K. Croke, Joan Hamory, Eric Hsu, M. Kremer, E. Miguel
The WHO has recently debated whether to reaffirm its long-standing recommendation of mass drug administration (MDA) in areas with more than 20 percent 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 percent CI: 0.24, 1.26; p=0.0038), there is substantial evidence that MDA has no impact on weight or other child outcomes. This paper updates the TMSDG analysis by including studies omitted from that analysis and extracting additional data from included studies, and finds that the TMSDG analysis is underpowered: Power is inadequate to rule out weight gain effects that would make MDA cost effective relative to comparable interventions in similar populations, and underpowered to reject the hypothesis that the effect of MDA is different from the effect that might expected, given deworming's effects on those 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 percent level using the TMSDG dataset, and with a p value < 0.001 using the updated sample. In the full sample, including studies in settings where prevalence is low enough that the WHO does not recommend deworming, the average effect on child weight is 0.134 kg (95 percent CI: 0.031, 0.236, random effects). In environments with greater than 20 percent prevalence, where the WHO recommends mass treatment, the average effect on child weight is 0.148 kg (95 percent CI: 0.039, 0.258). The implied average effect of MDA on infected children in the full sample is 0.301 kg. At 0.22 kg per U.S. dollar, the estimated average weight gain per dollar is more than 35 times that from school feeding programs as estimated in RCTs. Under-powered meta-analyses 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.
{"title":"Does Mass Deworming Affect Child Nutrition? Meta-Analysis, Cost-Effectiveness, and Statistical Power","authors":"K. Croke, Joan Hamory, Eric Hsu, M. Kremer, E. Miguel","doi":"10.1596/1813-9450-7921","DOIUrl":"https://doi.org/10.1596/1813-9450-7921","url":null,"abstract":"The WHO has recently debated whether to reaffirm its long-standing recommendation of mass drug administration (MDA) in areas with more than 20 percent 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 percent CI: 0.24, 1.26; p=0.0038), there is substantial evidence that MDA has no impact on weight or other child outcomes. This paper updates the TMSDG analysis by including studies omitted from that analysis and extracting additional data from included studies, and finds that the TMSDG analysis is underpowered: Power is inadequate to rule out weight gain effects that would make MDA cost effective relative to comparable interventions in similar populations, and underpowered to reject the hypothesis that the effect of MDA is different from the effect that might expected, given deworming's effects on those 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 percent level using the TMSDG dataset, and with a p value < 0.001 using the updated sample. In the full sample, including studies in settings where prevalence is low enough that the WHO does not recommend deworming, the average effect on child weight is 0.134 kg (95 percent CI: 0.031, 0.236, random effects). In environments with greater than 20 percent prevalence, where the WHO recommends mass treatment, the average effect on child weight is 0.148 kg (95 percent CI: 0.039, 0.258). The implied average effect of MDA on infected children in the full sample is 0.301 kg. At 0.22 kg per U.S. dollar, the estimated average weight gain per dollar is more than 35 times that from school feeding programs as estimated in RCTs. Under-powered meta-analyses 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.","PeriodicalId":383151,"journal":{"name":"PsychRN: Child Development (Topic)","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124882938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raj Chetty, Nathaniel Hendren, Frina Lin, Jeremy Majerovitz, Benjamin Scuderi
We show that differences in childhood environments play an important role in shaping gender gaps in adulthood by documenting three facts using population tax records for children born in the 1980s. First, gender gaps in employment rates, earnings, and college attendance vary substantially across the parental income distribution. Notably, the traditional gender gap in employment rates is reversed for children growing up in poor families: boys in families in the bottom quintile of the income distribution are less likely to work than girls. Second, these gender gaps vary substantially across counties and commuting zones in which children grow up. The degree of variation in outcomes across places is largest for boys growing up in poor, single-parent families. Third, the spatial variation in gender gaps is highly correlated with proxies for neighborhood disadvantage. Low-income boys who grow up in high-poverty, high-minority areas work significantly less than girls. These areas also have higher rates of crime, suggesting that boys growing up in concentrated poverty substitute from formal employment to crime. Together, these findings demonstrate that gender gaps in adulthood have roots in childhood, perhaps because childhood disadvantage is especially harmful for boys.
{"title":"Childhood Environment and Gender Gaps in Adulthood","authors":"Raj Chetty, Nathaniel Hendren, Frina Lin, Jeremy Majerovitz, Benjamin Scuderi","doi":"10.1257/AER.P20161073","DOIUrl":"https://doi.org/10.1257/AER.P20161073","url":null,"abstract":"We show that differences in childhood environments play an important role in shaping gender gaps in adulthood by documenting three facts using population tax records for children born in the 1980s. First, gender gaps in employment rates, earnings, and college attendance vary substantially across the parental income distribution. Notably, the traditional gender gap in employment rates is reversed for children growing up in poor families: boys in families in the bottom quintile of the income distribution are less likely to work than girls. Second, these gender gaps vary substantially across counties and commuting zones in which children grow up. The degree of variation in outcomes across places is largest for boys growing up in poor, single-parent families. Third, the spatial variation in gender gaps is highly correlated with proxies for neighborhood disadvantage. Low-income boys who grow up in high-poverty, high-minority areas work significantly less than girls. These areas also have higher rates of crime, suggesting that boys growing up in concentrated poverty substitute from formal employment to crime. Together, these findings demonstrate that gender gaps in adulthood have roots in childhood, perhaps because childhood disadvantage is especially harmful for boys.","PeriodicalId":383151,"journal":{"name":"PsychRN: Child Development (Topic)","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128369612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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