Suchergebnisse

In the summer of 1998, Bangladesh was inundated by significant flooding that covered two-thirds of the country and affected more than 30 million people. Although annual flooding is normal and expected in Bangladesh, the 1998 floods caused extraordinary devastation and were considered a "century" flood. Homestead flooding, crop loss, and infrastructure damage compromised household food security and increased disease prevalence in a population with already high rates of poverty and malnutrition. Unfortunately, this type of scenario has become increasingly common around the world: a significant crisis—whether environmental, economic, or political—devastates a large population of densely-settled households who are already trapped in chronic poverty. How do households anticipate and respond to such crises in the context of ongoing livelihood struggles? Do shocks affect investments in human capital? More specifically, what happens to children in the wake of such shocks? In this paper I use longitudinal data from the post-flood period in rural Bangladesh to examine how children's human capital, as measured by nutritional status, responds to severe flooding and its aftermath. I emphasize the importance of analyzing these responses in a dynamic context, linking exposure to shocks and nutritional outcomes to longer-term measures of household vulnerability and resilience. I pose two related research questions. First, did flood exposure in 1998 cause marginal growth faltering in children? To isolate the effects of the flood and address the endogeneity of flood exposure, I use a difference-in-difference estimator and village fixed effects. I also exploit the fact that younger children are more vulnerable than older children to nutrition shocks. I next ask whether the effects of flooding on child growth faltering were mediated by household resources, hypothesizing that households with lower levels of pre-flood resources are less able to protect children from nutrition shocks. These analysis help to answer several important policy questions related to crisis and recovery in vulnerable populations. The results reveal the extent to which children were nutritionally compromised by the flood, and which children fared worst. The analyses also contribute specifically to the design and implementation of livelihood interventions, and relief and recovery efforts. Can households use physical, financial and human capital to protect children's nutritional status from significant shocks to income and food security? If so, is it more effective to focus on long-term asset-building strategies in vulnerable populations, or to facilitate asset recovery post-shock through access to credit and other forms of relief? Given the increasing exposure to shocks and the quantity of resources allocated post-disaster to relief and recovery, these questions are not trivial.

Despite the popularity and widespread implementation of school feeding programmes, evidence of their impact on school participation and nutritional status is mixed. In this study we evaluate feeding programmes in three districts of the Lao People's Democratic Republic. Feeding modalities included on-site feeding, take-home rations, and a combined modality. District-level implementation of the intervention sites and selective take-up presented considerable evaluation challenges. To address these, we use difference-in-difference estimators with propensity-score weighting to construct plausible counterfactuals. We find minimal evidence that school feeding increased enrolment or improved nutritional status. Several robustness checks and possible explanations for null findings are presented.

Development projects and policies displace an estimated ten million people each year worldwide. In this study we investigate the association between population redistribution schemes and children's human capital outcomes. Using a new dataset from the Lao People's Democratic Republic (Lao PDR), we first describe the resettlement status, nutritional status, and educational attainment of children. We then ask whether children in households that have been resettled have worse nutritional status and lower educational attainment than children in non-resettled households. We use propensity-score matching methods to address unobserved heterogeneity in the likelihood of being resettled. Results suggest that resettlement is associated with poorer long-term outcomes but better short-term outcomes. Ethnicity and district are important predictors of both resettlement status and human capital.

Data from the Indonesia Family Life Survey are used to investigate the impact of a major expansion in access to midwifery services on women's use of antenatal care and delivery assistance. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in poor communities that were distant from health‐care centers. We analyze information from pregnancy histories to relate changes in the choices that individual women make across pregnancies to the arrival of a trained midwife in the village. We show that regardless of a woman's educational level, the placement of village midwives in communities is associated with significant increases in women's receipt of iron tablets and in their choices about care during delivery—changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy. The results of the study suggest that bringing services closer to women can change their patterns of use.

Vaccine-preventable deaths among adults remain a major public health concern, despite continued efforts to increase vaccination rates in this population. Alternative approaches to immunization delivery may help address under-vaccination among adults. This systematic review assesses the feasibility, acceptability, and effectiveness of community pharmacies as sites for adult vaccination. We searched 5 electronic databases (PubMed, EMBASE, Scopus, Cochrane, LILACS) for studies published prior to June 2016 and identified 47 relevant articles. We found that pharmacy-based immunization services (PBIS) have been facilitated by state regulatory changes and training programs that allow pharmacists to directly provide vaccinations. These services are widely accepted by both patients and pharmacy staff, and are capable of improving access and increasing vaccination rates. However, political and organizational barriers limit the feasibility and effectiveness of vaccine delivery in pharmacies. These studies provide evidence to inform policy and organizational efforts that promote the efficacy and sustainability of PBIS.

Purpose To investigate partisanship in COVID-19 attitudes, and assess partisan or scientific messaging effects on COVID-19 vaccination intentions. Design Two-wave survey with two-arm randomized experiment. Setting Recruited Pennsylvania residents online. Sample 2037 (May 2020) and 1577 (October 2020) Pennsylvania residents, aged 18–94 years. Intervention Respondents saw messaging that presented either President Trump or scientists endorsing the vaccine, then reported their vaccination intentions. Measures Likert scale items measuring COVID-19 attitudes (May), including mask wearing and vaccination intentions (May and October). Analysis Partisan differences in attitudes were analyzed by chi-square; differences in support for mask wearing and vaccination intentions were also analyzed by Mann–Whitney U. The messaging experiment was analyzed by chi-square, Mann–Whitney U, and survey-weighted multivariate logistic regression. Results Significant partisan differences were found in all attitudes. The partisan split in support for mask wearing increased from May to October, whereas the split in vaccination intentions decreased. Compared to partisan messaging, scientific messaging increased overall odds of intending to vaccinate by 32% in May (adjusted odds ratio [AOR]=1.32, 95% confidence interval [CI] = 1.06-1.65), and increased odds among Democrats by 142% in October (AOR = 2.42, CI = 1.29-4.55). Scientific messaging had no significant effect on independents or Republicans. Conclusion Partisan COVID-19 attitudes were widespread and persistent. Partisan endorsement of the vaccine positively influenced those with congruent beliefs, while scientific messaging produced consistent effects across political affiliation.

Widespread SARS-CoV-2 vaccine uptake will be critical to resolution of the COVID-19 pandemic. Politicians have the potential to impact vaccine sentiment and uptake through vaccine-related communication with the public. We used tweets (n = 6,201), abstracted from Quorum, a public affairs software platform, to examine changes in the frequency of vaccine-related communication by legislators on the social media platform, Twitter. We found an increase in vaccine-related tweets by legislators following the arrival of SARS-CoV-2 in the United States. In the pre-COVID-19 era the majority of vaccine-related tweets were generated by Democrat and state senators. The increase in tweets following the arrival of COVID-19, however, was greater among Republican and federal legislators than Democrat or state legislators. This suggests that legislators who were previously less engaged in public discussion of vaccination, became engaged following the arrival of SARS-CoV-2, which may have implications for COVID-19 vaccine uptake among their followers.

Objectives. To understand the experiences of local health jurisdictions with Senate Bill 277 (SB277), the California law that eliminated nonmedical vaccine exemptions for public- and private-school entry. Methods. We conducted semistructured telephone interviews with health officers and local health department (LHD) staff in California between August and September 2017. Results. Two overall themes emerged: (1) vague legislative and regulatory language led to variation in the interpretation and implementation of SB277, and (2) lack of centralized review of medical exemptions allowed medical exemptions that are not consistent with valid contraindications for immunizations to be accepted. Variation in the interpretation and implementation was commonly reported with provisions related to individualized education programs and special education, and independent study programs and homeschooling. Without a centralized review of medical exemption requests, respondents reported variation in the interpretation of which specialties of physicians can write medical exemptions, which conditions constitute a valid contraindication for immunization, and the process for reporting a questionable or suspicious medical exemption. Conclusions. The regulatory language within SB277 led to variation in how the law was interpreted and implemented within and across LHD jurisdictions and school districts.

IMPORTANCE: California implemented 3 interventions to increase uptake of vaccines. In 2014, Assembly bill 2109 tightened requirements for obtaining a personal belief exemption. A 2015 campaign provided educational materials to school staff on the proper application of conditional admission for kindergartners who were not up to date on required vaccinations. In 2016, Senate bill 277 eliminated personal belief exemptions. Prior research has not evaluated these 3 interventions together with regard to the vaccination status of students. OBJECTIVE: To assess the changes in the yearly rates of kindergartners who were not up to date on required vaccinations who were entering school during the period of the interventions, by focusing on geographic clustering and the potential contacts of these kindergartners. DESIGN, SETTING, AND PARTICIPANTS: Observational study that used cross-sectional school-entry data from 2000-2017 to calculate the rates of kindergartners attending California schools who were not up to date on required vaccinations. EXPOSURES: Assembly bill 2109, a conditional admission education program, and Senate bill 277. MAIN OUTCOMES AND MEASURES: The primary outcome was the yearly rate of kindergartners without up-to-date vaccination status. The secondary outcomes were (1) the modified aggregation index, which was used to assess the potential within-school contacts among kindergartners without up-to-date vaccination status, (2) the number of geographic clusters of schools with rates for kindergartners without up-to-date vaccination status that were higher than the rates for schools located outside the cluster, and (3) the number of schools located inside the geographic clusters. RESULTS: In California between 2000 and 2017, 9 323 315 children started attending kindergarten and 721 593 were not up to date on required vaccinations. Prior to the interventions, the statewide rate of kindergartners without up-to-date status for required vaccinations increased from 7.80% during 2000 to 9.84% during 2013 and then ...