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

描述(由申请人提供)：经常有人声称，撒哈拉以南非洲人(SSA)正因疾病和死亡而遭受重创。然而，有有限但耐人寻味的证据表明，农村家庭和社区具有出人意料的韧性，健康冲击的直接影响随着时间的推移受到大家庭和农村社区人力资本和社会资本调整的影响。然而，SSA中没有数据能够对多代农村家庭采用的一系列相互关联的应对机制进行复杂的经济计量和动态分析。拟议项目的总体目标是(1)创建马拉维家庭与健康纵向研究(MLSFH)，它将提供世界上最贫穷国家之一十多年来人口、社会经济和健康状况的罕见记录，以及(2)研究贫穷的农村个人、家庭、家庭和社区应对高发病率和高死亡率的影响的机制。拟议研究的具体目标包括：(1)用特殊人群的新样本和新的微观数据扩展现有的纵向调查和生物标记物数据，以创建公开可用的MLSFH，(A)涵盖1998-2010年期间，(B)涵盖儿童、青少年、成年人和老年人，(C)提供关于三代人健康的全面调查、人体测量和生物标记物数据，(D)包括创新方面，如易受伤害的高危人群和向家庭和社区提供货币健康奖励的实验设计；和(2)分析MLSFH，以评估针对高发病率和死亡率的多重和潜在竞争或强化反应的后果--在特别服务协议中第一次涉及许多主题--对捐赠的控制、未观察到的特征、内生决策过程和有选择地参与卫生预防努力，包括分析(A)家庭应对机制，如改变时间使用、人力资本投资和家庭内转移以及使用各种形式的累积社会资本，(B)与健康相关的期望的模式、形成和行为后果，(C)健康状况不佳和死亡率低的短期和长期微观后果，以及(D)重要的公共卫生干预措施的长期影响，例如推出一项雄心勃勃的国家方案，提供检测和治疗或货币保健奖励。

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.