The mental health of youth and young adults during the transition to adulthood in Egypt

Background: There has been growing interest in the stalled transition to adulthood in the Middle East and North Africa (MENA) and its consequences for young people's socioeconomic outcomes. However, little is known about how important life transitions relate to youth psychosocial well-being in the region. Objective: Drawing on a life course framework, we estimate the associations between making transitions in education, employment, and marriage with changes in mental health among young people in Egypt. Methods: We descriptively analyze mental health scores, measured via the Self-Reporting Questionnaire-20 and disaggregated by gender, for a panel of young people first surveyed in 2009 at ages 13-29 and followed up in late 2013 and early 2014. We regress change in mental health scores against indicators of making different transitions. Results: Young women experience worse mental health than young men overall. Lower school achievement was associated with poorer mental health; being out of the labor force was an additional risk factor for young men. While average mental health scores improved over time, over a quarter of the sample experienced worsening mental health, related to failure to marry and find a job among older men, and failure to finish schooling among younger women. Conclusions: Mental health is an important but often overlooked component of youth well-being during the transition to adulthood in MENA, and potentially other low- and middle-income countries. Contribution: This is the first paper to empirically examine the relationship between psychosocial well-being and achieving important socioeconomic milestones among a nationally representative cohort of young people in MENA

Exploration of pathways related to the decline in female circumcision in Egypt

BACKGROUND: There has been a large decline in female genital circumcision (FGC) in Egypt in recent decades. Understanding how this change has occurred so rapidly has been an area of particular interest to policymakers and public health officials alike who seek to further discourage the practice elsewhere. METHODS: We document the trends in this decline in the newest cohorts of young girls and explore the influences of three pathways—socioeconomic development, social media messages, and women’s empowerment—for explaining the observed trends. Using the 2005 and 2008 Egypt Demographic and Health Surveys, we estimate several logistic regression models to (1) examine individual and household determinants of circumcision, (2) assess the contributions of different pathways through which these changes may have occurred, and (3) assess the robustness of different pathways when unobserved community differences are taken into account. RESULTS: Across all communities, socioeconomic status, social media messages, and women’s empowerment all have significant independent effects on the risk of circumcision. However, after accounting for unobserved differences across communities, only mother’s education and household wealth significantly predict circumcision outcomes. Additional analyses of maternal education suggest that increases in women’s education may be causally related to the reduction in FGC prevalence. CONCLUSIONS: Women’s empowerment and social media appear to be more important in explaining differences across communities; within communities, socioeconomic status is a key driver of girls’ circumcision risk. Further investigation of community-level women’s educational attainment for mothers suggests that investments made in female education a generation ago may have had echo effects on girls’ FGC risk a generation later

The economic benefits of malaria elimination: do they include increases in tourism?

BACKGROUND: Policy makers have speculated that one of the economic benefits of malaria elimination includes increases in foreign direct investment, particularly tourism. METHODS: This study examines the empirical relationship between the demand for travel and malaria cases in two countries with large tourism industries around the time in which they carried out malaria-elimination campaigns. In Mauritius, this analysis examines historical, yearly tourist arrivals and malaria cases from 1978–1999, accounting for the background secular trend of increasing international travel. In Dominican Republic, a country embarking upon malaria elimination, it employs a time-series analysis of the monthly, international tourist arrivals from 1998–2010 to determine whether the timing of significant deviations in tourist arrivals coincides with malaria outbreaks. RESULTS: While naïve relationships exist in both cases, the results show that the relationships between tourist arrivals and malaria cases are relatively weak and statistically insignificant once secular confounders are accounted for. CONCLUSIONS: This suggests that any economic benefits from tourism that may be derived from actively pursuing elimination in countries that have high tourism potential are likely to be small when measured at a national level. Rather, tourism benefits are likely to be experienced with greater impact in more concentrated tourist areas within countries, and future studies should seek to assess these relationships at a regional or local level

Income Inequality and Mortality: The Costa RIcan Case

In recent decades there has been much debate on the extent to which income inequality affects health outcomes. The majority of studies in this literature have examined the relationship between income distribution and health outcomes in the contexts of high-income nations. This dissertation evaluates both the ecological and individual-level relationship between income inequality and mortality in the context of a middle-income country, Costa Rica. The Costa Rican case is particularly interesting because its strong social safety net, political organization, and history limit the effects of income inequality on health through indirect channels. Using 20 years of household data, this study begins by documenting changes in income inequality at the canton level. These data reveal that on average inequality has been growing at an annual rate of 0.5%. Using these inequality data, Vital Statistics Mortality records, and longitudinal methods, this study next examines whether cantons with greater growth in inequality also experienced increasing mortality. The analyses indicate that there is no relationship between changes in income inequality and changes in all-cause mortality; however, a relationship does exist for specific causes of death. Area-level inequality was found to be associated with an increase in suicide mortality rates, and a decrease in cardiovascular, respiratory cancer, and breast cancer mortality rates. At the individual-level survival analysis was applied to a new census-mortality linked dataset that allows for a 20-year prospective follow-up. These individual level analyses also test whether income inequality disproportionately affects the poor. In the case of all-cause mortality, the results suggest that there is no association between income inequality and time to death for either the entire sample or for the poor. Contrary to expectations the magnitudes of the estimated effects indicate that residents living in areas with increasing income inequality had a survival advantage for cardiovascular mortality, which further confirms the results found at the ecological level. Overall, this study finds that while inequality has been increasing in Costa Rica, it had limited effect on mortality, indicating that in an environment where safety net services are available, the negative effects of income inequality may be limited to suicide mortality

Income Inequality and Mortality: The Costa RIcan Case

In recent decades there has been much debate on the extent to which income inequality affects health outcomes. The majority of studies in this literature have examined the relationship between income distribution and health outcomes in the contexts of high-income nations. This dissertation evaluates both the ecological and individual-level relationship between income inequality and mortality in the context of a middle-income country, Costa Rica. The Costa Rican case is particularly interesting because its strong social safety net, political organization, and history limit the effects of income inequality on health through indirect channels. Using 20 years of household data, this study begins by documenting changes in income inequality at the canton level. These data reveal that on average inequality has been growing at an annual rate of 0.5%. Using these inequality data, Vital Statistics Mortality records, and longitudinal methods, this study next examines whether cantons with greater growth in inequality also experienced increasing mortality. The analyses indicate that there is no relationship between changes in income inequality and changes in all-cause mortality; however, a relationship does exist for specific causes of death. Area-level inequality was found to be associated with an increase in suicide mortality rates, and a decrease in cardiovascular, respiratory cancer, and breast cancer mortality rates. At the individual-level survival analysis was applied to a new census-mortality linked dataset that allows for a 20-year prospective follow-up. These individual level analyses also test whether income inequality disproportionately affects the poor. In the case of all-cause mortality, the results suggest that there is no association between income inequality and time to death for either the entire sample or for the poor. Contrary to expectations the magnitudes of the estimated effects indicate that residents living in areas with increasing income inequality had a survival advantage for cardiovascular mortality, which further confirms the results found at the ecological level. Overall, this study finds that while inequality has been increasing in Costa Rica, it had limited effect on mortality, indicating that in an environment where safety net services are available, the negative effects of income inequality may be limited to suicide mortality

Evaluation of SMS reminder messages for altering treatment adherence and health seeking perceptions among malaria care-seekers in Nigeria.

In Nigeria, access to malaria diagnostics may be expanded if drug retailers were allowed to administer malaria rapid diagnostic tests (RDTs). A 2012 pilot intervention showed that short message service (SMS) reminder messages could boost treatment adherence to RDT results by 10-14% points. This study aimed to replicate the SMS intervention in a different population, and additionally test the effect of an expanded message about anticipated RDT access policy change on customers' acceptability for drug retailers' administration of RDTs. One day after being tested with an RDT, participants who purchased malaria treatment from drug shops were randomized to receive (1) a basic SMS reminder repeating the RDT result and appropriate treatment actions, (2) an expanded SMS reminder additionally saying that the 'government might allow pharmacists/chemists to do RDTs' or (3) no SMS reminders (i.e. control). Using regression analysis, we estimate intent-to-treat (ITT) and treatment effects on the treated for 686 study participants. Results corroborate previous findings that a basic SMS reminder increased treatment adherence [odds ratio (OR) = 1.53, 95% CI 0.96-2.44] and decreased use of unnecessary anti-malarials for RDT-negative adults [OR = 0.63, 95% CI 0.39-1.00]. The expanded SMS also increased adherence for adults [OR = 1.42, 95% CI 0.97-2.07], but the effects for sick children differed-the basic SMS did not have any measurable impact on treatment adherence [OR = 0.87, 95% CI 0.24-3.09] or use of unnecessary anti-malarials [OR = 1.27, 95% CI 0.32-1.93], and the expanded SMS actually led to poorer treatment adherence [OR = 0.26, 95% CI 0.10-0.66] and increased use of unnecessary anti-malarials [OR = 4.67, 95% CI 1.76-12.43]. Further, the targeted but neutral message in the expanded SMS lowered acceptance for drug retailers' administration of RDTs [OR = 0.55, 95% CI 0.10-2.93], counter to what we hypothesized. Future SMS interventions should show consistent positive results across populations and be attuned to message length and content before initiating a larger messaging campaign

Exploration of pathways related to the decline in female circumcision in Egypt

Abstract Background There has been a large decline in female genital circumcision (FGC) in Egypt in recent decades. Understanding how this change has occurred so rapidly has been an area of particular interest to policymakers and public health officials alike who seek to further discourage the practice elsewhere. Methods We document the trends in this decline in the newest cohorts of young girls and explore the influences of three pathways—socioeconomic development, social media messages, and women’s empowerment—for explaining the observed trends. Using the 2005 and 2008 Egypt Demographic and Health Surveys, we estimate several logistic regression models to (1) examine individual and household determinants of circumcision, (2) assess the contributions of different pathways through which these changes may have occurred, and (3) assess the robustness of different pathways when unobserved community differences are taken into account. Results Across all communities, socioeconomic status, social media messages, and women’s empowerment all have significant independent effects on the risk of circumcision. However, after accounting for unobserved differences across communities, only mother’s education and household wealth significantly predict circumcision outcomes. Additional analyses of maternal education suggest that increases in women’s education may be causally related to the reduction in FGC prevalence. Conclusions Women’s empowerment and social media appear to be more important in explaining differences across communities; within communities, socioeconomic status is a key driver of girls’ circumcision risk. Further investigation of community-level women’s educational attainment for mothers suggests that investments made in female education a generation ago may have had echo effects on girls’ FGC risk a generation later