Malaria and Primary Education : A Cross-Country Analysis on Primary Repetition and Completion Rates

This paper explores the link between P. Falciparum malaria - most of malaria morbidity and mortality is due to the malignant Plasmodium Falciparum - and primary education in terms of school performances at the macroeconomic stage. Cross-country regression analysis shows that the relation between school results (measured by repetition and completion rates) and the P. Falciparum malaria index is strong. The results implies that the achievement of the education Millennium Development Goals will require more than just focusing on expenditure in primary education. It does not imply that resources in education are unnecessary but that increasing resources in education and improving education resources management alone are unlikely to be sufficient. This paper suggests that health conditions and especially diseases that alter cognitive capacities of children such as malaria should be taken into account much more seriously. This study also sees the need to place emphasis on research that will improve the quality of interventions to prevent malaria. Specific education expenditure to face Malaria should be examined in addition to health policies.Malaria incidence, human capital, development.

‘Recessions, healthy no more?’: A note on Recessions, Gender and Mortality in France

URL des Documents de travail : http://ces.univ-paris1.fr/cesdp/cesdp2016.htmlDocuments de travail du Centre d'Economie de la Sorbonne 2016.08 - ISSN : 1955-611XThis study uses aggregate panel data on 96 French départements from 1982 to 2012 to investigate the relationship between macroeconomic conditions, gender and mortality. I use previously employed panel data methods, based on mortality variation across French départements and years. The novelty is to analyze the effect of gender-specific unemployment on gender-specific mortality. Within this “area-gender approach”, I give a particular attention to gender-cause-specific mortality such as prostate cancer, maternal mortality, female breast cancer, cervical cancer and ovarian cancer in addition to other cause-specific mortality. The analysis is undertaken for several age-groups, several time windows and different geographical aggregates of unemployment. The results reveal that the relationship between unemployment and mortality in France is weak and confirm recent conclusions from U.S. state-level analysis by Rhum [Ruhm, C.J., 2015. Recessions, Healthy no more?. Journal of Health Economics 42, 17-28]

The economics of malaria in Africa

Consultable à http://hdl.handle.net/10419/96345WIDER Working Paper, No. 2014/047Malaria still claims a heavy human and economic toll, specifically in sub-Saharan Africa. Even though the causality between malaria and poverty is presumably bi-directional, malaria plays a role in the economic difficulties of the region. This article provides an analysis of the economic consequences of malaria (with an emphasis on human capital accumulation and productivity), and a discussion of policies aimed at reducing its incidence. A major initiative has been the distribution of insecticidal bed-nets at a highly subsidized price. An economic-epidemiology model is used to explain why such policy is doomed to fail in presence of a very high poverty incidence, as observed in the African region

How well do DRGs for appendectomy explain variations in resource use? : An analysis of patient-level data from 10 European countries

Appendectomy is a common and relatively simple procedure to remove an inflamed appendix, but the rate of appendectomy varies widely across Europe. This paper investigates factors that explain differences in resource use for appendectomy. We analysed 106,929 appendectomy patients treated in 939 hospitals in ten European countries. In stage one, we tested the performance of three models in explaining variation in the (log of) cost of the inpatient stay (seven countries) or length-of-stay (three countries). The first model used only the Diagnosis Related Groups (DRGs) to which patients were coded; the second used a core set of general patient-level and appendectomy-specific variables; and the third model combined both sets of variables. In stage two, we investigated hospital-level variation. In classifying appendectomy patients, most DRG systems take account of complex diagnoses and comorbidities, but use different numbers of DRGs (range: 2 to 8). The capacity of DRGs and patient-level variables to explain patient-level cost variation ranges from 34% in Spain to over 60% in England and France. All DRG systems can make better use of administrative data such as the patient’s age, diagnoses and procedures, and all countries have outlying hospitals that could improve their management of resources for appendectomy

Impact of a malaria intervention package in schools on Plasmodium infection, anaemia and cognitive function in schoolchildren in Mali: a pragmatic cluster-randomised trial.

BACKGROUND: School-aged children are rarely targeted by malaria control programmes, yet the prevalence of Plasmodium infection in primary school children often exceeds that seen in younger children and could affect haemoglobin concentration and school performance. METHODS: A cluster-randomised trial was carried out in 80 primary schools in southern Mali to evaluate the impact of a school-based malaria intervention package. Intervention schools received two interventions sequentially: (1) teacher-led participatory malaria prevention education, combined with distribution of long-lasting insecticidal nets (LLINs), followed 7 months later at the end of the transmission season by (2) mass delivery of artesunate and sulfadoxine-pyrimethamine administered by teachers, termed intermittent parasite clearance in schools (IPCs). Control schools received LLINs as part of the national universal net distribution programme. The impact of the interventions on malaria and anaemia was evaluated over 20 months using cross-sectional surveys in a random subset of 38 schools(all classes), with a range of cognitive measures (sustained attention, visual search, numeracy, vocabulary and writing) assessed in a longitudinal cohort of children aged 9-12 years in all 80 schools. RESULTS: Delivery of a single round of IPCs was associated with dramatic reductions in malaria parasitaemia (OR 0.005, 95% CI 0.002 to 0.011, p<0.001) and gametocyte carriage (OR 0.02, 95% CI 0.00 to 0.17, p<0.001) in intervention compared with control schools. This effect was sustained for 6 months until the beginning of the next transmission season. IPCs was also associated with a significant decrease in anaemia (OR 0.56, 95% CI 0.40 to 0.78, p=0.001), and increase in sustained attention (difference +0.23, 95% CI 0.10 to 0.36, p<0.001). There was no evidence of impact on other cognitive measures. CONCLUSION: The combination of malaria prevention education, LLINs and IPCs can reduce anaemia and improve sustained attention of school children in areas of highly seasonal transmission. These findings highlight the impact of asymptomatic malaria infection on cognitive performance in schoolchildren and the benefit of IPCs in reducing this burden. Additionally, malaria control in schools can help diminish the infectious reservoir that sustains Plasmodium transmission

The scope of coverage under the Rotterdam Rules - Unimodal and multimodal aspects

U radu se proučavaju, raščlanjuju i interpretiraju sve relevantne odredbe o polju primjene Roterdamskih pravila. Analizira se njihovo opće polje primjene, govori se o ugovorima, prijevozima te subjektima prijevoznih poslova na koje se Roterdamska pravila primjenjuju. Proučavaju se i specifične odredbe o posebnim isključenjima. Tumači se u kojem opsegu Roterdamska pravila pokrivaju multimodalni prijevoz te se govori o multimodalnosti kao obilježju suvremenog prijevoza i unifikaciji multimodalnog prijevoza. Pomno se ulazi u sadržaj i doseg odredbi kojima se propisuju uvjeti koji moraju biti ispunjeni da bi odredbe druge međunarodne prijevozne konvencije imale prednost u odnosu na odredbe Roterdamskih pravila. Nastoji se ukazati i na razlike u pogledu njezinog polja primjene i polja primjene međunarodnih konvencija koje su na snazi, a kojima se uređuje prijevoz stvari morem. Odredbe o polju primjene iznimno su važne i zadiru u bit nove konvencije, njezinu koncepciju, temeljna načela i ciljeve novog pravnog uređenja koje Konvencija propisuje. Najvažnije novine polja primjene Roterdamskih pravila u odnosu na međunarodne konvencije koje su na snazi, a koje uređuju prijevoz stvari morem jesu proširenje polja primjene na prijevoze “od vrata do vrata” i novo uređenje prijevoznih isprava. Cilj rada je skrenuti pažnju na polje primjene kao važno pitanje koje utječe na recepciju Roterdamskih pravila i istaknuti ona rješenja koja se najviše kritiziraju i za koja se osnovano može pretpostaviti da predstavljaju zapreku za njihovu recepciju.This paper considers the application of provisions of the United Nations Convention on Contracts for the International Carriage of Goods Wholly or Partly by Sea (the Rotterdam Rules). The scope of coverage issues go to the heart of the new Convention. This article highlights the major topics relating to the scope of coverage. All aspects of this key issue are examined here: the general scope of application; criteria that must be satisfied for the Convention to be applied; types of transactions that the Convention might govern; application to certain parties. Some of these questions have been particularly controversial. Moreover, this paper addresses the circumstances under which the Rotterdam Rules give way to other conventions. The author discusses issues that may arise from the fact that the Convention will cover both the inward and the outward carriage. It further considers specific exclusions from the Convention. Differences between the Rotterdam Rules and the international legislation in force are pointed out. One of the most significant changes introduced by the Rotterdam Rules to the existing law is the expansion of its scope of coverage to include the door-to-door transport. The Convention covers both the inbound and the outbound international shipments to or from a Contracting State. The Convention applies to contracts in both the liner and the non-liner trades, but not to charterparties and other contracts for the use of a ship or of any space thereon. Volume contract, to which the Convention applies, may provide for greater or lesser obligations and liabilities than those imposed by the Rotterdam Rules

Malaria and Primary Education: A Cross-Country Analysis on Primary Repetition and Completion Rates

URL des Documents de travail : http://ces.univ-paris1.fr/cesdp/cesdp2007.htmlDocuments de travail du Centre d'Economie de la Sorbonne 2007.13 - ISSN : 1955-611XThis paper explores the link between P. Falciparum malaria - most of malaria morbidity and mortality is due to the malignant Plasmodium Falciparum - and primary education in terms of school performances at the macroeconomic stage. Cross-country regression analysis shows that the relation between school results (measured by repetition and completion rates) and the P. Falciparum malaria index is strong. The results implies that the achievement of the education Millennium Development Goals will require more than just focusing on expenditure in primary education. It does not imply that resources in education are unnecessary but that increasing resources in education and improving education resources management alone are unlikely to be sufficient. This paper suggests that health conditions and especially diseases that alter cognitive capacities of children such as malaria should be taken into account much more seriously. This study also sees the need to place emphasis on research that will improve the quality of interventions to prevent malaria. Specific education expenditure to face Malaria should be examined in addition to health policies.Ce travail explore la relation entre le paludisme à P. falciparum - le seul mortel et le plus répandu - et l'éducation primaire en termes de résultats scolaires au niveau macroéconomique. L'analyse en coupe transversale réalisée montre que le lien entre les performances des enfants dans le primaire (mesurées par les taux de redoublement et d'achèvement dans le primaire) et l'indice de paludisme à P. falciparum utilisé est fort. Ces résultats laissent penser que l'accomplissement de l'objectif d'éducation universelle nécessite une approche plus large et non uniquement focalisée sur les dépenses d'éducation (publiques ou privés) mais aussi sur des dépenses de santé spécifiques. Cela ne veut pas dire que les efforts réalisés jusqu'ici sont inutiles. Cela semble vouloir dire que pour améliorer la qualité de l'éducation, il faut également prendre en compte l'état de santé des enfants et les maladies affectant particulièrement leurs capacités cognitives dont le paludisme. Les dépenses spécifiques d'éducation et de santé pour faire face au fléau du paludisme devraient faire l'objet de recherches plus approfondies

L'impact du paludisme sur l'éducation primaire : une analyse en coupe transversale des taux de redoublement et d'achèvement

EDEPSInternational audienceThis paper explores the link between P. falciparum malaria – most of malaria morbidity and mortality is due to the malignant Plasmodium falciparum – and primary education in terms of school performances at the macroeconomic stage. Cross-country regression analysis shows that the relation between school results (measured by repetition and completion rates) and the P. falciparum malaria index is strong.The results implies that the achievement of the education Millennium Development Goals will require more than just focusing on expenditure in primary education. This paper suggests that health conditions and especially diseases that alter cognitive capacities of children such as malaria should be taken into account. This study also sees the need to place emphasis on research that will improve the quality of interventions to prevent malaria. Specific education expenditure to face Malaria should be examined in addition to health policies.Ce travail explore la relation entre le paludisme à P.falciparum – le seul mortel et le plus répandu – et l'éducation primaire en termes de résultats scolaires au niveau macroéconomique. L'analyse en coupe transversale réalisée montre que le lien entre les performances des enfants dans le primaire (mesurées par les taux de redoublement et d'achèvement dans le primaire) et l'indice de paludisme à P.falciparum utilisé est fort.Ces résultats laissent penser que l'accomplissement de l'objectif d'éducation universelle nécessite une approche plus large et non uniquement focalisée sur les dépenses d'éducation (publiques ou privées) mais aussi sur des dépenses de santé spécifiques. Pour améliorer la qualité de l'éducation, il faut également prendre en compte l'état de santé des enfants et les maladies affectant particulièrement leurs capacités cognitives dont le paludisme. Les dépenses spécifiques d'éducation et de santé pour faire face au fléau du paludisme devraient faire l'objet de recherches plus approfondies

Malaria and economic development

This thesis contributes to the literature on the endogenous relationship between the health status of a population and the economic development of a nation. We focus on a wide phenomenon touching many low-income countries: malaria. Firstly, we propose to rethink the economic analysis of malaria by combining economic epidemiology tools with the poverty trap literature. The endogeneity of malaria with respect to households and individuals socioeconomic characteristics and choices remains a particularly relevant and unresolved issue. In spite of massive efforts to generalize efficient prevention (such as ITNs), malaria remains prevalent in many countries. We design a theoretical model of rational preventive behaviors in response to the disease, which includes endogenous externalities and disease characteristics. Two important conclusions emerge from the model. First, agents increase their preventive behaviors when the degree of prevalence of malaria in a society is more severe. This result is consistent with the literature on "prevalenceelastic behavior". Second, we find that multiple equilibria are theoretically possible and so is the existence of malaria traps, defined as any self-reinforcing mechanism, which causes malaria to persist. Two implications discussed in this chapter concern malaria exogeneity for trapped communities and possible mechanisms to get out of the trap (through public policies). For the communities trapped and if the disease affects negatively some economic variables, it is plausible to assume that the disease itself generates the socio-economic obstacles to its control. Secondly, we try to understand the socioeconomic effects of malaria. If malaria deaths and illness occur mostly in young African children, the economic literature on the subject primarily focused on its effects on adult productivity or on private health and public expenditure accumulation related to the disease. The last three chapters of this thesis tackle the question of the economic effects of malaria under a new angle: the effects of the disease on children human capital accumulation, which can potentially have heavy consequences on future generations. A small but growing number of medical studies are drawing an alarming report of the impact of malaria on creative and intellectual development of children. Given the frightening distribution of falciparum malaria, any effect of malaria on cognitive function or educational achievement is likely to result in a massive macroeconomic loss. Our macroeconomic results show that performance of educational systems in countries with intensive malaria is lower than in countries not affected by malaria, other things being equal. These results suggest that the macroeconomic effects of malaria on education are not negligible, taking into account the number of malaria clinical cases worldwide. These results are then confronted to two microeconomic analyses. We start with data from Demographic and Health Surveys. We next move to a longitudinal investigation we carried out in a village in a malaria endemic area in Mali in collaboration with the Malaria Research and Center training. From a methodological point of view, thanks to a multi-disciplinary approach, we improve the measure of malaria indicators generally used in economic studies. The main finding of this thesis relates to the effects of asymptomatic malaria. Asymptomatic malaria is defined as a malariapositive smear for P. falciparum parasitaemia associated with no clinical symptoms. Asymptomatic malaria affects significantly school performances of the children in endemic area. We also show that higher income offers little protection against the negative effects of asymptomatic malaria on education in the village. Our results can lead to change the social and psychological perception of the risks associated with malaria, thus opening promising prospects as regards to malaria eradication and control programs.Cette thèse contribue à la littérature sur la relation endogène entre l'état de santé d'une population et le développement économique d'une nation. Nous nous focalisons pour cela sur un phénomène de grande ampleur touchant de nombreux pays en développement: l'endémie palustre. Dans un premier temps, nous reformulons le cadre théorique dans lequel la relation bidirectionnelle entre paludisme et développement économique est généralement analysée. Nous utilisons un modèle d'épidémiologie économique qui place la maladie et les comportements préventifs au centre de l'analyse et débouche sur des comportements dits «prévalence-élastiques». Nous montrons que ce modèle conduit à de possibles équilibres multiples et, par conséquent, à des trappes de santé potentielles du fait des externalités engendrées par les décisions des agents. Une implication forte de ces trappes concerne le caractère exogène de la maladie pour les communautés piégées. Une autre implication importante concerne les politiques de contrôle de la maladie. Si les communautés sont piégées dans de telles trappes et que la maladie affecte négativement certaines variables économiques, il est possible que la maladie engendre, de par sa nature même, des obstacles socioéconomiques à son contrôle. Dans un deuxième temps, nous cherchons donc à mieux comprendre les effets socioéconomiques du paludisme. Si le paludisme touche principalement les enfants, les études économiques sur le sujet se sont essentiellement focalisées sur ses effets sur la productivité chez l'adulte ou l'accumulation des dépenses de santé privées et publiques liées à la maladie. Les trois derniers chapitres de cette thèse abordent la question des effets économiques du paludisme sous un angle nouveau: celui des conséquences de la maladie sur l'accumulation de capital humain chez l'enfant, pouvant avoir des conséquences lourdes sur les générations futures. Certaines études médicales font un constat alarmant de l'impact du paludisme sur les capacités de développement créatif et intellectuel chez l'enfant. Nos résultats montrent que les pays intensivement touchés par le paludisme ont des systèmes éducatifs moins performants par rapport aux pays non touchés. Ces résultats suggèrent des effets non négligeables du paludisme au niveau macroéconomique, compte tenu de l'ampleur de l'endémie palustre. Ils sont ensuite confirmés par deux analyses microéconomiques à partir de données DHS et d'une enquête longitudinale que nous avons réalisée dans un village en zone endémique au Mali en collaboration avec le Malaria Research and Training Center. D'un point de vue méthodologique, nous améliorons la mesure des indicateurs de paludisme généralement utilisés dans les études économiques. L'une des principales découvertes de cette thèse concerne les effets du paludisme asymptomatique. Le paludisme asymptomatique à P. falciparum affecte significativement les performances scolaires des enfants en zone endémique. Nous montrons également qu'un niveau de richesse plus élevé ne protège pas des effets négatifs de la parasitémie sur l'éducation. Nos résultats peuvent déboucher sur une modification de la perception sociale et psychologique des risques associés à la maladie, ouvrant ainsi des perspectives prometteuses en matière de politique de lutte