Outline: Synthesis Paper - Friedman School of Nutrition Science and
Transcription
Outline: Synthesis Paper - Friedman School of Nutrition Science and
Mapping Hunger in Panama: A Report on Mapping Malnutrition Prevalence Beatrice Lorge Rogers, James Wirth, Kathy Macías, Parke Wilde Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University Boston, Massachusetts USA March 2007 Acknowledgments This report is the result of a collaboration between the World Food Programme, Office for Latin America and the Caribbean, and the Friedman School of Nutrition Science and Policy, Tufts University, Boston. The authors deeply appreciate the advice and support of our project officers, Judith Thimke, Carlos Acosta, and Mahadevan Ramachandran. We received helpful advice on the PovMap method from Qinghua Zhao and Peter Lanjouw of the World Bank. We appreciate the responsiveness of individuals responsible for management of the data sets with which we worked: Roberto González Batista and Edith de Kowalczyk Arosemena of the Ministerio de Economía y Finanzas (MEF). We received many responses from other individuals in these offices; their help is acknowledged even though we cannot identify all of them by name. Patrick Florance at Tufts University provided help in implementing GIS analysis. We also received support from the offices of the World Food Program: Xinia Soto and Lilibeth Herrera at WFP/LAC in Panama, for which we are grateful. ii Table of Contents 1. Introduction................................................................................................................. 1 1.2 Goals of the Project............................................................................................. 4 2. Data............................................................................................................................. 4 2.1 General considerations........................................................................................ 4 2.2 Data Used in the Present Analysis ...................................................................... 5 3. Results......................................................................................................................... 8 3.1 Chronic Malnutrition Prevalence Rates: Standardized Categories................... 10 3.2 Malnutrition Prevalence by Quartiles ............................................................... 12 3.3 Malnutrition Prevalence: Numbers of Children Affected................................. 14 3.4 Relationship of Poverty Prevalence to Malnutrition Prevalence ...................... 17 4. Discussion................................................................................................................. 19 5. Next steps.................................................................................................................. 20 6. References................................................................................................................. 22 Appendix........................................................................................................................... 25 Technical Appendix Tables .......................................................................................... TA 1 iii List of Tables Table 2.1. Characteristics of Data Sets Used in the Analysis 5 Table 3.1: Comparison of Malnutrition Prevalence and Mean HAZ based on Small Area Estimation and Survey Estimates 9 Country Descriptive Statistics on Malnutrition 10 Table 3.3: Figure Figure 1: Range and Number of Malnourished Children In Panama (based on HAZ) by Province 16 List of Maps Map 1 Map 2 Map 3 Map 4 Map 5 Map 6 Map 7 Map 8 Map 9 Map 10 Provinces and Zones, Panama Prevalence of Chronic Malnutrition, Non-Indigenous, Standardized Categories Prevalence of Chronic Malnutrition, Indigenous, Standardized Categories Prevalence of Chronic Malnutrition Based on Small Area Estimation, by Dominio Prevalence of Chronic Malnutrition, Non-Indigenous, Based on Small Area Estimation, By District Prevalence of Chronic Malnutrition, Indigenous, Based on Small Area Estimation, by District Number of Chronically Malnourished Children, NonIndigenous Areas, Based on Small Area Estimation, by District Number of Chronically Malnourished Children, Indigenous Areas, Based on Small Area Estimation, by District Discordance of Poverty and Malnutrition, Non-Indigenous Areas Discordance of Poverty and Malnutrition, Indigenous Areas Appendix Tables Table A1 Data Requirements for the Prediction of Malnutrition Table A2 Variables Used in the Analysis of Malnutrition, Panama Technical Appendix iv 6 11 11 12 13 14 14 15 18 19 Mapping Hunger: A Report on Mapping Malnutrition Prevalence in the Dominican Republic, Ecuador, and Panama Beatrice Lorge Rogers, James Wirth, Kathy Macías, Parke Wilde Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University Boston, Massachusetts USA March, 2007 1. Introduction The government of Panama has made a commitment to reducing the prevalence of malnutrition in the country, and has implemented a series of programs to address various aspects of malnutrition including supplementary feeding programs for pregnant and lactating women and their children (PAC – Programa de Alimentación Complementaria), school feeding, and various micronutrient supplementation programs. Recently, a program of conditional cash transfers was implemented, targeted to the poorest corregimientos, and a cash transfer program, the bono familiar was started as a pilot. Of course, reducing poverty and hunger is the first Millennium Development Goal (UN 2001), where “hunger” is commonly defined in terms of nutritional status, which in turn is measured as children’s anthropometric status. Panama has seen a deterioration in the nutrition situation between the most recent Encuesta de Niveles de Vida (ENV) conducted in 2003, and the previous survey of 1997. Growth retardation, or chronic malnutrition, rose nationally from 14% in 1997 to 21% in 2003. There was an alarming increase in the prevalence of growth retardation among children less than six months of age, from 4% in 1997 to 13% in 2003. Increases in chronic malnutrition prevalence between the two surveys were observed in urban and rural areas, and among the extreme poor, poor, and non-poor, though of course the prevalences are much higher among the poor and extreme poor, the rural, and especially the indigenous populations. At the same time, there was a small (statistically significant) increase in the percentage of preschool children at risk of overweight, or actually overweight – from 21% to 22% at risk, and from 3.7% to 4.1% overweight (Valdez and Castro de Barba 2006). The observation of a worsening situation with respect to chronic malnutrition resulted in the initiation of changes in the design and targeting of supplementary feeding programs to emphasize expanded services to the districts with the highest prevalence of extreme poverty (most of which are in indigenous areas), and the priority districts, and in the 1 initiation of the conditional cash transfer and bono familiar food stamp programs. 1 The bono familiar was initiated as a pilot, starting in Santa Fé and Mironó, and expanded to a few other indigenous areas in 2006. All these programs are seen as an integral part of the government’s strategic plan to combat extreme poverty (Gabinete Social 2006). An important step toward realizing the goal of reducing malnutrition (here interpreted to refer to undernutrition, not nutritional excess) is to identify the places where the problem is the most severe. Localizing malnutrition makes it possible to understand better the underlying causes of the problem in different places, and to target resources appropriately to the areas in which they will make the most difference. In addition, mapping provides a powerful tool for visualization of the nature of the nutrition problem in a country. Maps, because they are intuitively interpretable, can be useful for evidence based advocacy purposes. In this study, the outcome of interest is childhood malnutrition, measured in terms of anthropometric status (height-for-age) of children less than five years of age. A child falling below negative two standard deviations of the mean HAZ is considered malnourished. 2 Nutrition surveys typically collect information representative at the Province level, but previous studies have found significant variation in nutritional outcomes among smaller administrative units within provinces (Fujii, 2003; Larrea et al. 2005; Benson 2006). The present study used the technique of Small Area Estimation (SAE) to analyze data from three countries: Ecuador, Panama, and the Dominican Republic, in order to produce subprovincial estimates of child malnutrition. 1.1 Analytic Approach: Small Area Estimation The technique of Small Area Estimation (SAE) makes it possible to use sample survey data, combined with a national census, to develop malnutrition prevalence estimates at highly disaggregated levels. The approach of Small Area Estimation is to identify a 1 The districts with extreme poverty are: Kankintú, Müna, Besiko, Nole Duima, Mironó, Kusapín, Comarca Kuna Yala, Ñürum, Cémaco, and Sambú. The Priority districts are Chiriquí Grande, Bocas de Toro, Las Palmas, Donoso, Cañazas, Santa Fé, Chepigana, Chirmán, Tolé, La Pintada, Changuinola, Olá, Pinogana, Chagres, San Francisco, Soná, Penonomé, La Mesa, Calobre, and Renacimiento. 2 Each anthropometric indicator has a different interpretation. Low height-for-age (HAZ), or stunting, is an indicator of chronic malnutrition, the result of long-term food insufficiency, often combined with other conditions (low birth weight, frequent illness). Low weight-for-height is a measure of thinness; if severe, it indicates wasting or acute malnutrition: a lack of food in the short term (also often combined with current illnesses like diarrhea and infection). Global malnutrition is measured by weight-for-age (WAZ). A child can be malnourished by this criterion if s/he is stunted or wasted; either condition would result in a child having low weight-for-age. These indicators are calculated with reference to standardized growth curves for children under age five. It is widely recognized that the growth trajectory of healthy, well-nourished children is similar among populations, irrespective of nationality or ethnicity, so that international standards are appropriate to assess nutritional status at the population level across countries (WHO 1995; 2006). The surveys used in this study made use of the NCHS/CDC/WHO anthropometric standards for growth (Waterlow et al 1977). New standards were published in 2006 (WHO 2006) that might slightly alter the distribution of malnutrition prevalence reported here (deOnis et al 2006). 2 sample survey representative of the national population that contains information on the outcome of interest – in this case, malnutrition. A predictive model is developed based on the information contained in the survey, using variables that are also present in the national census. The parameters derived from that predictive model are then applied to the census data, producing estimates of malnutrition for every geographic unit in the census. The level of disaggregation is constrained only by the desired level of precision: the smaller the unit, the less precise the estimate (Hentschel et al 2000). We used a program developed by the World Bank for estimating poverty prevalence, and adapted it for use with nutrition indicators. 3 The program performs both steps of the process: it first performs the regression analysis using a statistically representative household sample survey, and then applies the results to census data, producing percent prevalence estimates at any level of geographic disaggregation. The PovMap program uses a statistical technique called bootstrapping to estimate a standard error around each estimate from the census data; this makes it possible to assess the precision of the estimate produced, construct confidence intervals, and determine whether two geographic units are statistically significantly different from each other. 4 The present report provides estimates of malnutrition prevalence for children under age five in Panama. The key indicator of malnutrition in these countries, as in most of Latin America, is low height-for-age (HAZ), or stunting. Wasting is quite uncommon in most Latin American settings, including Panama. The prevalence of stunting at the national level based on our SAE results is 24.3% for Panama, and of wasting is 10.2%, higher than in most Latin American countries. Note though, as we shall see below, these figures vary between the indigenous and nonindigenous populations. The precision of the malnutrition estimates falls as the prevalence falls, and this is reflected in the model fit, or R2 of the regressions used to develop the predictions in PovMap, and in the standard errors of the estimates (Demombynes et al 2002). It stands to reason that in countries and regions with a high prevalence of malnutrition, environmental and socioeconomic causes predominate; as 3 At the writing of this report, PovMap v. 2.0 (beta version) can be downloaded free at the World Bank Website: http://iresearch.worldbank.org/PovMap/index.htm. See Zhao 2005 4 SAE estimates the outcome variable for each child in a community according to the following equation: 1) Y = β0 +β1W + β2 X + β3 Z + u, where X, W, and Z are vectors of individual, household, and community characteristics respectively. The term u represents the disturbance or error term, which may be decomposed into two parts as follows: 2) u ci = η c + εci , where η c is the variance accounted for by the community, and εci is the variance accounted for at the individual levelTo produce an estimate of the variance around the estimate of the individual’s nutritional outcome, the computer repeats the regression a given number of times, sampling randomly from the variances around the parameter estimates (βs) and the error terms (η and ε). The variances are derived from the regression model estimated using the survey data. The approach is described in a number of papers that explain the underlying statistics and give examples of applications to estimation of the prevalence of poverty (Elbers, Lanjouw, and Lanjouw, 2003, 2001; Zhao, 2005; Hentschel et al. 2000; Demombynes et al. 2002) and malnutrition (e.g., Fujii 2003; 2005; Larrea 2005; Gilligan et al. 2003; Haslett and Jones 2005). 3 conditions improve in a country, the remaining malnutrition may be due in large part to idiosyncratic characteristics of a child’s household and caretaker – factors that cannot be included in the present model because such information is not included in the census. 1.2 Goals of the Project The goal of the present project was to apply the PovMap method to the estimation of malnutrition prevalence in three countries, including Panama. The purpose was to see whether the method, developed for poverty estimation, would produce estimates of malnutrition prevalence that were consistent with previous survey results, and then to use the technique to estimate the prevalence of malnutrition at a more disaggregated level. A second purpose of this project was to develop clear guidance to others wishing to adapt the PovMap method to the estimation of malnutrition prevalence. A companion to this report provides a manual for the application of this method (Rogers et al. 2007). 5 2. Data 2.1 General considerations Causal models of malnutrition depend on having information on the child, his household, and the community in which he lives. A wide literature on the causes and the factors associated with malnutrition provides guidance on the types of information that could be used to predict the nutritional status of a child (UNICEF 1990, 1991; Smith and Haddad 2000). Appendix Table A1 shows examples of the key variables and the level (individual, household, community) at which they are measured. The SAE process depends on having enough variables that are comparable in both the survey and the census. One challenge of using the SAE method is to find suitable proxies for variables that would ideally be included in a predictive model. The survey and the census must contain similar information on the individual child and on the household. Additional variables can be added to the predictive model, which describe the location in which the child lives. Every segment represented in the survey will also be represented in the census 6 , so that information on the segment or the community in which the segment is located can be derived from the census and added to the survey data. In addition to information on individual children and their households and communities, secondary sources can provide institutional and geographic information that contributes to a more accurate prediction of malnutrition prevalence, such as access to health and 5 A complete report on the results of all three country studies is available from the authors or from WFP/LAC. 6 Not every sample survey uses the census sampling frame. In such cases, it may not be possible to match census segments with survey segments (see, for example, Simler 2006). In such cases, information can be calculated at the smallest unit for which the survey and sample segments can be matched – the community, the district. In all the countries in the present study, survey and census segments could be matched. Since official boundaries of administrative units may change, a key step in preparation for analysis is to ensure that the same boundaries are used for these units in both the census and the survey. 4 schooling services, and coverage by social programs; land use (percentage of land in agriculture, forests, swamp, and other uses), climate (rainfall, history of flooding and drought), elevation and slope. (Appendix Table A2 shows the variables used in the analysis, with their sources.) Merging data from diverse sources poses challenges, as geographic units of institutional and geographic data must correspond to the units of the survey and the census. Data sets, both administrative and geographic, cannot be merged until the definitions of administrative levels are made consistent. Further, the survey and the census must have been implemented fairly close to each other in time, and there should not have been any major social or economic disruptions between the survey and the census that would be likely to change the situation with regard to nutrition, food security, or poverty. 2.2 Data Used in the Present Analysis Table 2.1 summarizes the characteristics of the core data sets used. Table 2.1 Data Sets Used in the Analysis Name of Survey ENV Encuesta de Niveles de Vida Year of Survey 2003 Survey representative Province, Sampling at what level Domain, Urban/Rural Number of 6,363 households in survey Number of children 1,955 (aged 1-5 years) in survey Number of children 248,731 (aged 1-5 years) in Census Year of Census 2000 The data sets used for the Panama analysis were the Encuesta de Niveles de Vida (ENV), implemented in 2003, and the National Census, implemented in 2000. The ENV was a Living Standards Measurement Survey supported by the World Bank, with a sample of 8,000 households, a relatively small sample for such a survey. Geographic information was obtained from a variety of publicly available sources. Appendix Table A2 shows the variables included in the Panama analysis along with their sources. The first administrative level below national is the Province; there are 9 provinces, 3 indigenous areas, called comarcas, with the status of provinces, and two comarcas with the status of corregimiento (Atlas 2006). The second administrative unit is the District, of which there are 75, and the third administrative unit is the corregimiento. There were 593 corregimientos in Panama at the time of the Census; these are the corregimientos and 5 their boundaries included in the present analysis. 7 The ENV collected information to be representative of fourteen domains, or “dominios”. These domains correspond approximately to the country’s nine provinces, except for the province of Panama, which was divided into five sampling domains: Panama City, the rest of the District of Panama, the District of San Miguelito, and Panama Oeste and Panama Este. The survey was representative of these domains. Map 1: Panama Provinces Indigenous areas constituted a single domain. In addition to the three comarcas, whose population is largely or entirely indigenous, there are five provinces (Bocas del Toro, Chiriquí, Darien, Panama, Veraguas) that have significant indigenous populations. In these provinces, if a segment had a population that was greater than 50% indigenous by self-report, that segment was included in the domain Indigenous Areas; otherwise, it was included in the province in which it was located geographically. Thus, all the domains for which ENV results are reported correspond to a Province or a defined contiguous geographic area within a province, except for the domain “Indigenous Areas”, which is geographically dispersed. In order to apply the SAE method and compare our resulting estimates to the results from the ENV, we classified every census segment according to its percentage indigenous 7 New corregimientos have been formed since then; as of 2006 there are 621 corregimientos in Panama. 6 population, and placed all the segments with more than 50% indigenous individuals into the “Indigenous Areas” domain. 8 This division affects the presentation of our results in the form of maps. Our estimates were at the district level, but some districts have two separate estimates, one for the indigenous portion, and one for the non-indigenous portion. Thus, estimates are presented separately for the indigenous and non-indigenous domains. This separation allows us to see clearly the dramatic differences in malnutrition prevalence between the indigenous and non-indigenous areas of the country. There was an important limitation in the Panama census data set. Age of the child is a key variable for predicting nutritional status. Typically, an infant grows close to his recommended growth trajectory for the first six months of life (that period for which breastfeeding is sufficient for growth), and then begins to drop below it. Malnutrition rates increase for children up to the age of about 24 months, and then stabilize or even drop slightly up to age five. For this reason, malnutrition rates for children under age five should be measured starting at six months; including children younger than this will underestimate malnutrition, since younger infants have not yet fallen off their growth path. In the Panama census, only age in completed years is available, even for infants. The predictive model was thus estimated using age in completed years. We did not include children below 12 months in the model. We had the choice of including children below six months, or excluding children 6 to 11 months. We concluded that including infants 0 to 6 months would produce misleadingly low estimates of malnutrition prevalence. 2.4 Level of Disaggregation of the Estimates We initially performed our estimates at the level of the corregimiento, but found that due to small population sizes and quite imprecise estimates at this level, the district-level estimates were more reliable. It might be possible to improve the precision of the estimates, and thus permit estimation at the level of the corregimiento by modifying the model. Some specific steps that might be taken are: remove from the model any variables whose coefficients are non-significant and have high standard errors; introduce interaction terms that would modify the effects of certain key variables according to child’s age or selected geographic characteristics. 9 Another possibility is to perform the original survey regressions in a statistical program that allows the use of a robust regression technique to identify multivariate outliers; these cases could be removed or down-weighted prior to conducting the estimation using PovMap. 8 In ENV, indigenous segments are those with greater than 50% indigenous population (see http://www.mef.gob.pa/ ). To assure comparability between our estimates and the survey results, we recalculated the percentage of indigenous population in the survey segments. 9 PovMap offers some options for testing variations on the predictive (Beta) model. It also offers a test to determine whether the model is overfitted to the specific data set being used. 7 3. Results Table 3.1 shows malnutrition prevalence (based on HAZ), and average HAZ, comparing the estimates derived from SAE with the same measures derived from the survey data alone. These figures provide an initial sense of the plausibility of the SAE estimates. These results are reassuring: in general, the SAE procedure, estimated at the district level and aggregated to the level of province, produces estimates that are within 2 SE’s of the survey-derived figures. 8 Table 3.1: Comparison of Malnutrition Prevalence and Mean HAZ of Small Area Estimation and Survey Estimates: Panama Malnutrition Prevalence Mean HAZ National Hunger Mapping *Survey Hunger Mapping *Survey Dominio N Model** Results Estimates Results Estimates 123 0.128 0.113 -0.515 -0.380 (N=1955) 1 Panama City (K=82) (0.023) (0.132) (R2=0.2940) 0.179 0.195 -0.851 -0.763 2 District of Panama 106 (0.035) 3 San Miguelito 0.108 61 (0.168) 0.039 (0.024) 4 Panama Oeste 0.181 189 0.223 143 0.169 0.168 296 0.210 0.251 96 0.279 0.161 119 0.238 0.193 156 0.137 0.203 112 0.115 0.174 66 0.151 0.175 47 0.134 0.175 105 0.094 336 0.670 (0.042) -0.779 -0.702 -0.868 -0.592 -1.003 -0.820 -0.882 -0.674 -0.900 -0.275 (0.145) 0.253 (0.037) 14 Indigenous Areas -1.006 (0.145) (0.035) 13 Veraguas -1.196 (0.206) (0.034) 12 Los Santos -1.212 (0.145) (0.053) 11 Herrera -0.757 (0.138) (0.032) 10 Darien -1.040 (0.139) (0.031) 9 Chiriqui -0.985 (0.197) (0.041) 8 Colon -0.721 (0.160) (0.037) 7 Cocle -0.845 (0.125) (0.039) 6 Bocas del Toro -0.283 (0.150) (0.028) 5 Panama Este -0.493 -1.007 -1.032 (0.146) 0.629 -2.466 -2.297 (0.132) Note: Hunger mapping results are based up predictions of a national-level model calculated in PovMap 2.0 * Survey estimates of malnutrition prevalence and mean HAZ scores are based on children 1 - 5 years of age with HAZ = ± 5. Prevalences weighted using the inverse of the household sampling fraction (varname=factor) ** Hunger mapping results calculated using "cluster locational effect" ( ) Standard Errors Displayed in Parentheses 9 Table 3.2 shows the mean, median and range of prevalence of malnutrition according to the three malnutrition indicators: HAZ, WHZ and WAZ as estimated by SAE, to show how these estimates vary. Many of the maps shown below describe malnutrition prevalence in terms of the distribution within the country, that is, by national-level quartile. This table, and the map that follows, show information about the absolute prevalence Table 3.2. Malnutrition Indicators for Panama: Prevalence Percentages Mean a Median IQR Minimum Maximum National Prevalence (mean prev, weighted) a HAZ Malnutrition Prevalence WHZ WAZ 37.92 24.73 19.00-58.71 10.56 92.48 10.21 8.40 2.42 – 5.32 1.06 42.59 21.48 18.11 11.23 – 31.23 4.10 64.86 24.32 10.20 14.26 Simple mean of the small areas, based on small area estimates at the distrito level. 3.1 Chronic Malnutrition Prevalence Rates: Standardized Categories The following two maps show prevalence of stunting in Panama, with separate estimates for indigenous areas.). These maps show malnutrition prevalence by HAZ, using common categories, rather than the relative measure of quartiles. 10 Map 2: Panama, Non-Indigenous, Standardized Categories Map 3: Panama, Indigenous Areas, Standardized Categories 11 These maps demonstrate the sharp differences in estimated prevalence for the nonindigenous and indigenous areas. Among the non-indigenous districts, not one has a prevalence rate above 40 percent. Among the Indigenous areas, only three have prevalence rates below 40 percent, and none is below 20 percent. The two have the appearance of completely different countries. In the discussion that follows, results are presented, largely in terms of quartiles of malnutrition prevalence and numbers of children affected. The quartiles emphasize how areas within the countries vary with respect to each other, not with respect to an absolute level. The quartile boundaries vary widely between the indigenous and the nonindigenous areas, and in some cases, the quartile spans a very wide range. It is important to pay attention to these details in interpreting the results that follow. 3.2 Malnutrition Prevalence by Quartiles The next three maps demonstrate the value of disaggregating malnutrition estimates. Map 4 shows the prevalence estimates based on SAE at the level of the dominio. The next two maps show malnutrition prevalence estimates at the district level. Two maps are shown for the district level estimates: one for the non-indigenous areas, and one for the indigenous areas. These maps clearly demonstrate the degree of variability among districts within a given province or domain. Map 4 12 Map 5 Map 6 13 Note the pronounced difference in the quartile boundaries for the indigenous and nonindigenous districts. Among the indigenous, the very lowest quartile starts at 35 percent prevalence, and reaches to 56 percent. Among the non-indigenous areas, a prevalence of 35 percent puts the district squarely in the worst, highest prevalence quartile. Thus if national quartile boundaries were used rather than quartiles calculated separately for the indigenous and non-indigenous districts, the indigenous area map would be entirely in the highest quartile, while all the non-indigenous districts would all be in the lower three. 3.3 Malnutrition Prevalence: Numbers of Children Affected The next set of maps show that while prevalence is clearly far worse among the indigenous areas, the actual numbers of children affected by malnutrition are higher in the non-indigenous areas, reflecting the fact that the indigenous population as a whole represents only 11.3 percent of the population of Panama (Bermudez 2006). Given the small percentage of the population that is indigenous, it is striking that fully 39 percent of the 60,522 chronically malnourished children in Panama are living in the indigenous areas of the country. Taken together, these maps show that the indigenous are a relatively small but highly vulnerable population, concentrated in rural areas; among the indigenous districts, those closer to the cities (Panama and Colón) have lower rates of malnutrition than those areas that are further away from these population centers. Map 7 14 Map 8: 15 Figure 1 Range and Number of Malnourished Children In Panama (based on HAZ) by Province Range of prevelance estim ates Num ber of Malnourished Children Indigenous Segments Comarca Ngöbe Bungle 12440 Comarca Embére Comarca Kuna Yala Veraguas Los Santos Herrera Darien Chiriqui Colón Coclé Bocas del Toro Panama Este Panama Oeste District of San Miguelito District of Panama Panama City 100 75 50 25 0 0 Percent of children 2500 5000 7500 Number of children 16 10000 The maps and graph above show once again how different conclusions about targeting would be drawn based on percent prevalence and based on absolute numbers. The five domains that represent the province of Panama show widely varying prevalence rates, but all are relatively low; yet together, these areas account for over 16,000 malnourished children or about 25 percent of the national total of 60,522. The indigenous segments and the indigenous comarca of Ngöbe Buglé show the highest prevalence and also account for the largest number of malnourished children: close to 20,000, or about a third of the total. Based on these results, we can calculate the consequences of targeting interventions based on prevalence alone, or based on numbers of children affected. The ten districts with the highest number of malnourished children account for 27,958 children, or 46 percent of all malnourished children. If the districts with the highest prevalence were targeted (with prevalence calculated nationally, without separating Indigenous from non-Indigenous), 18,030 children or about 30% of the total would be reached. Once again, we do not wish to suggest that areas of high prevalence and small numbers be ignored; rather, we point out the importance of considering both numbers and prevalence in the design of nutrition interventions. 3.4 Relationship of Poverty Prevalence to Malnutrition Prevalence Poverty is closely related to malnutrition, and low purchasing power is a key predictor of malnutrition in virtually all studies. Still, one of the striking results of this analysis is that poverty and malnutrition rates show a great deal of divergence. Poverty is not a perfect predictor of the presence of malnutrition, because there are multiple factors besides poverty that affect children’s nutritional status. Maps 8 and 9 show graphically, for nonindigenous and indigenous areas, the degree of discordance at the district level between quartile of poverty and quartile of malnutrition (by HAZ). For these maps, both malnutrition quartile and poverty quartile were calculated separately for the nonindigenous areas and the indigenous areas. Poverty estimates were produced using SAE by Panama’s Instituto Panamericano de Geografía e Historia (IPGH) 10 at the District level, The maps show districts that are in the same quartile of poverty and hunger; those that differ by only one quartile, and those that differ by two or more (that is, a district in the lowest quartile of poverty but the third or fourth quartile of malnutrition prevalence, for example). The pink colors indicate that malnutrition estimates are higher than poverty; in the blue areas, poverty is higher. The darker colors indicate greater divergence. It is striking how few areas show agreement between the poverty and the malnutrition quartiles of prevalence, and how many diverge by two or more quartiles. This is particularly noteworthy given that both the poverty estimates and the malnutrition estimates are based on the same survey with census data. The discordance between estimates of malnutrition and poverty is unambiguous. For non-indigenous areas, there are 38 districts in which poverty and malnutrition quartiles disagree. Of these, 25 have higher malnutrition, and 13 have higher poverty. For 10 Estimates from Panama’s IPGH poverty mapping project, conducted by the Ministerio de Economía y Finances, were constructed using the same data sources as the Tufts malnutrition mapping study, the 2003 ENV and 2000 Census. 17 indigenous areas, there are 27 districts in which poverty and malnutrition quartiles disagree. Of these, 11 have higher malnutrition, and 16 have higher poverty. There are a total of 7,672 children in districts that are in the lowest quartile of malnutrition, but not of poverty: 113 in indigenous areas and 7,559 in non indigenous areas. If a program were targeted to the two highest quartiles of poverty for both non-indigenous and indigenous areas without considering malnutrition, 20 districts that show the two highest quartiles of malnutrition would be excluded, resulting in 6,007 malnourished children potentially being missed, or 10.2% of total malnourished. These results show the added value that is gained by estimating malnutrition prevalence rather than relying on poverty as a proxy for malnutrition. Map 9: Discordance of Poverty and Malnutrition, Non-Indigenous Areas 18 Map 10: Discordance of Poverty and Malnutrition, Indigenous Areas 4. Discussion Small Area Estimation has enormous potential to guide policy decisions to address malnutrition. Nutrition surveys cannot generally be disaggregated below the level of province, and we have seen that there is wide variation in malnutrition prevalence within provinces. With the information provided by these estimates, much better targeting is possible. A key result of the analysis is the demonstration that areas of high malnutrition prevalence are not always those where the greatest numbers of malnourished children are living. These results suggest establishing targeting mechanisms and priorities based on a dual strategy: one based on locating the large number of malnourished children living in relatively more affluent urban areas, and another based on reaching those areas that have very high prevalence, many of them in more remote and rural locations. Such a dual 19 strategy is critical in Panama because the prevalence rates for malnutrition are exceedingly high among the indigenous population, and this population tends to located disproportionately in rural, relatively remote areas. Although their numbers are small, the very high proportion of children affected by malnutrition means that targeting of indigenous populations should be a high priority. Malnutrition is in many ways a more complex and less predictable phenomenon than poverty, subject to the influence of more unobservable (in a survey setting) factors relating to child and caretaker characteristics and family environment. For this reason, it would build confidence in the application of SAE techniques to estimating malnutrition prevalence if a body of empirical work were produced that confirmed their accuracy with on-the-ground verification. The criterion for accuracy is correct classification: if areas are divided into highest prevalence, high, medium, and low, does the measurement of malnutrition on the ground preserve these same classifications? We hoped to provide even more disaggregated estimates of malnutrition prevalence, but these estimates were generally too imprecise for us to have confidence in these results. It might well be possible to improve precision by modifying the model, eliminating imprecisely estimated parameters and judiciously adding interaction terms, and by eliminating multivariate outliers through robust regression implemented prior to running the data in PovMap. It would be worth making this effort particularly for those districts that comprise large populations: the urban districts of the province of Panama. At the same time, it may well be that for most policy purposes, the first sub-provincial level is sufficient for most purposes given the administrative structure in place in these countries. Once a geographic area is identified as high-risk, on-the-ground assessment will be needed to determine the nature of the intervention to be designed and implemented. The power of the SAE technique is that it allows conclusions to be drawn about conditions on the ground at a level of detail that would be impossible if these conclusions had to be based on primary data collection. Once a model is developed, SAE could presumably be used also to track changes in the local situation, and thus probable changes in the prevalence of malnutrition. Recall, though, that the disaggregated prevalence estimates are based on having census data. Typically, censuses are repeated at best at ten-year intervals, while surveys may be repeated every five or six years. A new survey would make it possible to explore whether the underlying factors associated with malnutrition in the country had changed, so that the direction or strength of the association of a particular condition or characteristic with nutritional status was altered. But it is the census that provides the information about the distribution of those conditions, for example, notable changes in housing quality, sanitation, access to public services or to roads and markets, that would permit re-estimation of malnutrition prevalence. 5. Next steps A number of institutions have committed themselves to promoting the use of SAE for hunger mapping in Latin America, including the World Bank, the World Food 20 Programme, and national governments. Our experience suggests that this is both feasible and potentially valuable as a means of understanding the nature of the nutrition problem in different areas of a country, improving the targeting of resources, and advocating for attention to be given to problems of hunger and malnutrition. If this is to be a regionwide effort, then institutionalizing the capacity to implement the analysis, specifically with respect to nutrition, and to apply it to mapping the results should be a high priority. We have developed a manual for the implementation of PovMap for estimating malnutrition prevalence (Rogers et al., 2007). Plans are under way to develop intensive course modules for the purpose. Key decisions include not only the content and structure of the training, but also the best place within the government or the research and academic communities to institutionalize the capacity for the analysis. A second effort that is already in process is the modification of PovMap to adapt it to the specialized needs of malnutrition estimation: specifically, to adjust for the multiple layers of clustering, and also to allow for negative values of the outcome variable. This will produce estimates that are more statistically defensible, with standard errors that are a more accurate reflection of the precision of the estimate. Whether this improves the results in the sense that it changes the classification of the areas is an empirical question to investigate. Field-testing of the prevalence estimates produced by the SAE technique should be a high priority. Promotion of the use of SAE and hunger mapping is based on the confidence that the estimates produced are valid and accurate. Up to now, there have been few field studies that would verify the SAE approach, and more of these have related to poverty than to malnutrition. We recommend harmonizing data collection efforts within countries. Often, different government agencies are responsible for different data collection efforts, but there is no reason why they could not consider the possibilities for improving the consistency of these efforts. A series of workshops among the various institutions responsible for national surveys, that would bring together the responsible people in a country to consider the possibilities, might start a productive process that, in the longer term, would improve the usefulness of all the data collection efforts. 21 6. References Atlas Universal y de Panamá 2006. Panamá:.Promotora Educativa S.A. Benson, T. 2006. Insights from poverty maps for development and food relief program targeting. International Food Policy Research Institute. Food Consumption and Nutrition Division Discussion Paper 205. Benson, T.; J.Chamberlin; I.Rhinehart, 2005. A Investigation of the Spatial Determinants of the Local Prevalence of Poverty in Rural Malawi. Food Policy 30:5-6 Oct/Dec 2005, 532-50. Bermudez, Odilia 2006. Situación Nutricional, Patrón de Consumo y Acceso a Alimentos: Informe Final de Consultoría. Panama: Min. de Economia y Finanzas, Dirección de Políticas Sociales, April. Demombynes, G.; C.Elbers; J. Lanjouw; P.Lanjouw; J.Mistiaen; B.Ozler, 2002. Producing an Improved Geographic Profile of Poverty: Methodology and Evidence from Three Developing Countries. WIDER Discussion Paper 2002-39. Elbers, C.; J.O.Lanjouw; P.Lanjouw, 2002; Micro Level Estimation of Welfare. Washington DC World Bank Policy Research Paper WPS2911, October. Elbers C., Lanjouw J. and Lanjouw P. 2003. “Micro-level estimation of poverty and inequality”, Econometrica, 71, 355-364. Elbers, C., J.O.Lanjouw, P. Lanjouw, 2004. Imputed Welfare Estimates in Regression Analysis. Washington DC: World Bank Policy Research Paper WPS 3294, April. Engle, P.; P.Menon; L.Haddad, 2001. Care and Nutrition: Concepts and Measurement. Washington DC: International Food Policy Research Institute. Fujii, T. 2003. Micro-Level Estimation of the Prevalence of Stunting and Underweight Among Children in Cambodia. Report to Ministry of Health, Royal Government of Cambodia (preliminary report). UN World Food Programme, March (mimeo). Fujii, T., 2005. Micro-level Estimation of Child Malnutrition Indicators and Its Application in Cambodia. Washington, DC: World Bank, Policy Research Working Paper WPS3662, July. Gabinete Social 2006. Sistema de Protección Social. Resumen de trabajo del Ministerio de Desarrollo Social. Panamá. Gilligan, D.; A. Veiga; M.H.D.Benicio; C.A.Monteiro, 2003. An Evaluation of Geographic Targeting in Bolsa Alimentação in Brazil: Report Submitted to the 22 Government of Brazil. Washington DC: International Food Policy Research Institute, April. Haslett, S., Jones, G. 2005. Small area estimation using surveys and censuses: some practical and statistical issues. Statistics in Transition. 7(3), 541 – 555. Haslett, S.; G.Jones; with D. Parajuli, forthcoming. Small Area Estimation of Poverty, Caloric Intake, and Malnutrition in Nepal. Kathmandu: Government of Nepal, Central Bureau of Statistics. World Food Programme and World Bank. Hentschel, J.; J.O.Lanjouw; P.Lanjouw; J. Poggi, 2000. Combining Census and Survey Data to Trace the Spatial Dimensions of Poverty. World Bank Economic Review 14:1, (January) 147-165. Larrea, C., 2005. Poverty, Food Poverty, and Malnutrition Regression Models for Ecuador. Taken from the EcuaMapAlimentaria website on August, 18, 2006. http://www.ecuamapalimentaria.info/ deOnis, M.; A.W.Onyango; E.Borghi; C.Garze; H.Yang, 2006. Comparison of the World Health Organization (WHO) Child Growth Standards and the National center for Health Statistics/WHO international growth reference: implications for child health programmes. Public Health Nutrition 9:7, 942-947. Rogers, BL.; J.Wirth; P.Wilde; K.Macías, 2007 Introduction to the Estimation of Malnutrition Prevalence by Small Area Estimation using the PovMap Program. Boston, MA: Tufts University Friedman Nutrition School; Report submitted to World Food Programme/LAC, Panama, February 2007. Simler, K. 2006. Nutrition Mapping in Tanzania: An Exploratory Analysis. Washington DC: International Food Policy Research Institute, Food Consumption and Nutrition Division Discussion Paper #204, March. Smith, L.; L.Haddad, 2000. Overcoming Child Malnutrition in Developing Countries: Past Achievements and Future Choices. Washington DC: International Food Policy Research Institute. Agriculture, Food and Environment Discussion Paper #30. UNICEF (United Nations Children’s Fund), 1991. Strategy for improved nutrition for children and women in developing countries. UNICEF Policy Review. New York: UNICEF. United Nations 2001. Road Map Towards the Implementation of the United Nations Millennium Declaration: Report of the Secreary General. A/56/326, 6 September 2001 Valdés, V.E.; R.Castro de Barba 2006. Hacia La Erradicación de la Desnutrición Infantile en Centroamérica y Panamá. Anexo A: Diagnóstico de la Desnutrición Infantil 23 en el País y Los Instrumentos para Combatirla. Panamá, República de Panamá, December. Waterlow, J.C.; R.Buzina; W.Keller; JM Lane; MZ Nichaman; JM Tanner. 1977. The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bulletin of the World Health Organization 55: 489-498 WHO (World Health Organization) WHO Child Growth Standards: Length/Height-forage, Weight-for-age, Weight-for-length, Weight-for-height and Body Mass Index-for age Methods and Development. Geneva: World Health Organization 2006 WHO (World Health Organization) 1995. Physical Status: The Use and Interpretation of Anthropometry. Geneva: WHO. Zhao, Q., 2005. User Manual for PovMap 1.1a. Development Research Group. From the World Bank website, August 12, 2006. http://iresearch.worldbank.org/PovMap/index.htm 24 Appendix Table A1 Data Requirements for the Prediction of Malnutrition Table A2 Variables Used in the Analysis of Malnutrition, Panama 25 Table A1: Data Requirements for the Prediction of Malnutrition Level Variable Individual Age in months Gender Birth Order Food consumption Illness Household Household size Number of children under 5 yrs of age Number of adult females Number of persons per room - crowding Census, Survey Census, Survey Survey; rare in census Rare in survey; never in census Survey, not census Education of child’s mother Education levels of adult household members Economic status, wealth – ownership of key consumption goods Food consumption: Adequacy Diversity Sources – purchase, home production, etc. Quality of housing Household water source Household sanitation: latrine, garbage disposal Electricity, fuel, telephone Income, total, by source, earner Livelihoods: income sources, earners Female/Male household head Ethnicity of members Location: urban/rural Household food insecurity Community/Cluster Economic Inequality Marketing infrastructure: Access to roads Transportation infrastructure Volatility of prices Services: Access to health services Access to/enrollment in school Local livelihoods: Dependence on agriculture Unemployment Remittances Distance in kilometers to urban centers, markets Ethnic diversity Province/Region Possible Source Land type, quality, land uses Climate:Rainfall; Droughts; Floods Topography Elevation, slope 26 Census, survey Census, survey Census, survey Census, survey Survey; usually no link to mother in census Census, survey Census, survey Rarely if ever available in survey; never in census Census, Survey Census, Survey Census, Survey Census, survey Rarely collected in survey or census Limited information Census, Survey Usually available census and survey Census, survey Rarely collected in survey or census Can be computed from hh assets GIS GIS Secondary sources; rarely avail. Government sources Variable data, often not consistent between survey and census GIS Census GIS GIS GIS Table A2: Variables Used in the Analysis of Malnutrition, Panama Level Variable Source Individual Child Nutrition status Age Gender ENV Census/ENV Census/ENV Household Household size Number of children under five yrs of age Number of adult females Number of persons per room - crowding % of employed household members Female/Male household head Marital status of household head Education status of household head Education level of adult household members Per capita household salary Household sanitation: methods of garbage disposal, access to toilet facilities Electricity, cooking fuel, telephone Housing type and building materials Household water source and access Census/ENV Census/ENV Census/ENV Census/ENV Census/ENV Census/ENV Census/ENV Census/ENV Census/ENV Community/Segmento Education level of household heads Sanitation services: water, septic, garbage Household services – electricity, fuel, telephone Ethnicity of household heads Segment is urban or rural Access to all-year roads Distance to urban center Topography Land type Floods since 1998 Population density a The Earth Resources Observation and Science system, part of the US Geological Survey b The Earth Resources Observation and Science system, part of the US Geological Survey c Comisión Centroamericana de Ambiente y Desarrollo, http://www.ccad.ws d Sistema de Inventario de Desastres Region/Corregimiento 27 Census/ENV Census/ENV Census/ENV Census/ENV Census Census Census Census Census CCAD GFK Macon EROS System, USGSb CCADc Desinventard Census/WFP Technical Appendix Tables Table 1. District Level Prevalence Percentage and Number of Children Affected by Chronic Malnutrition 2 Table 2. Variable Names and Descriptions 5 Table 3. Regression Results (Beta Model) 10 Table 4. Census and Survey Variables and Recoding 12 Table 5. Comparison of Survey and Census Descriptive Statistics 27 Technical Appendix 1 Table 1. District Prevalence and Number of Children Affected (HAZ) : Non-Indigenous and Indigenous Segments District Name Bocas del Toro BOCAS DEL TORO CHANGUINOLA CHIRIQUÍ GRANDE Coclé AGUADULCE (CAB) ANTÓN LA PINTADA NATÁ OLÁ PENONOMÉ Colón COLÓN CHAGRES DONOSO PORTOBELO SANTA ISABEL Chiriquí ALANJE BARÚ BOQUERÓN BOQUETE BUGABA DAVID DOLEGA GUALACA REMEDIOS RENACIMIENTO SAN FÉLIX SAN LORENZO TOLÉ Darién CHEPIGANA PINOGANA Herrera CHITRÉ LAS MINAS LOS POZOS OCÚ PARITA PESÉ SANTA MARÍA Los Santos GUARARÉ Technical Appendix ID Prevalence Standard Total Error Children NON-INDIGENOUS SEGMENTS WITHIN DISTRICTS 101 102 103 23.38 14.53 24.57 7.45 3.30 6.38 346 2966 436 81 431 107 201 202 203 204 205 206 14.42 28.22 24.61 20.37 30.58 28.54 3.12 5.01 5.55 4.23 6.42 5.05 3005 4363 2464 1590 562 7359 433 1231 606 324 172 2100 301 302 303 304 305 13.67 34.24 25.98 20.62 20.12 3.33 6.16 6.94 6.09 4.54 16258 1118 1345 793 310 2222 383 349 164 62 401 402 403 404 405 406 407 408 409 410 411 412 413 22.92 20.37 17.42 24.21 21.22 12.72 13.29 22.16 22.42 39.77 17.15 19.59 32.10 5.41 3.90 4.16 7.20 3.86 3.07 3.54 4.19 5.47 8.02 4.83 4.51 5.67 1230 5297 1018 898 5424 8929 1376 757 285 1633 337 432 802 282 1079 177 217 1151 1136 183 168 64 649 58 85 257 501 502 19.93 21.23 4.74 6.22 2116 1061 422 225 601 602 603 604 605 606 607 12.83 32.16 21.85 18.16 16.49 14.88 16.57 3.25 6.53 4.99 3.86 4.36 3.65 4.16 2948 795 642 1308 611 935 556 378 256 140 238 101 139 92 701 15.76 4.40 576 91 2 Malnourished Children Table 1. District Prevalence and Number of Children Affected (HAZ) : Non-Indigenous and Indigenous Segments District Name LAS TABLAS LOS SANTOS MACARACAS PEDASÍ POCRÍ TONOSÍ Panamá ARRAIJÁN BALBOA CAPIRA CHAME CHEPO CHIMÁN LA CHORRERA PANAMÁ (CIUDAD) PANAMA (Resto del Distrito) SAN CARLOS SAN MIGUELITO TABOGA Veraguas ATALAYA CALOBRE CAÑAZAS LA MESA LAS PALMAS MONTIJO RÍO DE JESÚS SAN FRANCISCO SANTA FÉ SANTIAGO SONÁ District Name Bocas del Toro BOCAS DEL TORO CHANGUINOLA CHIRIQUÍ GRANDE Colón COLÓN DONOSO SANTA ISABEL Chiriquí ALANJE BARÚ Technical Appendix ID Prevalence Standard Error Total Children Malnourished Children 702 703 704 705 706 707 15.16 14.25 21.60 24.31 19.03 23.93 3.24 3.77 5.11 6.17 4.80 4.92 1404 1497 687 230 180 802 213 213 148 56 34 192 801 802 803 804 805 806 807 808 12.93 17.63 30.26 18.88 22.69 21.84 18.81 13.00 3.26 5.71 5.63 4.79 4.24 5.07 3.06 2.49 13148 228 3460 1654 2884 343 10623 25033 1700 40 1047 312 654 75 1998 3254 808 809 810 811 18.18 26.37 11.06 21.14 4.14 5.46 2.35 8.39 26924 1438 22370 76 4895 379 2474 16 901 902 903 904 905 906 907 908 909 910 911 ID 14.24 3.87 649 92 15.96 5.04 1186 189 19.71 6.61 1596 315 24.86 6.72 1089 271 30.65 5.64 1723 528 15.70 4.78 1120 176 19.10 5.93 401 77 23.31 7.31 949 221 17.14 5.15 1248 214 10.56 2.97 5434 574 19.21 4.87 2469 474 INDIGENOUS SEGEMENTS WITHIN DISTRICTS Prevalence Standard Total Malnourished Error Children Children 101 102 103 75.84 57.54 74.33 20.87 5.90 6.45 869 5673 594 659 3264 442 301 303 305 50.90 53.85 58.50 9.42 11.37 13.11 145 20 22 74 11 13 401 402 64.20 62.07 8.88 7.94 124 491 80 305 3 Table 1. District Prevalence and Number of Children Affected (HAZ) : Non-Indigenous and Indigenous Segments District Name BOQUERÓN BOQUETE BUGABA DAVID DOLEGA GUALACA REMEDIOS RENACIMIENTO SAN FÉLIX SAN LORENZO TOLÉ Darién CHEPIGANA PINOGANA Panamá ARRAIJÁN CHEPO CHIMÁN LA CHORRERA PANAMÁ SAN CARLOS SAN MIGUELITO Veraguas CAÑAZAS LAS PALMAS SANTA FÉ SANTIAGO Comarca Kuna Yala COMARCA KUNA YALA Comarca Emberá CÉMACO SAMBÚ Comarca Ngöbe Buglé BESIKO MIRONÓ MÜNA NOLE DUIMA ÑÜRÜM KANKINTÚ KUSAPÍN Technical Appendix ID Prevalence Standard Error Total Children Malnourished Children 403 404 405 406 407 408 409 410 411 412 413 57.57 73.29 86.20 56.41 72.25 76.25 73.22 92.48 76.40 69.09 77.29 12.03 19.54 7.24 9.94 17.55 21.13 9.43 6.50 7.86 7.63 4.80 28 7 51 109 8 4 52 22 57 94 418 16 5 44 61 6 3 38 20 44 65 323 501 502 52.01 60.72 7.48 8.18 1130 502 588 305 801 805 806 807 808 809 810 55.84 73.81 47.21 38.50 61.24 77.00 70.61 7.19 7.03 7.77 26.24 7.13 25.82 9.15 785 673 229 6 576 3 95 438 497 108 2 353 2 67 903 905 909 910 35.21 65.58 57.15 47.75 9.72 6.53 8.87 16.36 169 201 316 12 60 132 181 6 1001 59.35 9.89 3688 2189 1101 1102 54.12 45.45 8.97 10.10 881 261 477 119 1201 1202 1203 1204 1205 1206 1207 72.59 82.94 82.84 86.87 74.14 64.48 61.35 5.78 4.40 4.18 4.05 4.95 6.56 7.08 2516 1516 4335 1420 1576 3055 2272 1826 1257 3591 1234 1168 1970 1394 4 Table 2: Variable Names and Descriptions Variable Name Description Individual-Level Variables haz Height for age Z-score waz Weight for age Z-score whz Weight for Heigth Z-score hombre Child sex (Male = 1, Female=0) age1223 Child aged 12 -23 months (Yes = 1, No = 0) age2435 Child aged 24 - 35 months (Yes = 1, No = 0) age3659 Child aged 36 - 69 months (Yes = 1, No = 0) Household-Level Variables fheadhh Head of household is female (Yes =1, No =0) Number of kids aged 0 to 59 months in the num_kids059 household Number of adult females aged 15 to 64 years in the household num_adfem num_tot Number of total members in the household Ratio of members in the vivienda to rooms in crowding the vivienda Ratio of employed members of household to total members depratio Head of household is either 'casado' or 'unido' mari_uni (Yes = 1, No = 0) Head of household is separated from 'marriage'/'union' or 'divorced (Yes = 1, No = mari_sep 0) Head of household is 'widow(er)' (Yes = 1, No = 0) mari_viudo Head of household is 'single' (Yes = 1, No = mari_soltero 0) Head of household has no formal education or ed_nonenr No Response(Yes = 1, No = 0) Head of household has completed preschool or hase some primary education (Yes = 1, No ed_presp = 0) Head of household has completed primary ed_prime school education (Yes = 1, No = 0) Head of household has some secondary ed_ssec school education (Yes = 1, No = 0) Head of household has completed secondary school education (Yes = 1, No = 0) ed_csec Head of household has completed vocational ed_cvoc education (Yes = 1, No = 0) Head of household has more advanced ed_suped (university +) education (Yes = 1, No = 0) Highest level of education of adult female (15 hifemed - 64) within the household Highest level of education of adult female (15 hifemedsq - 64) within the household squared (quadratic) Highest level of education of adult male (15 himaled 64) within the household Technical Appendix 5 Type a Source C C C D D D D ENV ENV ENV Census/ENV Census/ENV Census/ENV Census/ENV D Census/ENV C Census/ENV C C Census/ENV Census/ENV C Census/ENV C Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV C Census/ENV C Census/ENV C Census/ENV Base Case b * * * Table 2: Variable Names and Descriptions Variable Name Description Highest level of education of adult male (15 64) within the household squared (quadratic) Number of children (6-11yrs) in the household priminhh attending primary school Number of children (6-11yrs) in the household not attending primary school primouthh Number of children (12-17yrs) in the secinhh household attending secondary school Number of children (12-17yrs) in the secouthh household not attending secondary school sal_percap Per capita total salary of the household salfem_percap Per capita salary of females of the household Household connected to Community Septic System (1=Yes, 0=Other Sanitation types) san_alcan Household has Septic Tank (1=Yes, 0=Other san_tanq Sanitation types) Household has Latrine or hole in ground san_hueco (1=Yes, 0=Other Sanitation types) Household has no Sanitation Service (1=Yes, 0=Other Sanitation types) san_notien Household members have exclusive use of Sanitation (1=Yes, 0=Other Sanitation User types) usosolo Household members have Shared and No Response of Sanitation (1=Yes, 0=Exclusive usocompnr use of sanitation) Cooking Fuel of Gas/Electricity (1=Household use Gas/Electricity, 0=Other Cooking Fuel types) com_gaselec Cooking Fuel of Wood/Charcoal (1=Household use Wood/Charcoal, 0=Other com_lencar Cooking Fuel types) Cooking Fuel when HH does not cook com_nc (1=Does not cook, 0=Other Cooking Fuels) Dummy if household has a phone or cellular telecell phone (1=Yes, 0=No) Vivienda-Level Variables Vivienda type of Individual homes (1=Casa viv_casa Individual, 0=Other Vivienda types) Vivienda type of Improvised Housing viv_improv (1=Improvisada, 0=Other Vivienda types) Vivienda type for Apartments (1=Apartamento, 0=Other Vivienda types) viv_apartam Vivienda type for Room in a Dwelling (1=Cuarto en Casa de vecinidad, 0=Other viv_cuarto Vivienda types) Roof type of Concrete and Tile (1=tile or t_contej concrete, 0=Other roof types) himaledsq Technical Appendix 6 Type a Source C Census/ENV C Census/ENV C Census/ENV C Census/ENV C C C Census/ENV Census/ENV Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV Base Case b * * * D D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV * Table 2: Variable Names and Descriptions Variable Name Description t_fibmema t_pajpen p_bloq p_madera p_quinad p_metal p_cana p_sinotr pisoconc pisomade pisotier piso_otronr acuedpoz aguapozrio aguadent aguafuer elecmuncom elecplant elecotronr basserv bastira basentq basotronr Technical Appendix Roof type of Fiber, Metal, or Wood (1=fiber (tejalit, panalit) or metal or wood, 0=Other roof types) Roof type of Straw (1=straw (paja or penca), 0=Other roof types) Walls made of Brick (1=Yes, 0=Other Wall types) Walls made of Wood (1=Yes, 0=Other Wall types) Walls made of Adobe (1=Yes, 0=Other Wall types) Walls made of Metal (1=Yes, 0=Other Wall types) Walls made of Straw, i.e. Caña, Paja, Penca (1=Yes , 0=Other Wall types) Walls made of Other (1=Without Wall, Other, No Response, 0=Other Wall types) Floor made of Concrete, i.e. Tile, Brick, Stone (1=Yes, 0=Other Floor types) Floor made of Wood (1=Yes, 0=Other Floor types) Floor made of Dirt (1=Yes, 0=Other Floor types) Floor made of Other (1=Other materials and no response, 0=Other Floor types) Vivienda receives water from community water system (1=Yes, 0=Other Water types) Vivienda receives water from river or well (1=Yes, 0=Other Water types) Vivienda has water inside the dwelling (1=Yes, 0=Other Water Location types) Vivienda has water outside of Dwelling (1=Yes, 0=Other Water Location types) Vivienda connected to community/public electricity grid (1=Yes, 0=Other Electricity types) Vivienda produces own electricity with generator (1=Yes, 0=Other Electricity types) Vivienda recieves electricity from other method/no response (1=Yes, 0=Other Electricity types) Garbage removed by collection service (1=Yes, 0=Other Garbage Elimination) Garbage thrown in nearby lots or under patio (1=Yes, 0=Other Garbage Elimination) Garbage thrown into river/stream (1=Yes, 0=Other Garbage Elimination) Garbage burned/Burried (1=Yes, 0=Other Garbage Elimination) 7 Type a Source D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV D Census/ENV Base Case b * * * * * * * Table 2: Variable Names and Descriptions Variable Name Description Segmento-Level Variables Percent of households in upm/segmento seg_ed_prime whose heads have completed primary school Percent of households in upm/segmento whose heads have completed secondary seg_ed_csec school Percent of households in upm/segmento whose heads have completed vocational seg_ed_cvoc school Percent of households in upm/segmento whose heads have completed superior seg_ed_suped education Percent of households in upm/segmento that have community water source seg_acuedpoz Percent of households in upm/segmento that seg_aguadent have access to water inside their dwelling Percent of households in upm/segmento that seg_basserv have garbage collection service Percent of households in upm/segmento that seg_elecmuncom have electricity from the community Percent of households in upm/segmento that have sanitation linked to community septic seg_san_alcan system Percent of households in upm/segmento that seg_usosolo exclusively use their toilet facilities Percent of households in upm/segmento seg_com_gaselec whose cooking fuel is either gas or electricity Percent of households in upm/segmento that have a telephone seg_telefono Percent of households in upm/segmento that seg_cell have a cellular telephone Percent of households in upm/segmento that seg_indig have an indigenous household head urban Type of segment (urban=1, rural=0) Corregimiento-Level Variables Population density (population/area in km2) of corregimiento corr_popdens Distance (m) from border of Corregimiento to db_20t100k nearest city w/ pop 20-100k Distance (m) from border of Corregimiento to db_100pk nearest city w/ pop 100+k elevmean Mean elevation (meters) of Corregimiento elevrang Elevation range (meters) in Corregimiento % of Corregimiento that is Bosques siempreverdes y semisiempreverdes de latifoliadas per_bsvd % of Corregimiento that is Sistemas per_agpec agropecuarios % of Corregimiento that is Bosques per_bsdl semideciduos de latifoliadas Technical Appendix 8 Type a Source C Census C Census C Census C Census C Census C Census C Census C Census C Census C Census C Census C Census C Census C D Census Census/ENV C WFP C GFK MACON C C C GFK MACON EROS EROS C CCAD C CCAD C CCAD Base Case b * Table 2: Variable Names and Descriptions Variable Name Description Type a Source per_agua C CCAD C CCAD C CCAD C CCAD C Desinventar C Census/ENV C C ENV Census per_mang per_oth per_road num_flood Model Variables dcorregc sweight cweight % of Corregimiento that is Cuerpos de agua % of Corregimiento that is Bosques manglares % of Corregimiento that is Pantanos y humedales, Areas con escasa vegetacion, Sistemas productivos acuaticos (camaroneras, salineras), Sabanas, Bosques deciduos de latifoliadas, Paramos, Urbano % of Corregimiento within 5 km of an all year road # of floods (inundaciones or Marejedas) since 1998 per District Unique ID 9 digits long - Dominio (2), Province (2), District (2), Corregimiento (2), Indigenous Segs (1) Survey weight, equal to the ENV expansion factor variable divided by 100 (factor/100) Census weight, a constant equal to one a Base Case refers to the variable that is omitted from the model to avoid overspecification (i.e. the "dummy variable trap") b D=Dichotomous (Dummy) Variable, C=Continuous Variable Technical Appendix 9 Base Case b Table 3. Regression results Dependent Variable = Height for Age Z-score Std. Variable Names Coefficient Err. _intercept_ 9.562 0.431 AGE1223 -0.048 0.071 AGE2435 0.036 0.071 AGUAFUER -0.080 0.165 AGUAPOZRIO -0.122 0.186 BASENTQ 0.117 0.109 BASOTRONR 0.020 0.227 BASTIRA 0.235 0.151 COM_LENCAR 0.146 0.138 COM_NC 1.352 0.619 CORR_POPDENS 0.016 0.007 CROWDING -0.012 0.018 DB_100PK 0.000 0.000 DB_20T100K 0.000 0.000 DEPRATIO -0.224 0.222 ED_CSEC -0.311 0.452 ED_CVOC 0.107 0.382 ED_PRESP 0.129 0.217 ED_PRIME 0.138 0.241 ED_SSEC -0.215 0.304 ED_SUPED -0.920 1.025 ELECOTRONR -0.175 0.165 ELECPLANT -0.141 0.123 ELEVMEAN 0.000 0.000 ELEVRANG 0.000 0.000 FHEADHH 0.163 0.103 HIFEMED -0.187 0.217 HIFEMEDSQ 0.042 0.037 HIMALED -0.015 0.063 HIMALEDSQ 0.001 0.009 HOMBRE -0.120 0.058 MARI_SEP -0.032 0.121 MARI_SOLTERO -0.020 0.181 MARI_VIUDO 0.052 0.165 NUM_ADFEM 0.029 0.051 NUM_FLOOD -0.005 0.002 NUM_KIDS059 -0.128 0.050 NUM_TOT 0.007 0.026 PER_AGPEC 0.000 0.001 PER_AGUA -0.012 0.014 PER_BSDL 0.001 0.003 PER_MANG 0.005 0.005 PER_OTH 0.001 0.002 PER_ROAD -0.002 0.002 PISOMADE 0.029 0.163 Technical Appendix 10 t 22.172 -0.670 0.507 -0.484 -0.657 1.068 0.086 1.556 1.057 2.185 2.305 -0.678 -0.586 -0.022 -1.008 -0.688 0.281 0.596 0.571 -0.709 -0.898 -1.061 -1.141 -0.689 1.431 1.582 -0.862 1.132 -0.247 0.072 -2.058 -0.267 -0.111 0.316 0.571 -1.989 -2.563 0.271 0.254 -0.905 0.499 1.064 0.692 -1.131 0.180 |Prob|>t 0.000 0.503 0.612 0.628 0.511 0.286 0.931 0.120 0.290 0.029 0.021 0.498 0.558 0.982 0.313 0.492 0.779 0.551 0.568 0.479 0.370 0.289 0.254 0.491 0.152 0.114 0.389 0.258 0.805 0.943 0.040 0.789 0.911 0.752 0.568 0.047 0.010 0.786 0.800 0.366 0.618 0.287 0.489 0.258 0.857 Table 3. Regression results Dependent Variable = Height for Age Z-score Std. Variable Names Coefficient Err. PISOTIER -0.261 0.132 PISO_OTRONR -0.003 0.275 PRIMINHH -0.061 0.043 PRIMOUTHH -0.120 0.095 P_CANA -0.200 0.191 P_MADERA -0.222 0.122 P_METAL -0.182 0.194 P_QUINAD -0.172 0.194 P_SINOTR -0.517 0.285 SALFEM_PERCAP 0.000 0.001 SAL_PERCAP 0.001 0.000 SAN_ALCAN -0.062 0.146 SAN_NOTIEN 0.093 0.142 SAN_TANQ 0.186 0.095 SECINHH -0.145 0.054 SECOUTHH -0.164 0.072 SEG_ACUEDPOZ 0.000 0.002 SEG_AGUADENT 0.000 0.002 SEG_BASSERV -0.003 0.002 SEG_CELL -0.005 0.003 SEG_COM_GASELEC 0.005 0.002 SEG_ED_CSEC 0.002 0.003 SEG_ED_CVOC 0.005 0.008 SEG_ED_PRIME -0.007 0.002 SEG_ED_SUPED 0.000 0.004 SEG_ELECMUNCOM 0.000 0.002 SEG_INDIG -0.008 0.002 SEG_SAN_ALCAN 0.000 0.002 SEG_TELEFONO 0.003 0.002 SEG_USOSOLO 0.002 0.002 TELECELL 0.113 0.076 T_CONTEJ 0.042 0.145 T_PAJPEN 0.145 0.159 URBAN 0.045 0.106 USOCOMPNR -0.160 0.096 VIV_APARTAM -0.028 0.158 VIV_CUARTO -0.018 0.174 VIV_IMPROV -0.568 0.327 N K R-Square Adjusted R-Square Technical Appendix 1955 82 0.294 0.263 11 t -1.969 -0.009 -1.417 -1.263 -1.047 -1.817 -0.935 -0.885 -1.812 -0.501 1.372 -0.423 0.657 1.966 -2.682 -2.288 0.272 0.093 -1.871 -1.698 1.954 0.466 0.617 -3.062 0.124 0.066 -4.869 -0.121 1.461 0.993 1.478 0.292 0.909 0.428 -1.666 -0.176 -0.103 -1.738 |Prob|>t 0.049 0.993 0.157 0.207 0.295 0.069 0.350 0.376 0.070 0.616 0.170 0.673 0.512 0.049 0.007 0.022 0.785 0.926 0.061 0.090 0.051 0.641 0.538 0.002 0.902 0.947 0.000 0.904 0.144 0.321 0.140 0.770 0.363 0.669 0.096 0.861 0.918 0.082 Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics Individual Sex Age Parentesco P02_SEXO 1. Hombre 2. Mujer P03_EDAD Age in years P003 1. Hombre 2. Mujer agemo Age in months P01_JEFE p002 1. Jefe 2. Conyuge del Jefe 3. Hijo/a 4. Nuera o Yerno 5. Nieto o Bisnieto 6. Padre o Madre del Jefe 7. Suegro/a 8. Otro Pariente 9. No Pariente Technical Appendix 1. Jefe (a) 2. Esposa(o) o companera(o) 3. Hijo/a 4. Yerno/Nuera 5. Nieto/a 6. P/Madre 7. Suegro/a 8. Hermano/a 9. Cunado/a 10. Otro Pariente 11. Empleado/a Domestico/a 12. Pensionista/Huesped 13. Otro no pariente 12 hombre (c) (s) Hombre age1223 – 1 year old age2435 – 2 years old age3659 – 3 -5 years old jefe (c) (s) jefe Esposa (c) Conyuge del Jefe (s) Esposo(a) o Companero(a) hijo (c) (s) hijo(a) bloodrel (c) Nuera o Yerno, Nieto o Bisnieto, Suegro/a, Padre o Madre, Otro Pariente (s) Yerno/Nuera, Nieto/a, P/Madre, Suegro/a, Hermano/a, Cunado/a, Otro Pariente nobldrel (c) No Pariente Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics (s) Empleado/a Domestico/a, Pensionista/huseped, Otro, no pariente Household Female Headed Household Total persons in household Number of Adult Females (age15-64) in household Number of Children (aged 059 months) in household Crowding Female Headed Household if: 1) Self report as head and female 2) No male head is present, oldest female spouse is household head 3) No head or spouse of head is identified, head is oldest member 15-64 (HH is female headed if this person is female) 4) If no head or spouse or member 15-64, oldest member is head (HH is female headed if this person is female) fheadhh H22_TPER Integer 1 – 37 Calculated using age (P03_EDAD) and sex (P02_SEXO) Calculated using age (P03_EDAD) H22_TPER/V05_NCUA Total members/ rooms miembros Integer 1 – 23 Calculated using age (edadmo) and sex (P003) num_tot Calculated using age (edadmo) num_kids059 miembros/cuartos Total members/ rooms crowding The ENV data had housing units Technical Appendix 13 num_adfem Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics Dependency Ratio (# of non-working household members/total members) Marital Status of Household Head Calculated using P14_TRAB and H22_TPER with no rooms, which would make the cuartos variable have a value of zero. In order to avoid dividing by zero, we changed these zero values to one room because an analysis of all these cases showed that they were “choza/rancho” with no walls. Calculated using P701 and miembros P04_ESTC p301 1. Unido/a 2. Separado/a de matrimonio 3. Separado/a de union 4. Casado/a 5. Divorciado/a 6. Viudo/a 7. Soltero/a 8. Menor de 15 anos Technical Appendix 1. Unido(a) 2. Casado(a) 3. Separado(a) de matrimonio 4. Separado(a) de unión 5. Divorciado(a) 6. Viudo(a) 7. Soltero(a) 9. NR 14 depratio mari_uni (c) (s) Unido, Casado mari_sep (c) (s) Separado de matrimonio, Separado de union, Divorciado mari_viudo (c) (s) Viudo(a) mari_soltero (c) (s) Soltero(a) mari_nr (c) Menor de 15 anos (s) NR Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics Education of Household Head* p546a – NivelAprobado P11_EDUC 0. NA 1. preescolar 3. ensenanza especial 11-15. primaria 1-5 16. primaria completa 19. primaria ND 21 – 23. vocacional 1-3 29. vocacional ND 31 – 34. secundaria 1-4 35. secundaria 35? 36. secundaria completa 39. secundaria ND 41 – 43. superior no universitaria 1-3 49. superior no universitaria ND 51 – 56. universitaria 1-6+ 59. universitaria ND 61. postgrado 69. postgrado ND 71-72. maestria 1-2 79. mestria ND 81- 84. doctarado 1-4 Technical Appendix 0. Ninguno 1. Preescolar 2. Primaria 3. 1er. Ciclo 4. 2do. Ciclo 5. Vocacional o Profesional y Técnica 6.Universitaria 7. No Universitaria 8. Postgrado / Maestría / Doctorado 99. NR p548 – Certificado 1 Certificado de Primaria 2 Certificado de Vocacional o Profesional y Técnico 3 Certificado de 1er. Ciclo 4 Diploma de 2do. Ciclo 5 Diploma de Educación Superior No Universitaria 6 Técnico 15 ed_nonenr (c) NA, ND (s) Ninguno ed_presp (c) Prescolar, Ensenaza especial (s) Prescolar, Primaria (no certificado) ed_prime (c) Primaria completa (s) Primaria (certificado) ed_ssec (c) Values 31- 35, 39 (s) 1er. Ciclo, 2do. Ciclo (no certificado) ed_csec (c) Secundaria Completa (s) 2do. Ciclo (certificado) ed_cvoc (c) Vocacional – Value 23. (s) Vocacional o Profensional y Técnica (certificado) ed_suped (c) Values 41 - 89 (s) Universitaria, No Universitaria, Postgrado/Maestría/Doctorado Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics 89. doctorado ND 99. ND 7 Licenciatura 8 Postgrado, Maestría, doctorado 9 Otro 99 NR To make the variables in the last column, for each level of schooling (preschool, primary, secondary, vocational, and superior), we assigned a person to have completed that level of schooling if they responded as having completed that level. Otherwise, all other responses were considered as having “some” level of that education. For example, a person had “some primary education”, if s/he was coded as P11_EDUC=11-15, 19. For vocational, having reached the final year of vocational schooling (P11_EDUC=23) was considered completed Technical Appendix 16 To make variables in the last column, we combined information from the ENV variables listed above. A person was considered to have completed a level of education if s/he had a certificate from that level. However, if they replied as having attended a certain level of schooling (p546) but did not have a certificate, s/he has some level of that schooling. For example, a person had some primary education if s/he responded to having attended primary school (p546a=2) but did not obtain a certificate (p547=2). All values of superior education and Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics vocational education. Highest Education for Any Female 15 - 64 in Household Calculated using ed_*variables, P02_SEXO, and P03_EDAD Highest Education for Any Female 15 - 64 in Household Squared Highest Education for Any Male 15 - 64 in Household Calculated quadratic term of hifemed Technical Appendix beyond were collapsed into one category – superior education. Calculated using ed_* variables, hifemed 0 – no female 15 -64 present P003 and agemo 1 – no education/ No Response 2 – pre-school 3 – some primary 4 – primary 5 – some secondary 6 – secondary 7 – some vocational 8 – superior and beyond Calculated quadratic term of hifemedsq hifemed Calculated using ed_*variables, P02_SEXO, and P03_EDAD Calculated using ed_* variables, himaled P003 and agemo 0 – no Male 15 -64 present 1 – no education/ No Response 2 – pre-school 3 – some primary 4 – primary 5 – some secondary 6 – secondary 7 – some vocational 8 – superior and beyond 17 Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics Highest Education for Any Male 15 - 64 in Household Squared Enrollment Per Capita Salary Per Capita Female Salary Dwelling Dwelling (vivienda) Type Technical Appendix Calculate quadratic term by squaring himaled Calculate quadratic term by squaring himaled himaledsq Calculated using P10_ESCU and P03_EDAD Calculated using P520 and P004 priminhh - # of Primary Age Children in School For each household, we totaled the number of primary school aged children (5-11 years old) attending or not attending school. If a household had no children of in that age range, the values for priminhh and primouthh would both be zero. The same procedure was followed for secondary school aged children (12-17 years old). Calculated using P23A_SUEL and H22_TPER Calculated using P23A_SUEL, H22_TPER and P02_SEXO Calculated using p729 and miembros Calculated using p729, miembros and P003 sal_percap V01_TIPO v01 – TipoViv viv_casa (c) Ind. Permanente, Ind. 18 primouthh - # of Primary Age Children Not in School secinhh - # of Secondary Age Children in School secouthh - # of Secondary Age Children Not in School salfem_percap Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics 1. Ind. Permanente 2. Ind. Semipermanente 3. Improvisada 4. Apartamiento 5. Cuarto en casa vecindad 6. Local no destinado 7. Damnificado 8. Indigente 9. Hogar particular colectivo 10. Asilos 11. Barcos 12. Carceles cuarteles colonia penal 13. Conventos y otras viviendas 14. Galeras casa barracas 15. Hospitales clinicas sanatorios 16. Hoteles pensiones y casa de hosped 17. Internados 18. Reformatorios 19. Otras 20. Retenes 21. Empadronamiento previo Technical Appendix 19 1. Casa Individual 2. Choza o Rancho 3. Apartamento 4. Cuarto en Casa de Vecindad 5. Improvisada 6. Otro 9. NR Semipermanente (s) Casa Individual viv_improv (c) (s) Improvisada viv_apartam (c) (s) Apartamento viv_cuarto (c) (s) Cuarto en Casa de Vecindad viv_otronr (c) Values 6 – 23 (s) Values 6 and 9 Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics Material del Techo 22. Y mas con datos de viv 23. Y mas sin datos de viv V07_TECHO v03 Material de las Paredes 0. No aplica 1. Concreto (cemento) 2. Teja 3. Tejalit panalit techolit 4. Metal (zinc aluminio etc.) 5. Madera protegida 6. Paja o penca 7. Otros materials V06_PARE 1. Concreto / cemento 2. Teja 3. Fibra-cemento 4. Metal 5. Madera 6. Paja o penca 7. Otros materiales 9. NR v02 0. No Aplica 1. Bloque ladrillo pedra concreto 2. Madera (tablas troza) 3. Quincha adobe 4. Metal (zinc, aluminio etc.) 5. Paja, penca, cana, palos 6. Otros materials 7. Sin paredes Technical Appendix 1. Bloque, ladrillo, etc. 2. Madera 3. Quincha / adobe 4. Metal 5. Caña, paja, penca, palos 6. Sin paredes 7. Otros materiales 9. NR 20 t_contej (c) (s) Concreto, Cemento, Teja t_fibmema (c) Tejalit, Panalit, Techolit, Metal, Madera (s) Fibra-Cemento, Metal, Madera t_pajpen (c) (s) Paja o Penca t_otronr (c) (s) Otros Materiales, NR, NA p_bloq (c) Bloque, Ladrillo, Pedra, Concreto (s) Bloque, Ladrillo, etc. p_madera (c) (s) Madera (tables troza) p_quinad (c) (s) Quincha, Adobe p_metal (c) (s) Metal (zinc, aluminio etc.) p_cana (c) (s) Caña, Paja, Penca, Palos p_sinotr Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics Material del Piso v04 – Piso V08_PISO 0. No Aplica 1. Pavimentado 2. Madera 3. Tierra 4. Otro Tenancy 1. Concreto / cemento 2. Mosaico, ladrillo, granito, mármol 3. Madera 4. Tierra / arena 5. Otros materiales 9. NR V04_TENE v05 1. Propia totalmente pagada 2. Propia hipotecada 3. Alquilada 4. Cedida o prestada 5. Ocupantes de hecho 9. NR 0. No Aplica 1. hiptecada 2. alquilada 3. propia 4. cedida 5. condenada 6. otra 7. no declarada Technical Appendix 21 (c) (s) Otros Materiales, Sin Paredes, NR, NA pisoconc (c) Pavimentado (s) Concreto/cemento, mosaico, ladrillo, granito, marmol pisomade (c) (s) Madera pisotier (c) Tierra (s) Tierra / Arena piso_otronr (c) No Aplica, Otro (s) Otros Materiales, NR ten_prop (c) (s) (Propia) totalmenta pagada ten_hipo (c) (s) (Propia) hipotecada ten_alqu (c) (s) Alquilada ten_ced (c) Cedida (s) Cedida o prestada ten_otro (c) Condenada, Otro Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics Water Source Location of Water Technical Appendix (s) Ocupantes de hecho ten_nr (c) No Aplica, No Declarado (s) NR v19 – AguaBeber V09_AGUA acuedpoz (c) (s) Acueducto Publico, 0. No aplica 1. Acueducto público Acueducto de la Comunidad, 1. acueducto publico del idaan 2. Acueducto de la comunidad Acueducto Particular, Pozo 2. acueducto publico de la 3. Acueducto particular Sanitario comunidad 4. Pozo sanitario aguapozrio 3. acueducto particular 5. Pozo brocal no protegido (c) Brocal no protegido, agua 4. pozo sanitario 6. Río, vertiente, quebrada, lluvia, pozo superficial, rio o 5. brocal no protegido lluvia quebrada, carro cisterna 6. agua lluvia 7. Otro (s) Pozo brocal no protegido, Rio, 7. pozo superficial 9. NR vertiente, quebrada, lluvia, otro 8. rio o quebrada agua_nr 9. carro cisterna (c) No Aplica 10. otro (s) NR V10_AGIN v22 aguadent (c) Dentro 0. no aplica 1. Dentro de la vivienda (s) Dento de la vivienda, En el 1. Dentro 2. En el patio de la vivienda patio de la vivienda, Dentro de 2. fuera 3. Dentro de la vivienda y el la vivienda y el patio patio aguafuer 4. Fuera de la vivienda y del (c) Fuera 22 Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics patio 9. NR Eliminacion de la Basura V14_BASU v33 0. no aplica 1. carro recolector publico 2. carro recolector privado 3. terreno baldio 4. rio quebrada o mar 5. incineracion o quema 6. entierro 7. otra forma Electricity 1. Servicio de vehículos o carro del Municipio 2. Servicio de vehículos particulares 3. La botan a otros lotes 4. La botan o tiran dentro del patio 5. La botan o tiran al río, quebrada o mar 6. La queman 7. La entierran 8. Otro 9. NR V12_LUZ v35 0. no aplica 1. electrico publico Technical Appendix 1. Eléctrico Público 2. Eléctrico de la Comunidad 23 (s) Fuera de la vivienda y del patio Agulocnr (c) No Aplica (s) NR basserv (c) Carro recolector publico/privado (s) Servicio de vehiculos o carro del Municipio, Servicio de vehiculos particulares bastira (c) Rio quebrada o mar (s) La botan a otros lotes o tiran dentro del patio, la botan o tiran al rio, quebrada, o mar basentq (c) Incineracion or quema, entierro (s) La queman, La entierran basotronr – otro, NR (c) Otra forma (s) Otro, NR elecmuncom (c) Electrico Publico, Electrico de la comunidad (s) Electrico Publico, Electrico de Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics 2. electrico de la comunidad 3. electrico propio (planta) 4. querosin/diesel 5. gas 6. otro Servicio Sanitorio 3. Electricidad del Municipio 4. Electricidad Propia 5. Electricidad de particulares 6. Querosín o diesel, gas 7. Otro 9. NR H16_SANI v29 0. no aplica 1. de hueco o letrina 2. conectado a alcantarillado 3. conectado a tanque septico 4. no tiene Uso del Sanitorio 1. conectado a alcantarillado sanitorio 2. conectado a tanque septico 3. de hueco o letrina 4. no tiene 9. NR H17_SUSO v32 0. no aplica Technical Appendix 1. Sólo del hogar 24 la comunidad, Electricidad del municipio, elecplant (c) Electricidad Propia (planta), querosin/diesel (s) Electricidad Propia, Electricidad de particulares, Querosin o diesel, gas elecotronr (c) (s) No Aplica (NR), Otro san_alcan (c) (s) Conectado a alacantarillado sanitorio san_tanq (c) (s) Conectado a tanque septico san_hueco (c) (s) De Hueco o Letrina san_notien (c) (s) no tiene san_nr (c) No aplica (s) NR usosolo (c) Exclusivo Hogar (s) Solo del hogar Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics 1. exclusivo Hogar 2. compartido con otros hogares Cooking Fuel (combustible) Phone (Land & Cellular) 2. Compartido con otros hogares 3. Compartido con otras viviendas 9. NR H18_COMB v38 0. no aplica 1. gas 2. lena 3. carbon 4. querosin 5. electricidad 6. no cocina H19_CTRES 0. No Aplica 1. Si 2. No 9. No declarado H19_DTCEL 1. Gas 2. Leña 3. Electricidad 4. No cocina 5. Otro 9. NR V40a1 1. Sí 2. No 9. NR v40a2 0. No Aplica 1. Si Technical Appendix 1. Sí 2. No 25 usocomp (c) Compartido con otros hogares (s) Compartido con otras hogares o viviendas uso_nr (c) No Aplica (s) NR com_gaselec (c) (s) Gas, Electricidad com_lencar (c) Leña, Carbon, Querosin (s) Leña, Otro com_nc (c) No Aplica, No Cocina (s) NR telecell (c) (s) Si Table 4: Census and Survey Variables and Recoding Variable Group Panama Census (c) ENV Survey (s) Matched Variables Variable names in italics 2. No 9. No declarado Technical Appendix 9. NR 26 Table 5: Comparison of Survey and Census Descriptive Statistics Survey (ENV) Variable Names Mean SD Range Mean Individual-Level Variables hombre 0.514 0.500 0, 1 0.511 age1223 0.247 0.431 0, 1 0.233 age2435* 0.233 0.423 0, 1 0.256 age3659 0.520 0.500 0, 1 0.511 Household-Level Variables fheadhh* 0.237 0.425 0, 1 0.195 num_kids059* 1.838 1.145 1, 8 1.730 num_adfem* 1.646 1.032 0, 7 1.601 num_tot* 6.900 3.827 2, 23 6.187 crowding* 3.223 2.970 0.31, 23 3.007 depratio* 0.711 0.161 0.14, 1 0.269 mari_uni 0.837 0.369 0, 1 0.846 mari_sep 0.097 mari_viudo 0.036 mari_soltero 0.029 ed_nonenr* 0.159 ed_presp 0.161 ed_prime* 0.238 ed_ssec 0.208 ed_csec* 0.122 ed_cvoc* 0.008 ed_suped 0.104 hifemed* 4.161 hifemedsq* 21.487 himaled* 3.540 himaledsq* 18.141 priminhh* 0.968 primouthh 0.099 secinhh* 0.433 secouthh* 0.202 sal_percap* 53.093 salfem_percap* 17.795 san_alcan 0.197 san_tanq* 0.213 san_hueco* 0.422 san_notien* 0.168 usosolo* 0.697 usocompnr* 0.303 com_gaselec* 0.691 com_lencar* 0.305 com_nc* 0.005 telecell* 0.363 Vivienda-Level Variables viv_casa* 0.900 viv_improv* 0.006 Census SD Range 0.500 0.423 0.436 0.500 0, 1 0, 1 0, 1 0, 1 0.396 0.938 0.985 3.035 2.541 0.168 0.361 0, 1 1, 13 0, 12 2, 37 0.2, 32 0, 0.9 0, 1 0.296 0.187 0.167 0.366 0.367 0.426 0.406 0.328 0.090 0.305 2.043 17.921 2.369 17.972 1.110 0.414 0.709 0.518 101.055 51.319 0.398 0.410 0.494 0.374 0.460 0.460 0.462 0.460 0.068 0.481 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 8 0, 64 0, 8 0, 64 0, 6 0, 5 0, 4 0, 3 0, 1667 0, 806 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0.089 0.035 0.030 0.107 0.163 0.259 0.195 0.139 0.023 0.107 4.456 23.628 4.023 21.267 0.800 0.084 0.395 0.171 70.718 23.473 0.204 0.179 0.484 0.132 0.736 0.264 0.729 0.269 0.002 0.340 0.285 0.184 0.171 0.310 0.370 0.438 0.397 0.346 0.150 0.309 1.942 17.939 2.255 18.356 0.994 0.377 0.722 0.491 137.890 65.927 0.403 0.383 0.500 0.339 0.441 0.441 0.444 0.443 0.040 0.474 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 8 0, 64 0, 8 0, 64 0, 11 0, 10 0, 8 0, 8 0, 3833 0, 3500 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0, 1 0.300 0.078 0, 1 0, 1 0.877 0.016 0.329 0.127 0, 1 0, 1 A1 Table 5: Comparison of Survey and Census Descriptive Statistics Survey (ENV) Census Variable Names Mean SD Range Mean SD Range viv_apartam* 0.051 0.219 0, 1 0.061 0.238 0, 1 viv_cuarto* 0.038 0.192 0, 1 0.047 0.211 0, 1 t_contej* 0.042 0.201 0, 1 0.068 0.252 0, 1 t_fibmema 0.823 0.382 0, 1 0.810 0.393 0, 1 t_pajpen 0.135 0.342 0, 1 0.121 0.327 0, 1 p_bloq* 0.576 0.494 0, 1 0.657 0.475 0, 1 p_madera* 0.227 0.419 0, 1 0.144 0.351 0, 1 p_quinad* 0.037 0.188 0, 1 0.048 0.213 0, 1 p_metal 0.030 0.170 0, 1 0.034 0.182 0, 1 p_cana 0.108 0.311 0, 1 0.100 0.300 0, 1 p_sinotr 0.021 0.145 0, 1 0.017 0.130 0, 1 pisoconc* 0.677 0.468 0, 1 0.714 0.452 0, 1 pisomade* 0.100 0.300 0, 1 0.064 0.244 0, 1 pisotier 0.195 0.397 0, 1 0.204 0.403 0, 1 piso_otronr* 0.028 0.164 0, 1 0.018 0.134 0, 1 acuedpoz 0.836 0.370 0, 1 0.851 0.356 0, 1 aguapozrio 0.164 0.370 0, 1 0.149 0.356 0, 1 aguadent* 0.799 0.400 0, 1 0.516 0.500 0, 1 aguafuer* 0.201 0.400 0, 1 0.484 0.500 0, 1 elecmuncom* 0.575 0.494 0, 1 0.708 0.455 0, 1 elecplant* 0.391 0.488 0, 1 0.276 0.447 0, 1 elecotronr* 0.033 0.179 0, 1 0.016 0.125 0, 1 basserv* 0.447 0.497 0, 1 0.483 0.500 0, 1 bastira* 0.185 0.389 0, 1 0.153 0.360 0, 1 basentq 0.339 0.474 0, 1 0.350 0.477 0, 1 basotronr* 0.029 0.168 0, 1 0.014 0.119 0, 1 * Survey and Census means significantly different at p<0.05 (two-sampled t-test w/ equal variances) Survey N = 1,955 (based on haz dataset) Census N = 248,731 A2