Dasgupta Susmita, Roy Subhendu, Wheeler David
The World Bank, 1818 H Street NW, Washington, DC 20433, USA.
World Bank, University of Phoenix, 5 Foster Road, Lexington, MA 02421, USA.
Health Policy Open. 2021 Mar 1;2:100038. doi: 10.1016/j.hpopen.2021.100038. eCollection 2021 Dec.
This paper explores the sources of spatial variation in child wasting and maternal anemia in three Indian states and six Bangladeshi divisions. Our initial probability models incorporate traditionally-cited variables from Demographic and Health Surveys such as mother's education, mother's age and household wealth, along with seasonal fluctuations and regional fixed effects. The regional fixed effects are highly significant, even after controlling for the traditionally-cited determinants. We then re-estimate our models, replacing regional fixed effects with measures of four factors that exhibit spatial clustering in the study area: provision of health services, political instability, religious culture, and flood-proneness. Our re-estimated models show highly significant effects for all four factors, thereby highlighting potential gains from more effective policy interventions at the regional level. Mothers and children whose socioeconomic status is identical have much better health outcomes in areas where health services are relatively plentiful, political stability prevails, key protein sources are more plentiful, and water is abundant. Our results also demonstrate a strong association of mother's health status post-partum with long term health outcomes for children.
本文探讨了印度三个邦和孟加拉国六个行政区儿童消瘦和孕产妇贫血的空间差异来源。我们最初的概率模型纳入了人口与健康调查中传统引用的变量，如母亲的教育程度、母亲的年龄和家庭财富，以及季节性波动和区域固定效应。即使在控制了传统引用的决定因素之后，区域固定效应仍然非常显著。然后，我们重新估计模型，用研究区域内呈现空间聚集的四个因素的指标取代区域固定效应：卫生服务的提供、政治不稳定、宗教文化和易受洪水影响程度。我们重新估计的模型显示，所有四个因素都有非常显著的影响，从而突出了在区域层面进行更有效政策干预的潜在收益。在卫生服务相对充足、政治稳定、主要蛋白质来源更丰富、水源充足的地区，社会经济地位相同的母亲和儿童的健康状况要好得多。我们的结果还表明，母亲产后的健康状况与儿童的长期健康结果之间存在很强的关联。
