Child malnutrition in farm households: Three essays on agriculture, health, and economic development.
Darrouzet-Nardi, Amelia.
2017-04-14T13:33:02.621Z
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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 large-s... read morecale 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
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