Adrienne M. Lucas

The Impact of Malaria Eradication on Fertility

The malaria eradication campaign that started in Sri Lanka in the late 1940s virtually eliminated malaria transmission on the island. I use the preeradication differences in malaria endemicity within Sri Lanka to identify the effect of malaria eradication on fertility and child survival. Malaria eradication increased the number of live births through increasing age-specific fertility and causing an earlier first birth. The effect of malaria on the transition time to higher-order births is inconclusive. Malaria could directly or indirectly affect survival probabilities of live births. I exploit the particular epidemiology of malaria that causes more severe sequelae during an initial pregnancy. I find differential changes in survival probabilities by birth order that are most likely due to the direct in utero effects of malaria. The increase in population growth after malaria eradication reconciles the contradictory findings in the macroeconomic and microeconomic literatures: the increased productivity and education from malaria eradication will only appear in aggregate measures like GDP per capita after a delay because of the initial increase in the population size.

Can at Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?

The single largest item in the US foreign aid health budget is antiretroviral therapy (ART) for the treatment of HIV/AIDS. Many supply- and demand-side factors in sub-Saharan Africa could cause smaller than expected epidemiological effects of this at-scale drug provision. We provide what appears to be the first quasi-experimental evidence on the effect of at-scale drug provision in a poor country, using the phased rollout of ART in Zambia, a setting where approximately one in six adults are HIV positive. Combining anthropometric data from national household surveys and a spatially based triple-difference specification, we find that local ART introduction increased the weight of high HIV likelihood adult women. This finding from a clinically difficult setting suggests that the generalized challenges of scalability of ART for adult health in sub-Saharan Africa are surmountable.

Schooling, Wealth, Risky Sexual Behaviour, and HIV/AIDS in Sub-Saharan Africa

Abstract Economic growth and development have improved human health in many regions, while sub-Saharan Africa continues to lag behind. Economic theory and the existing empirical evidence suggest that development may not generate large reductions in the leading cause of adult mortality in the region, HIV/AIDS, and may increase risky sexual behaviour. We examine the association between schooling/material standard of living and HIV risk using data from more than 500,000 respondents in 32 sub-Saharan African countries. The results of our descriptive analysis suggest that the rapid increase in primary school completion without improvements in living standards or secondary school completion might not mitigate HIV transmission.