Educación y aprendizaje: resultados iniciales de la quinta ronda de encuestas (2016) de Niños del Milenio - Perú

A los 15 años, el 37% de los integrantes de la cohorte menor tenían edad avanzada para el año normativo —es decir, extraedad—, en comparación con el 49% de los participantes en la cohorte mayor cuando tenían la misma edad. Así, se observa que los jóvenes de la cohorte menor están avanzando mejor en su educación que los de la cohorte mayor. Sin embargo, entre ambas cortes existen grandes diferencias asociadas con la pobreza, el origen étnico, el área de residencia y la educación materna. A pesar de las mejoras en el rendimiento, la mayoría de jóvenes de 15 años de la cohorte menor no pueden resolver problemas matemáticos simples. El rendimiento en las pruebas de los jóvenes que han vivido siempre en áreas urbanas se encuentra entre 13 y 9 puntos porcentuales por encima del rendimiento de sus pares que siempre han vivido en áreas rurales. El rendimiento de los jóvenes que han migrado de las áreas rurales a las urbanas se encuentra en el medio. Para la cohorte más joven, se puede observar una gran brecha —de casi 25 puntos porcentuales— en el vocabulario entre grupos de niños de 5 años. A los 15 años, esta brecha disminuye ligeramente, a 16 puntos porcentuales

Intergenerational Transmission of Poverty and Inequality: Young Lives

Parents play major roles in determining the human capital of children, and thus the income of children when they become adults. Models of investments in children’s human capital posit that these investments are determined by parental resources (financial and human capital) and child endowments within particular market and policy environments. Many empirical studies are consistent with significant associations between parental resources and investments in their children. And there is considerable emphasis in the scholarly and the policy literatures on the degree of intergenerational mobility and the intergenerational transmission of economic opportunities, and therefore the intergenerational transmission of poverty – or of affluence. Therefore policies or other developments that affect the extent of poverty and/or inequality in the parents’ generation are likely to have impacts on the extent of poverty and/or inequality in the children’s generation. However the extent of these intergenerational effects is an empirical question that this paper explores using the Young Lives data to estimate intergenerational associations between parental resources and investments in human capital of children and then, under the assumption that these associations reflect causal effects, to simulate what impacts changes in poverty and inequality in the parents’ generation have on poverty and inequality in the children’s generation. The results suggest that reductions in poverty and in inequality in the parents’ generation reduce poverty and inequality in the children’s generation some, but not much

¿Qué hemos aprendido del estudio longitudinal Niños del Milenio en el Perú? : síntesis de hallazgos

Desde el 2001, Niños del Milenio se caracterizó por ser un estudio ambicioso. Fue diseñado para entender de qué manera la pobreza infantil se asociaba o tenía impacto en el desarrollo de alrededor de 12 000 niños y niñas de 4 países: Etiopía, India, Perú y Vietnam. Al mismo tiempo, se buscaba que estos resultados fueran relevantes no solo para la comunidad académica, sino también para las personas que toman decisiones en políticas y programas, tanto en cada país como a escala internacional. Con estos fines, el diseño del estudio contempló inicialmente el seguimiento de dos grupos a lo largo de su niñez, adolescencia y adultez temprana. La selección de los participantes en el Perú se realizó de manera aleatoria, excluyendo al 5% de distritos más ricos del país, dado el énfasis del estudio en comprender las dinámicas de la pobreza. A los dos grupos de participantes en el estudio los llamamos cohorte mayor, nacida en 1994, y cohorte menor, nacida en el 2001. Iniciamos la recolección de datos de la cohorte mayor con cerca de 750 niños y niñas de 8 años de edad en promedio, mientras que la menor se inició con poco más de 2000 niños y niñas de 1 año de edad en promedio. A ellos y a sus familiares se les aplicaron encuestas en sus hogares, las cuales se realizaron en los años 2002, 2006, 2009, 2013 y 2016, llamadas ronda 1 a ronda 5, sucesivamente. El diseño del estudio y el momento de recolección de datos permitieron comparar los niveles de desarrollo de niños y niñas de la misma edad, pero en diferentes momentos. Al finalizar cada ronda, se publicó un informe breve con los principales resultados, así como informes más detallados con estudios sobre temáticas específicas. Junto con las encuestas de hogares, se ha recogido información sobre las comunidades donde viven los niños y niñas. Asimismo, se ha realizado algunos subestudios. El primero es un estudio cualitativo que se desarrolló en los cuatro países, también de manera longitudinal. En este seguimos a una submuestra de 51 niños, niñas y jóvenes por país, de ambas cohortes, en los años 2007, 2008-2009, 2011 y 2014. Estos datos han permitido profundizar en aspectos clave de la infancia, como la transición hacia la escuela primaria y secundaria, y las transiciones hacia la vida adulta: el trabajo, la educación superior o técnica, y la maternidad y paternidad. Con ello se ha contribuido, además, a la comprensión subjetiva del bienestar infantil en general y, específicamente, en relación con el acceso a servicios —educación y salud—. Finalmente, en dos momentos, 2011 y 2017, hemos visitado a las niñas y niños integrantes de una submuestra de la cohorte menor, así como a sus pares, en instituciones educativas tanto de primaria como de secundaria. Estas encuestas, que se han enfocado en las oportunidades educativas de diferentes grupos de estudiantes, nos sirvieron para analizar si existe una correlación entre, por una parte, los antecedentes individuales y familiares de un niño o niña; y por la otra, la calidad de la institución educativa a la que asiste. El conjunto de datos recogidos nos permite contar con abundantes insumos para analizar factores relevantes de la vida y el desarrollo de los participantes en el estudio. Este ejercicio de recolección de datos arroja dos resultados interesantes. El primero es la impresionante movilidad de las familias en el Perú. En la primera ronda, los niños de la cohorte menor se encontraban en 27 distritos; y los de la cohorte mayor, en 24. En la quinta ronda, los niños de la cohorte menor se encontraban en 209 distritos y 7 países extranjeros; y los de la cohorte mayor, en 115 distritos y 5 países extranjeros. El segundo resultado interesante es que, en casi cualquier indicador revisado —por ejemplo, en educación, los años completados de estudios o el rendimiento en pruebas; o en salud, el porcentaje con desnutrición crónica—, encontramos mejores resultados para la cohorte menor que para la mayor. Esto seguramente se explica por las circunstancias en que ambas cohortes nacieron: la mayor, en momentos en que el Perú empezaba a recuperarse luego de años de violencia y crisis económica; y la menor, cuando gran parte del país estaba en paz, la recuperación económica era más firme y se había restablecido la democracia. Si bien este hallazgo aporta esperanza sobre el futuro, no se debe soslayar el hecho de que en el país persisten inmensas brechas en oportunidades y resultados entre grupos de la población. Por ejemplo, aunque la pobreza se ha reducido considerablemente desde que Niños del Milenio empezó a recolectar datos, sigue siendo un factor que limita el potencial de desarrollo de un grupo de la población. La pobreza, sin embargo, no viene sola, sino que a menudo se combina con otras características individuales y familiares que pueden dificultar el contexto en el que se desarrolla un peruano o peruana. Así, durante estos 15 años, hemos podido ver que las oportunidades y resultados son menores para niños y jóvenes que han crecido en una zona rural, cuya madre cuenta con poca educación o cuya familia es indígena. Cuando estas tres características se presentan en un individuo o familia —lo que ocurre en muchos casos—, los retos son aún mayores. Las niñas y las jóvenes también enfrentan dificultades en su desarrollo, vinculadas sobre todo a nociones tradicionales acerca de cómo debería ser y qué debería hacer una mujer en el Perú

Household food group expenditure patterns are associated with child anthropometry at ages 5, 8 and 12 years in Ethiopia, India, Peru and Vietnam

Population-level analysis of dietary influences on nutritional status is challenging in part due to limitations in dietary intake data. Household expenditure surveys, covering recent household expenditures and including key food groups, are routinely conducted in low- and middle-income countries. These data may help identify patterns of food expenditure that relate to child growth. Objectives We investigated the relationship between household food expenditures and child growth using factor analysis. Methods We used data on 6993 children from Ethiopia, India, Peru and Vietnam at ages 5, 8 and 12y from the Young Lives cohort. We compared associations between household food expenditures and child growth (height-for-age z scores, HAZ; body mass index-for-age z scores, BMI-Z) using total household food expenditures and the “household food group expenditure index” (HFGEI) extracted from household expenditures with factor analysis on the seven food groups in the child dietary diversity scale, controlling for total food expenditures, child dietary diversity, data collection round, rural/urban residence and child sex. We used the HFGEI to capture households’ allocations of their finances across food groups in the context of local food pricing, availability and preferences Results The HFGEI was associated with significant increases in child HAZ in Ethiopia (0.07), India (0.14), and Vietnam (0.07) after adjusting for all control variables. Total food expenditures remained significantly associated with increases in BMI-Z for India (0.15), Peru (0.11) and Vietnam (0.06) after adjusting for study round, HFGEI, dietary diversity, rural residence, and whether the child was female. Dietary diversity was inversely associated with BMI-Z in India and Peru. Mean dietary diversity increased from age 5y to 8y and decreased from age 8y to 12y in all countries. Conclusion Household food expenditure data provide insights into household food purchasing patterns that significantly predict HAZ and BMI-Z. Including food expenditure patterns data in analyses may yield important information about child nutritional status and linear growth

Children with access to improved sanitation but not improved water are at lower risk of stunting compared to children without access: a cohort study in Ethiopia, India, Peru, and Vietnam

Background This study’s purpose was to understand associations between water, sanitation, and child growth. Methods We estimated stunting (height-for-age Z score <−2 SD) and thinness (BMI-Z <−2 SD) risk ratios using data from 7,715 Ethiopian, Indian, Peruvian, and Vietnamese children from the Young Lives study. Results In unadjusted models, household access to improved water and toilets was often associated with reduced stunting risk. After adjusting for child, household, parent, and community variables, access to improved water was usually not associated with stunting nor thinness except in Ethiopia where access to improved water was associated with reduced stunting and thinness at 1y and 5y. In contrast, in both unadjusted and adjusted models, stunting at 1y was less common among children with good toilet access than among those without access and this difference persisted when children were 5y and 8y. For example, in adjusted estimates, Vietnamese 5y olds with access to improved toilets had relative stunting risk at 8y 0.62-0.68 that of 5y olds with no access to improved toilets. Water and toilets were rarely associated with thinness. Conclusions Results from our study indicate that access to improved sanitation is more frequently associated with reduced stunting risk than access to improved water. However, additional studies are needed before drawing definitive conclusions about the impact of toilets relative to water. This study is the first to our knowledge to demonstrate the robust and persistent importance of access to improved toilets in infancy, not only during the first year but continuing into childhood. Additional longitudinal investigations are needed to determine concurrent and long-term associations of WASH with stunting and thinness

Evidence-based planning and costing palliative care services for children : novel multi-method epidemiological and economic exemplar

Background: Children’s palliative care is a relatively new clinical specialty. Its nature is multi-dimensional and its delivery necessarily multi-professional. Numerous diverse public and not-for-profit organisations typically provide services and support. Because services are not centrally coordinated, they are provided in a manner that is inconsistent and incoherent. Since the first children’s hospice opened in 1982, the epidemiology of life-limiting conditions has changed with more children living longer, and many requiring transfer to adult services. Very little is known about the number of children living within any given geographical locality, costs of care, or experiences of children with ongoing palliative care needs and their families. We integrated evidence, and undertook and used novel methodological epidemiological work to develop the first evidence-based and costed commissioning exemplar. Methods: Multi-method epidemiological and economic exemplar from a health and not-for-profit organisation perspective, to estimate numbers of children under 19 years with life-limiting conditions, cost current services, determine child/parent care preferences, and cost choice of end-of-life care at home. Results: The exemplar locality (North Wales) had important gaps in service provision and the clinical network. The estimated annual total cost of current children’s palliative care was about £5.5 million; average annual care cost per child was £22,771 using 2007 prevalence estimates and £2,437- £11,045 using new 2012/13 population-based prevalence estimates. Using population-based prevalence, we estimate 2271 children with a life-limiting condition in the general exemplar population and around 501 children per year with ongoing palliative care needs in contact with hospital services. Around 24 children with a wide range of life-limiting conditions require end-of-life care per year. Choice of end-of-life care at home was requested, which is not currently universally available. We estimated a minimum (based on 1 week of end-of-life care) additional cost of £336,000 per year to provide end-of-life support at home. Were end-of-life care to span 4 weeks, the total annual additional costs increases to £536,500 (2010/11 prices). Conclusions: Findings make a significant contribution to population-based needs assessment and commissioning methodology in children’s palliative care. Further work is needed to determine with greater precision which children in the total population require access to services and when. Half of children who died 2002-7 did not have conditions that met the globally used children's palliative care condition categories, which need revision in light of findings

Anomaly or Augury? Global Food Prices Since 2007

This article reviews the dynamics of global food prices since the food crisis of2007–08, the extent to which international prices have influenced national prices and poverty and wellbeing outcomes, and considers whether this exceptional period represents an anomaly or likely signals future episodes of food price volatility. It finds that although some factors that contributed to recent events have eased considerably, some significant drivers remain structural threats to future food security. There is little reason to be confident that recent reductions in food prices and volatilities augur well for the food security or wellbeing of those living on low and precarious incomes in the future

Transition from children's to adult services for adolescents/young adults with life-limiting conditions : developing realist programme theory through an international comparison

Abstract Background Managing transition of adolescents/young adults with life-limiting conditions from children’s to adult services has become a global health and social care issue. Suboptimal transitions from children’s to adult services can lead to measurable adverse outcomes. Interventions are emerging but there is little theory to guide service developments aimed at improving transition. The Transition to Adult Services for Young Adults with Life-limiting conditions (TAYSL study) included development of the TASYL Transition Theory, which describes eight interventions which can help prepare services and adolescents/young adults with life-limiting conditions for a successful transition. We aimed to assess the usefulness of the TASYL Transition Theory in a Canadian context to identify interventions, mechanisms and contextual factors associated with a successful transition from children’s to adult services for adolescents/young adults; and to discover new theoretical elements that might modify the TASYL Theory. Methods A cross-sectional survey focused on organisational approaches to transition was distributed to three organisations providing services to adolescents with life-limiting conditions in Toronto, Canada. This data was mapped to the TASYL Transition Theory to identify corresponding and new theoretical elements. Results Invitations were sent to 411 potentially eligible health care professionals with 56 responses from across the three participating sites. The results validated three of the eight interventions: early start to the transition process; developing adolescent/young adult autonomy; and the role of parents/carers; with partial support for the remaining five. One new intervention was identified: effective communication between healthcare professionals and the adolescent/young adult and their parents/carers. There was also support for contextual factors including those related to staff knowledge and attitudes, and a lack of time to provide transition services centred on the adolescent/young adult. Some mechanisms were supported, including the adolescent/young adult gaining confidence in relationships with service providers and in decision-making. Conclusions The Transition Theory travelled well between Ireland and Toronto, indicating its potential to guide both service development and research in different contexts. Future research could include studies with adult service providers; qualitative work to further explicate mechanisms and contextual factors; and use the theory prospectively to develop and test new or modified interventions to improve transition

Young Lives survey design and sampling (Round 5): Ethiopia

This fact sheet describes the survey methods and sample design in Ethiopia and attrition rates throughout 15 years of the study (from Round 1 in 2002 to Round 5 in 2016). It also provides information on the sites where Young Lives children live in order to contextualise the findings of the accompanying fact sheets, which present preliminary results of the fifth survey round in the four areas of: Education and Learning, Growth and Nutrition, Youth Transitions: Skills, Work and Family Formation, and Poverty and Intergenerational Change

Young Lives Ethiopia: Lessons from longitudinal research with the children of the millennium

This summary is based on the Young Lives Country Report Lessons from Longitudinal Research with the Children of the Millennium, highlighting the context in which this research was conducted, key findings, and implications for policy and practice. The full report in Amharic and English is available here, detailing acknowledgements, photo credits and references