This study evaluates a 6-month early childhood father engagement intervention delivered in-person to fathers in the Rohingya camps and surrounding host communities in Cox’s Bazar, Bangladesh. The intervention is an added component to an existing intervention that works with mothers of 0–3-year-old children to improve positive outcomes of child development and targets fathers with children below 3 years, with objectives to promote fathers’ wellbeing by improving their emotional literacy, encouraging fathers to strengthen relationships with their spouses and children, and encouraging responsive and stimulating caregiving practices among fathers. We used a cluster-randomized controlled trial design (total N = 2002 fathers, 786 in the Rohingya camps and 1216 in the host communities) to assess the impact of the program on fathers’ parenting and engagement with family (reported by both fathers and mothers), fathers’ mental health, and child development. We find that the program has a positive impact on the fathers’ parenting (father reported) and engagement with family (father and mother reported), as well as on father-reported child social-emotional development, compared to the mother-only program. While the program did not have a main effect on directly assessed child development outcomes, we do find that baseline mother-reported stimulation with child and mother health moderate the impact on father-reported child social-emotional development in the camp community (larger positive impacts for fathers from households with lower baseline mother-reported stimulating behaviors and health). We also find that child gender and mother-reported stimulating behaviors moderate impacts on multiple mother-reported child developmental outcomes in both host and camp communities (treatment effects on these outcomes were negative for boys and positive but weak for girls, and larger positive impacts on mother-reported motor development were found among mothers from households who reported lower stimulation at baseline). Additionally, child age moderates the impact on fathers’ collaboration with the mother (reported by the mother), such that the treatment effect is larger for mothers of older children. Our findings demonstrate the potential of father-focused programs as powerful caregiver interventions. Pre-registered with REES (13880.1v2); retrospectively registered at ISRCTN (ISRCTN13510859).

This research evaluates Mexico’s 2002 universal preschool mandate using a local difference-in-differences design to isolate policy impacts from school-entry-age effects. Although the mandate significantly boosted cognitive test scores, particularly for higher-income households not participating in Prospera (the conditional cash transfer program for the poor), it proved most effective at improving grade progression for disadvantaged groups. Specifically, boys from Prospera households saw the largest reduction in grade failure. Additionally, the reform enhanced noncognitive skills for boys from non-Prospera households, with no comparable gains for girls. Overall, the findings reveal critical gender and socioeconomic heterogeneity in early childhood educational intervention impacts.

Extreme heat is an increasingly important pathway through which climate change may affect human capital, learning, productivity, and health, but evidence on contemporaneous heat exposure and cognitive performance remains limited in low- and middle-income countries and everyday, non-school settings. We analyzed data from 5,183 adolescents and young adults aged 12–22 years and their household heads in rural Andhra Pradesh and Maharashtra, India, assessed at home during spring and summer 2022 across an observed ambient temperature range of 27–46°C. Ambient temperature was measured directly at the dwelling immediately before testing, capturing the thermal conditions under which cognitive tasks were performed rather than relying on daily averages, weather stations, or geographically aggregated exposure measures. Adolescents and young adults completed standardized assessments of fluid reasoning, English reading, native-language reading, and mathematics; household heads completed Raven’s Progressive Matrices under the same household environmental conditions. In village fixed-effects models, each 1°C higher temperature was associated with 0.040 SD lower Raven’s scores, 0.042 SD lower English reading scores, 0.034 SD lower native-language reading scores, and 0.045 SD lower mathematics scores among adolescents and young adults. Higher temperature was also associated with 0.018 SD lower Raven’s scores among household heads. Associations were generally consistent across sex and socioeconomic groups. Reading and mathematics associations remained robust to adjustment for seasonality and time of day, while the Raven’s association attenuated. These findings provide exposure-precise evidence that higher ambient temperatures are associated with lower cognitive performance across multiple domains and generations in a heat-exposed rural LMIC setting. As climate change increases the frequency and intensity of extreme heat, adaptation planning should consider not only heat-related illness and mortality but also the cognitive conditions that support learning, work, caregiving, and decision-making in everyday household environments.

Due to rapid population aging, the number of Chileans with dementia is estimated to triple by 2050. Measurement of multiple cognitive domains in population-based surveys that facilitate studies of associations between earlier experiences and cognition among older populations are rare. The purpose of this paper is to describe the survey protocol (Chile-Cog) for assessment of cognitive function in a sample of Chileans ages 60 and above. Chile’s distinctively high life expectancy and educational attainment relative to other Latin American countries, and its rapid transition from a middle- to a high-income economy, make it a valuable setting for studying life-course influences on cognitive health at older ages. The sample for the Chile-Cog was drawn from the longitudinal Chilean Social Protection Survey (SPS) in 2019 and it is nationally representative of individuals aged 60 and above. The survey protocol consists of in-person interviews to assess multiple cognitive domains, including orientation, immediate and delayed memory, attention, language, visuospatial ability, and executive function. In addition, interviews were conducted with individuals knowledgeable about the respondents’ health and daily activities. A sample of 2,033 respondents aged 60 and above in 2019 was interviewed, representing a 73

This study uses longitudinal data from Ethiopia, India, Peru, and Vietnam to assess the associations between adolescent skills and their physical growth in life-cycle periods that are overlapping or following puberty growth spurts. In place of total growth over a life-cycle period, our analysis uses conditional growth, which is the part of height change that is uncorrelated with height at the start of the period. The adolescents' cognitive achievements are based on their test results in math, receptive vocabulary, and reading comprehension, and their socioemotional skills are based on their self-efficacy, self-esteem, and peer relations. The main findings include: (1) adolescent cognitive achievements are associated with preadolescence and early adolescence growth; (2) the association between cognitive skills and physical growth continues into late adolescence for boys in poor regions; (3) significant associations are found between adolescents' socioemotional skills and their growth in preadolescence, adolescence or both; and (4) across adolescent groups by sex and poor versus nonpoor regions, growth between ages 12 and 15 is associated with their socioemotional skills. The findings of this study provide additional insights to support age-specific investments in the health and nutrition of preadolescents and adolescents.

OBJECTIVES:This study aimed to investigate associations of own and parental schooling with cognitive performance measured using the Harmonized Cognitive Assessment Protocol (HCAP) in Chile, a context distinct from previous studies using the HCAP. METHODS:Using Chile-Cog HCAP data linked to the Chilean Social Protection Longitudinal Survey, we used multivariate-adjusted regressions for individuals aged ≥60 to estimate associations between own and parental schooling and global HCAP and domain-specific scores, and examined gender differences (n = 1,791). RESULTS:Own schooling, with basic covariates, is associated with 40% of the variance in global HCAP scores. Less-than-primary versus lower-secondary schooling is associated with lower global HCAP scores and with lower orientation, memory, executive function, language, and visuospatial domain scores. Postsecondary versus lower-secondary schooling is associated with higher global and domain-specific scores: orientation, memory, executive function, language, and visuospatial. Including parental schooling yields lower estimates for own schooling, and maternal completion of primary schooling or above is associated with higher global scores than less-than-primary schooling. Being female is not significantly associated with global HCAP scores, but it was positively associated with memory scores and negatively with the visuospatial scores. Interaction between own schooling and being female suggests significantly higher scores for primary schooling for female than male for the orientation and memory domains. DISCUSSION:These results reinforce the findings of earlier studies regarding the strong association of schooling with better cognition in a South American country that transitioned from a developing to a high-income country during respondents' lifetimes.

Various challenges are thought to render female-headed households (FHHs) in the Arab region vulnerable to poverty. Yet, previous studies show mixed results regarding the extent of FHH poverty and the absence of household-panel-survey data hinders analysis of poverty dynamics. We address these challenges by proposing a novel classification of FHHs and analyze synthetic panels constructed from 20 rounds of repeated-cross-sectional surveys from Egypt, Iraq, Jordan, Mauritania, the West Bank and Gaza, and Tunisia spanning the past two decades. We find that the definition of FHHs matters for measuring poverty levels and dynamics. Most types of FHHs are less poor than non–FHHs on average, but FHHs with females as a majority of adults are generally poorer. FHHs are more likely to escape poverty than households on average, but FHHs without children are the most likely to do so. While more children are generally associated with more poverty for FHHs, there is heterogeneity across countries in addition to heterogeneity across definitions of FHHs. The findings provide useful inputs for the design and targeting of social-protection programs aimed at reducing gender inequalities and poverty in the Arab region.

This paper develops and estimates a dynamic model, which integrates value‐added and school‐choice models, to evaluate grade‐by‐grade and cumulative impacts of the Mexican Prospera conditional cash transfer (CCT) program on educational achievement. The empirical application advances the previous literature by estimating policy impacts on learning, accounting for dynamic selective school attendance, and incorporating both observed and unobserved heterogeneity. A dynamic framework is critical for estimating cumulative learning effects because lagged achievements are important determinants of current achievements. The model is estimated using rich nationwide Mexican administrative data on schooling progression and mathematics and Spanish test scores in grades 4–9 along with student and family survey data. The estimates show significant CCT impacts on learning and educational attainment, particularly for students from poorer households. Results show that telesecondary schools (distance learning) play a crucial role in facilitating school attendance and in fostering skill accumulation.

OBJECTIVES:Higher schooling attainment is associated with better cognitive function at older ages, but it remains unclear whether the relationship is causal. We estimated causal effects of schooling on performances on the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word-recall (memory) test at older ages in China, Ghana, India, Mexico, Russia, and South Africa. METHODS:We used harmonized data (n = 30,896) on older adults (≥50 years) from the World Health Organization Study on Global Ageing and Adult Health. We applied an established nonparametric partial identification approach that bounds causal effects of increasing schooling attainment at different parts of the schooling distributions under relatively weak assumptions. RESULTS:An additional year of schooling increased word-recall scores by between 0.01 and 0.13 SDs in China, 0.01 and 0.06 SDs in Ghana, 0.02 and 0.09 SDs in India, 0.02 and 0.12 SDs in Mexico, and 0 and 0.07 SDs in South Africa when increasing schooling from never attended to primary. No results were obtained for Russia at this margin due to the low proportion of older adults with primary schooling or lower. At higher parts of the schooling distributions (e.g., high school or university completion), the bounds cannot statistically reject null effects. DISCUSSION:Our results indicate that increasing schooling from never attended to primary had long-lasting effects on memory decades later in life for older adults in 5 diverse low- and middle-income countries.

We revisit the much-investigated relationship between schooling and health, focusing on cognitive abilities at older ages using the Harmonized Cognition Assessment Protocol in the Health & Retirement Study. To address endogeneity concerns, we employ a nonparametric partial identification approach that provides bounds on the population average treatment effect using a monotone instrumental variable together with relatively weak monotonicity assumptions on treatment selection and response. The bounds indicate potentially large effects of increasing schooling from primary to secondary but are also consistent with small and null effects. We find evidence for a causal effect of increasing schooling from secondary to tertiary on cognition. We also replicate findings from the Health & Retirement Study using another sample of older adults from the Midlife in United States Development Study Cognition Project.

BACKGROUND:Poverty is strongly associated with numerous adverse health outcomes. Government-led cash transfer programmes are crucial to poverty reduction strategies in many low-income and middle-income countries (LMICs). Although extensive research from individual programmes exists on the effects of cash transfers on beneficiaries, evidence of these programmes' population-wide health effects remains scarce. Previously, we showed that cash transfer programmes are associated with substantially reduced mortality rates among women and young children at the population level in LMICs. In this study, we aimed to explore the mechanisms underlying these reductions. METHODS:In this two-stage difference-in-differences study, we combined individual-level data from Demographic and Health Surveys in 37 LMICs with a comprehensive database of government-led cash transfer programmes between 2000 to 2019 to compare countries with cash transfer programmes and countries without these programmes before and after the introduction of them. We evaluated the effects of cash transfer programmes on 17 outcomes related to maternal health service use, fertility and reproductive decision making, caregiver health behaviours, and child health and nutrition. Outcomes were assessed across all respondents of the surveys but could not be differentiated between recipients and non-recipients for countries with cash-transfer programmes. FINDINGS:Among 37 countries included in the study, 20 introduced large-scale cash transfer programmes during the study period. We included data from 2 156 464 livebirths, and 954 202 children younger than 5 years. We identified statistically significant effects of cash transfer programmes on early antenatal care (5·0 percentage points, 95% CI 2·1 to 7·9; padjusted=0·0019), facility deliveries (7·3 percentage points, 3·2 to 11·3; padjusted=0·0014), delivery by a skilled birth attendant (7·9 percentage points, 3·2 to 12·6; padjusted=0·0027), desired pregnancies (1·9 percentage points, 0·5 to 3·2; padjusted=0·014), interdelivery intervals (2·5 months, 1·8 to 3·1; padjusted=0·0017), unmet needs for contraception (-10·3 percentage points, -15·2 to -5·3; padjusted=0·0006), exclusive breastfeeding (14·4 percentage points, 13·3 to 15·5; padjusted=0·0004), minimum acceptable diets (7·5 percentage points, 5·5-9·5; padjusted=0·0009), measles vaccinations (5·3 percentage points, 1·6 to 8·9; padjusted=0·026), male twin livebirths (0·8 per 1000 male livebirths, 0·3 to 1·4; padjusted=0·023), diarrhoeal illness (-6·4 percentage points, -11·7 to -1·1; padjusted=0·038), and underweight nutritional status (-2·0 percentage points, -3·6 to -0·4; padjusted=0·029). There were no statistically significant effects on age at first birth (1·6 months, -1·3 to 4·4; padjusted=0·48), intended pregnancies (-0·2 percentage points, -2·8 to 2·3; padjusted=0·86), small birth sizes (0·4 percentage points, -0·7 to 1·4; padjusted=0·53), wasting (-2·1 percentage points, -5·0 to 0·9; padjusted=0·17), and stunting (4·3 percentage points, -0·2 to 8·7; padjusted=0·10). INTERPRETATION:As many countries consider the future of their cash transfer programmes, including whether to embrace approaches such as basic or guaranteed incomes, these findings provide new evidence on the numerous ways in which such programmes can improve population health. FUNDING:US National Institutes of Health.

This article focuses on three general dimensions of support for human-capital development of Sub-Saharan African children under five years old: nurturing care, nutrition, and preprimary programs. We simulate the Costs of Inaction of under-investments in these three dimensions of early life human capital. For preprimary programs we also simulate the long-run economic losses due to program closures during the Covid-19 pandemic. Our results suggest that: (i) the Costs of Inaction of not implementing nutritional programs for all stunted children 0-2 years of age is close to 3 % of GDP in some countries with high prevalences of stunting; (ii) the Costs of Inaction of not reaching universal coverage in preprimary is 1.6 % of GDP on average for the region; (iii) the Costs of Inaction as a share of GDP of not expanding home-visits programs to children 3-5 years considered developmentally not on track is 2.6 % of GDP, on average for the region; and (iv) the costs of reducing preprimary school participation due to COVID-19 ranges from 0.1 % of GDP to 6.0 % of GDP depending on pre-pandemic preprimary participation rates.

[This corrects the article PMC11271173.].

After-school tutoring has risen globally despite limited evidence of effectiveness. We implement a randomized after-school tutoring program in rural China where many children are left-behind by parents in care of grandparents. Compared to tutees cared for by parents, those in care of grandparents reported much smaller home-tutoring reductions but larger test-score gains. We interpret our data analysis with a model with tutoring efficacy and substitution between private and public inputs both differing by family background: Increased public tutoring generates larger test-score gains for children who experience greater tutoring efficacy and lesser substitution with household inputs, consistent with our estimates.

Global warming is changing precipitation patterns, particularly harming communities in low-and-middle income countries (LMICs). Whilst the long-term effects of being exposed to rainfall shocks early in life on school-achievement tests are well-established, there is little population-based evidence from LMICs on the mechanisms through which these shocks operate. Executive functions (EFs) are key for children’s learning abilities. This paper analyses the effects of early exposure to rainfall shocks on four foundational cognitive skills (FCSs), including EFs that have been found to be key predictors of educational success. These skills were measured via a series of tablet-based tasks administered in Peru as part of the Young Lives longitudinal study (YLS). We combine the YLS data with gridded data on monthly precipitation to generate monthly, community-level rainfall shock estimates. The key identification strategy relies on temporary climatic shocks being uncorrelated with other latent determinants of FCSs development. Our results show significant negative effects of early life exposure to rainfall shocks on EFs—especially, on working memory—measured in later childhood. We also find evidence of rainfall shocks decreasing households’ abilities to invest in human capital, which may affect both FCSs and domain-specific test scores. Finally, there is suggestive, but not conclusive, evidence that a conditional-cash-transfer program providing poor households with additional financial resources might partially offset the effects of the rainfall shocks.

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