficient 0.02, 0.023-0.034), gender equality (beta coefficient -0.42, -0.56 to -0.27), HIV prevalence (beta coefficient -0-037, -0.04 to -0.030), and older age (beta coefficient 0.20, 0.08-0.32) were associated with the proportion of female index cases. Interpretation Our study shows the need to focus on both sexes in HIV prevention strategies, such as promotion of condom use and mitigation of risk behaviours.
  • Publication
    Do Unsafe Tetanus Toxoid Injections Play a Significant Role in the Transmission of HIV/AIDS? Evidence from Seven African Countries
    (2008) de Walque, D.
    OBJECTIVES: Although sexual transmission is generally considered to be the main factor driving the HIV/AIDS epidemic in Africa, recent studies have claimed that iatrogenic transmission should be considered as an important source of HIV infection. In particular, receipt of tetanus toxoid injections during pregnancy has been reported to be associated with HIV infection in Kenya. The objective of this paper is to assess the robustness of this association among women in nationally representative HIV surveys in seven African countries. METHODS: The association between prophylactic tetanus toxoid injections during pregnancy and HIV infection was analysed, using individual-level data from women who gave birth in the past five years. These data are from the nationally representative Demographic and Health Surveys, which included HIV testing in seven African countries: Burkina Faso 2003 (N = 2424), Cameroon 2004 (N = 2600), Ethiopia 2005 (N = 2886), Ghana 2003 (N = 2560), Kenya 2003 (N = 1617), Lesotho 2004 (N = 1278) and Senegal 2005 (N = 2126). RESULTS: Once the odds ratios (OR) were adjusted for five-year age groups and for ethnic, urban and regional indicators, the association between prophylactic tetanus toxoid injections during pregnancy and HIV infection was never statistically significant in any of the seven countries. Only in Cameroon was there an association between previous tetanus toxoid injection and HIV positivity but it became weaker (OR 1.53, 95% CI 0.91 to 2.57) once urban location and ethnic group were adjusted for. CONCLUSIONS: Although the risk of HIV infection through unsafe injections and healthcare should not be ignored and should be reduced, it does not seem that there is, at present and in the seven countries studied, strong evidence supporting the claim that unsafe tetanus toxoid injections are a major factor driving the HIV epidemic.
  • Publication
    Variations in Condom Use by Type of Partner in 13 Sub-Saharan African Countries
    (2011) de Walque, Damien
    Using nationally representative data from 13 sub-Saharan African countries, we reinforce and expand upon previous findings that men report using condoms more frequently than women do and that unmarried respondents report that they use condoms with casual partners more frequently than married individuals report using them with their spouses. Based on descriptive, bivariate, and multivariate analyses, we also demonstrate to a degree not previously shown in the current literature that married men from most countries report using condoms with extramarital partners about as frequently as unmarried men report using them with casual partners. Married women from most of the countries included in the study reported using condoms with extramarital partners less frequently than unmarried women reported using them with casual partners. This result is especially troubling because marriage usually ensures regular sexual intercourse, thereby providing more opportunities for a person to pass HIV infection from an extramarital partner to his or her spouse. These findings about high-risk behaviors can be used to better target future HIV-transmission-prevention efforts.