Coffey hemoglobin presentation_short_version

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2. 3. 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 WHO (2005) estimated anemia prevalence among children under five 4. 5. causes of hemoglobin deficiency in young children malaria intestinal parasites environmental enteropathy dietary deficiencies on diet and disease, see Friis et al., 2003 background 6. links between OD & hemoglobin open defecation spreads intestinal parasites worms live in feces feces on the ground get onto feet and into mouths this has been known since at least the 1930s (Cairncross, 2003) open defecation exposes kids to fecal pathogens that could lead to enteropathy background 7. links between height & hemoglobin this study is consistent with other research on open defecation and height open defecation thought to cause stunting through enteropathy and diarrhea research indicates that hemoglobin deficiency causes children to be shorter and thinner larger bodies need more red blood cells to transport oxygen (see Owen, 1989) background 8. 1. cross country analysis 9. data hemoglobin: Demographic & Health Surveys from 45 countries 81 surveys have kids 6-35 months surveys date from 1995 2012 almost 60% of surveys are from SSA GDP/capita: Penn World Tables malaria: WHO incidence estimates (Korenromp, 2005) cross country analysis 10. identification how are open defecation levels across countries and years associated with hemoglobin levels across countries and years? cross sectional analysis 11. open defecation predicts average hemoglobin across countries 12. specification hcry is the average gm/dL of hemoglobin of children 6-35 months in country c, in region r, in year y odcry is the fraction of households openly defecating in country c, in region r, in year y mcr2004: the countrys estimated incidence of malaria (new cases per year/number of people at risk) GDPcry: country and year specific per capita GDP y : year fixed effects cross country analysis 13. open defecation predicts average hemoglobin across countries 14. additional specifications (not shown) use log of open defecators per square kilometer as an independent variable use the 77 country years with hemoglobin measures for kids aged 6 to 59 months cross country analysis 15. 2. cross sectional analysis from India & Nepal 16. 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 1990 2010 fractionofthepopulationwithnoaccesstosanitation open defecation is worst in South Asia from: WHO & Unicef Joint Monitoring Report, 2012 17. data Indias National Family Health Survey 3 (2005) 36,000 kids 6-59 months with hemoglobin data 26,000 kids with hemoglobin & food intake data Nepals Demographic & Health Survey (2011) 2,100 kids with hemoglobin data 1,000 kids with hemoglobin & food intake data cross sectional analysis: India & Nepal 18. identification how is open defecation across places within South Asian countries associated with hemoglobin levels of children in those places? cross sectional analysis: India & Nepal 19. summary statistics 20. specification hip is the hemoglobin (gm/dL) of child i in primary sampling unit (PSU) p odp is the fraction of households openly defecating in the childs PSU Mip (medicine): does the child take iron supplements?; did she take de-worming medicine in last 6 months? Fip (food): breast feeding; number of time fed solid/semi-solid food in last 24 hours; ate meat in last 24 hours; ate dark green leafy vegetables in last 24 hours cross sectional analysis: India & Nepal 21. elecp is the fraction of households in the childs PSU with electricity urbanp is whether or not the childs PSU is urban Eip (mothers education): linear or dummy variable controls for mothers education SESip (socioeconomic status): childs household wealth percentile, or asset ownership dummies (AipXsexip): 120 sex-specific age-in-month indicators cross sectional analysis: India & Nepal 22. open defecation predicts hemoglobin in India 23. open defecation predicts hemoglobin in Nepal 24. 3. fixed effects analysis from Nepal 25. data Nepals Demographic & Health Surveys from 2006 and 2011 4,680 kids 6-59 months in 2006 2,100 kids 6-59 months in 2011 15 percentage point drop in open defecation from 2006-2011 about 50% of households (2006) to about 35% of households (2011) fixed effects analysis: Nepal 26. identification how is change over time in open defecation within 25 urban and rural parts of each DHS region (subsequently referred to as regions) associated with change in hemoglobin levels in those regions? fixed effects analysis: Nepal 27. specification hiyr: hemoglobin measure of child i, in year y, in region r odyr: fraction of HH openly defecating in the childs region elecyr: fraction of HH with electricity in the childs region y: year of survey fixed effect (indicator for 2011) r: region fixed effect Eiyr: indicators for mothers years of education SESiyr: economic status dummies (Aiyr X sexiyr): 120 sex-specific age-in-month indicators fixed effects analysis: Nepal 28. change in open defecation predicts change in hemoglobin in Nepal 29. 30. 31. summary statistics