Martina Björkman Nyqvist

Climate change is increasing the intensity of extreme weather events. Health is a primary channel through which climate change affects welfare. Yet, estimates of the mitigating effects of health system strengthening are largely missing. We combine data from a randomized trial inducing variation in healthcare access with naturally-occurring variation in growing-season precipitation to study the adaptive impact of community healthcare in a low-income country setting. The risk of infant death increases following low growing-season rainfall, but access to community healthcare reduces this risk by 46 %. Using our estimates coupled with projections from climatological models implies even larger potential adaptive effects.

Quantitative research on human trafficking is scant due to lack of data. This study makes use of a unique survey we collected on former victims of trafficking and vulnerable women and girls in the Philippines. We start by exploring the correlates of trafficking and show that household composition (in particular the presence of older sisters) and plausibly exogenous measures of health and economic shocks predict the likelihood of being tracked. We then study the effects of trafficking on victims' intertemporal and risk preferences using entropy balancing. We find that trafficking victims are not differentially patient, but they are more risk-loving. Our novel data and findings are pertinent to the design of policies intending to prevent trafficking and reintegrate victims.

This study evaluates a communication training program for mothers in Uganda, motivated by prior evidence suggesting that mothers often prioritize children’s needs more than fathers. The program aims to enable women to effectively communicate their knowledge and preferences about child health to their husbands, thereby increasing investments in children’s health. Using a randomized experiment, we find that the program increases spousal discussion about the family’s health, nutrition, and finances. It also increases women’s and children’s intake of animal-sourced foods, as well as household spending on these foods. We find that birthweight of newborns increases. However, the program did not increase households’ adoption of measured health-promoting behaviors or improve other child anthropometric measures.

We study the impact of the COVID-19 pandemic and associated school closure on primary school children’s learning and mental wellbeing in Assam, India. Using a comprehensive dataset that tracked and repeatedly surveyed approximately 5000 children across 200 schools between 2018 and 2022, we find that children lost the equivalent of nine months of learning in mathematics and eleven months in language, during the pandemic. Children lacking resources and parental support experienced the largest losses. Regular practice, teacher interaction, and technology were associated with less learning loss. Over the same period, children’s psychological wellbeing improved. Our research provides valuable insights for designing post-emergency programs.
• During the pandemic primary school children in Assam lost 9–11 months of learning.• Children with fewer resources and support at home lost the most.• Teachers’ calls, regular practice, and technology were associated with smaller losses.• Children’s psychological well-being improved during the pandemic.

The slow pace of improvement in service delivery and health outcomes for pregnant women and newborns in developing countries has been a major concern for policy makers in recent decades. This paper presents the results from a randomized controlled trial of a community health worker program designed to enhance uptake of child and maternal health services in Northern Nigeria. Three interventions were evaluated: the deployment of community health educators, health educators with the provision of safe birth kits, and health educators with community dramas. The results suggest that the interventions increased utilization of antenatal, postnatal, and infant care. Maternal and newborn health practices improved as well as health knowledge. In addition, the community health worker program was more effective when supplemented with additional program components.

Identifying individuals most at risk of HIV infection is a priority for policymakers. Apart from specific groups, however, little is known about how to identify those at high risk in the population. Research suggests that attitudes toward risk and time preferences may influence risky sexual behavior, but no studies have so far investigated the interplay between risk attitudes, time preference, and HIV infection. We collect data on risk and time preferences using hypothetical games (multiple price list method) at baseline and data on HIV status at baseline (2010) and endline (2012) allowing us to calculate incidence rate over a 2-year period among 675 participants, males and females 18–32 years old in Lesotho. We find robust evidence of a statistically significant positive associations between HIV incidence and prevalence and risk-loving attitudes, while the associations with risky behaviors and time preferences are not statistically significant. A measure of attitude toward risk, relatively easy to administer to individuals in a survey, is thus associated with future HIV status. This is an important finding for policymakers and suggests the importance of targeting HIV prevention programs to risk-loving individuals and therefore improving program efficiency. © 2022 John WileyXX1Sons, Ltd.

How can quality be improved in markets in developing countries, which are known to be plagued by substandard and counterfeit ("fake", in short) products? We study the market for antimalarial drugs in Uganda, where we randomly assign entry of a retailer (non-governmental organization (NGO)) providing a superior product-an authentic drug priced below the market-and investigate how incumbent firms and consumers respond. We find that the presence of the NGO had economically important effects. Approximately one year after the new market actor entered, the share of incumbent firms selling fake drugs dropped by more than 50% in the intervention villages, with higher quality drugs sold at significantly lower prices. Household survey evidence further shows that the quality improvements were accompanied by consumers expecting fewer fake drugs sold by drug stores. The intervention increased use of the antimalarial drugs overall. The results are consistent with a simple model where the presence of a seller committed to high quality, as opposed to an average firm, strengthens reputational incentives for competing firms to improve quality in order to not be forced out of the market, leading to "good driving out bad".

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs. © 2021, The Author(s).

The delivery of basic health products and services remains abysmal in many parts of the world where child mortality is high. This paper shows the results from a large- scale randomized evaluation of a novel approach to health care delivery. In randomly selected villages, a sales agent was locally recruited and incentivized to conduct home visits, educate households on essential health behaviors, provide medical advice and referrals, and sell preventive and curative health products. Results after 3 years show substantial health impact: under 5-years child mortality was reduced by 27 percent at an estimated average cost of $68 per life- year saved

Background: Maternal and newborn mortality continue to be major challenges in Nigeria. While greater participation of men in maternal and newborn health has been associated with positive outcomes in many settings, male involvement remains low. The objective of this analysis was to investigate male involvement in maternal and newborn health in Jigawa state, northern Nigeria. Methods: This qualitative study included 40 event narratives conducted with families who had experienced a maternal or newborn complication or death, in-depth interviews with 10 husbands and four community leaders, and four focus group discussions with community health workers. The interviews focused on understanding illness recognition and care seeking as well as the role of husbands at each stage on the continuum of maternal and newborn health. Data were transcribed, translated to English, and coded and analyzed using Dedoose software and a codebook developed a priori. Results: This paper reports low levels of knowledge of obstetric and newborn complications among men and limited male involvement during pregnancy, childbirth and the post-partum period in Jigawa state. Men are key decision-makers around the location of the delivery and other decisions linked to maternal and newborn health, and they provide crucial resources including nutritious foods and transportation. However, they generally do not accompany their wives to antenatal visits, are rarely present for deliveries, and do not make decisions about complications arising during delivery and the immediate post-partum period. These gendered roles are deeply ingrained, and men are often ridiculed for stepping outside of them. Additional barriers for male involvement include minimal engagement with health programs and challenges at health facilities including a poor attitude of health providers towards men and accompanying family members. Conclusion: These findings suggest that male involvement is limited by low knowledge and barriers related to social norms and within health systems. Interventions engaging men in maternal and newborn health must take into account these obstacles while protecting women's autonomy and avoiding reinforcement of gender inequitable roles and behaviors.