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This paper examines potential relations between factors related to fertility and the access to and use of natural resources in Petén, Guatemala. The Petén forms the heart of the Selva Maya, the largest lowland humid forest in Mesoamerica. The rapid in-migration of subsistence maize farmers has converted much of the Petén's forests to agricultural fields. Population dynamics have been transformed in that virtually all farm families have arrived since the 1970s and that total fertility rates exceed the national rural mean. Continued migration, exceptionally high fertility, a youthful population, and a large consumer to producer ratio are hypothesized to be related to the dramatic land cover dynamics shaping the landscape of the Petén. An emerging body of literature suggests that environmental factors can affect fertility decision-making and behaviors, especially in natural resource dependent economies like that of the Petén. This paper examines these relationships using data from the 1998/99 Demographic Health Survey in Guatemala. Data on natural resource access and utilization were collected as part of an environment module, in addition to demographic and health information. This dataset, the first ever environmental module of the Demographic Health Survey, provides a unique opportunity to examine possible relationships between fertility and the environment in a tropical agricultural frontier.

This paper examines potential relations between factors related to fertility and the access to and use of natural resources in Petén, Guatemala. The Petén forms the heart of the Selva Maya, the largest lowland humid forest in Mesoamerica. The rapid inmigration of subsistence maize farmers has converted much of the Petén’s forests to agricultural fields. Population dynamics have been transformed in that virtually all farm families have arrived since the 1970s and that total fertility rates exceed the national rural mean. Continued migration, exceptionally high fertility, a youthful population, and a large consumer to producer ratio are hypothesized to be related to the dramatic land cover dynamics shaping the landscape of the Petén. An emerging body of literature suggests that environmental factors can affect fertility decision-making and behaviors, especially in natural resource dependent economies like that of the Petén. This paper examines these relationships using data from the 1998/99 Demographic Health Survey in Guatemala. Data on natural resource access and utilization were collected as part of an environment module, in addition to demographic and health information. This dataset, the first ever environmental module of the Demographic Health Survey, provides a unique opportunity to examine possible relationships between fertility and the environment in a tropical agricultural frontier.

Background: Performance-based financing (PBF) strategies are promoted as a supply-side, results-based financing mechanism to improve primary health care. This study estimated the effects of Rwanda's PBF program on less-incentivized child health services and examined the differential program impact by household poverty.Methods: Districts were allocated to intervention and comparison for PBF implementation in Rwanda. Using Demographic Health Survey data from 2005 to 2007-08, a community-level panel dataset of 5781 children less than 5 years of age from intervention and comparison districts was created. The impacts of PBF on reported childhood illness, facility care-seeking, and treatment received were estimated using a difference-in-differences model with community fixed effects. An interaction term between poverty and the program was estimated to identify the differential effect of PBF among children from poorer families.Results: There was no measurable difference in estimated probability of reporting illness with diarrhea, fever or acute respiratory infections between the intervention and comparison groups. Seeking care at a facility for these illnesses increased over time, however no differential effect by PBF was seen. The estimated effect of PBF on receipt of treatment for poor children is 45 percentage points higher (p = 0.047) compared to the non-poor children seeking care for diarrhea or fever.Conclusions: PBF, a supply-side incentive program, improved the quality of treatment received by poor children conditional on patients seeking care, but it did not impact the propensity to seek care. These findings provide additional evidence that PBF incentivizes the critical role staff play in assuring quality services, but does little to influence consumer demand for these services. Efforts to improve child health need to address both supply and demand, with additional attention to barriers due to poverty if equity in service use is a concern. [ABSTRACT FROM AUTHOR]

Background: The relationship between health services and population outcomes is an important area of public health research that requires bringing together data on outcomes and the relevant service environment. Linking independent, existing datasets geographically is potentially an efficient approach; however, it raises a number of methodological issues which have not been extensively explored. This sensitivity analysis explores the potential misclassification error introduced when a sample rather than a census of health facilities is used and when household survey clusters are geographically displaced for confidentiality. Methods: Using the 2007 Rwanda Service Provision Assessment (RSPA) of all public health facilities and the 2007-2008 Rwanda Interim Demographic and Health Survey (RIDHS), five health facility samples and five household cluster displacements were created to simulate typical SPA samples and household cluster datasets. Facility datasets were matched with cluster datasets to create 36 paired datasets. Four geographic techniques were employed to link clusters with facilities in each paired dataset. The links between clusters and facilities were operationalized by creating health service variables from the RSPA and attaching them to linked RIDHS clusters. Comparisons between the original facility census and undisplaced clusters dataset with the multiple samples and displaced clusters datasets enabled measurement of error due to sampling and displacement. Results: Facility sampling produced larger misclassification errors than cluster displacement, underestimating access to services. Distance to the nearest facility was misclassified for over 50% of the clusters when directly linked, while linking to all facilities within an administrative boundary produced the lowest misclassification error. Measuring relative service environment produced equally poor results with over half of the clusters assigned to the incorrect quintile when linked with a sample of facilities and more than one-third misclassified due to displacement. Conclusions: At low levels of geographic disaggregation, linking independent facility samples and household clusters is not recommended. Linking facility census data with population data at the cluster level is possible, but misclassification errors associated with geographic displacement of clusters will bias estimates of relationships between service environment and health outcomes. The potential need to link facility and population-based data requires consideration when designing a facility survey. [ABSTRACT FROM AUTHOR]