Health insurance and child mortality: Evidence from India.

Although less than a third of the population in developing countries is covered by health insurance, the number has been on the rise. Many countries have implemented national insurance policies in the past decade. However, there is limited evidence on their impact on child mortality in low- and middle-income contexts. Here we document the child mortality reducing effects of an at-scale national level health insurance policy in India. The Rashtriya Swasthya Bima Yojana (RSBY), was rolled out across India between 2008 and 2013. Leveraging the temporal and spatial variation in program implementation, we demonstrate that it lowered infant mortality by 6% and child under five mortality by 5%. The effects are largely concentrated among urban poor households. In terms of mechanisms, we find that the program effects seem to be driven by increased usage of reproductive health services by mothers. We also demonstrate a rise in usage of complementary health services that were were not covered under the policy (such as child immunizations), which suggests that RSBY had significant positive spillover effects on health care usage.

Impact of 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach on malaria prevalence in Tanzania.

BACKGROUND: Progress in malaria control has stalled in recent years and innovative surveillance and response approaches are needed to accelerate malaria control and elimination efforts in endemic areas of Africa. Building on a previous China-UK-Tanzania pilot study on malaria control, this study aimed to assess the impact of the 1,7-malaria Reactive Community-Based Testing and Response (1,7-mRCTR) approach implemented over two years in three districts of Tanzania. METHODS: The 1,7-mRCTR approach provides community-based malaria testing via rapid diagnostic tests and treatment in villages with the highest burden of malaria incidence based on surveillance data from health facilities. We used a difference-in-differences quasi-experimental design with linear probability models and two waves of cross-sectional household surveys to assess the impact of 1,7-mRCTR on malaria prevalence. We conducted sensitivity analyses to assess the robustness of our results, examined how intervention effects varied in subgroups, and explored alternative explanations for the observed results. RESULTS: Between October 2019 and September 2021, 244,771 community-based malaria rapid tests were completed in intervention areas, and each intervention village received an average of 3.85 rounds of 1-7mRCTR. Malaria prevalence declined from 27.4% at baseline to 11.7% at endline in the intervention areas and from 26.0% to 16.0% in the control areas. 1,7-mRCTR was associated with a 4.5-percentage-point decrease in malaria prevalence (95% confidence interval: - 0.067, - 0.023), equivalent to a 17% reduction from the baseline. In Rufiji, a district characterized by lower prevalence and where larviciding was additionally provided, 1,7-mRCTR was associated with a 63.9% decline in malaria prevalence. CONCLUSIONS: The 1,7-mRCTR approach reduced malaria prevalence. Despite implementation interruptions due to the COVID-19 pandemic and supply chain challenges, the study provided novel evidence on the effectiveness of community-based reactive approaches in moderate- to high-endemicity areas and demonstrated the potential of South-South cooperation in tackling global health challenges.

Leveraging men's education as an effective pathway for improving diet quality: Evidence from rural India.

Investing in nutrition sensitive sectors such as education can be an effective strategy for combatting malnutrition. In this paper we analyze the role that men's education plays in determining dietary diversity outcomes using primary data from 3600 households across four districts of India. Dietary diversity scores were calculated to reflect the quality of food intake, for households and women. Men's education level was considered as the primary driver of diet diversity. To establish a causal link between men's education and diet diversity, the education level of parents and siblings were used as instrumental variables. We find that men's education levels are associated with significantly higher diet diversity scores both for the household and for women. The role of men's education continues to be a significant determinant of diet quality after controlling for household and individual- level confounding factors including the education level of the woman. The results are consistent across different definitions of the diet diversity score and reference period. Methodologically we extend the evidence on the education-nutrition pathway from being associational to causal in nature. Results from this study point to the benefits of leveraging men's education as an effective pathway for improving nutritional outcomes within households.

Mental health effects of education.

We analyze the role of education as a determinant of mental health. To do this, we leverage the age-specific exposure to an educational reform as an instrument for years of education and find that the treated cohorts gained more education. This increase in education had an effect on mental health more than 2 decades later. An extra year of education led to a lower likelihood of reporting any symptoms related to depression (11.3%) and anxiety (9.8%). More educated people also suffered less severe symptoms - depression (6.1%) and anxiety (5.6%). These protective effects are higher among women and rural residents. The effects of education on mental well-being that we document are potentially mediated through better physical health, improved health behavior and knowledge, and an increase in women's empowerment.

Development of Amine-Functionalized Metal-Organic Frameworks Hollow Fiber Mixed Matrix Membranes for CO2 and CH4 Separation: A Review.

CO2 separation from raw natural gas can be achieved through the use of the promising membrane-based technology. Polymeric membranes are a known method for separating CO2 but suffer from trade-offs between its permeability and selectivity. Therefore, through the use of mixed matrix membranes (MMMs) which utilizes inorganic or hybrid fillers such as metal-organic frameworks (MOFs) in polymeric matrix, the permeability and selectivity trade-off can be overcome and possibly surpass the Robeson Upper Bounds. In this study, various types of MOFs are explored in terms of its structure and properties such as thermal and chemical stability. Next, the use of amine and non-amine functionalized MOFs in MMMs development are compared in order to investigate the effects of amine functionalization on the membrane gas separation performance for flat sheet and hollow fiber configurations as reported in the literature. Moreover, the gas transport properties and various challenges faced by hollow fiber mixed matrix membranes (HFMMMs) are discussed. In addition, the utilization of amine functionalization MOF for mitigating the challenges faced is included. Finally, the future directions of amine-functionalized MOF HFMMMs are discussed for the fields of CO2 separation.

COVID-19 vaccine preferences in India.

India's mass vaccination efforts have been slow due to high levels of vaccine hesitancy. This study uses data from an online discrete choice experiment with 1371 respondents to rigorously examine the factors shaping vaccine preference in the country. We find that vaccine efficacy, presence of side effects, protection duration, distance to vaccination centre and vaccination rates within social network play a critical role in determining vaccine demand. We apply a non-parametric model to uncover heterogeneity in the effects of these factors. We derive two novel insights from this analysis. First, even though, on average, domestically developed vaccines are preferred, around 30% of the sample favours foreign-developed vaccines. Second, vaccine preference of around 15% of the sample is highly sensitive to the presence of side effects and vaccination uptake among their peer group. These results provide insights for the ongoing policy debate around vaccine adoption in India.

What doesn't kill her, will make her depressed.

In this paper we study the long run effects of the 1959-61 Chinese Famine on mental health outcomes. We focus on cohorts that were born during the famine and examine their mental health as adults, when they are roughly 55 years of age. We find that early-life exposure to this famine leads to a large statistically significant negative impact on women's mental health, while there is limited effect on men. This gender differential effect is observed because male fetuses experience a stronger natural selection as compared to female fetuses, which implies that in the longer run, surviving females may exhibit larger detrimental effects of early-life famine exposure. Thus, the observed effects are a composite of two well-established factors, the survival of the fittest and the Fetal Origins hypothesis.

Are Women in Rural India Really Consuming a Less Diverse Diet?

BACKGROUND: It is widely considered that women have less diverse diets than other household members. However, it has been challenging to establish this empirically since women's diet diversity is measured differently from that of other household members. OBJECTIVE: In this article, we compare women's dietary diversity with that of their respective households and thereby generate a measure of "dietary gap." METHODS: We measure women's "dietary gap" by using the difference of homogenized household and woman dietary scores (using the same scales). This is done using primary data on 3600 households from 4 districts in India. Additionally, we show the robustness of our results to variations in scale and recall periods used to construct the diet diversity scores. RESULTS: Mean difference tests indicate that women consistently consume 0.1 to 0.5 fewer food groups relative to other household members, with the results being statistically significant at the 1% level. The food groups driving this dietary gap are nonstaples like Vitamin A-rich fruits and vegetables, meat/fish/poultry, and dairy. CONCLUSIONS: Results point toward the discrimination faced by women in the variety of the food consumed, the importance of considering comparability in creating indices of diet diversity, and the need to collect more detailed information on diets. To our knowledge, this is one of the first studies to examine dietary discrimination faced by women using common scales.

Market Access, Production Diversity, and Diet Diversity: Evidence From India.

BACKGROUND: Recent literature, largely from Africa, shows mixed effects of own-production on diet diversity. However, the role of own-production, relative to markets, in influencing food consumption becomes more pronounced as market integration increases. OBJECTIVE: This paper investigates the relative importance of two factors - production diversity and household market integration - for the intake of a nutritious diet by women and households in rural India. METHODS: Data analysis is based on primary data from an extensive agriculture-nutrition survey of 3600 Indian households that was collected in 2017. Dietary diversity scores are constructed for women and households is based on 24-hour and 7-day recall periods. Household market integration is measured as monthly household expenditure on key non-staple food groups. We measure production diversity in two ways - field-level and on-farm production diversity - in order to account for the cereal centric rice-wheat cropping system found in our study locations. The analysis is based on Ordinary Least Squares regressions where we control for a variety of village, household, and individual level covariates that affect food consumption, and village fixed effects. Robustness checks are done by way of using a Poisson regression specifications and 7-day recall period. RESULTS: Conventional measures of field-level production diversity, like the number of crops or food groups grown, have no significant association with diet diversity. In contrast, it is on-farm production diversity (the field-level cultivation of pulses and on-farm livestock management, and kitchen gardens in the longer run) that is significantly associated with improved dietary diversity scores, thus suggesting the importance of non-staples in improving both individual and household dietary diversity. Furthermore, market purchases of non-staples like pulses and dairy products are associated with a significantly higher dietary diversity. Other significant determinants of dietary diversity include women's literacy and awareness of nutrition. These results mostly remain robust to changes in the recall period of the diet diversity measure and the nature of the empirical specification. CONCLUSIONS: This study contributes to the scarce empirical evidence related to diets in India. Additionally, our results indicate some key intervention areas - promoting livestock rearing, strengthening households' market integration (for purchase of non-staples) and increasing women's awareness about nutrition. These are more impactful than raising production diversity.

Marriage Age, Social Status, and Intergenerational Effects in Uganda.

This study examines whether Ugandan women who marry at younger ages fare differently on a wide range of later-life outcomes than women who marry at later ages. Using a nationally representative data set, I identify the plausibly causal impacts of women's marriage age by using age at menarche as an instrumental variable. Results indicate that a one-year delay in marriage for Ugandan women leads to higher educational attainment (0.5-0.75 years), literacy (10 percentage points), and labor force participation (8 percentage points). I also explore intergenerational effects of later marriage and find that the children of mothers who marry later have higher BMI (0.11 kg/m2) and hemoglobin levels (0.18 g/dl), and they are also less likely to be anemic (4 percentage points). Finally, I present evidence suggesting that the observed effects might be mediated through an enhancement of women's agency within their household and positive assortative matching in the marriage market. By pointing to the beneficial consequences of delaying marriage, this research calls for concerted policy action to prevent child marriage.