Achyuta Adhvaryu

Endowments at Birth and Parents' Investments in Children

Do parents invest more in higher quality children, or do they compensate for lower quality by giving more to children with lower endowments? We answer this question in the context of a large-scale iodine supplementation programme in Tanzania. We find that children with higher programme exposure were more likely to receive necessary vaccines and were breastfed for longer. Siblings of treated children were also more likely to be immunised. Fertility behavior and investments at the time of birth were unaffected.

Psychological distress in Ghana: associations with employment and lost productivity

ObjectivesMental health disorders account for 13% of the global burden of disease, a burden that low-income countries are generally ill-equipped to handle. Research evaluating the association between mental health and employment in low-income countries, particularly in sub-Saharan Africa, is limited. We address this gap by examining the association between employment and psychological distress.MethodsWe analyzed data from the Ghana Socioeconomic Panel Survey using logistic regression (N = 5,391 adults). In multivariable analysis, we estimated the association between employment status and psychological distress, adjusted for covariates. We calculated lost productivity from unemployment and from excess absence from work that respondents reported was because of their feelings of psychological distress.FindingsApproximately 21% of adults surveyed had moderate or severe psychological distress. Increased psychological distress was associated with increased odds of being unemployed. Men and women with moderate versus mild or no psychological distress had more than twice the odds of being unemployed. The association of severe versus mild or no distress with unemployment differed significantly by sex (P-value for interaction 0.004). Among men, the adjusted OR was 12.4 (95% CI: 7.2, 21.3), whereas the association was much smaller for women (adjusted OR = 3.8, 95% CI: 2.5, 6.0). Extrapolating these figures to the country, the lost productivity associated with moderate or severe distress translates to approximately 7% of the gross domestic product of Ghana.ConclusionsPsychological distress is strongly associated with unemployment in Ghana. The findings underscore the importance of addressing mental health issues, particularly in low-income countries.

Schooling, Child Labor, and the Returns to Healthcare in Tanzania

We study the effects of accessing better healthcare on the schooling and labor supply decisions of sick children in Tanzania. Using variation in the cost of formal-sector healthcare to predict treatment choice, we show that accessing better healthcare decreases length of illness and changes children’s allocation of time to school and work. Children attend school for more days per week—but not for more hours per day—as a result of accessing better healthcare. There are no significant effects on child labor, but the results suggest that time spent in physically strenuous activities such as farming and herding increases.

The Long-Run Impacts of Adult Deaths on Older Household Members in Tanzania

HIV/AIDS is drastically changing the demographic landscape in high-prevalence countries in Africa. The prime-age adult population bears the majority of the mortality burden, and these “missing” prime-age adults have implications for the socioeconomic well-being of surviving family members. This study uses a 13-year panel from Tanzania to examine the impacts of prime-age mortality on the time use and health outcomes of older adults, with a focus on long-run impacts and gender dimensions. Prime-age deaths are weakly associated with increases in working hours of older women when the deceased adult was coresident in the household. The association is strongest when the deceased adult was living with the elderly individual at the time of death and for deaths in the distant past, suggesting that shorter-run studies may not capture the full extent of the consequences of adult mortality for survivors. Holding more assets seems to buffer older adults from having to work more after these shocks. Most health indicators are not worse for older adults when a prime-age household member has died, although more distant adult deaths are associated with an increased probability of acute illness for the surviving elderly. For deaths of children who were not residing with their parents at baseline, the findings show no impact on hours worked or health outcomes.

The impact of a novel franchise clinic network on access to medicines and vaccinations in Kenya: a cross-sectional study

Objectives To study the impact of a new franchise health clinic model (The HealthStore Foundations CFWShops) on access to vaccinations and treatment for acute illnesses in a nationally representative sample of children in Kenya. Design The authors used multivariate linear and count regressions to examine associations between receipt of vaccinations or treatment and proximity to a franchise health clinic, adjusting for individual, household and clinic attributes as well as region fixed effects. Setting Demographic and Health Survey data from Kenya, 2008–2009. Participants 6079 Kenyan children younger than 5 years, of whom 2310 reported recent acute illness. Main outcome measures Outcomes for all children were number of polio doses received, number of DPT doses received, receipt of BCG vaccine, receipt of measles vaccine and number of total vaccinations received. Outcomes for acutely ill children were receipt of any medical treatment, treatment for fever, treatment for malaria and treatments specifically stocked by CFWShops. Results Children living within 30 km of a CFWShop received 0.129 (p=0.017) and 0.113 (p=0.025) more DPT and polio doses, respectively; and 0.285 more total vaccinations (p=0.023). Among acutely ill children, CFWShop proximity was associated with significant increases in the probabilities of receiving any medical treatment (0.142; p<0.001), treatment for fever (0.117; p=0.007) and treatments specifically stocked by CFWShops (0.064; p=0.015). Use of CFWShop services was not significantly different for lower-income vis-a-vis higher-income households. Conclusions The franchise health clinic model could substantially increase access to essential vaccinations and treatments in low-income countries. Moreover, the models benefits may accrue to lesser- and higher-income households alike.

Healthcare Choices, Information and Health Outcomes

Self-selection into healthcare options biases estimates of the effects of healthcare on health outcomes. We exploit exogenous variation in the cost of formal-sector care to show that the use of such care improves short-term health outcomes for acutely ill children in Tanzania. Better treatment-specific information, rather than greater access to medicines, appears to be the primary mechanism for this effect: children who use formal-sector care are as a result more likely to get timely treatment and adhere to their medications.

Health, Enterprise, and Labor Complementarity in the Household

We study the role of household enterprise as a coping mechanism after health shocks. Using variation in the cost of traveling to formal sector health facilities to predict recovery from acute illness in Tanzania, we show that individuals with prolonged illness switch from farm labor to enterprise activity. This response occurs along both the extensive (entry) and intensive (capital stock and labor supply) margins. Family members who are not ill exhibit exactly the same pattern of responses. Deriving a simple extension to the canonical agricultural household model, we show that our results suggest complementarities in household labor.

Misdiagnosis, Learning, and the Adoption of New Malaria Therapy in Tanzania

We examine the role of social learning in the adoption of a new and effective therapy for malaria. In our model, individuals learn about the effectiveness of the new therapy by observing the health outcomes of past adopters. We show that misdiagnosis of malaria -- which is common in resource-poor settings -- can slow the learning process and stifle adoption. Using data from a pilot program which distributed the new therapy through health facilities in Tanzania, we estimate a learning effect and test for the role of misdiagnosis in learning and adoption. Our empirical strategy accounts for various potential sources of bias, including persistence in the local disease environment and selection into adoption based on the severity of illness. We find that when past adopters have poor health outcomes, the subsequent probability of adoption decreases. This learning effect is smaller in villages where misdiagnosis is more prevalent, and adoption rates in these places are lower over time. Finally, we simulate pairing the introduction of the new therapy with a new diagnostic test for malaria. The results of the simulation show that when misdiagnosis is reduced, learning occurs more quickly and adoption rates are higher.