Assessing groundwater quality and its association with child undernutrition in India.

BACKGROUND AND OBJECTIVES: Groundwater contamination poses a significant health challenge in India, particularly impacting children. Despite its importance, limited research has explored the nexus between groundwater quality and child nutrition outcomes. This study addresses this gap, examining the association between groundwater quality and child undernutrition, offering pertinent insights for policymakers. DATA AND METHODS: The study uses data from the fifth round of the National Family Health Survey (NFHS) and the Central Groundwater Board (CGWB) to analyze the association between groundwater quality and child nutritional status. The groundwater quality data were collected by nationwide monitoring stations programmed by CGWB, and the child undernutrition data were obtained from the NFHS-5, 2019-21. The analysis included descriptive and logistic regression model. The study also considers various demographic and socio-economic factors as potential moderators of the relationship between groundwater quality and child undernutrition. FINDINGS: Significant variation in groundwater quality was observed across India, with numerous regions displaying poor performance. Approximately 26.53 % of geographical areas were deemed unfit for consuming groundwater. Environmental factors such as high temperatures, low precipitation, and arid, alluvial, laterite-type soils are linked to poorer groundwater quality. Unfit-for-consumption groundwater quality increased the odds of undernutrition, revealing a 35 %, 38 %, and 11 % higher likelihood of stunting, underweight, and wasting in children, with higher pH, Magnesium, Sulphate, Nitrate, Total Dissolved Solids, and Arsenic, levels associated with increased odds of stunting, underweight, and wasting. Higher temperatures (>25 °C), high elevations (>1000 m), and proximity to cultivated or industrial areas all contribute to heightened risks of child undernutrition. Children consuming groundwater, lacking access to improved toilets, or living in rural areas are more likely to be undernourished, while females, higher-income households, and those consuming dairy, vegetables, and fruits daily exhibit lower odds of undernutrition. POLICY IMPLICATIONS: Policy implications highlight the urgent need for investment in piped water supply systems. Additionally, focused efforts are required to monitor and improve groundwater quality in regions with poor water quality. Policies should emphasize safe sanitation practices and enhance public awareness about the critical role of safe drinking water in improving child health.

LivWell: a sub-national Dataset on the Living Conditions of Women and their Well-being for 52 Countries.

Data on women's living conditions and socio-economic development are important for understanding and addressing the pronounced challenges and inequalities faced by women worldwide. While such information is increasingly available at the national level, comparable data at the sub-national level are missing. We here present the LivWell global longitudinal dataset, which includes a set of key indicators on women's socio-economic status, health and well-being, access to basic services and demographic outcomes. It covers 447 regions in 52 countries and includes a total of 265 different indicators. The majority of these are based on 199 Demographic and Health Surveys (DHS) for the period 1990-2019 and are complemented by extensive information on socio-economic and climatic conditions in the respective regions. The resulting dataset offers various opportunities for policy-relevant research on gender inequality, inclusive development and demographic trends at the sub-national level.

Information exchange in laboratory markets: competition, transfer costs, and the emergence of reputation.

Public reputation mechanisms are an effective means to limit opportunistic behavior in markets suffering from moral hazard problems. While previous research was mostly concerned with the influence of exogenous feedback mechanisms, this study considers the endogenous emergence of reputation through deliberate information sharing among actors and the role of barriers in hindering information exchange. Using a repeated investment game, we analyze the effects of competition and transfer costs on players' willingness to share information with each other. While transfer costs are a direct cost of the information exchange, competition costs represent an indirect cost that arises when the transfer of valuable information to competitors comes at the loss of a competitive advantage. We show that barriers to information exchange not only affect the behavior of the senders of information, but also affect the ones about whom the information is shared. While the possibility of sharing information about others significantly improves trust and market efficiency, both competition and direct transfer costs diminish the positive effect by substantially reducing the level of information exchange. Players about whom the information is shared anticipate and react to the changes in the costs by behaving more or less cooperatively. For reputation building, an environment is needed that fosters the sharing of information. Reciprocity is key to understanding information exchange. Even when it is costly, information sharing is used as a way to sanction others.

Evaluating an MFI Community Health Worker Program: How microfinance group networks influence intervention outreach and impact.

BACKGROUND: Community Health Workers (CHWs) are considered to be a cost-effective and inclusive solution to address the persistent health workforce shortage in many low and middle-income countries. In recent years, microfinance institutions (MFIs) got increasingly engaged in providing health services delivered by CHWs. Despite their growing importance, little is known about the impacts and implementation barriers of these mostly small-scale initiatives. This paper evaluates an MFI-led CHW program in the Philippines and studies the role of microfinance group networks in influencing program outreach and impact. The intervention aims at disseminating information in poor communities, improving health monitoring through increased check-ups and raising social support. METHODS: Clustered randomized controlled trial in 70 communities in the greater area of Metro Manila, the Philippines. The main data was collected in a baseline and follow-up survey and is complemented with extensive sociometric network and geographical data. The main outcome variable is a composite health index based on 10 indicators. The role of the health worker's embeddedness and connectedness in the community for program success is tested using tools of social network analysis. RESULTS: The intervention led to a 3.8% (95% confidence interval (CI) = 1.3, 6.4) improvement in the composite health outcome. Effects across indicators are mixed and mainly driven by changes in immediate health monitoring behavior: The probability for routine examinations increased in the treatment group by 10.6% (95% CI = 3.2, 18.1), for regular blood pressure checks by 9.6% (95% CI = 3.3, 15.9), and for having access to a health care provider by 7.2% (95% CI = 0.93, 13.5). No statistical effects on general knowledge and social support are observable. Social networks are a key driver of program outreach and impact. Close friends and acquaintances of health workers used and benefited substantially more from the program than more distant ties. CONCLUSIONS: Despite the promising immediate behavioral impacts, it remains questionable to what extent such small-scale MFI initiatives can bring transformative and sustainable changes without external support. Microfinance group networks played an important role for the success of the health intervention and further research is needed to better understand how these affect the health care utilization decisions of the clients.

The health knowledge mechanism: evidence on the link between education and health lifestyle in the Philippines.

Studies have found substantial differences in health-related behavior and health care usage between educational groups, which may explain part of the well-documented educational gradient in health. The allocative efficiency hypothesis offers a behavioral explanation for these reported differences. According to this theory, the educated possess more health knowledge and information, allowing them to make better health choices. We perform a mediation analysis to study this mechanism using original survey data from the Philippines, a lower-middle-income country. As an extension of previous empirical research, we construct a comprehensive index that captures different dimensions of health knowledge. Using generalized propensity scores, we find strong support for the allocative efficiency argument. Schooling is significantly associated with health knowledge levels, which explain up to 69% of the education effect on health lifestyle. This corresponds to twice the mediation strength of economic resources, suggesting an important role of this factor in explaining education effects on health decisions.