Young people's perceptions of youth-oriented health services in urban Soweto, South Africa: a qualitative investigation.

BACKGROUND: In 2006, the South African Department of Health adopted and scaled-up loveLife's Youth Friendly Services (YFS) initiative to a national policy to improve youth utilization of health programmes by strengthening community sensitisation and counselling services. As these services roll-out, alternative services to target young people are also becoming more popular. Success of any of these services, however, is dependent upon young people's perceptions of these health services as a whole. This paper aims to examine the knowledge and perceptions of current health services oriented towards young people and examine potential alternative approaches to health service delivery. METHODS: The study was conducted in urban Soweto, South Africa. Twenty-five in-depth interviews were conducted between May-July 2012. Twenty-three of these were analysed according to modified grounded theory. RESULTS: Knowledge of YFS was very low with no thorough knowledge of the programme's purpose or activities. In general, young people were dissatisfied with the current health services in Soweto citing a lack of resources, long waiting times, and poor quality of care heightened by an underlying lack of choice and perceived inequity. When compared to alternative models of service delivery, no particular model was preferred over another. CONCLUSIONS: Greater knowledge of whether and to what extent local clinics in Soweto are implementing YFS standards is needed. If implemented, improved outreach and advertisement is suggested. In-service training of nurses should be prioritized with a focus on sensitivity and equitable treatment to all

The impact of an experimental nutritional intervention in childhood on education among Guatemalan adults:

"Studies have shown that malnourished children in developing countries score lower on tests of cognitive function and fail to acquire fine motor skills at the normal rate. Do the effects of nourishment—good or bad—in early childhood linger into adolescence and adulthood, or do they fade away after a few years? This paper provides new evidence of the effects of early childhood nutritional interventions on adult outcomes, using longitudinal data and methods well suited to address the concerns that have been raised about earlier studies." from Textmalnutrition, Children, Education, Nutrition,

The Impact of Nutrition during Early Childhood on Education among Guatemalan Adults

Early childhood nutrition is thought to have important effects on education, broadly defined to include various forms of learning. We advance beyond previous literature on the effect of early childhood nutrition on education in developing countries by using unique longitudinal data begun during a nutritional experiment during early childhood with educational outcomes measured in adulthood. Estimating an intent-to-treat model capturing the effect of exposure to the intervention from birth to 36 months, our results indicate significantly positive, and fairly substantial, effects of the randomized nutrition intervention a quarter century after it ended: increased grade attainment by women (1.2 grades) via increased likelihood of completing primary school and some secondary school; speedier grade progression by women; a one-quarter SD increase in a test of reading comprehension with positive effects found for both women and men; and a one-quarter SD increase on nonverbal cognitive tests scores. There is little evidence of heterogeneous impacts with the exception being that exposure to the intervention had a larger effect on grade attainment and reading comprehension scores for females in wealthier households. The findings are robust to an array of alternative estimators of the standard errors and controls for sample attrition.education, schooling, Guatemala, nutrition, economic development, Latin America

Activities contributing to energy expenditure among Guatemalan adults

<p>Abstract</p> <p>Background</p> <p>Guatemala has experienced a substantial increase in overweight and obesity in recent years, yet physical activity patterns and consequent energy expenditure are largely unexplored in this population.</p> <p>Methods</p> <p>To describe overall physical activity levels (PAL) and activities contributing to daily energy expenditure, we analyzed time spent in daily activities as reported by 985 women and 819 men, living in rural and urban areas of Guatemala in 2002–04.</p> <p>Results</p> <p>Physical activity levels recommended to prevent obesity (PAL ≥ 1.70) differed by residence/occupation among men (agricultural-rural: 77%; nonagricultural-rural: 36%; urban: 24%; P < 0.01), but not women (rural: 2%; urban: 3%; P = 0.5). Median energy expenditure was higher among agricultural-rural men (44 MET*h/d; MET = metabolic equivalent) compared to nonagricultural-rural (37 MET*h/d) and urban men (35 MET*h/d; P < 0.01); energy expenditure was slightly lower among rural compared to urban women (34 MET*h/d vs. 35 MET*h/d; P < 0.01). Occupation was the largest contributor to energy expenditure (19–24 MET*h/d); among women and nonagricultural-rural and urban men this was primarily of a light intensity. Energy expenditure in sedentary activities ranged from 2 MET*h/d among rural women to 6 MET*h/d among agricultural-rural men. Any sports/exercise time was reported by 35% and 5% of men and women, respectively. Nevertheless, the majority of participants believed they were significantly active to stay healthy.</p> <p>Conclusion</p> <p>Overall, energy expenditure was low in the population not dedicated to agricultural occupations; an increased focus on active leisure-time behaviors may be needed to counterbalance reductions in energy expenditure consequent to sedentarization of primary occupations.</p

What determines adult cognitive skills?: Impacts of preschooling, schooling, and post-schooling experiences in Guatemala

"Most investigations into the importance and determinants of adult cognitive skills assume that (1) they are produced primarily by schooling, and (2) schooling is statistically predetermined or exogenous. This study uses longitudinal data collected in Guatemala over 35 years to investigate production functions for adult cognitive skills—that is, reading-comprehension skills and nonverbal cognitive skills—as being dependent on behaviorally determined preschooling, schooling, and post-schooling experiences. We use an indicator of whether the child was stunted (child height-for-age Z-scoreHuman capital, cognitive skills, Stunting, work experience, Development, Education, Gender, Health and nutrition,

The consequences of early childhood growth failure over the life course:

This paper examines the impact over the life course of early childhood growth failure as measured by achieved height at 36 months. It uses data collected on individuals who participated in a nutritional supplementation trial between 1969 and 1977 in rural Guatemala and who were subsequently reinterviewed between 2002 and 2004. It finds that individuals who did not suffer growth failure in the first three years of life complete more schooling, score higher on tests of cognitive skill in adulthood, have better outcomes in the marriage market, earn higher wages and are more likely to be employed in higher-paying skilled labor and white-collar jobs, are less likely to live in poor households, and, for women, fewer pregnancies and smaller risk of miscarriages and stillbirths. Growth failure has adverse impacts on body size and several dimensions of physical fitness in adulthood but does not have marked effects on risk indicators of cardiovascular and related chronic diseases. These results provide a powerful rationale for investments that reduce early-life growth failure.Chronic disease, early life growth failure, fertility, Human capital, Poverty, Undernutrition, Wages,

The Impact of Nutrition during Early Childhood on Education among Guatemalan Adults

Early childhood nutrition is thought to have important effects on education, broadly defined to include various forms of learning. We advance beyond previous literature on the effect of early childhood nutrition on education in developing countries by using unique longitudinal data begun during a nutritional experiment during early childhood with educational outcomes measured in adulthood. Estimating an intent-to-treat model capturing the effect of exposure to the intervention from birth to 36 months, our results indicate significantly positive, and fairly substantial, effects of the randomized nutrition intervention a quarter century after it ended: increased grade attainment by women (1.2 grades) via increased likelihood of completing primary school and some secondary school; speedier grade progression by women; a one-quarter SD increase in a test of reading comprehension with positive effects found for both women and men; and a one-quarter SD increase on nonverbal cognitive tests scores. There is little evidence of heterogeneous impacts with the exception being that exposure to the intervention had a larger effect on grade attainment and reading comprehension scores for females in wealthier households. The findings are robust to an array of alternative estimators of the standard errors and controls for sample attrition

What Determines Adult Cognitive Skills? Impacts of Pre-Schooling, Schooling and Post-Schooling Experiences in Guatemala

Most investigations of the importance of and the determinants of adult cognitive skills assume that (a) they are produced primarily by schooling and (b) schooling is statistically predetermined. But these assumptions may lead to misleading inferences about impacts of schooling and of pre-schooling and post-schooling experiences on adult cognitive skills. This study uses an unusually rich longitudinal data set collected over 35 years in Guatemala to investigate production functions for adult (i) reading-comprehension and (ii) non-verbal cognitive skills as dependent on behaviorally-determined pre-schooling, schooling and post-schooling experiences. Major results are: (1) Schooling has significant and substantial impact on adult reading comprehension (but not on adult non-verbal cognitive skills) —but estimates of this impact are biased upwards substantially if there is not control for behavioral determinants of schooling in the presence of persistent unobserved factors such as genetic endowments and/or if family background factors that appear to be correlated with genetic endowments are included among the first-stage instruments. (2) Both pre-schooling and post-schooling experiences have substantial significant impacts on one or both of the adult cognitive skill measures that tend to be underestimated if these pre- and post-schooling experiences are treated as statistically predetermined—in contrast to the upward bias for schooling, which suggests that the underlying physical and job-related components of genetic endowments are negatively correlated with those for cognitive skills. (3) The failure in most studies to incorporate pre- and post-schooling experiences in the analysis of adult cognitive skills or outcomes affected by adult skills is likely to lead to misleading over-emphasis on schooling relative to these pre-and post-schooling experiences. (4) Gender differences in the coefficients of the adult cognitive skills production functions are not significant, suggesting that most of the fairly substantial differences in adult cognitive skills favoring males on average originate from gender differences in completed grades of schooling and in experience in skilled jobs favoring males. These four sets of findings are of substantial interest in themselves. But they also have important implications for broader literatures, pointing to limitations in the cross-country growth literature of using schooling of adults to represent human capital, supporting hypotheses about the importance of childhood nutrition and work complexity in explaining the “Flynn effect” of substantial increases in measured cognitive skills over time, and questioning the interpretation of studies that report productivity impacts of cognitive skills without controlling for the endogeneity of such skills

What Determines Adult Cognitive Skills? Influences of Pre-Schooling, Schooling, and Post-Schooling Experiences in Guatemala

Most empirical investigations of the effects of cognitive skills assume that they are produced by schooling, and that schooling is exogenous. Drawing on a rich longitudinal data set to estimate production functions for adult reading-comprehension cognitive skills and adult nonverbal cognitive skills, we find that (1) Schooling attainment has a significant and substantial effect on adult reading-comprehension cognitive skills but not on adult nonverbal cognitive skills; and (2) Pre-schooling and post-schooling experiences have substantial positive significant effects on adult cognitive skills. Pre-schooling experiences that increase height for age at age six years substantially and significantly increase adult reading-comprehension and nonverbal cognitive skills, even after controlling for schooling attainment and post-school skilled job tenure. Post-schooling tenure in skilled jobs also has a significant positive effect on adult reading-comprehension and nonverbal cognitive skills, although the latter estimate is sensitive to how we treat gender. Age also has significant positive effect but with diminishing returns on adult reading-comprehension cognitive skills. The findings (1) reinforce the importance of early life investments; (2) support the importance of childhood nutrition (“Flynn effect”) and work complexity in explaining increases in cognitive skills; (3) question interpretations of studies reporting productivity impacts of cognitive skills without controlling for endogeneity; and (4) point to limitations in using adult schooling alone to represent human capital

What Determines Adult Cognitive Skills? Impacts of Pre-Schooling, Schooling and Post-Schooling Experiences in Guatemala

Most investigations of the importance of and the determinants of adult cognitive skills assume that (a) they are produced primarily by schooling and (b) schooling is statistically predetermined. But these assumptions may lead to misleading inferences about impacts of schooling and of pre-schooling and post-schooling experiences on adult cognitive skills. This study uses an unusually rich longitudinal data set collected over 35 years in Guatemala to investigate production functions for adult (i) reading-comprehension and (ii) nonverbal cognitive skills as dependent on behaviorally-determined pre-schooling, schooling and post-schooling experiences. Major results are: (1) Schooling has significant and substantial impact on adult reading comprehension (but not on adult nonverbal cognitive skills)—but estimates of this impact are biased upwards substantially if there are no controls for behavioral determinants of schooling in the presence of persistent unobserved factors such as genetic endowments and/or if family background factors that appear to be correlated with genetic endowments are included among the first-stage instruments. (2) Both pre-schooling and post-schooling experiences have substantial significant impacts on one or both of the adult cognitive skill measures that tend to be underestimated if these pre- and post-schooling experiences are treated as statistically predetermined—in contrast to the upward bias for schooling, which suggests that the underlying physical and job-related components of genetic endowments are negatively correlated with those for cognitive skills. (3) The failure in most studies to incorporate pre- and post-schooling experiences in the analysis of adult cognitive skills or outcomes affected by adult cognitive skills is likely to lead to misleading over-emphasis on schooling relative to these pre-and post-schooling experiences. (4) Gender differences in the coefficients of the adult cognitive skills production functions are not significant, suggesting that most of the fairly substantial differences in adult cognitive skills favoring males on average originate from gender differences in schooling attainment and in experience in skilled jobs favoring males. These four sets of findings are of substantial interest in themselves. But they also have important implications for broader literatures, reinforcing the importance of early life investments in disadvantaged children in determining adult skills and options, pointing to limitations in the cross-country growth literature of using schooling of adults to represent human capital, supporting hypotheses about the importance of childhood nutrition and work complexity in explaining the “Flynn effect” of substantial increases in measured cognitive skills over time, and questioning the interpretation of studies that report productivity impacts of cognitive skills without controlling for the endogeneity of such skills.