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. 2023;36(1):505-544.
doi: 10.1007/s00148-022-00886-1. Epub 2022 Mar 31.

The effects of an epidemic on prenatal investments, childhood mortality and health of surviving children

Patricia I Ritter  1 , Ricardo A Sanchez  2
Affiliations

The effects of an epidemic on prenatal investments, childhood mortality and health of surviving children

Patricia I Ritter et al. J Popul Econ. 2023.

Abstract

The potential death toll from an epidemic is larger than the number of deaths directly associated with the infection. In this study, we find that prenatal exposure to a cholera epidemic in Peru increased childhood mortality and that surviving children were more likely to be underweight and to suffer from diarrhea. We further find that a significant part of this mortality happened during the first day of life, and that prenatal exposure to cholera decreased prenatal care and institutional deliveries, suggesting that the mortality and possibly other longer-term effects were partially driven by a reduction in prenatal investments.

Keywords: Childhood mortality; Cholera; Diarrheal diseases; Epidemics; In utero; Infectious diseases; Institutional deliveries; Parental investments; Prenatal care.

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Figures

Fig. 1
Fig. 1
Weekly incidence of cholera epidemic. Data source: General Directorate of Epidemiology, of the Ministry of Health of Peru
Fig. 2
Fig. 2
Incidence and mortality of cholera epidemic. Data source: General Directorate of Epidemiology, of the Ministry of Health of Peru
Fig. 3
Fig. 3
Spread of the Cholera Epidemic in Peru by Month and Region Note: The graph from January shades the departments where the first cases where detected. The graphs from the rest of the months show the raw variation we exploit in our regressions, that is, the three-month cholera incidence by region and month. Different shades represent different quintiles of incidence
Fig. 4
Fig. 4
Event study—mortality rate—cholera incidence 3rd trimester in utero. Note: Graph includes point estimates from the event study (normalized to 0 the coefficient of 1990) and 95% confidence intervals of wild bootstrap inferences to correct for the small number of regions
Fig. 5
Fig. 5
Placebo event study—maternal education—cholera incidence 3rd trimester in utero. Note: Graph includes point estimates from the event study (normalized to 0 the coefficient of 1990) and 95% confidence intervals of wild bootstrap inferences to correct for the small number of regions
Fig. 6
Fig. 6
Event study—mortality rate—cholera incidence first trimester in utero. Note: Graph includes point estimates from the event study (normalized to 0 the coefficient of 1990) and 95% confidence intervals of wild bootstrap inferences to correct for the small number of regions
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