Health

Changes in height-for-age of Egyptian children from 1995 to 2014: Implications for improving child health outcomes

Background Stunting is a serious health problem in Egypt. Stunting rates and height-for-age z-score (HAZ) distributions changed notably in Egypt over time, yet the factors that led to these changes remain unknown. This study examines the factors associated with these changes and provides important considerations for designing interventions to achieve the Sustainable Development Goal (SDG) of ending all forms of malnutrition by 2030. Methods Leveraging data from Egypt’s Demographic and Health Survey for the years 1995, 2003, and 2014, we employ a Recentered Influence Function (RIF) approach that goes beyond the conventional way of measuring stunting as a binary indicator to examine changes across the entire HAZ distribution. The RIF decomposes changes in the HAZ distribution over time into differences attributable to changes in the levels of the determinants of nutrition (covariate effects) and in the strength of the association between these determinants and HAZ (coefficient effects). Results The stylized facts show a puzzling increase in stunting rates despite improvements in the level of the determinants of nutrition. Our RIF results attribute the change in stunting rates and other parts of the HAZ distribution primarily to changes in the association between the determinants of nutrition and HAZ (coefficient effects) rather than in the level of the determinants (covariate effects). The results also show that the determinants of nutrition could have heterogeneous impacts at different quantiles of the HAZ distribution. Conclusion To reduce stunting rates and achieve the SDG of ending malnutrition, our findings highlight the need for targeted interventions. Interventions should be geographically targeted, promote gender and income equality, improve maternal nutrition, and expand access to better sanitation facilities. This is in addition to wealth redistribution and reforming Egypt’s subsidy program to focus on nutritious food.

Modeling the association between repeated measures of hemoglobin during pregnancy and adverse birth outcomes

C’est la vie! Mixed impacts of an edutainment television series in West Africa

Edutainment is a promising tool for changing behavior at scale, yet little is known about how to maximize impacts. We undertake an experimental evaluation of a popular West African television series, C’est la vie!, delivered through film clubs targeted at adolescent girls and young women in rural Senegal. We examine impacts on violence against women and girls and sexual and reproductive health. Results show C’est la vie! improved knowledge on both domains three months after film clubs ended, as well as violence-related attitudes nine months later, however, had no impact on behaviors. We investigate design components intended to strengthen impacts, generally finding no additional impacts from post-screening discussions, engaging men, and podcasts. Our findings suggest that edutainment is an engaging way to reach viewers on sensitive themes, however more evidence is needed on how to effectively deliver edutainment content for sustained behavior change at scale.