Malaria and Labor Productivity (with Oladele Akogun (Modibo Adama University of Technology and Common Heritage Foundation), Jed Friedman (World Bank), and Pieter Serneels (University of East Anglia))

The consequences of ill health for productivity and economic development are presumed to be severe yet the rigorous evidence base for such a linkage is small. In previous work, statistically significant and large intent to treat effects were estimated on earnings, labor supply and productivity of a curative malaria treatment at a large sugarcane plantation in Nigeria. 

A mobile health clinic was established on the plantation and used an exogenously determined ordering of workers to test and treat workers. Despite large treatment effects, we find that workers have low rates of seeking curative and preventative treatments. To better understand this puzzle, this study offers access to malaria treatment and insurance at exogenously varied prices to estimate its effect on take-up and frequency of health care.

In another study phase, the study will also measure the effect of treatment on both worker productivity and physical activity.  This will allow estimation of the effects of malaria on physical activity in general, and allow us to extrapoliate our findings in this context to other physical occupations in endemic areas.

Since 2009, we have collected 5 rounds of data including replication of the study's main findings, a willingness to pay study, alternative measurement of productivity using accelerometers, and a policy simulation.  


Agriculture and Nutrition Programs (with Deanna Olney (IFPRI), Abdoulaye Pedehombga (HKI)

and Marie Ruel (IFPRI))

In 2010, Helen Keller International implemented an enhanced-homestead food production (E-HFP) program in Burkina Faso with the specific objectives of improving women’s agricultural production of nutrient rich foods as well children’s nutritional status.  This program was expected to achieve these objectives through a set of production and nutrition interventions through three primary program impact pathways. The first pathway, increasing women’s production of micronutrient-rich foods and the availability and consumption of these foods was expected to improve both household food security as well as children’s nutritional status.  The second pathway, increasing income through the sale of surplus production was again expected to improve these two primary outcomes. The third program impact pathway aimed to specifically improve children’s nutritional status by improving beneficiaries’ health and nutrition-related knowledge and encouraging parental adoption of optimal health and nutrition behaviors with their children.      

A cluster-randomized impact evaluation was designed whereby 55 villages were randomly assigned to a control group (n=25) or to one of two intervention groups (n=15 each).  Both intervention groups received both the production and nutrition interventions with the only difference between the two being the implementers of the BCC strategy – either the older women leaders or the health committee members.  It was expected that the program would have the most impact on improving the nutritional status of children during the first 1000 days of life, therefore children between the ages of 3 and 12 months of age were targeted by the program.  The mothers of all children between the ages of 3 and 12 months of age living in the intervention villages were invited to participate in the E-HFP program and were further invited to participate in the impact evaluation along with their husbands and children between the ages of 3 and 12 months of age. Households with children between 3 and 12 months of age at the time of the baseline study living in control villages were also invited to participate in the impact evaluation. The inclusion of a control group in an impact evaluation ensures that a counterfactual can be established which allows the measurement of the causal program impact, comparing randomly assigned participants with and without access to the program over the same time period.  

Agricultural Production, Dietary Diversity and Climate Variability

(with Kevin McGee (World Bank) and Gbemisola Oseni (World Bank))

Household definitions used in multi-topic household surveys vary between surveys but have potentially significant implications for household composition, production, and poverty statistics. Standard definitions of the household usually include some intersection of keywords relating to residency requirements, common food consumption, and intermingling of income or production decisions. Despite best practices intending to standardize the definition of the household, it is unclear which types of definitions or which intersections of keywords in a definition result in different household compositions. This paper conducts a randomized survey experiment of four different household definitions in Mali to examine the implications for household-level statistics. This approach permits analysis of the trade-offs between alternative definition types. We find that additional keywords in definitions increase rather than decrease household size and significantly alters household composition. Definitions emphasizing common consumption or joint production increase estimates of the levels of household assets and consumption statistics, but not on per adult equivalency asset and consumption statistics, relative to open-ended definitions of the household. In contrast, definition type did not affect production statistics in levels, though we observe significant differences in per adult equivalency terms. Our findings suggest that variations in household definition have implications for measuring household welfare and production.