Document Type

Working Paper

Date of this Version

2-14-2020

Funding

We gratefully acknowledge the generous support for the Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) by the the Swiss Programme for Research on Global Issues for Development (SNF r4d Grant 400640_160374) and the pilot funding received through the Penn Center for AIDS Research (CFAR), supported by NIAID AI 045008 and the Penn Institute on Aging. We are also grateful for support for the Malawi Longitudinal Study of Families and Health (MLSFH) by the Rockefeller Foundation; the National Institute of Child Health and Human Development (NICHD, Grant Nos. R03 HD05 8976, R21 HD050653, R01 HD044228, R01 HD053781); the National Institute on Aging (NIA, Grant Nos. P30 AG12836 and R21 AG053763); the Boettner Center for Pensions and Retirement Security at the University of Pennsylvania; and the NICHD Population Research Infrastructure Program (Grant Nos. R24 HD-044964), all at the University of Pennsylvania.

Abstract

Evidence for the effectiveness of population health screenings to reduce the burden of non-communicable diseases in low income countries remains very limited. We investigate the sustained effects of a health screening in Malawi where individuals received a referral letter if they had elevated blood pressure. Using a regression discontinuity design and a matching estimator, we find that receiving a referral letter reduced blood pressure and the probability of being hypertensive by about 22 percentage points four years later. These lasting effects are explained by a 20 percentage points increase in the probability of being diagnosed with hypertension. There is also evidence of an increase in the uptake of medication, while we do not identify improvements in hypertension-related knowledge or risk behaviors. The health screening had some positive effects on mental health. Overall, this study suggests that population-based hypertension screening interventions are an effective tool to improve health in low-income contexts.

Keywords

health screening, hypertension, non-communicable diseases, regression discontinuity design, matching estimator, low income countries, Malawi

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Date Posted: 14 February 2020