Anu Rammohan

Ageing faster with AIDS in Africa

This article discusses how the proportion of elderly people in Africa infected with HIV/AIDS is increasing which brings good and bad news. Good because increased access to treatment means that patients are living with longer life expectancy but bad because meeting the complexities of geriatric care for HIV-infected adults will further challenge overwhelmed health systems. It touches on the neglect in the AIDS response for older people and states that the perception that HIV is a problem only for young people and that older Africans are not at risk for HIV infection needs to be dispelled.

Infant mortality and child nutrition in Bangladesh

The excess female infant mortality observed in South Asia has typically been attributed to gender discrimination in the intra-household allocation of food and medical care. However, studies on child nutrition find no evidence of gender differences. A natural explanation could be that in environments of high infant mortality of females, the surviving children are healthier, so that child nutrition cannot be studied independently of mortality. In this paper, we use data from the 2004 Bangladesh Demographic Health Survey to investigate if there are any gender differences in survival probabilities and whether this leads to differences in child nutrition. We argue the importance of establishing whether or not there exists a dependence relationship between the two random variables--infant mortality and child nutrition--and in order to detect this we employ a copula approach to model specification. The results suggest, for example, that while male children have a significantly lower likelihood of surviving their first year relative to female children, should they survive they have significantly better height-for-age Z-scores. From a policy perspective, household wealth and public health interventions such as vaccinations are found to be important predictors of better nutritional outcomes.

Paternal education status significantly influences infants' measles vaccination uptake, independent of maternal education status.

BackgroundDespite increased funding of measles vaccination programs by national governments and international aid agencies, structural factors encumber attainment of childhood measles immunisation to levels which may guarantee herd immunity. One of such factors is parental education status. Research on the links between parental education and vaccination has typically focused on the influence of maternal education status. This study aims to demonstrate the independent influence of paternal education status on measles immunisation.MethodsComparable nationally representative survey data were obtained from six countries with the highest numbers of children missing the measles vaccine in 2008. Logistic regression analysis was applied to examine the influence of paternal education on uptake of the first dose of measles vaccination, independent of maternal education, whilst controlling for confounding factors such as respondent’s age, urban/rural residence, province/state of residence, religion, wealth and occupation.ResultsThe results of the analysis show that even if a mother is illiterate, having a father with an education of Secondary (high school) schooling and above is statistically significant and positively correlated with the likelihood of a child being vaccinated for measles, in the six countries analysed. Paternal education of secondary or higher level was significantly and independently correlated with measles immunisation uptake after controlling for all potential confounders.ConclusionsThe influence of paternal education status on measles immunisation uptake was investigated and found to be statistically significant in six nations with the biggest gaps in measles immunisation coverage in 2008. This study underscores the imperative of utilising both maternal and paternal education as screening variables to identify children at risk of missing measles vaccination prospectively.

The Determinants of Married Women's Autonomy in Indonesia

Abstract This paper investigates the determinants of married womens autonomy in Indonesia using the 2000 Indonesian Family Life Survey 3 (IFLS3). It considers the role of kinship norms and the effect of labor force participation on married womens autonomy. The measure of autonomy is based on self-reported answers to an array of questions relating to decision-making authority in the household. They include own-clothing, child-related and personal autonomy, physical mobility, and economic autonomy. The analysis examines if variations in womens autonomy are due to the prevailing kinship norms related to marriage in the community. In keeping with the anthropological literature, the analysis finds that living in patrilocal communities reduces physical autonomy for married women, whereas living in uxorilocal communities improves personal and child-related decision-making autonomy. Estimation results show that labor force participation, higher educational attainment, and increases in household wealth all have positive effects on married womens autonomy in Indonesia.

The Impact of Childcare Costs on the Full-Time/Part-Time Employment Decisions of Australian Mothers

Using data from the HILDA (Household Income and Labour Dynamics), this paper examines the implications of childcare costs on maternal employment status by distinguishing between full-time and part-time work. Our empirical approach uses an ordered probit model taking into account the endogeneity associated with both wages and childcare costs. Results indicate that childcare costs have a statistically insignificant effect on the decision to work either full time or part time. Moreover, the reported elasticities of part-time and full-time work with respect to childcare costs are relatively low. Finally, our results indicate that Australian mothers respond to an increase in wages by increasing both their full-time and part-time employment. Conversely, an increase in the number of young children (particularly under four years of age) and an increase in non-labour income reduce the likelihood of the mother is observed to be working.

Maternal autonomy and child nutrition: Evidence from rural Nepal

Purpose - The purpose of this paper is to analyze the main determinants of child nutrition in rural Nepal, focusing on the influential role of maternal autonomy. Design/methodology/approach - This paper uses data from the 2006 Nepal Demographic Health Survey (NDHS) to estimate econometric models using OLS and logit techniques. The dependent variables are the two anthropometric measures of child weight-for-height (a measure of wasting) and height-for-age (a measure of stunting). Findings - No evidence was found of gender discrimination against the girl child in either of our nutritional measures. However, our results show that the explanatory variables have differential effects on male and female children. Estimation results show that maternal autonomy variables have a limited influence on child nutrition measures, but household wealth has a large positive impact on child nutrition, both short-term and long term. Originality/value - The large sample size and the range of questions available in our nationally representative dataset, allows us to explore the influence of household level social and economic factors on child nutrition. A study of the role of maternal decision-making power and control over assets on the nutritional status of children is an important issue in a developing country like Nepal, where health and education outcomes remain poor for large segments of the population.

Addressing Female Iron-Deficiency Anaemia in India: Is Vegetarianism the Major Obstacle?

Objectives. We examined the influence of vegetarian diet on the risk of developing anaemia among Indian women and suggest initiatives for addressing diet-related iron-deficiency anaemia. Methods. We analysed data on diet, social class, and haemoglobin levels from the nationally representative Indian National Family and Health Survey 2005/06 for a sample of 81,301 women aged 15–49 years using logistic regression models. Results. After controlling for individual-level factors and household level socioeconomic characteristics, daily consumption of meat, fish, and eggs was associated with lower odds of being moderately or severely anaemic. Our analysis also revealed that economic characteristics such as being from higher wealth quintiles, being in paid employment, and rural residence reduced the odds of having iron-deficiency anaemia among Indian women. Discussion. As a large proportion of Indians subsist on iron-poor vegetarian diets for religious, economic, and cultural reasons, large-scale iron supplementation and fortification of commonly consumed vegetarian foodstuffs constitute a feasible, culturally appropriate, and cost-effective strategy for addressing this major public health problem. Consumption of cheap iron-rich foodstuffs should be promoted. Effective poverty alleviation and hookworm prevention programs are also important. Large-scale cohort and intervention studies are urgently required to further define the influence of vegetarianism on iron deficiency anaemia in India.

Determinants of Schooling in Egypt: The Role of Gender and Rural/Urban Residence

In this paper, we examine if there are gender differences in schooling attainment and the extent to which these differences are exacerbated for rural children in Egypt. Using a nationally representative cross-sectional survey, our estimation results find strong support for the hypothesis that being male and living in urban areas significantly improves child schooling. We show that relative to a female child who is “never enrolled” in school, a male child is over twice as likely to be currently attending school, and over two-and-a-half times more likely to have some schooling. These positive effects are particularly strong for rural male children. There are also regional variations, with a child (male or female) living in Upper Rural Egypt having a significantly lower likelihood of being currently enrolled. Finally, our estimation results point to large positive effects of fathers education on the probability of current enrolment for all children. Mothers education, however, improves only the likelihood of current enrolment for female children, with no significant effect on male children.

District-level variations in childhood immunizations in India: The role of socio-economic factors and health infrastructure

Routine childhood immunizations against measles and DPT are part of the World Health Organizations (WHO) Expanded Program on Immunization (EPI) set up in 1974, with the aim of reducing childhood morbidity and mortality. Despite this, immunization rates are sub-optimal in developing countries such as India, with wide heterogeneity observed across districts and socio-economic characteristics. The aim of this paper is to examine district-level variations in the propensity to vaccinate a child in India for measles and DPT3, and analyse the extent to which these immunizations are given age-inappropriately, either prematurely or delayed. The present study uses data from the Indian District Level Household Survey (DLHS-3) collected in 2008, and the final sample contains detailed information on 42157 children aged between 12 and 60 months, across 549 Indian districts for whom we have complete information on immunization history. Our empirical study analyses: (i) the district-level average immunization rates for measles and DPT3, and (ii) the extent to which these immunizations have been given age-appropriately. A key contribution of this paper is that we link the household-level data at the district level to data on availability and proximity to health infrastructure and district-level socio-economic factors. Our results show that after controlling for an array of socio-economic characteristics, across all our models, the districts income per capita is a strong predictor of better immunization outcomes for children. Mothers education level at the district-level has a statistically significant and positive influence on immunization outcomes across all our models.

Correlates of first dose of measles vaccination delivery and uptake in Indonesia

OBJECTIVE To determine health systems-related, familial, and cultural factors which influence the delivery and uptake of measles vaccination in Indonesia. METHODS Logistic regression analysis of data collected during the 2007 Indonesian Demographic and Health Survey was undertaken by the authors to investigate these factors. The 2007 Indonesian Demographic and Health Survey dataset is a nationally representative, randomly sampled survey containing 15 065 children aged between 9 and 59 months. RESULTS 72.8% of children had received the measles vaccine. Vaccination coverage was similar for males and females; however, coverage was higher amongst urban children, 80.1%, compared to 68.5% in rural areas. The key findings of the regression analysis were congruent with the results of previous research targeting vaccination coverage. After controlling for all other factors, maternal age, maternal education, wealth, the use of a skilled birth attendant, and postnatal check-ups were positively and significantly (P< 0.01) correlated with measles vaccination. The number of children per household was negatively correlated (P<0.01). CONCLUSIONS In order to enhance measles vaccination coverage in Indonesia, delivery to, and uptake by, rural and low socio-economic populations require substantial improvements. Mass health education and health systems improvements are also required.