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1 The Long Term Association of Diarrhea with School Success A case study from Pakistan Jonathan Mitchell CIES March 2008.

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Presentation on theme: "1 The Long Term Association of Diarrhea with School Success A case study from Pakistan Jonathan Mitchell CIES March 2008."— Presentation transcript:

1 1 The Long Term Association of Diarrhea with School Success A case study from Pakistan Jonathan Mitchell CIES March 2008

2 Why Diarrhea? Leading cause of infant mortality Average of 3.3 episodes per child per year Associated with PEM Strongly associated with micronutrient deficiencies ORS has reduced fatality rates, but not incidence or duration ORS has increased diarrhea survivors A link with developmental impairment would have profound policy implications There is little to no research 2

3 The Data Location: Oshikhandas, Northern Areas Pakistan Diarrhea information collected weekly Weight and height every quarter Parental income and education End of year tests in Math, English and Urdu Total of 107 children (39 girls and 66 boys) 3

4 The Analysis Ordered stepwise linear regression Income, education and malnutrition variables entered first Diarrhea variables entered last 4

5 Math Variable Standardized Coefficient Change in R SquaredP value FI -Father's income0.2290.0510.015 14PB2 - Episodes lasting more than 14 days before 2-0.2550.0650.007 Total RSquared0.116 5 VariableStand CoefP Value 14PB2 – Episodes lasting more than 14 days before 2* -0.2550.007 TDURB2 – Total diarrhea days before 2*-0.2140.025 14PA2 – Episodes lasting more than 14 days after 20.0450.640 TDURA2 – Total diarrhea days after 2-0.1470.124

6 English 6 Variable Standardized Coefficient Change in R SquaredP value FI -Father's income0.2850.0810.002 A2EP - After 2 episodes-0.2600.0670.005 Total RSquared0.148 VariableStand CoefP Value A2EP - After 2 episodes *-0.2600.005 TDURA2 - Total diarrhea days after 2 *-0.2580.005 B2EP - Before 2 episodes-0.1170.217 TDURB2 - Total diarrhea days before 2-0.1400.138

7 Urdu Fathers Income and Education were together significant at the 5% level FI and FE together accounted for 14.1% of variation Height for Age at age 2 was nearly significant (p=0.07) and explained an additional 3.1% No diarrhea variables approached statistical significance 7

8 Discussion -- For this group of children: All three subjects closely associated with FI Malnutrition as measured by HA, WA and WH not associated with impairment in Math and English FE and HA at age 2 positively associated with Urdu performance – why? English and Math, but not Urdu, had a strong negative association with diarrhea, though vulnerable periods differ 8

9 Conclusions and Policy Implications Diarrhea, particularly of longer duration, is an important risk factor for impaired school performance Findings consistent with hypothesis of causality through micronutrient or trace element deficiencies Investment in diarrhea prevention and duration reduction may have significant long term payoffs in terms of reduced drop-out, improved promotion, and better learning 9


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