81198 enGender Impact: The World Bank’s Gender Impact Evaluation Database Anemia and School Participation Author(s) Edward Miguel, Gustavo Bobonis, Charu Puri-Sharma Contact gustavo.bobonis@utoronto.ca Country India Organizing Theme Health, Education and Skills Status Completed Intervention Category Iron Supplements Sector Health, Nutrition & Population Anemia is among the most widespread health problems for children in developing countries. This paper evaluates the impact of a randomized health intervention delivering iron supplementation and deworming drugs to Indian preschool children. At baseline, 69 percent were anemic and 30 percent had intestinal worm infections. Weight increased Abstract among assisted children, and preschool-participation rates rose by 5.8 percentage points, reducing absenteeism by one-fifth. Gains were especially pronounced for those most likely to be anemic at baseline. Results contribute to a growing view that school-based health programs are an effective way of promoting school attendance in less developed countries. Gender Connection Gender Informed Analysis Gender Outcomes Gender disaggregated nutrition, school enrollment, school attendance IE Design Clustered Randomized Control Trial (Clustered at pre-school level) The health intervention consisted of delivering iron supplementation and deworming drugs to 2-6 year old children through an existing pre-school network in the slums of Delhi, India. During October and November 2001, the NGO enumerators – called Community Health Volunteers – conducted parent-teacher meetings in each pre-school to inform them Intervention about the project, and to obtain consent for their children’s participation. Health camps were conducted three times a year. There were three different treatment arms. Treatment arm 1 received a dose of iron every 3 months and received a deworming pill and a vitamin A pill. Treatment 2 received the deworming pill and a vitamin A pill while treatment 3 just received Vitamin A pill. Intervention Period Mid December 2001-September 2002; children were treated 3 times a year The sample includes 200 Preschools in Delhi averaging about 12 children each, totaling Sample population 2392 children. There were two control groups. One received deworming drugs and vitamin A, the other Comparison conditions received just Vitamin A. All groups attended the health camps. Unit of analysis Household Level Evaluation Period October 2001- October 2002 Last updated: 14 August 2013 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database At baseline 69 percent of children in the sample were anemic, while 30 percent suffered from intestinal helminth (worm) infections. Large gains in child weight were observed – roughly 0.5 kg (1.1 lbs.) on average – in the treatment schools relative to comparison schools during the first five months of the project. Most importantly for this study, average pre-school participation rates increased sharply – by 5.8 percentage points – among assisted children, reducing preschool absenteeism by roughly one-fifth. Program treatment effects are most pronounced for subgroups with high baseline anemia rates, in particular, for girls and children in low socioeconomic status areas. Given the low cost of the intervention – Results US$1.70 per child per year – these results suggest the health intervention is a highly cost- effective means of improving child pre-school participation in a poor urban setting where iron deficiency anemia and worm infections are widespread. One plausible channel through which these pre-school attendance gains could have long-run impacts is an improvement in future primary school performance – and in fact, 71 percent of parents in the study area claimed (in a baseline survey) that improved primary school preparedness was an important motivation for sending their children to pre-schools. In nutritional improvements, there are significantly larger gains for girls than boys and also in school participation. There was an additional year of the experiment that was not studied due to contamination. Primary study limitations Additionally there were high levels of non-random attrition. ICICI Bank, National Science Foundation, World Bank, University of California, Berkeley Funding Source Center for Health Research, Hellman Fund Bobonis, G. J., Miguel, E., & Puri-Sharma, C. (2006). Anemia and school participation. Reference(s) Journal of Human Resources, 41(4), 692-721. Link to Studies http://jhr.uwpress.org/content/XLI/4/692.short Microdata Last updated: 14 August 2013 2