Abstract:
Nearly half of all children under age five in India are undernourished, yet parents often fail to recognize malnutrition in their children. I examine a potential explanation using a field experiment with 1,527 mother–child pairs in the state of Telangana. I show that parents frequently normalize malnutrition, benchmarking growth against local peers rather than global standards. While nearly 40% of children were stunted at baseline, 84% of their mothers described their height as “normal” or “tall”, with misclassification especially pronounced in high-malnutrition communities. Randomly selected mothers received personalized feedback on their child’s growth percentiles based on WHO standards, along with height and weight reference values at different percentile ranks to recalibrate benchmarks for healthy growth. The intervention shifted beliefs, raised growth aspirations, and improved child diets. Within six months, treated children gained 0.10–0.19 standard deviations in anthropometric z-scores, with a 13–35% reduction in malnutrition rates. Treatment effects were strongest for undernourished children in high-malnutrition areas—precisely where peers are shortest and misperceptions largest. These findings highlight distorted parental beliefs arising from downward-biased local growth norms as a key barrier to nutrition investment and show that targeted belief-correction offers a scalable and highly cost-effective approach to meaningfully improve child health. 

Abstract: There is little causal evidence on factors that can protect individuals against Alzheimer’s Disease and Related Dementias (ADRD) risk. We study the causal effect of education on ADRD, exploiting a regression discontinuity generated by a compulsory schooling reform. ADRD was ascertained based on medical history, hospital records, and death registries, addressing concerns about selective sample attrition. We find that education reduces incidence of ADRD and may delay its onset. Using molecular genetic data, we show that the reform weakened the relationship between genetics and ADRD incidence, implying this genetic risk is not immutable and can be modified by social policy.

Abstract:
While education is among the most consistent predictors of cognitive health and dementia risk, it is unclear whether this reflects the benefits of schooling itself, underlying genetic predispositions, or the unequal distribution of educational opportunities across societies. Using data from the IGEMS Consortium of over 4,500 twins from eight registries in the USA, Sweden, Denmark, and Australia, we examine how genetic propensity for education and national/historical contexts of inequality shape dementia risk in later life. Dementia risk was measured with the Latent Dementia Index, a validated continuous indicator of dementia-related impairment, while key predictors included both attained education, a polygenic score (PGS) for educational attainment, and cohort- and country-specific Gini indices of educational inequality. Ordinary least squares and within–between twin models were estimated to separate between-family from within-family effects. Results show that higher education is associated with lower likelihood of dementia; the educational attainment PGS also predicts likelihood of dementia, although both associations are attenuated when comparing twins within families. Country-level educational inequality moderated these effects; education and PGSED were stronger predictors of cognition in more egalitarian contexts. Our findings emphasize the interplay of both genes and social stratification in shaping cognitive aging.

Abstract:
Background: India’s 1.4 million community health and nutrition workers (CHNWs) serve 158 million beneficiaries under the Integrated Child Development Services (ICDS) programme. We assessed the impact of a data capture, decision support, and job-aid mobile app for the CHNWs on two primary outcomes—(1) timeliness of home visits and (2) appropriate counselling specific to the needs of pregnant women and mothers of children <12 months.

Methods: We used a quasi-experimental pair-matched controlled trial using repeated cross-sectional surveys to evaluate the intervention in Bihar and Madhya Pradesh (MP) separately using an intention-to-treat analysis. The study was powered to detect difference of 5–9 percentage points (pp) with type I error of 0.05 and type II error of 0.20 with endline sample of 6635 mothers of children <12 months and 2398 pregnant women from a panel of 841 villages.

Results: Among pregnant women and mothers of children <12 months, recall of counselling specific to the trimester of pregnancy or age of the child as per ICDS guidelines was higher in both MP (11.5pp (95% CI 7.0pp to 16.0pp)) and Bihar (8.0pp (95% CI 5.3pp to 10.7pp)). Significant differences were observed in the proportion of mothers of children <12 months receiving adequate number of home visits as per ICDS guidelines (MP 8.3pp (95% CI 4.1pp to 12.5pp), Bihar: 7.9pp (95% CI 4.1pp to 11.6pp)). Coverage of children receiving growth monitoring increased in Bihar (22pp (95% CI 0.18 to 0.25)), but not in MP. No effects were observed on infant and young child feeding practices.

Conclusion: The at-scale app integrated with ICDS improved provision of services under the purview of CHNWs but not those that depended on systemic factors, and was relatively more effective when baseline levels of services were low. Overall, digitally enabling CHNWs can complement but not substitute efforts for strengthening health systems and addressing structural barriers.

Abstract:
Introduction: Millions of children in India still suffer from poor health and under-nutrition, despite substantial improvement over decades of public health programmes. The Anganwadi centres under the Integrated Child Development Scheme (ICDS) provide a range of health and nutrition services to pregnant women, children <6 years and their mothers. However, major gaps exist in ICDS service delivery. The government is currently strengthening ICDS through an mHealth intervention called Common Application Software (ICDS-CAS) installed on smart phones, with accompanying multilevel data dashboards. This system is intended to be a job aid for frontline workers, supervisors and managers, aims to ensure better service delivery and supervision, and enable real-time monitoring and data-based decision-making. However, there is little to no evidence on the effectiveness of such large-scale mHealth interventions integrated with public health programmes in resource-constrained settings on the service delivery and subsequent health and nutrition outcomes.

Methods and analysis: This study uses a village-matched controlled design with repeated cross-sectional surveys to evaluate whether ICDS-CAS can enable more timely and appropriate services to pregnant women, children <12 months and their mothers, compared with the standard ICDS programme. The study will recruit approximately 1500 Anganwadi workers and 6000+ mother-child dyads from 400+ matched-pair villages in Bihar and Madhya Pradesh. The primary outcomes are the proportion of beneficiaries receiving (a) adequate number of home visits and (b) appropriate level of counselling by the Anganwadi workers. Secondary outcomes are related to improvements in other ICDS services, and knowledge and practices of the Anganwadi workers and beneficiaries.