Essays on the Economics of Disease Control and Child Malnutrition
Ervin, Paul Alan
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Determining the benefits of infectious diseases control can provide the impetus for policy makers to prioritize disease control, but this requires knowledge about how control measures affect disease outcomes and how to monetize these outcomes, so that disease control can be viewed as a benefit rather than a cost. The first part of this dissertation investigates how preventative canine rabies vaccination affects human rabies post-exposure prophylaxis (PEP) demand and human rabies deaths. It begins by estimating a mean (median) value of a statistical life (VSL) of approximately US $128,000 ($54,000) from the human rabies PEP demand decision following an animal attack in an area where rabies is endemic using contact-tracing data from the Serengeti District of Tanzania for the years 2002 to 2007. This is followed by developing and calibrating an economic model of canine rabies control that incorporates the benefits of control in terms of reductions in human PEP and human rabies deaths valued by the VSL. The model suggests that dog vaccination provides large benefits at low vaccination coverage levels, even if PEP demand increases with dog vaccination. This suggests that investing in dog vaccination provides large returns. The second part of this dissertation investigates the determinants of improvements in child nutrition in Paraguay between the years 2005 and 2012 using an Oaxaca decomposition technique. Before 2005, Paraguay observed a high stunting prevalence and one of the highest rural-urban child malnutrition differentials in the world. Yet by 2012, the country was able to decrease stunting prevalence to 10% nationally and eliminate the rural-urban gap. I find that statistically significant improvements in female education, income, access to safe water, and more favorable household demographics were associated with nearly half of the total improvement in rural child HAZ. While, in urban areas, statistically significant improvements in female education and access to improved sanitation accounted for only a quarter of the total improvement in urban child HAZ. These findings suggest that policy interventions should be tailored to the needs of rural and urban populations, and that female education is very important in both areas.