This literature review focuses on education and health in its examination of the role that households and families play in choosing how to invest the human capital of their members. The introductory section describes the history of the development of economic models of the household and reviews how theoretical developments have become linked with data collection. The second section of the report looks at the effects of income on nutritional status and the reverse influence of nutrition (health) on labor productivity (income). Despite the controversies existing in the literature and the difficulties in choosing among the array of solutions to defined problems there is little doubt that investments in education and health enhance productivity fertility child health and child educational attainment. In an attempt to shed light on the underlying mechanisms in these relationships Section 3 focuses on the estimation of reduced form demands for human capital and considers the measurement of human capital; the effects of determinants such as education household resources and community resources; endogenous program placement and selective migration; and the possible estimation bias imposed by fertility and mortality selection. Section 4 continues this investigation by considering the process underlying the production of human capital in terms of the empirical issues involved in estimation of static and dynamic production functions as well as applications to child health and applications to educational attainment. Section 5 relates labor productivity to education and considers data issues the functional form of studies ability family background and school quality. Recent developments in modeling household behavior in a dynamic setting are reviewed in Section 6 and Section 7 describes links among individuals households and families. The concluding section notes that continued integration of survey data collection with theoretical frameworks will lead to a substantial improvement in our understanding of the magnitude of the significance of the effects predicted by the theory.

Human resources: empirical modeling of household and family decisions.

A total of 144 studies were analysed to examine the impact of improved water supply and sanitation facilities on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. These diseases were selected because they are widespread and illustrate the variety of mechanisms through which improved water and sanitation can protect people. Disease-specific median reduction levels were calculated for all studies, and separately for the more methodologically rigorous ones. For the latter studies, the median reduction in morbidity for diarrhoea, trachoma, and ascariasis induced by water supplies and/or sanitation was 26%, 27%, and 29%, respectively; the median reduction for schistosomiasis and dracunculiasis was higher, at 77% and 78%, respectively. All studies of hookworm infection were flawed apart from one, which reported a 4% reduction in incidence. For hookworm infection, ascariasis, and schistosomiasis, the reduction in disease severity, as measured in egg counts, was greater than that in incidence or prevalence. Child mortality fell by 55%, which suggests that water and sanitation have a substantial impact on child survival. Water for personal and domestic hygiene was important in reducing the rates of ascariasis, diarrhoea, schistosomiasis, and trachoma. Sanitation facilities decreased diarrhoea morbidity and mortality and the severity of hookworm infection. Better water quality reduced the incidence of dracunculiasis, but its role in diarrhoeal disease control was less important than that of sanitation and hygiene.

Effects of improved water supply and sanitation on ascariasis diarrhoea dracunculiasis hookworm infection schistosomiasis and trachoma.

Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis.

The question of why to evaluate a programme is seldom discussed in the literature. The present paper argues that the answer to this question is essential for choosing an appropriate evaluation design. The discussion is centered on summative evaluations of large-scale programme effectiveness, drawing upon examples from the fields of health and nutrition but the findings may be applicable to other subject areas. The main objective of an evaluation is to influence decisions. How complex and precise the evaluation must be depends on who the decision maker is and on what types of decisions will be taken as a consequence of the findings. Different decision makers demand not only different types of information but also vary in their requirements of how informative and precise the findings must be. Both complex and simple evaluations, however, should be equally rigorous in relating the design to the decisions. Based on the types of decisions that may be taken, a framework is proposed for deciding upon appropriate evaluation designs. Its first axis concerns the indicators of interest, whether these refer to provision or utilization of services, coverage or impact measures. The second axis refers to the type of inference to be made, whether this is a statement of adequacy, plausibility or probability. In addition to the above framework, other factors affect the choice of an evaluation design, including the efficacy of the intervention, the field of knowledge, timing and costs. Regarding the latter, decision makers should be made aware that evaluation costs increase rapidly with complexity so that often a compromise must be reached. Examples are given of how to use the two classification axes, as well as these additional factors, for helping decision makers and evaluators translate the need for evaluation--the why--into the appropriate design--the how.

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Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact.

OBJECTIVES: This study examined the relationship of functional health literacy to self-reported health and use of health services. METHODS: Patients presenting to two large, urban public hospitals in Atlanta, Ga, and Torrance, Calif, were administered a health literacy test about their overall health and use of health care services during the 3 months preceding their visit. RESULTS: Patients with inadequate functional health literacy were more likely than patients with adequate literacy to report their health as poor. Number of years of school completed was less strongly associated with self-reported health. Literacy was not related to regular source of care or physician visits, but patients in Atlanta with inadequate literacy were more likely than patients with adequate literacy to report a hospitalization in the previous year. CONCLUSIONS: Low literacy is strongly associated with self-reported poor health and is more closely associated with self-reported health than number of years of school completed.

The relationship of patient reading ability to self-reported health and use of health services

If they lived in households without piped water or a toilet, Malaysian infants who did not breast-feed were five times more likely to die after 1 week of age than those who breast-fed, when other significant factors affecting infant mortality were taken into account. This is double the relative risk associated with not breast-feeding for infants born into households with toilets, whether or not they had piped water. Analogously, improvements in toilet sanitation appear to have reduced mortality twice as much among infants who did not breast-feed as among those who did. These findings, from a retrospective survey of infants born to a probability sample of 1,262 women in peninsular Malaysia, confirm the pernicious synergistic effect of poor sanitation and nonbreastfeeding that was postulated previously on theoretical grounds. Promoting and maintaining high initiation of breast-feeding is thus particularly important where poor sanitation is prevalent. Even more affluent areas should not be neglected, however, because socioeconomic improvement, including improved environmental sanitation, is often accompanied by decreased breast-feeding. Although the risk to each nonbreast-fed infant was less in those areas, infants there were less likely to breast-feed in Malaysia, and hence they made up a significant proportion of lives that could be saved by breast-feeding.

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Mother's milk and sewage: their interactive effects on infant mortality.

Mothers recall data collected in Malaysia in 1976-77 are analyzed to study correlates of mortality of 5471 infants. Respondent population is 1262 women living in 52 primary sampling units of Peninsular Malaysia. Lengths of unsupplemented and supplemented breastfeeding and presence of piped household water and toilet sanitation are related to infant mortality in regressions that also control other correlates. The analysis is disaggregated into 3 periods of infancy. Through 6 months of feeding unsupplemented breastfeeding is more strongly associated with fewer infant deaths than is supplemented breastfeeding. Type of sanitation is generally more strongly associated with mortality than is type of water supply. The effects of breastfeeding and the environmental variables are shown to be strongly interactive and to change systematically during the course of infancy. Breastfeeding is more strongly associated with infant survival in homes without piped water or toilet sanitation. In homes with modern facilities supplemented breastfeeding has no significant effect and unsupplemented breastfeeding is statistically significant only for mortality in days 8-28. Presence of modern water and sanitation systems appears unimportant for mortality of infants who are breastfed without supplementation for 6 months. (authors)

Environmental factors in the relationship between breastfeeding and infant mortality: the role of sanitation and water in malaysia

The effect of toilets piped water and maternal literacy on infant mortality was analyzed using data from the Malaysian Family Life Survey collected in 1976-1977. The effect of toilets and piped water on infant mortality was dependent on whether or not mothers were literate. The impact of having toilets was greater among the illiterate than among the literate but the impact of piped water was greater among the literate than among the illiterate....The authors infer that literate mothers protect their infants especially in unsanitary environments lacking toilets and that when piped water is introduced they use it more effectively to practice better hygiene for their infants. (EXCERPT)

Maternal literacy modifies the effect of toilets and piped water on infant survival in malaysia

Individual-level retrospective data from the Malaysian Family Life Survey are used to examine why the infant mortality rate (IMR) has declined rapidly in Malaysia since World War II. Substantial increases in mothers’ education and improvements in water and sanitation have contributed. However, breastfeeding reductions have kept the IMR from declining as rapidly as it would have otherwise. The detrimental effects of reduced breastfeeding more than offset the beneficial effects of water and sanitation improvements. The majority of the IMR decline, however, is not explained by changes in the variables considered here, or in their relationships with infant mortality.

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Jean-Pierre Habicht

Papers

Mother's milk and sewage: their interactive effects on infant mortality.

Environmental factors in the relationship between breastfeeding and infant mortality: the role of sanitation and water in malaysia

Maternal literacy modifies the effect of toilets and piped water on infant survival in malaysia

Infant mortality decline in malaysia, 1946-1975: the roles of changes in variables and changes in the structure of relationships

"Environmental factors in the relationship between breastfeeding and infant mortality: The role of sanitation and water in Malaysia"