Sanitation and Child Health in India

This study contributes to the understanding of key drivers of stunted growth, a factor widely recognized as major impediment to human capital development. Specifically, it examines the effects of sanitation coverage and usage on child height for age in a semi-urban setting in Northern India. The study uses instrumental variables to control for endogeneity of sanitation usage coverage. The study finds that sanitation coverage plays a significant and positive role in height growth during the first years of life

Behavioural response to a sudden health risk: Dengue and educational outcomes in Colombia

Epidemics tend to have a debilitating influence on the lives of directly afflicted families. However, the presence of an epidemic can also change the behaviour and outcomes of those not directly affected. This paper makes use of a short, sharp, unexpected epidemic to examine the behavioural response of the general public to a sudden shift in the perceived risk to an individual's health and mortality. Our analysis finds that unafflicted school students change their behaviour substantially, affecting important life outcomes. In particular, we find that close to 4 fewer students, out of a typical class of 47 pupils, sit their school leaving examination for every additional 10 cases of severe Dengue per 10 000 inhabitants in a municipality. We rule out several possible mechanisms, leaving an increase in the salience of the disease's risks as a plausible explanation for our findings

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Estimating the gains of early detection of hypertension over the marginal patient

Este estudio estimó el impacto potencial de los programas de diagnóstico temprano en los resultados de salud en Inglaterra. Específicamente, si aconsejar a las personas que visiten a su médico de cabecera debido a un caso sospechoso de hipertensión leve daría como resultado (i) un aumento en el diagnóstico y tratamiento de la presión arterial alta; (ii) un mejor estilo de vida reflejado en medidas objetivas como el índice de masa corporal y los niveles de presión arterial; (iii) una probabilidad reducida de aparición de otras enfermedades cardiovasculares, como la diabetes. Para abordar el posible sesgo de selección en la selección, se explota una característica del Estudio Longitudinal Inglés del Envejecimiento, lo que motiva un diseño de discontinuidad de regresión. Si las mediciones de la presión arterial de los encuestados están por encima de un umbral clínico estándar, se les recomienda visitar a su médico de familia para confirmar la hipertensión. Dos años después del protocolo, hay evidencia de un aumento en el diagnóstico (5,7 pp, p-val = 0,06) y el uso de medicamentos (6 pp, p-val = 0,007) para el tratamiento de la enfermedad. Sin embargo, cuatro años después del protocolo, la diferencia en diagnóstico y medicación desapareció (4 pp, p-val = 0,384; 3,4 pp, p-val = 0,261). Además, no hay diferencias en los niveles de presión arterial observados (sistólica 0,026 mmHg, p-val = 0,815; diastólica -0,336 mmHg, p-val = 0,765), o índice de masa corporal ((0,771, p-val = 0,154)) . Tampoco hay diferencias en el diagnóstico de diabetes (1,7 pp, p-val = 0,343) o enfermedades relacionadas con el corazón (3,6 pp, p-value = 0,161). En conclusión, el empujón produce un diagnóstico más temprano de alrededor de dos años, pero no hay ganancias perceptibles en los resultados de salud después de cuatro años.This study estimated the potential impact of early diagnosis programs on health outcomes in England. Specifically, if advising individuals to visit their family doctor due to a suspected case of mild hypertension would result in (i) an increase in the diagnosis and treatment of high blood pressure; (ii) an improved lifestyle reflected in objective measures such as the body-mass-index and blood pressure levels; (iii) a reduced probability of the onset of other cardiovascular diseases, such as diabetes. To address potential selection bias in screening, a feature of the English Longitudinal Study of Ageing is exploited, motivating a regression discontinuity design. If respondents’ blood pressure measurements are above a standard clinical threshold, they are advised to visit their family doctor to confirm hypertension. Two years after the protocol, there is evidence of an increase in diagnosis (5.7 pp, p-val = 0.06) and medication use (6 pp, p-val = 0.007) for treating the condition. However, four years after the protocol, the difference in diagnosis and medication disappeared (4 pp, p-val = 0.384; 3.4 pp, p-val = 0.261). Moreover, there are no differences on observed blood pressure levels (systolic 0.026 mmHg, p-val = 0.815; diastolic -0.336 mmHg, p-val = 0.765), or Body-Mass Index ((0.771, p-val = 0.154)). There are also no differences on diagnosis of diabetes (1.7 pp, p-val = 0.343) or heart related conditions (3.6 pp, p-value = 0.161). In conclusion, the nudge produces an earlier diagnosis of around two years, but there are no perceivable gains in health outcomes after four years

Informal versus Formal: Microfirms' Productivity Gaps

Aunque existe evidencia de una brecha de productividad entre las empresas formales e informales, esta "prima de formalidad" está menos explorada en el caso de las microempresas. La informalidad de las microempresas es una preocupación central en los países de ingresos bajos y medios, y es clara su necesidad para el diseño de políticas que aborden esta cuestión, ya que constituyen el grueso del tejido económico. Llenamos este vacío estimando una prima de productividad para el caso de Colombia, considerando dos márgenes de informalidad: el extensivo, referido al registro de empresas, y el intensivo, que incluye también las regulaciones laborales. Utilizamos un conjunto de datos longitudinales único de la Encuesta de Microestablecimientos del DANE, que sigue a aproximadamente 39.000 microempresas con hasta 9 empleados durante 2012-2016. Utilizamos la transición hacia y desde la formalidad para estimar la prima de productividad (ventas anuales por trabajador) entre las empresas informales y las formales, explorando así las diferencias relativas a la productividad inicial. Utilizamos una regresión cuantílica de efectos fijos. Encontramos evidencia de una prima para los márgenes extensivo e intensivo, una brecha que disminuye junto con la productividad de la empresa. La evidencia de estas primas está relacionada con dos estrategias de crecimiento de las empresas: un aumento de las inversiones de capital para el margen extensivo y un aumento de la calidad del capital humano para el margen intensivo. Además, encontramos que la prima es notoriamente más amplia para las empresas jóvenes (menos de tres años en el negocio) con un gradiente más pronunciado. No encontramos diferencias sistemáticas entre sectores, género de los propietarios y motivación. Estos resultados son una nueva evidencia que apoya la existencia de una prima y la transición hacia y desde la formalidad de las microempresas en los países de renta media. Además, sugieren que las políticas de formalización y crecimiento de las microempresas deberían orientarse a promover y potenciar los beneficios de la formalidad.Although evidence of a productivity gap between formal and informal firms is observed, this 'formality premium' is less explored for microfirms. The informality of microfirms is a central concern in low- and middle-income countries, and a crucial demand is noted for designing policies addressing this issue because they are the bulk of the economic tissue. We fill this void by estimating a productivity premium for the case of Colombia, considering two margins of informality: extensive, referring to business registration, and the intensive, which includes as well labor regulations. We use a unique longitudinal dataset from the Microenterprise Survey by the Colombian Statistics Department, which follows approximately 39,000 microfirms with up to 9 employees during 2012–2016. We utilize the transition into and out of formality to estimate the productivity premium (yearly sales per worker) between informal and formal firms, thereby exploring differences concerning initial productivity. We use a fixed-effects quantile regression for self-employees and firms of two or more workers. We find evidence of a premium for both the extensive and intensive margins, a gap that is decreasing along with the firm's productivity. The evidence of these premiums is related to two growth strategies of firms: an increase in capital investments for the extensive margin and an increase in human capital quality for the intensive margin. Further, we find the premium is notoriously wider for young firms (less than three years in the business) with a steeper gradient. We do not find systematic differences across sectors, gender of the owners, and motivation. These results are new evidence that supports the existence of a premium and the transition into and out of formality of microfirms in middle-income countries. Moreover, they suggest that microfirms' formalization and growth policies should be oriented toward promoting and enhancing formality's benefits

Wealth and inequality gradients for the detection and control of hypertension in older individuals in middle-income economies around 2007-2015

Las desigualdades socioeconómicas en la detección y tratamiento de enfermedades no transmisibles representan un desafío para los sistemas de salud de los países de ingresos medios (PRM) en el contexto del envejecimiento de la población. Este desafío es particularmente apremiante con respecto a la hipertensión debido a su creciente prevalencia entre las personas mayores en los PRM, especialmente entre aquellos con un nivel socioeconómico (SES) más bajo. Usando datos comparativos de China, Colombia, Ghana, India, México, Rusia y Sudáfrica, evaluamos sistemáticamente la asociación entre el SES, medido en forma de índice de riqueza, y la detección y control de la hipertensión alrededor de los años 2007-15. Además, determinamos qué factores observables, como las características sociodemográficas y de salud, explican las desigualdades existentes relacionadas con el NSE en la detección y el control de la hipertensión utilizando una descomposición de Blinder-Oaxaca. Los resultados muestran que la prevalencia de hipertensión no detectada se asocia significativamente con un NSE más bajo. Para la hipertensión no controlada, existe evidencia de un gradiente significativo en tres de los seis países en el momento en que se recolectaron los datos. Las diferencias entre las áreas rurales y urbanas, así como entre las personas con un nivel educativo bajo y alto, representan la mayor proporción de las desigualdades SES en la detección y el control de la hipertensión en ese momento. El mejor acceso a la atención primaria de la salud en los PRM desde entonces puede haber contribuido a una reducción de las desigualdades en salud en la detección y el tratamiento de la hipertensión. Sin embargo, queda por investigar si este ha sido el caso.Socioeconomic inequalities in the detection and treatment of non-communicable diseases represent a challenge for healthcare systems in middle-income countries (MICs) in the con text of population ageing. This challenge is particularly pressing regarding hypertension due to its increasing prevalence among older individuals in MICs, especially among those with lower socioeconomic status (SES). Using comparative data for China, Colombia, Ghana, India, Mexico, Russia and South Africa, we systematically assess the association between SES, measured in the form of a wealth index, and hypertension detection and control around the years 2007-15. Furthermore, we determine what observable factors, such as socio-demographic and health characteristics, explain existing SES-related inequalities in hypertension detection and control using a Blinder-Oaxaca decomposition. Results show that the prevalence of undetected hypertension is significantly associated with lower SES. For uncontrolled hypertension, there is evidence of a significant gradient in three of the six countries at the time the data were collected. Differences between rural and urban areas as well as lower and higher educated individuals account for the largest proportion of SES inequalities in hypertension detection and control at the time. Improved access to primary healthcare in MICs since then may have contributed to a reduction in health inequalities in detection and treatment of hypertension. However, whether this indeed has been the case remains to be investigated

Short Term Health Shocks and School Attendance: The Case of a Dengue Fever Outbreak in Colombia.

This paper makes use of a short, sharp, unexpected health shock in the form of the 2010\ud Colombian Dengue outbreak to examine the direct and indirect impact of negative health\ud shocks on behaviour of households in affected areas. Our analysis combines data from several sources in order to obtain a comprehensive picture of the influence of the outbreak, and furthermore to understand the underlying mechanisms driving the effects. Our initial analysis indicates that the outbreak had a substantial negative effect on the health status of adults and adversely affected their ability to function as usual in their daily lives. In our aggregated school data, in areas with high levels of haemorrhagic Dengue we observe a reduction innational exam attendance (last year of secondary school) and on enrolment rates in primary education. Further analysis aims to exploit detailed individual level data to gain a more in depth understanding of the precise channels through which this disease influenced the behaviour and outcomes of the poor in Colombia

Are Public Libraries Improving Quality of Education? : When the Provision of Public Goods is Not Enough

This paper analyzes the relation between public, education-related infrastructure and the quality of education in schools. The analysis uses a case study of the establishment of two large, high-quality public libraries in low-income areas in Bogotá, Colombia. It assesses the impact of these libraries on the quality of education by comparing national test scores (SABER 11) for schools close to and far from the libraries before (2000–02) and after (2003–08) the libraries were opened. The paper introduces a Blinder-Oaxaca decomposition on difference-in-differences estimates to assess whether variation of traditional determinants of mathematics, verbal, and science test scores explains the estimates. The analysis finds differences that are not statistically different from zero that could be attributed to the establishment of the libraries. These results are robust to alternative specifications, a synthetic control approach, and an alternative measure of distance

Sanitation and marriage markets in India: Evidence from the total sanitation campaign

We analyse the marriage decisions of men and women in rural India, focusing on the added attractiveness of sanitation within the marital living arrangement. We demonstrate that the Government's Total Sanitation Campaign (TSC) changed marriage market outcomes for both men and women. To decompose the overall policy impact on the marriage market equilibrium, we develop a simple matching model. The model is identified and estimated using data from the Indian Human Development household survey (IHDS) and quasi-random variation from the TSC. Decompositions reveal that (i) cohorts within TSC exposed markets experienced a shift in marital gains both across matches and within a given match, which is characterised by a marked gender asymmetry, and that (ii) TSC exposure led to a decline in women's effective control over resources, reflected in the surplus division