Risks, interventions, and costs in early life health and development

Abstract

Reductions in child mortality over the past decades have been impressive globally. With declining mortality rates, interest in child development has been increasing. However, evidence on the magnitude of the burden of poor child development, as well as the knowledge bases regarding the most cost-effective interventions and key target populations are still limited. In the first paper of this thesis, “Human capital loss attributable to stunting risks: A systematic analysis of the impact of risk factors for childhood stunting on schooling and income losses in 137 developing countries”, we highlight that alleviating poverty-related risk factors for stunting in low- and middle-income countries may not only benefit children’s nutritional status, but also result in increased education and larger labor market incomes in the long run. This work underscores the important impacts of early life investment and identifies key areas of intervention for governments and stakeholders. In the second paper, “The impact of parsimonious versus comprehensive cost estimation in cost-effectiveness analysis: Economic evaluation of a kangaroo mother care program in Mali”, we show ways in which costs are frequently underestimated in cost-effectiveness analyses. In our case study, we find that failing to account for administrative costs, demand-creation costs, and costs to patients’ families results in cost-effectiveness ratios that are orders of magnitude smaller than if costs were comprehensively accounted for. This work suggests that existing cost-effectiveness estimates may need to be reviewed, and future studies should focus on comprehensive costing data collection in order to provide reliable evidence for resource allocation. Recognizing the importance of early intervention in child development, in the third paper, “Can placental characteristics predict child development delays? Findings from São Paulo Western Region Cohort Study”, we examine the relative ability of birth characteristics from hospital records, maternal risk factors measured in surveys, and placental characteristics from pathology exam records to predict developmental delay at age three years. We find that placental characteristics have additional predictive ability of developmental adversity and may provide a novel opportunity to identify infants who would benefit from developmental intervention, helping maximize the impact of targeted programs.