Child malnutrition, consumption growth, maternal care and price shocks: new evidence from Northern Ghana

Figures & data

Figure 1. Framework of the immediate and underlying causes of child malnutrition. Source: Adapted from Black et al. (2008).

Table 1. Inputs and nutritional outcomes (N = 2460).

Variable	Mean	SD	Min	Max
Inputs: Health status
No diarrhoea in last two weeks	0.58	0.49	0	1
No other illness in last two weeks	0.70	0.46	0	1
Inputs: Food intake
Consumed iron-rich food yesterday	0.68	0.47	0	1
Consumed grains, roots and tubers yesterday	0.80	0.40	0	1
Consumed dairy products yesterday	0.21	0.41	0	1
Consumed vitamin A-rich fruits and vegetables yesterday	0.70	0.46	0	1
Consumed other fruits and vegetables yesterday	0.11	0.31	0	1
Consumed three or more meals yesterday	0.45	0.50	0	1
Nutritional outcomes
HAZ	−1.28	1.68	−5.92	5.91
Stunted (HAZ < −2)	0.31	0.46	0	1
Severely stunted (HAZ < −3)	0.13	0.34	0	1

Table 2. Marginal effects from probit models on health and nutrition inputs in children aged between 6 and 59 months.

	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)
	No diarrhea in last 2 weeks	No other illness in last 2 weeks	Iron-rich food	Grains, roots and tubers	Dairy products	Vitamin-A rich fruits and vegetables	Other fruits and vegetables	Meal frequency (at least 3 per day)
Parental characteristics
Mother's education (ref = none)
Some primary	−0.067	−0.015	0.023	−0.028	−0.023	−0.007	0.012	0.036
	0.042	0.042	0.036	0.036	0.024	0.038	0.027	0.035
Primary completed or above	0.018	0.054*	0.039	0.015	0.012	−0.034	0.024	0.009
	0.037	0.032	0.029	0.027	0.025	0.035	0.022	0.034
Mother's age	0.007***	0.005*	0.005*	0.004	0.001	0.005**	−0.001	−0.001
	0.003	0.003	0.003	0.003	0.002	0.002	0.002	0.003
Living with father	−0.072	−0.069	0.036	−0.071	−0.040	−0.048	−0.028	−0.035
	0.054	0.044	0.048	0.046	0.034	0.040	0.028	0.044
Mother's agency (ref = Low)
Medium	0.119***	−0.006	−0.020	0.022	−0.040**	0.028	−0.024	−0.056**
	0.033	0.025	0.029	0.025	0.017	0.025	0.030	0.026
High	0.147***	−0.001	−0.038	0.016	−0.046***	−0.010	−0.031	−0.094***
	0.036	0.027	0.030	0.029	0.017	0.023	0.029	0.029
Nutritional knowledge	−0.008	0.009	0.007	0.011	0.010*	−0.008	−0.001	−0.013
	0.009	0.009	0.009	0.009	0.006	0.010	0.006	0.009
Self-reported health good/very good/excellent	0.156***	0.147***	0.034	−0.005	−0.013	0.019	0.004	−0.009
	0.021	0.026	0.027	0.022	0.018	0.024	0.017	0.025
Household characteristics
Log of AE household consumption	−0.068***	−0.075***	0.035*	0.020	0.016	0.033*	0.042***	0.078***
	0.019	0.019	0.021	0.020	0.015	0.019	0.012	0.017
Community characteristics
Vaccination coverage^1	0.034	−0.093
	0.072	0.066
Improved sanitation^1	−0.032	−0.167**
	0.074	0.073
Improved source of water^1	0.051	0.064
	0.049	0.042
Appropriate handwashing facilities^1	0.027	0.249*
	0.120	0.137
Mud floor^1	−0.097	0.090
	0.077	0.062
Slept under bed net^1	0.131*	0.023
	0.078	0.076
Distance to nearest health center	0.022*	−0.031***	0.038**	−0.013	0.006	−0.002	−0.032***	0.023
	0.013	0.012	0.017	0.012	0.008	0.010	0.008	0.014
Price of Guinea corn/sorghum			0.503**	0.117	−0.159	0.067	0.019	−0.125
			0.209	0.183	0.109	0.167	0.136	0.194
Price of maize			−0.051	−0.132	0.049	−0.161	−0.160	0.216
			0.166	0.154	0.088	0.153	0.105	0.147
Price of millet			−0.120*	−0.147*	−0.016	−0.098*	0.043	0.052
			0.063	0.085	0.036	0.054	0.048	0.062
Price of rice (local)			−0.141*	0.244***	0.068*	0.109	0.011	−0.108
			0.082	0.077	0.038	0.081	0.048	0.082
Price of dried fish			−0.007	0.002	−0.005*	−0.008**	0.003	−0.003
			0.005	0.004	0.003	0.003	0.004	0.004
Price of okro			0.022	−0.044***	0.001	−0.020	−0.000	0.016
			0.018	0.013	0.008	0.015	0.010	0.015
Price of petrol			0.005	0.003	−0.043	−0.110**	0.135***	−0.110*
			0.063	0.059	0.028	0.045	0.043	0.056
Observations	2460	2460	2460	2460	2460	2460	2460	2460
Tests for joint significance (p-value):
Parental characteristics	0.000	0.000	0.240	0.169	0.039	0.095	0.872	0.054
Household characteristics^2	0.000	0.000	0.082	0.148	0.154	0.010	0.000	0.000
Community characteristics	0.069	0.006	0.000	0.022	0.131	0.000	0.000	0.011

Notes: Cluster-robust standard errors in second row. Additional control variables not reported: child age dummies, sex, twin, birth order and number of siblings, birth interval, household size, share of women aged 12–49, age of head of household, sex of head of household and whether she/he ever went to school. *p < 0.10, **p < 0.05, ***p < 0.01. ¹ Non-self community mean. ² Includes household size, share of women aged 12–49, age of head of household, sex of head of household, and whether she/he ever went to school.

Table 3. OLS regression of child, paternal, household and community characteristics on height-for age (children 6–59 months).

	(1)
	Height-for-age
Parental characteristics
Mother's education (ref = none)
Some primary	−0.167
	0.137
Primary completed or above	−0.076
	0.109
Mother's age	0.015*
	0.008
Living with father	−0.233
	0.178
Mother's agency (ref = Low)
Medium	0.132
	0.089
High	0.022
	0.103
Nutritional knowledge	0.035
	0.028
Self-reported health good/very good/excellent	−0.088
	0.094
Household characteristics
Log of AE household consumption	0.148**
	0.062
Community characteristics
Vaccination coverage^1	0.392*
	0.199
Improved sanitation^1	0.169
	0.277
Improved source of water^1	−0.083
	0.162
Appropriate handwashing facilities^1	−0.604
	0.379
Mud floor^1	0.204
	0.246
Slept under bed net^1	0.593**
	0.286
Distance to nearest health center	0.027
	0.057
Price of Guinea corn/sorghum	−0.573
	0.591
Price of maize	0.269
	0.494
Price of millet	0.063
	0.229
Price of rice (local)	0.420*
	0.253
Price of dried fish	−0.017
	0.014
Price of okro	−0.062
	0.050
Price of petrol	0.008
	0.231
Observations	2460
R-squared	0.139
Tests for joint significance (p-value):
Parental characteristics	0.137
Household characteristics^2	0.025
Community characteristics	0.008

Notes: Cluster-robust standard errors in second row. Additional control variables not reported: child age dummies, sex, twin, birth order and number of siblings, birth interval, household size, head characteristics. *p < 0.10, **p < 0.05, ***p < 0.01. ¹ Non-self community mean. ² Includes household size, share of women aged 12–49, age of head, sex of head and whether head ever went to school.

Table 4. Parameters of simulations.

Simulation		Parameters
(1)	LEAP cash transfer	Increase household expenditures by monthly LEAP transfer amounts: 38 for two beneficiaries, 44 for three beneficiaries and 53 for four beneficiaries^1
(2)	Improved care environment	Set agency at ‘medium’ for mothers with low agency and set self-reported health at ‘good’ for all mothers
(3)	Price increases	Increase all prices by 10%

Notes: ¹ The baseline data includes the exact transfer amount for households enrolled into the LEAP program. For comparison households, we impute the (hypothetical) transfer amount by counting the number of eligible beneficiaries in the household (number of pregnant women and infants, people with a disability, elderly, and orphans) and assigning the transfer amount accordingly.

Table 5. Simulation results on health and food inputs and nutritional outcomes.

Variable		(1)		(2)		(3)
	Base value	LEAP transfer		Improved care		Price shock of 10%
		Prediction	% change	Prediction	% change	Prediction	% change
Health inputs
No diarrhoea	0.579	0.570	−1.6%	0.660	14.0%
		[0.540,0.600]		[0.625,0.696]
No other illness	0.695	0.687	−1.2%	0.731	5.2%
		[0.662,0.712]		[0.694,0.767]
Food inputs
Iron-rich food	0.682	0.688	0.9%	0.683	0.1%	0.693	1.6%
		[0.658,0.717]		[0.637,0.730]		[0.642,0.744]
Grains roots and tubers	0.804	0.808	0.5%	0.811	0.9%	0.816	1.5%
		[0.780,0.835]		[0.775,0.846]		[0.768,0.864]
Dairy products	0.208	0.210	1.0%	0.191	−8.2%	0.187	−10.1%
		[0.196,0.225]		[0.171,0.212]		[0.162,0.212]
Vitamin A-rich fruits and vegetables	0.697	0.701	0.6%	0.712	2.2%	0.635	−8.9%
		[0.678,0.724]		[0.676,0.747]		[0.589,0.682]
Other fruits and vegetables	0.110	0.115	4.5%	0.103	−6.4%	0.159	44.5%
		[0.096,0.134]		[0.077,0.128]		[0.118,0.199]
Meal frequency	0.448	0.458	2.2%	0.425	−5.1%	0.405	−9.6%
		[0.430,0.486]		[0.393,0.458]		[0.357,0.452]
Nutritional Outcomes
HAZ	−1.279	−1.259	1.6%	−1.252	2.1%	−1.274	0.4%
		[−1.349,−1.169]		[−1.365,−1.139]		[−1.462,−1.087]
Stunted	0.307	0.304	−1.0%	0.300	−2.3%	0.324	5.5%
		[0.283,0.325]		[0.274,0.326]		[0.275,0.372]

Notes: Results are based on the models from Tables 2 and 3. Predictions of stunting are based on probit models using the same independent variables as the HAZ model. 95% prediction interval in square brackets.

Black, R. E., L. H. Allen, Z. A. Bhutta, L. E. Caulfield, M. De Onis, M. Ezzati, C. Mathers, J. Rivera, and Maternal Child Undernutrition Study Group. 2008. “Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences.” The Lancet 371(9608): 243-260. doi: 10.1016/S0140-6736(07)61690-0

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