Child malnutrition in farm households: Three essays on agriculture, health, and economic development.
Darrouzet-Nardi, Amelia.
2015
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Abstract: The state
of nutrition and health around the world is progressing forward, but too slowly and with
great disparities across socioeconomic groups, livelihoods, and regions. A potential
promising way to improve health around the globe is through agriculture. This
dissertation examines the institutions and infrastructure that link agriculture and
health in low-income settings, using la... read morerge-scale spatial geographic, civil insecurity,
and climate data merged with household and individual health surveys. The assessment,
scalability, and effectiveness of policies and programs aimed at improving global health
through agriculture depends on the participant's and implementer's access to
well-functioning nearby institutions and infrastructure. An overarching theme of this
dissertation is that one's relative geographic isolation - and therefore one's access to
well-functioning institutions and infrastructure - is not exogenous to other factors
which also determine health and well-being; therefore, a natural experiment study design
is used to elicit the causal influence of geographic isolation on health. The first
chapter examines the relationships between civil insecurity - a proxy signal of
well-functioning institutions - and child health in Sub-Saharan Africa during the start
of the 21st century. The primary focus is on average health effects over a large and
diverse population which did not migrate away from civil conflict-affected areas. The
goal of this chapter is to increase external validity compared with studies that look at
a narrower range of health outcomes or more extreme examples of civil insecurity, such
as a declared war between states or genocide. This is the first study to merge conflict
incident reports and household survey data at this scale and resolution. The findings
indicate that child heights are negatively associated with exposure to civil insecurity
during the first year of life, and these effects differ between urban and rural
children. This study provides a basis for further investigation of the hypothesis that
geographic isolation is a key mediating factor for the associations between civil
insecurity and child health. The second chapter shifts the focus of the first chapter
from institutions to infrastructure at a global scale, testing whether household
proximity to older towns and cities has improved or worsened malnutrition among over
400,000 children and their 600,000 mothers across 43,850 communities in 46 low- and
middle-income countries between 1986 and 2011. Findings indicate that living closer to
older towns and cities can protect child heights and weights, while also increasing the
prevalence of child and maternal overweight in rural farm households. This is the first
study to investigate the consequences of nearby urbanization on rural farm households,
and the findings illustrate the potential benefits and risks of nearby markets for
global health. The third and final chapter presents a formal test of the hypothesis that
access to towns and cities can improve nutrition smoothing for rural farm households,
with an example focused on the Democratic Republic of the Congo (DRC). This chapter uses
spatial diversity across the DRC to investigate whether proximity to towns confers
resilience against seasonal determinants of maternal and infant health. The study design
is a natural experiment, exploiting the quasi-random timing of birth to identify
children exposed to adverse conditions. This study finds that children living closer to
town are protected against adverse environmental conditions at birth. Great achievements
have been made in improving global health during the start of the 21st century, and
there is substantial opportunity to further advance this difficult task. This
dissertation aims to improve understanding of the causal pathways between geographic
isolation, institutions, infrastructure, agriculture, and health, and to discover how to
exploit agriculture for global health improvement. The central finding is that
facilitating access to markets and services improves the abilities of farm families to
mitigate health risks, indicating that investments in infrastructure and institutional
capacity could allow for enduring progress at reducing health
disparities.
Thesis (Ph.D.)--Tufts University, 2015.
Submitted to the Dept. of Agriculture, Food and Environment.
Advisor: William Masters.
Committee: Jenny Aker, and Steven Block.
Keywords: Agriculture economics, Nutrition, and Public health.read less - ID:
- w0892p35j
- Component ID:
- tufts:20303
- To Cite:
- DCA Citation Guide EndNote
