Date of Award
Doctor of Philosophy
The first two chapters of this dissertation focus on the child health outcomes in brief, child diarrheal incidence in India, and child growth measures in Rwanda. The third chapter examines the determinants of timely access to health care in emergency departments in the United States. All three essays are different in their area of interest, data sources, and methodology.ESSAY 1 India has recorded the highest number of child diarrheal deaths at the global level. Oral Rehydration Therapy (ORT) would just provide hydration and few mineral supplements for infected children. However, their malnutrition and weakened immune system cannot be reversed. Malnutrition affects child growth, and causes stunting, and makes them susceptible to other forms of infections. The rotavirus vaccine provides a pseudo-sense of protection from non-rotaviral diarrhea. Preventing diarrhea right away from the source of the infection would be a better solution. Since most diarrheal pathogens are water borne, disinfection treatment of drinking water at the point of use could prevent diarrheal incidence of children and adults as well. Household data from the National Family and Health Survey and their estimators viz., Propensity Score Matching (PSM), and Inverse Probability Weights Regression Adjustment (IPWRA) have been employed to examine the effects of water treatment techniques in households. This chapter attempted a novel approach in studying all the popularly used water treatment techniques currently practiced in India in one study. They have been ranked for multi-value treatment effects model. Water filters with ceramic candles are more effective than other point-of-use water treatment techniques, followed by chlorination, water purifiers, and boiling. ESSAY 2 Rwanda is a sub-Sahara African country affected by genocide with a patriarchal family structure system. Higher poverty and gender imbalance were not alleviated by gender equality being on the political agenda. Despite the highest female representation in the parliament in the world, gender equality and liberty are confined to elite women. Additionally, flawed laws for women's equality made women's empowerment a paradoxical phenomenon. Women at the gross root levels, i.e., community and household, are still dependent or interdependent on men (husband/father). This has been confirmed by the findings in Chapter 3, that is, for most decisions, women are taken jointly with their partners. A minimal percentage of women are autonomous in their decisions and in their home. This study made an attempt to examine the mother’s autonomy in Rwanda and its impact on child health. Mother’s autonomy is negatively related to child’s height and weight for their age. Although the expected association between mother’s autonomy and child height/weight is positive, it would also depend on the historical and cultural context of the country of interest. Instrumental variable analysis is used to study women’s autonomy due to its complex and endogenous nature. Spousal educational difference and marriage-to-birth interval are valid instruments but weakly identified. ESSAY 3 An increasing burden on emergency services that exceeded its resources led to congestion in the emergency department (ED), with patients waiting for physicians on the examination bed and for inpatient bed transfer. This creates a blockage between access to healthcare and emergent patients. ED measures adopted to reduce ED congestion, boarding, and waiting times, such as ambulance diversion management, fast tracking of patients with low acuity, and bed coordination do not effectively control waiting time and boarding. ED crowding is a patient flow, but not necessarily a hospital resource deficiency. This is evident from the findings that even EDs with new treatment spaces still keep patients waiting for an inpatient bed, however, they reported a shorter wait time for the physician. Optimal utilization of nurses by floating them to needy units is effective in timely transfers of patients to inpatient beds compared to EDs without floating nurses.
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