We estimate the short-term cognitive effects of fine particulate matter (PM2.5) exposure using novel exposure data collected during cognitive testing in Kenya. Unlike most existing studies that rely on satellite-based or fixed monitoring station data, we measure highly localized ambient pollution using portable monitors deployed at cognitive testing sites and link these readings directly to Harmonized Cognitive Assessment Protocol (HCAP) scores. Higher PM2.5 exposure during testing is associated with lower cognitive performance, particularly in executive function, memory, and visuospatial tasks. Binned exposure models suggest a monotonic pattern, with more negative estimates at higher exposure levels. Notably, effects are significantly larger among more educated individuals, possibly due to greater task demands or lower chronic exposure that limits physiological adaptation. Given that cognitive impairment is evident even at PM2.5 levels below Kenya’s mean annual regulatory threshold of 35μg/m3, the findings suggest that short-term exposure may impose underappreciated human capital costs that current regulatory standards fail to mitigate. The results highlight the potential cognitive and economic returns to interventions that reduce air pollution exposures in low-resource settings.

The over-60 population in Sub-Saharan Africa is expected to grow rapidly in the coming decades, tripling between 2020 and 2050. Despite this explosive projected growth, few countries in the region have implemented policies designed to support older populations. Further, little research in economics has specifically examined aging in Sub-Saharan Africa, though many opportunities exist for economists to generate research evidence to inform the design of effective policies in this area. This paper conducts original data analysis to characterize the challenges and opportunities facing older Sub-Saharan Africans, and combines this with insights from a cross-disciplinary evidence review to identify four key facts and three paths forward for future economic research and policy around the design of health care systems, pensions, and other public support programs to prepare for an aging Africa.

A large literature has examined how best to target antipoverty programs to those most deprived in some sense (e.g., consumption). We examine the potential trade-off between this objective and targeting those most impacted by such programs. We work in the context of an NGO cash transfer program in Kenya, employing recent advances in machine learning methods and dynamic outcome data to learn proxy means tests that jointly target both objectives. Targeting solely on the basis of deprivation is not attractive in this setting under standard social welfare criteria unless the planner’s preferences are extremely redistributive. (JEL C45, D63, I31, I38, L31, O15)

Adapting cognitive tests to culturally diverse and low-resource settings is essential for expanding knowledge of cognitive health in older adults beyond high-income countries. However, contextual differences in novel settings can affect reliability and validity. There is limited evidence on the feasibility of implementing culturally adapted cognitive assessments in Sub-Saharan Africa, a region projected to have over 158 million adults aged 60 and older by 2050. The Longitudinal Study of Health and Ageing in Kenya (LOSHAK) is designed to address this measurement gap by evaluating cognitive tests in this context. We analyzed data from 205 adults aged 45 years and older from the Kaloleni/Rabai Health and Demographic Surveillance System in Coastal Kenya. Using McDonald’s omega and confirmatory factor analysis, we evaluated the internal consistency reliability and the factor structure of four cognitive domains (orientation, memory, executive functioning, language/fluency) and four psychosocial constructs (depressive symptoms, loneliness, subjective well-being, and life satisfaction). McDonald’s omegas ranged from ω = 0.78 to 0.95 for cognitive domains and were above 0.83 for each psychosocial domain, suggesting high reliability. Factor analyses revealed adequate to perfect fit for most domains, and patterns of factor loadings were mostly acceptable. The successful adaptation of these assessment tools in Kenya demonstrates the feasibility of implementing rigorous cognitive and psychosocial measurements in low-resource settings. These findings provide a methodological framework for future aging studies in similar contexts across Sub-Saharan Africa.

While child poverty is declining globally, many children in Sub-Saharan Africa still live in poverty and face obstacles that hinder them from achieving their full developmental potential. Parents' psychological well-being has important influences on child development directly or indirectly through the home learning environment (HLE). Still, there is a lack of research on this topic from Sub-Saharan Africa. To fill this gap, the present study examined associations among parents' psychological well-being, HLE, and children's socioemotional and cognitive development, using a large sample of 1,633 parents (73% mothers; 88% married; 38% completed some secondary school) and their children (M age = 7.7 years) from Kenya. There were unique processes between different aspects of parents' psychological well-being and child development: Parent depressive symptoms were directly associated with child development, whereas parent self-efficacy was directly and indirectly associated through HLE. The findings provide implications for developing family-focused preventive interventions in Sub-Saharan Africa.

Slack – the underutilization of factors of production – varies systematically with economic development. Using novel and detailed measures of the utilization of labor and capital from a large representative sample of firms in rural and urban Kenya, we show that utilization is increasing in firm size, market access, and economic activity. We present a model of firm capacity choice where indivisibility in at least one input is a key driver of slack. We embed the model in spatial general equilibrium, with features characteristic of low-income settings – including many small firms and high transport costs – and show that it rationalizes both the endogenous emergence of slack in steady-state and elastic aggregate supply curves. We empirically validate model predictions using reduced-form estimates of the general equilibrium effects of cash transfers from a large-scale RCT in Kenya. The parsimonious model replicates much of the experimental evidence, predicting a large real multiplier of 1.5, driven by expansion in low-utilization sectors and firms, and limited average price inflation. Counterfactual analyses indicate that multipliers are likely to be meaningfully smaller in lower slack settings, such as urban areas. We use the model to revisit the estimation of spatial spillovers in clustered RCTs and uncover non-trivial ’missing intercept’ effects on income and inflation. Additionally, we innovate methodologically by pre-registering key elements of model estimation and validation. The findings suggest that input indivisibilities and slack are key features of developing country settings, and are quantitatively important for macroeconomic dynamics and policies. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Background The Coronavirus Disease 2019 (COVID-19) pandemic and associated mitigation policies created a global economic and health crisis of unprecedented depth and scale, raising the estimated prevalence of depression by more than a quarter in high-income countries. Low- and middle-income countries (LMICs) suffered the negative effects on living standards the most severely. However, the consequences of the pandemic for mental health in LMICs have received less attention. Therefore, this study assesses the association between the COVID-19 crisis and mental health in 8 LMICs. Methods and findings We conducted a prospective cohort study to examine the correlation between the COVID-19 pandemic and mental health in 10 populations from 8 LMICs in Asia, Africa, and South America. The analysis included 21,162 individuals (mean age 38.01 years, 64% female) who were interviewed at least once pre- as well as post-pandemic. The total number of survey waves ranged from 2 to 17 (mean 7.1). Our individual-level primary outcome measure was based on validated screening tools for depression and a weighted index of depression questions, dependent on the sample. Sample-specific estimates and 95% confidence intervals (CIs) for the association between COVID-19 periods and mental health were estimated using linear regressions with individual fixed effects, controlling for independent time trends and seasonal variation in mental health where possible. In addition, a regression discontinuity design was used for the samples with multiple surveys conducted just before and after the onset of the pandemic. We aggregated sample-specific coefficients using a random-effects model, distinguishing between estimates for the short (0 to 4 months) and longer term (4+ months). The random-effects aggregation showed that depression symptoms are associated with a increase by 0.29 standard deviations (SDs) (95% CI [−.47, −.11], p -value = 0.002) in the 4 months following the onset of the pandemic. This change was equivalent to moving from the 50th to the 63rd percentile in our median sample. Although aggregate depression is correlated with a decline to 0.21 SD (95% CI [−0.07, −.34], p -value = 0.003) in the period thereafter, the average recovery of 0.07 SD (95% CI [−0.09, .22], p -value = 0.41) was not statistically significant. The observed trends were consistent across countries and robust to alternative specifications. Two limitations of our study are that not all samples are representative of the national population, and the mental health measures differ across samples. Conclusions Controlling for seasonality, we documented a large, significant, negative association of the pandemic on mental health, especially during the early months of lockdown. The magnitude is comparable (but opposite) to the effects of cash transfers and multifaceted antipoverty programs on mental health in LMICs. Absent policy interventions, the pandemic could be associated with a lasting legacy of depression, particularly in settings with limited mental health support services, such as in many LMICs. We also demonstrated that mental health fluctuates with agricultural crop cycles, deteriorating during “lean”, pre-harvest periods and recovering thereafter. Ignoring such seasonal variations in mental health may lead to unreliable inferences about the association between the pandemic and mental health.

We assess the impacts of a randomized school-based deworming intervention in Kenya on the mortality of recipients' children using a 23-year longitudinal data set of over 6,500 original participants and their offspring.The under-5 mortality rate fell by 22% (17 deaths per 1000 live births) for children of treatment group individuals.We find that a combination of improved health, education and living standards, increased urban residence, delayed fertility, and greater use of health care in the parent generation contributed to the reduction.The results provide evidence for meaningful intergenerational benefits of child health investments.

The COVID-19 pandemic has caused substantial challenges for small businesses across Kenya, where some enterprises recorded a drop of as much as 44 percent in revenue in the early months of the pandemic (Egger et al. 2020). Women entrepreneurs may face an especially high burden due to increased childcare responsibilities from school closures. Lower overall living standards as a result of the pandemic could reduce agency for women, increase stress, and impact intra-household dynamics, which could ultimately lead to changes in intra-household bargaining and impact the overall effect of increasing credit to female borrowers (de Mel, McKenzie and Woodruff 2009). The Kenya Life Panel Survey (KLPS) is a 20-year longitudinal panel with detailed measures of health, educational, social, and labor market outcomes for individuals that attended primary school in Busia, Kenya from 1998-2001. This study builds on the panel survey by conducting phone surveys with respondents and their spouses between June and October 2021 to address three key research questions. First, the study will look at the extent to which digital credit can support women’s work during the pandemic. The second set of research questions will focus on how intra-household substitution patterns look during the pandemic, and if this is the main channel affecting women’s work. Finally, the study will also assess how past (randomized) human capital interventions, including vocational training voucher programs and cash grants, affect female economic activity and digital credit access during the

We track the effects of the COVID-19 pandemic on mental health in eight Low and Middle Income Countries (LMICs) in Asia, Africa, and South America utilizing repeated surveys of 21,162 individuals. Many respondents were interviewed over multiple rounds pre- and post-pandemic, allowing us to control for time trends and within-year seasonal variation in mental health. We demonstrate how mental health fluctuates with agricultural crop cycles, deteriorating during pre-harvest “lean” periods. Ignoring this seasonal variation leads to unreliable inferences about the effects of the pandemic. Controlling for seasonality, we document a large, significant, negative impact of the pandemic on mental health, especially during the early months of lockdown. In a random effects aggregation across samples, depression symptoms increased by around 0.3 standard deviations in the four months following the onset of the pandemic. The pandemic could leave a lasting legacy of depression. Absent policy interventions, this could have adverse long-term consequences, particularly in settings with limited mental health support services, which is characteristic of many LMICs.

How large economic stimuli generate individual and aggregate responses is a central question in economics, but has not been studied experimentally. We provided one-time cash transfers of about USD 1000 to over 10,500 poor households across 653 randomized villages in rural Kenya. The implied fiscal shock was over 15 percent of local GDP. We find large impacts on consumption and assets for recipients. Importantly, we document large positive spillovers on non-recipient households and firms, and minimal price inflation. We estimate a local transfer multiplier of 2.5. We interpret welfare implications through the lens of a simple household optimization framework.

How large economic stimuli generate individual and aggregate responses is a central question in economics, but has not been studied experimentally. We provided one‐time cash transfers of about USD 1000 to over 10,500 poor households across 653 randomized villages in rural Kenya. The implied fiscal shock was over 15 percent of local GDP. We find large impacts on consumption and assets for recipients. Importantly, we document large positive spillovers on non‐recipient households and firms, and minimal price inflation. We estimate a local transfer multiplier of 2.5. We interpret welfare implications through the lens of a simple household optimization framework.

This cross-sectional study examines the extent to which mask mandates are followed and quantify the bias of self-reported mask usage in Kenya.

Despite numerous journalistic accounts, systematic quantitative evidence on economic conditions during the ongoing COVID-19 pandemic remains scarce for most low- and middle-income countries, partly due to limitations of official economic statistics in environments with large informal sectors and subsistence agriculture. We assemble evidence from over 30,000 respondents in 16 original household surveys from nine countries in Africa (Burkina Faso, Ghana, Kenya, Rwanda, Sierra Leone), Asia (Bangladesh, Nepal, Philippines), and Latin America (Colombia). We document declines in employment and income in all settings beginning March 2020. The share of households experiencing an income drop ranges from 8 to 87% (median, 68%). Household coping strategies and government assistance were insufficient to sustain precrisis living standards, resulting in widespread food insecurity and dire economic conditions even 3 months into the crisis. We discuss promising policy responses and speculate about the risk of persistent adverse effects, especially among children and other vulnerable groups.

Background Many countries in sub-Saharan Africa have so far avoided large outbreaks of COVID-19, perhaps due to the strict lockdown measures that were imposed early in the pandemic. Yet the harsh socio-economic consequences of the lockdowns have led many governments to ease the restrictions in favor of less stringent mitigation strategies. In the absence of concrete plans for widespread vaccination, masks remain one of the few tools available to low-income populations to avoid the spread of SARS-CoV-2 for the foreseeable future. Methods We compare mask use data collected through self-reports from phone surveys and direct observations in public spaces from population-representative samples in Ugunja subcounty, a rural setting in Western Kenya. We examine mask use in different situations and compare mask use by gender, age, location, and the riskiness of the activity Findings We assess mask use data from 1,960 phone survey respondents and 9,549 direct observations. While only 12% of people admitted in phone interviews to not wearing a mask in public, 90% of people we observed did not have a mask visible (77.7% difference, 95% CI 0.742, 0.802). Self-reported mask use was significantly higher than observed mask use in all scenarios (i.e. in the village, in the market, on public transportation). Interpretation We find limited compliance with the national government mask mandate in Kenya using directly observed data, but high rates of self-reported mask use. This vast gap suggests that people are aware that mask use is socially desirable, but in practice they do not adopt this behavior. Focusing public policy efforts on improving adoption of mask use via education and behavioral interventions may be needed to improve compliance. Funding Weiss Family Foundation, International Growth Centre

US$758 PPP for comparison villages in the low saturation group, revenues increased by US$348 PPP per household in treatment villages and by US$231 PPP in comparison villages (a 46 and 30 percent increase respectively) Gains in revenue were concentrated in the retail and manufacturing sectors. Enterprises in areas that received more cash transfers experienced meaningful gains in total revenues, in line with the increase in household expenditures. Revenues increased without noticeable changes in firm’s investment behavior (beyond a modest increase in inventories). These results suggest that increased demand induced by the transfers drove expansion of enterprise activity rather than by increased investment.