Early Childhood Nutritional Responses to Targeted Food Aid and Social Network Disruptions in Ugandan Internally Displaced Person's Camps

Abstract

Early childhood malnutrition, which is a series of symptoms including slow linear growth, decreased resistance to infection, and poor motor and cognitive functioning, has received increased attention in recent years as a key to economic development. While malnutrition can affect people at any age, the effects of malnutrition are most damaging <italic>in utero</italic> and during the first two years of life. Deficits during this period have long-term effects on health, educational attainment and productivity in adulthood. Thus, investing in efforts to provide children with minimal required nutrition can substantially improve future household welfare and promote economic development.

In Northern Uganda, parents had limited control over their children's nutritional outcomes as nearly all rural households were living in internally displaced persons (IDP) camps due to a civil conflict. Food in these camps was scarce, sanitation conditions were poor, and health care was underprovided. Additionally, the displacement severely disrupted the strong social structures in place in the village that households relied on day to day for many activities, including care for children.

This dissertation looks at early childhood health outcomes in these IDP camps and how these outcomes are affected by a food aid program and by social network influences. Chapter 3 examines the spillover effects of two types of food for education (FFE) programs on the nutritional outcomes of eligibles' younger siblings. FFE programs are criticized on the grounds that household redistribution responses mitigate nutritional benefits from the programs. However, this study shows that in some cases households redistribute program benefits to younger children who can benefit more from marginal improvements in nutritional status, which could increase returns to FFE.

In Chapter 4, I look at the effects of local social networks, the friends and family that households interact with on a daily basis, on preschoolers' nutritional outcomes. Social networks can affect demand for human capital investments by relaxing household time or budget constraints or by defining and reinforcing human capital preferences. However, empirically identifying the effect of social networks on human capital investment is usually problematic because households self-select their networks in ways that may be correlated with their abilities to make these investments. In Northern Ugandan Internally Displaced Persons Camps, networks were not entirely self-selected. Rebel activity, which forced households into camps in 2002, disrupted pre-existing social networks in ways that were exogenous to household human capital preferences. This paper uses the exogenous variation in network disruption to identify the impact of networks on child health outcomes. Using household survey data from the Uganda School-Based Feeding Evaluation, household data that I collected, and administrative data from the World Food Programme and local governments, I show that an increase in the average household's network size by one household (or roughly 25 percent of the network) improves height-for-age z-scores by .25 standard deviations for children born in the camp. This improvement is equivalent to moving from the 8th percentile to the 13th percentile in height for the average child in this sample. The result stands up to numerous falsification tests. Additionally, I find no evidence that in-camp network strength impacts nutritional outcomes determined before displacement, supporting the exogeneity of the disruption to household health preferences.