Among the household composition variables, only young children have a significant negative relation with BMI. This is consistent with a story in which the elderly are physically taxed by their responsibilities for child care _or_ in which the household preferentially allocates resources to the health of the young over the elderly. Surprisingly, the elderly in households with more prime-aged adults did not have higher BMI.'<sup>9</sup> This suggests either that there is no substitutability of labor between the elderly and prime-aged adults or that the additional work of the elderly when faced with a scarcity of prime-aged adults does not worsen health status. Using the same dataset, Beegle (1998) found that adults aged 51-65 in households with a prime-aged adult death in the past year increased their time spent on housework, but were no more likely to engage in farm work as a result of the death.

The elderly in urban areas had a BMI 1.3 points higher than those in rural areas but there was no significant relation between BMI and the proximity of a health facility.<sup>20</sup> BMI was not affected by the 1991 adult mortality rate in the community or an epidemic in the previous 6 months. However, BMI was lower by about 1.1 points in communities where the road is completely impassable during certain times of the year, compared to communities where the road was passable year round.<sup>_2_</sup> This might explain the lack of impact of proximity to a health facility: in communities where the road is impassable, the distance to a health facility and its quality are irrelevant. This finding presents an interesting paradox: Better infrastructure facilitates mobility, which has been implicated in raising the risk of acquiring HIV. Yet for many, especially the poor, the lack of basic road infrastructure is a major impediment to economic opportunities, better access to social services, and improved health outcomes.

Turning to short-run changes in BMI (Table 3, columns 2-4), the results in column 2 imply that there are no changes in BMI associated with a recent past or future adult death. However, when we allow the impact of adult deaths to vary by the level of assets in the household a more nuanced story emerges (column 3). There is no impact of a recent past or future adult death on the BMI of the elderly in the poorest households. However, in non-poor households, in which the BMI of the elderly is initially higher, we see a significant negative impact on BMI in the months prior to the adult death with a recovery back to normal levels after the death. This could be explained by a diversion of household resources to the medical care of 19 When household size is held constant (not shown), an increase in the number (or share) of prime-aged adults is associated with higher BMI. However, the negative coefficient on household size almost exactly equals the positive coefficient on prime-aged adults, so the net effect of an additional adult in the household on BMI is nil.

_2D_ The negative sign suggests that the elderly living within 5 km of a health facility have _worse_ physical health than those living more distant. However, this pattem could also be observed if the less healthy elderly chose to live with relatives who are closer to a health facility. Thus, the result should not properly be interpreted as an 'impact' of the proximity of health care. In a specification not shown here, BMI was not associated with indicators of health care quality at the nearest facility.

**_21_** At the time of the KHDS fieldwork in 1991-94, the quality of the road infrastructure in Kagera was extremely poor. The 100 km road between Bukoba town and the Ugandan border could take 5 hours or more to travel during the rainy season and the was sometimes completely cut off. (Personal observation, Ainsworth).

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