Microsoft powerpoint - 2. michael & ted_how research reframed the issue

Deworming and schooling
Beyond their direct health and nutrition impacts, worm
infections can also affect children’s schooling
Anemia, lethargy and weakness make attending school and learning difficult This is a critical channel from the point of view of economic development: schooling leads to greater productivity and Schooling impacts would provide a further public policy rationale for deworming U.C. Berkeley - Evidence to Action Symposium Using randomized evaluations to assess impacts
A School-based Deworming Project in Kenya
As in a medical trial, randomization provides a plausible
method for estimating program impacts
On average, treatment and control groups are similar in Over 90 percent infected with intestinal worms
(hookworm, roundworm, whipworm, schistosomiasis)
Treatment with albendazole and praziquantel twice per This is also a practical approach since logistical or financial constraints often require staggered program phase-in Pilot programs are an ideal testing ground for new 75 primary schools (children aged 6-18 years), treatment was phased in over three years, in 25 schools at a time U.C. Berkeley - Evidence to Action Symposium U.C. Berkeley - Evidence to Action Symposium The Impact of Deworming in Kenya (1998-2000)
Externality (Spillover) Impacts of Deworming
Rates of serious worm infections fell by half after one year, Deworming reduces re-infection for other community
Large reduction for untreated children in treatment Significant gains in child self-reported health, height schools (70% of effect on the treated) and for those within 6 km of treatment schools Large gains in school participation: Absenteeism fell by
one-quarter, or 7.5 percentage points
U.C. Berkeley - Evidence to Action Symposium U.C. Berkeley - Evidence to Action Symposium Externality (Spillover) Impacts of Deworming
Deworming reduces re-infection for other community members Large reduction for untreated children in treatment schools (70% of effect on the treated) and those within 6 km of treatment schools Taking these into account, deworming increases school
participation by one year at a cost of only 3.50 USD
Provides a strong rationale for deworming subsidies
U.C. Berkeley - Evidence to Action Symposium Impacts of Deworming and Iron in India (2001-03)
Impacts of Deworming in the U.S. South (1910)
Pre-school NGO health project in slums of Delhi, India Bleakley (2007) studies the large-scale Rockefeller 68% anemic, 24% worm infections at baseline Foundation campaign against worms in the U.S. South 200 pre-schools, children aged 3-6 years old 40% of school-aged children were infected with Treat with albendazole, iron, Vitamin A, < 2 USD/year Areas with higher hookworm infection rates prior to the Child weight improved by 0.6 kg on average intervention showed greater increases in school enrollment, School attendance gains of 6.3 percentage points
A long-term follow-up found substantial income gains
U.C. Berkeley - Evidence to Action Symposium U.C. Berkeley - Evidence to Action Symposium Deworming improves school participation
Three school deworming projects – in rural Africa, urban
India and the U.S. South – all led to substantial schooling
improvements
Current research work: longer-term labor market, health, fertility outcomes in Kenya, including among those who did not directly receive deworming drugs How effective is deworming relative to other programs? U.C. Berkeley - Evidence to Action Symposium How should deworming programs be designed?
Cost-sharing for deworming drugs vs. subsidies
Delivery through schools is cost effective
25 of 50 Group 1, Group 2 schools free treatment in 200125 of 50 Group 1, Group 2 schools cost-sharing in 2001 Price per household ranged from 0.40 USD for albendazole Increasing popularity of financial “sustainability” in
only schools, 1.30 USD for albendazole, praziquantel schools development programs
Cost-sharing drug costs with households is a natural way Massive reduction in deworming: 2001 take-up rate in free
treatment schools 75%, in cost-sharing schools was only 18%
to implement sustainable deworming programsUser fees are often advocated for health programs, as well as in water and other areas U.C. Berkeley - Evidence to Action Symposium U.C. Berkeley - Evidence to Action Symposium The illusion of sustainability?
Another approach to sustainability is behavioral change through health education – in this context, washing hands, wearing shoes, and avoiding infected fresh water Spending on health education the same as on drugsBut no observed behavioral change A “sustainable” approach to deworming programs may not The truly sustainable approach is long-term free deworming treatment delivered through schools U.C. Berkeley - Evidence to Action Symposium

Source: http://cega.berkeley.edu/assets/cega_events/19/E2A_Kremer___Miguel_(Presentation).pdf