John A. Maluccio

Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults

BACKGROUND Substantial, but indirect, evidence suggests that improving nutrition in early childhood in developing countries is a long-term economic investment. We investigated the direct effect of a nutrition intervention in early childhood on adult economic productivity. METHODS We obtained economic data from 1424 Guatemalan individuals (aged 25-42 years) between 2002 and 2004. They accounted for 60% of the 2392 children (aged 0-7 years) who had been enrolled in a nutrition intervention study during 1969-77. In this initial study, two villages were randomly assigned a nutritious supplement (atole) for all children and two villages a less nutritious one (fresco). We estimated annual income, hours worked, and average hourly wages from all economic activities. We used linear regression models, adjusting for potentially confounding factors, to assess the relation between economic variables and exposure to atole or fresco at specific ages between birth and 7 years. FINDINGS Exposure to atole before, but not after, age 3 years was associated with higher hourly wages, but only for men. For exposure to atole from 0 to 2 years, the increase was US

The Impact of Improving Nutrition During Early Childhood on Education Among Guatemalan Adults

0.67 per hour (95% CI 0.16-1.17), which meant a 46% increase in average wages. There was a non-significant tendency for hours worked to be reduced and for annual incomes to be greater for those exposed to atole from 0 to 2 years. INTERPRETATION Improving nutrition in early childhood led to substantial increases in wage rates for men, which suggests that investments in early childhood nutrition can be long-term drivers of economic growth.

Adult consequences of growth failure in early childhood

Using a longitudinal survey from rural Guatemala, we examine the effect of an early childhood nutritional intervention on adult educational outcomes. An intent-to-treat model yields substantial effects of an experimental intervention that provided highly nutritious food supplements to children, a quarter century after it ended: increases of 1.2 grades completed for women and one quarter SD on standardised reading comprehension and non-verbal cognitive ability tests for both women and men. Two-stage least squares results that endogenise the actual supplement intakes corroborate these magnitudes. Improving the nutrient intakes of very young children can have substantial, long-term, educational consequences.

The Impact of Nutrition during Early Childhood on Education among Guatemalan Adults

Background: Growth failure is associated with adverse consequences, but studies need to control adequately for confounding. Objective: We related height-for-age z scores (HAZs) and stunting at age 24 mo to adult human capital, marriage, fertility, health, and economic outcomes. Design: In 2002–2004, we collected data from 1338 Guatemalan adults (aged 25–42 y) who were studied as children in 1969–1977. We used instrumental variable regression to correct for estimation bias and adjusted for potentially confounding factors. Results: A 1-SD increase in HAZ was associated with more schooling (0.78 grades) and higher test scores for reading and nonverbal cognitive skills (0.28 and 0.25 SDs, respectively), characteristics of marriage partners (1.39 y older, 1.02 grade more schooling, and 1.01 cm taller) and, for women, a higher age at first birth (0.77 y) and fewer number of pregnancies and children (0.63 and 0.43, respectively). A 1-SD increase in HAZ was associated with increased household per capita expenditure (21%) and a lower probability of living in poverty (10 percentage points). Conversely, being stunted at 2 y was associated with less schooling, a lower test performance, a lower household per capita expenditure, and an increased probability of living in poverty. For women, stunting was associated with a lower age at first birth and higher number of pregnancies and children. There was little relation between either HAZ or stunting and adult health. Conclusion: Growth failure in early life has profound adverse consequences over the life course on human, social, and economic capital.

Age-based preventive targeting of food assistance and behaviour change and communication for reduction of childhood undernutrition in Haiti: a cluster randomised trial.

Early childhood nutrition is thought to have important effects on education, broadly defined to include various forms of learning. We advance beyond previous literature on the effect of early childhood nutrition on education in developing countries by using unique longitudinal data begun during a nutritional experiment during early childhood with educational outcomes measured in adulthood. Estimating an intent-to-treat model capturing the effect of exposure to the intervention from birth to 36 months, our results indicate significantly positive, and fairly substantial, effects of the randomized nutrition intervention a quarter century after it ended: increased grade attainment by women (1.2 grades) via increased likelihood of completing primary school and some secondary school; speedier grade progression by women; a one-quarter SD increase in a test of reading comprehension with positive effects found for both women and men; and a one-quarter SD increase on nonverbal cognitive tests scores. There is little evidence of heterogeneous impacts with the exception being that exposure to the intervention had a larger effect on grade attainment and reading comprehension scores for females in wealthier households. The findings are robust to an array of alternative estimators of the standard errors and controls for sample attrition.

Trust, Membership in Groups, and Household Welfare: Evidence from KwaZulu-Natal, South Africa

BACKGROUND Food-assisted maternal and child health and nutrition programmes usually target underweight children younger than 5 years of age. Previous evidence suggests that targeting nutrition interventions earlier in life, before children become undernourished, might be more effective for reduction of childhood undernutrition. METHODS We used a cluster randomised trial to compare two World Vision programmes for maternal and child health and nutrition, which included a behaviour change and communication component: a preventive model, targeting all children aged 6-23 months; and a recuperative model, targeting underweight (weight-for-age Z score <-2) children aged 6-60 months. Both models also targeted pregnant and lactating women. Clusters of communities (n=20) were paired on access to services and other factors and were randomly assigned to each model. Using two cross-sectional surveys (at baseline and 3 years later), we tested differences in undernutrition in children aged 12-41 months (roughly 1500 children per survey). Analyses were by intention to treat, both by pair-wise community-level comparisons and by child-level analyses adjusting for the clustering effect and child age and sex. This study is registered with ClinicalTrials.gov, number NCT00210418. FINDINGS There were no differences between programme groups at baseline. At follow-up, stunting, underweight, and wasting (using WHO 2006 reference data) were 4-6 percentage points lower in preventive than in recuperative communities; and mean anthropometric indicators were higher by +0.14 Z scores (height for age; p=0.07), and +0.24 Z scores (weight for age and weight for height; p<0.0001). The effect was greater in children exposed to the preventive programme for the full span between 6 and 23 months of age than in children exposed for shorter durations during this period. The quality of implementation did not differ between the two programmes; nor did use of services for maternal and child health and nutrition. INTERPRETATION The preventive programme was more effective for the reduction of childhood undernutrition than the traditional recuperative model.

The Nutrition Intervention Improved Adult Human Capital and Economic Productivity

Unfortunately these two literatures have remained largely unconnected. The group and network literature concludes that participation has important economic benefits even when the stated function of the group is noneconomic. In most cases however the mechanisms by which groups and networks achieve this are unclear. The determinants-of-trust and participation-in-groups literature highlights the importance of income and social homogeneity. What remains less understood is whether—and how—trust can be generated for example via participation in groups. This article links the empirical literatures referenced above by exploring the relationship between membership in groups and trust. Specifically using longitudinal data from KwaZulu-Natal Province South Africa we examine (1) the importance of trust in the decision to join groups; (2) the subsequent ability of groups to generate trust; and (3) the effect of group membership and trust on a measure of well-being per capita household income. In addition we disaggregate groups into financial and nonfinancial and we categorize “trust in people” by agent or actor. Therefore we can explore whether trust in different kinds of actors is important for participation in different kinds of groups and whether participation in different kinds of groups is important for generating trust in different kinds of actors. (excerpt)

Eradicating diseases: The effect of conditional cash transfers on vaccination coverage in rural Nicaragua.

This article reviews key findings about the long-term impact of a nutrition intervention carried out by the Institute of Nutrition of Central America and Panama from 1969 to 1977. Results from follow-up studies in 1988-89 and 2002-04 show substantial impact on adult human capital and economic productivity. The 1988-89 study showed that adult body size and work capacity increased for those provided improved nutrition through age 3 y, whereas the 2002-04 follow-up showed that schooling was increased for women and reading comprehension and intelligence increased in both men and women. Participants were 26-42 y of age at the time of the 2002-04 follow-up, facilitating the assessment of economic productivity. Wages of men increased by 46% in those provided with improved nutrition through age 2 y. Findings for cardiovascular disease risk factors were heterogeneous; however, they suggest that improved nutrition in early life is unlikely to increase cardiovascular disease risk later in life and may indeed lower risk. In conclusion, the substantial improvement in adult human capital and economic productivity resulting from the nutrition intervention provides a powerful argument for promoting improvements in nutrition in pregnant women and young children.

The Impact of Conditional Cash Transfers on Consumption and Investment in Nicaragua

Despite significant global efforts to improve vaccination coverage against major childhood diseases, vaccination rates are below 90%. To eradicate diseases such as measles, however, vaccination rates close to 95% are needed. We use a randomized experiment to investigate the effect of a demand incentive, a conditional cash transfer program, in improving vaccination coverage in rural Nicaragua. Double-difference estimates show the program led to large increases in vaccination coverage, and these resulted in vaccination levels greater than 95% for some vaccines. Effects were especially large for children who are typically harder to reach with traditional supply-side interventions.

The human capital study 2002-04: tracking, data collection, coverage, and attrition.

Abstract This article examines the impact of a Nicaraguan conditional cash transfer programme on measures of expenditures and productive investment. Despite clear evidence from a randomised evaluation that the programme increased current expenditures, there is little evidence that it increased agricultural or non-agricultural investment. An estimated marginal propensity to consume out of the transfers of nearly one, combined with no effect of cumulative past transfers on current consumption, corroborate the direct evidence on investment. In contrast to gains made in human capital investment, the potential for long term increases in consumption as a result of other forms of increased investment may be limited.