Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark.
Copenhagen Business School, Copenhagen, Denmark.
PLoS One. 2018 Jun 22;13(6):e0199542. doi: 10.1371/journal.pone.0199542. eCollection 2018.
Malaria is a major cause of morbidity and mortality in sub-Saharan Africa. It is also a dynamic contributor to poverty through its effects on children's cognitive development. This paper examines the degree to which malaria in early childhood impacts on educational achievement in later childhood. The substantial decline in malaria in the region over recent years allows an assessment of its impact to be made. Focusing on Tanzania, we combine data from the Malaria Atlas Project and the 2010-2014 Uwezo household surveys (N = 246,325). We relate the district-level risk of malaria in a child's year of birth to his/her performance in tests of acquired cognitive skills (literacy and numeracy). For causal identification, we rely on differences across districts in the pace of decline in malaria prevalence occurring over the last 15 years. We control for time-invariant district level, age, birth cohort and survey year effects, as well as district-level trends and individual and household-specific factors. In addition, we use sibling variation in birth-year exposure to malaria to strengthen our identification. A ten percentage-point decrease in malaria prevalence in birth year is associated with a 0.06 standard deviation (p = 0.000) increase in English literacy achievement. This estimate is comparable in magnitude to education intervention programs with very large effects. Our results are robust to a large number of sensitivity analyses. We find no statistically significant effects of birth-year malaria exposure on attainments in numeracy and Kiswahili, and we argue that this is probably attributable to strong ceiling effects in these test scores. We conclude that in Tanzania malaria is an important factor in geographical variation in English literacy. This indicates that malaria is a significant public health challenge to educational achievement in this country, and probably in other regions with malaria.
疟疾是撒哈拉以南非洲地区发病率和死亡率的主要原因。它也通过对儿童认知发展的影响成为贫困的一个动态因素。本文研究了儿童早期疟疾对后期儿童教育成就的影响程度。近年来，该地区疟疾发病率大幅下降，使我们能够评估其影响。本文以坦桑尼亚为例，结合疟疾地图集项目和 2010-2014 年 Uwezo 家庭调查的数据（N = 246325）。我们将儿童出生年份所在地区疟疾的风险与他们在后天认知技能测试（读写和计算）中的表现联系起来。为了进行因果识别，我们依赖于过去 15 年疟疾发病率下降速度在不同地区之间的差异。我们控制了地区层面的固定效应、年龄、出生队列和调查年份效应，以及地区层面的趋势和个人及家庭特定因素。此外，我们还利用出生年份接触疟疾的兄弟姐妹差异来加强我们的识别。出生年份疟疾流行率降低 10 个百分点，与英语读写能力提高 0.06 个标准差（p = 0.000）相关。这一估计与教育干预计划的效果非常大的效果相当。我们的结果对大量敏感性分析是稳健的。我们没有发现出生年份疟疾暴露对计算和斯瓦希里语成绩的有统计学意义的影响，我们认为这可能归因于这些测试分数的强天花板效应。我们的结论是，在坦桑尼亚，疟疾是英语读写能力地区差异的一个重要因素。这表明疟疾是该国教育成就的一个重大公共卫生挑战，可能在其他疟疾地区也是如此。
