ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
Department of Economics & Institut D'economia De Barcelona (IEB), Universitat de Barcelona, Spain; Centre for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain.
Econ Hum Biol. 2022 Jan;44:101100. doi: 10.1016/j.ehb.2021.101100. Epub 2021 Dec 11.
Despite the significant improvements achieved over the last ten years, primary education attainment in Mozambique is still low. Potential reasons acting from the demand perspective include ill health, among other factors. In Mozambique, ill health is still largely linked to malaria, which is a leading cause of outpatient contacts, hospital admissions and death, particularly among under-five and school-aged children. Despite this, in Mozambique and more generally, in malaria endemic countries, the identification and measurement of how improved malaria indicators may contribute to better school outcomes remains largely unknown. In particular, there is a low understanding of the extent to which better health translates immediately into school indicators, such as absenteeism and grades. In this study, we exploit the first year of a malaria elimination initiative implemented in Magude district (Southern Mozambique) that started in 2015, as a quasi-experiment to estimate the impact of malaria on selected primary school outcomes. While malaria was not eliminated, its incidence drastically dropped. We use as control a neighbouring district (Manhiça) with similar socio-economic and epidemiological characteristics. By employing a difference-in-differences (DiD) approach, we examine whether the positive health shock translated into improved school outcomes. Using information from school registers, we generated a dataset on school attendance and grades for 9,848 primary-school students from 9 schools (4 in the treated district and 5 in the control district). In our main specification, a repeated cross-section analysis, we find that the elimination initiative led to a 28% decrease in school absenteeism and a 2% increase in students' grades. Our results are robust across different specifications, including a panel DiD individual fixed effects estimate on a sub-sample of students. These findings provide evidence on the negative impact of malaria on primary education attainment and suggest remarkable economic benefits consequent to its elimination.
尽管在过去十年中取得了重大进展，但莫桑比克的小学教育普及率仍然很低。从需求的角度来看，可能的原因包括健康状况不佳等因素。在莫桑比克，健康状况不佳仍然主要与疟疾有关，疟疾是门诊就诊、住院和死亡的主要原因，特别是在五岁以下和学龄儿童中。尽管如此，在莫桑比克乃至更广泛的疟疾流行国家，对于改善的疟疾指标如何有助于提高学校成绩的认识和衡量仍然知之甚少。特别是，人们对于健康状况的改善如何直接转化为学校指标（如缺勤率和成绩）的程度了解甚少。在这项研究中，我们利用了 2015 年在莫桑比克南部马古德区实施的一项疟疾消除倡议的第一年作为准实验，来估计疟疾对选定小学成绩的影响。虽然疟疾没有被消除，但发病率大幅下降。我们选择了一个具有类似社会经济和流行病学特征的邻近区（马尼卡区）作为对照。通过采用差异-差异（DiD）方法，我们研究了积极的健康冲击是否转化为改善的学校成绩。我们利用学校登记处的信息，为来自 9 所学校（4 所位于处理区，5 所位于对照组）的 9848 名小学生生成了一个关于出勤率和成绩的数据。在我们的主要规格中，重复横截面分析发现，消除倡议导致学生缺勤率降低了 28%，学生成绩提高了 2%。我们的结果在不同的规格中都是稳健的，包括对学生子样本的面板 DiD 个体固定效应估计。这些发现提供了疟疾对小学教育普及的负面影响的证据，并表明消除疟疾带来了显著的经济效益。
