Worms at Work: Long-run Impacts of a Child Health Investment

Abstract

This study estimates long-run impacts of a child health investment, exploiting community-wide experimental variation in school-based deworming. The program increased labor supply among men and education among women, with accompanying shifts in labor market specialization. Ten years after deworming treatment, men who were eligible as boys stay enrolled for more years of primary school, work 17% more hours each week, spend more time in nonagricultural self-employment, are more likely to hold manufacturing jobs, and miss one fewer meal per week. Women who were in treatment schools as girls are approximately one quarter more likely to have attended secondary school, Smith, John Strauss, Glen Weyl, Alix Zwane; seminar participants at UC Berkeley, USC, Harvard, the J-PAL Africa Conference, the Pacific Conference on Development Economics, UCSF, the Gates Foundation WASH Convening in Berkeley, Yale, University of Oklahoma, Hamilton College, RAND, CGD, the World Bank, Maseno University, the NBER Labor Studies group, BREAD/CEPR Meeting in Paris, American University, University of Chicago, Columbia University, Stanford GSB, Makerere University, the AEA meetings (in San Diego), Notre Dame, University of Washington, Mathematica, the Institute for Fiscal Studies, Hong Kong University of Science and Technology, the International Health Economics Association conference; and the editor and four anonymous referees for helpful suggestions. We gratefully acknowledge our collaborators (International Child Support and Innovations for Poverty Action), and funding from NIH grants R01-TW05612 and R01-HD044475, NSF grants SES-0418110 and SES-0962614, the World Bank, the Social Science Research Council, and the Berkeley Population Center. Michael Kremer declares that he works with USAID, which supports deworming, and was formerly a board member of Deworm the World, a 501(c)3 organization. The content is solely the responsibility of the authors and does not necessarily reflect the views of any of our funders. 1637halving the gender gap. They reallocate time from traditional agriculture into cash crops and nonagricultural self-employment. We estimate a conservative annualized financial internal rate of return to deworming of 32%, and show that mass deworming may generate more in future government revenue than it costs in subsidies. JEL Codes: I10, I20, J24, O15.

The persistent effects of in utero nutrition shocks over the life cycle: Evidence from Ramadan fasting

“…How does this result compare to the results of other studies that estimate the effects on adult labor supply of various childhood and other experiences? Baird et al (2011) estimated that in rural Kenya children aged 9-16 who were given two or three years of deworming treatment worked 12 percent more hours on average than those who were not a decade later. On a base of 15.2 hours worked for the control group, this corresponds to 1.8 more hrs/wk.…”

“…Furthermore, less religious Muslims may be a better comparison group 4 Hoddinott et al (2008) explore the effect on hours worked by Guatemalan adults who were exposed to a randomly-distributed nutritional supplement when they were 0-24 months of age. Baird et al (2011) is also a recent notable exception looking at the effects of deworming on labor supply, although the deworming intervention was timed during later childhood.…”

Deworming Delusions? Mass Drug Administration in East African Schools

“…This is also a confounding factor in their subsequent 'Worms at Work' cohort study. Of the helminth infections mentioned in Miguel and Kremer's 2004 paper, S. mansoni is the only one that might have the longterm effects indicated in Baird et al (2015). If the 2001 cohort was heavily infected and never treated, after years of being asymptomatic, as young adults, they could have less energy than the cohort given praziquantel in the late 1990s.…”

“…The work has been heavily promoted at the World Bank by Bundy, as mentioned in the introduction of this article. It has been circulating in various forms as a working paper called 'Worms at Work' since 2010 and has recently been updated (Baird et al, 2015). Remarkably, this latest version continues to repeat the miscalculated headline figure from Miguel and Kremer's 2004 paper that deworming treatment reduced school absenteeism by one-quarter (Baird et al, 2015, p. 3).…”

“…Miguel, Kremer and their colleagues are currently grappling with these issues in their on-going Kenyan work on employment trajectories (Baird et al, 2015), but it is not at all clear how they will manage to satisfactorily resolve them and far too much is being expected.…”