Three Essays in Health Economics

I examine three issues in health economics. I first consider the effect of smoking bans on weight gain and find that while smoking bans do not lead to weight gain among the whole population, they may lead to slight increases in weight gain among current smokers. In the second essay I examine differences in maternal and infant health outcomes among mothers enrolled in the WIC program using a regression discontinuity approach. Results indicate that WIC participation decreases the likelihood of premature births, reduces the likelihood of breastfeeding and leads to decreases in maternal weight gain during pregnancy. Finally I examine how insurance coverage contributes to an individual\u27s decision to utilize several preventive care services. I find that in all cases individuals with insurance coverage are more likely to utilize all preventive care services examined and also that visiting a doctor\u27s office in the previous year is a significant driver in the uptake of preventive care services

The role of Ecotourism in the Reconstruction of postwar Rwanda.

Magister Artium (Development Studies) - MA(DVS)The study examines the role of ecotourism in the reconstruction of post-war Rwanda. This is in the context of widespread poverty throughout Rwanda, and the government's efforts to improve the population's welfare, following years of civil war .. The study is based on secondary data review, including government's policies on poverty alleviation, literature on the role of ecotourism in development and a case study of a national park where ecotourism is seen as bringing in much needed revenue. The study concludes that ecotourism in Rwanda has potential to contribute to economic growth, and this is in part due to the country's unique flora and fauna. However, the study also points out that several challenges to this potential remain. These include the country's still shaky security and the widespread poverty itself

Acceptance of Anti-Retroviral Therapy among Patients Infected with HIV and Tuberculosis in Rural Malawi Is Low and Associated with Cost of Transport

BACKGROUND: A study was conducted among newly registered HIV-positive tuberculosis (TB) patients systematically offered anti-retroviral treatment (ART) in a district hospital in rural Malawi in order to a) determine the acceptance of ART b) conduct a geographic mapping of those placed on ART and c) examine the association between “cost of transport” and ART acceptance. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cross-sectional analysis was performed on routine program data for the period of February 2003 to July 2004. Standardized registers and patient cards were used to gather data. The place of residence was used to determine road distances to the Thyolo district hospital. Cost of transport from different parts of the district was based on the known cost for public transport to the road-stop closest to the patient's residence. Of 1,290 newly registered TB patients, 1,003(78%) underwent HIV-testing of whom 770 (77%) were HIV-positive. 742 of these individuals (pulmonary TB = 607; extra-pulmonary TB = 135) were considered eligible for ART of whom only 101(13.6%) accepted ART. Cost of transport to the hospital ART site was significantly associated with ART acceptance and there was a linear trend in association between cost and ART acceptance (X(2) for trend = 25.4, P<0.001). Individuals who had to pay 50 Malawi Kwacha (1 United States Dollar = 100 Malawi Kwacha, MW) or less for a one-way trip to the Thyolo hospital were four times more likely to accept ART than those who had to pay over 100 MW (Adjusted Odds ratio = 4.0, 95% confidence interval: 2.0–8.1, P<0.001). CONCLUSIONS/SIGNIFICANCE: ART acceptance among TB patients in a rural district in Malawi is low and associated with cost of transport to the centralized hospital based ART site. Decentralizing the ART offer from the hospital to health centers that are closer to home communities would be an essential step towards reducing the overall cost and burden of travel