Consequences of High Morbidity and Mortality in a Low-Income Country

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DESCRIPTION (provided by applicant): It is often claimed that Sub-Saharan African (SSA) is being decimated and devastated by illness and death. There is, however, limited but intriguing evidence that rural families and communities are unexpectedly resilient and that the immediate impact of health shocks are modulated over time by the adjustments in the human and social capital of extended families and rural communities. However, no data exist in SSA that allow an econometrically-sophisticated and dynamic analysis of a broad range of interrelated coping mechanisms employed by multi-generational rural families. The general aim of the proposed project is to (1) create the Malawi Longitudinal Study of Families and Health (MLSFH), which will provide a rare record of more than a decade of demographic, socioeconomic and health conditions in one of the world's poorest countries, and (2) study the mechanisms through which poor rural individuals, families, households, and communities cope with the impacts of high morbidity and mortality. The specific aims of the proposed study include: (1) extend already existing longitudinal survey and biomarker data with new samples of special populations and new microdata to create a publicly available MLSFH that (a) covers the period 1998-2010, (b) encompasses children, adolescents, adults, and elderly, (c) provides comprehensive survey, anthropometric and biomarker data on health across three generations, and (d) includes innovative aspects such as vulnerable high-risk populations and experimental designs offering monetary health incentives to families and to communities; and (2) analyze the MLSFH to estimate the consequences of multiple and potentially competing or reinforcing responses to high morbidity and mortality with - on many topics for first time in SSA- controls for endowments, unobserved characteristics, endogenous decision processes and selective participation in health prevention efforts, including analyses of (a) household coping mechanisms such as altering time use, human capital investments and intrafamilial transfers and using various forms of accumulated social capital, (b) the patterns, formation and behavioral consequences of health-related expectations, (c) both short- and long-term micro-consequences of poor health and mortality and (d) the impact over time of important public-health interventions such as the introduction of an ambitious national program providing testing and treatment or monetary health incentives.