This study estimates long-run impacts of a child health investment, exploiting community-wide experimental variation in school-based deworming. The program increased labor supply among men and education among women, with accompanying shifts in labor market specialization. Ten years after deworming treatment, men who were eligible as boys stay enrolled for more years of primary school, work 17% more hours each week, spend more time in nonagricultural self-employment, are more likely to hold manufacturing jobs, and miss one fewer meal per week. Women who were in treatment schools as girls are approximately one quarter more likely to have attended secondary school, halving the gender gap. They reallocate time from traditional agriculture into cash crops and nonagricultural self-employment. We estimate a conservative annualized financial internal rate of return to deworming of 32%, and show that mass deworming may generate more in future government revenue than it costs in subsidies.
Recent research has pointed to large gaps in labor productivity between the agricultural and nonagricultural sectors in low-income countries, as well as between workers in rural and urban areas. Most estimates are based on national accounts or repeated cross-sections of micro-survey data, and as a result typically struggle to account for individual selection between sectors. This paper contributes to this literature using long-run individual-level panel data from two low-income countries (Indonesia and Kenya). Accounting for individual fixed effects leads to much smaller estimated productivity gains from moving into the non-agricultural sector (or urban areas), reducing estimated gaps by over 80 percent. Per capita consumption gaps between non-agricultural and agricultural sectors, as well as between urban and rural areas, are also close to zero once individual fixed effects are included. Estimated productivity gaps do not emerge up to five years after a move between sectors, nor are they larger in big cities. We evaluate whether these findings imply a re-assessment of the current conventional wisdom regarding sectoral gaps, discuss how to reconcile them with existing crosssectional estimates, and consider implications for the desirability of sectoral reallocation of labor.* We would like to thank
The WHO has recently debated whether to reaffirm its long-standing recommendation of mass drug administration (MDA) in areas with more than 20% prevalence of soil-transmitted helminths (hookworm, whipworm, and roundworm). There is consensus that the relevant deworming drugs are safe and effective, so the key question facing policymakers is whether the expected benefits of MDA exceed the roughly$0.30 per treatment cost. The literature on long run educational and economic impacts of deworming suggests that this is the case. However, a recent meta-analysis by Taylor-Robinson et al. (2015) (hereafter TMSDG), disputes these findings. The authors conclude that while treatment of children known to be infected increases weight by 0.75 kg (95% CI: 0.24, 1.26; p=0.0038), there is substantial evidence that MDA has no impact on weight or other child outcomes. We update the TMSDG analysis by including studies omitted from that analysis and extracting additional data from included studies, such as deriving standard errors from p-values when the standard errors are not reported in the original article. The updated sample includes twice as many trials as analyzed by TMSDG, substantially improving statistical power. We find that the TMSDG analysis is underpowered: it would conclude that MDA has no effect even if the true effect were (1) large enough to be cost-effective relative to other interventions in similar populations, or (2) of a size that is consistent with results from studies of children known to be infected. The hypothesis of a common zero effect of multiple-dose MDA deworming on child weight at longest follow-up is rejected at the 10% level using the TMSDG dataset, and with a pvalue < 0.001 using the updated sample. Applying either of two study classification approaches used in previous Cochrane Reviews (prior to TMSDG) also leads to rejection at the 5% level. In the full sample, including studies in environments where prevalence is low enough that the WHO does not recommend deworming, the average effect on child weight is 0.134 kg (95% CI: 0.031, 0.236, random effects estimation). In environments with greater than 20% prevalence, where the WHO recommends mass treatment, the average effect on child weight is 0.148 kg (95% CI: 0.039, 0.258). The implied average effect of MDA on infected children in the full sample (calculated by dividing estimated impact by worm prevalence for each study and applying a random effects model) is 0.301 kg. At 0.22 kg per U.S. dollar, the estimated average weight gain per dollar expenditure from deworming MDA is more than 35 times that from school feeding programs as estimated in RCTs. Under-powered meta-analyses (such as TMSDG) are common in health research, and this methodological issue will be increasingly important as growing numbers of economists and other social scientists conduct meta-analysis.
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