Poverty and health

Operation of the market study: Land access in urban areas: The case of Maputo
Raimundo JA and Raimundo IM: Urban LandMark, February 2012

In 2010, Urban LandMark undertook a survey of 568 households in two peri-urban sites in Maputo, Hulene B and Luis Cabral, to understand how ordinary urban dwellers access, hold and transact land. Although they are both located in the suburbs of Maputo city, Luis Cabral was established as a settlement for workers from the Maputo harbour, and has a longer history of urban settlement than Hulene B. Hulene B houses mainly internally displaced people from the civil war and floods. While most the plots in Luis Cabral have been surveyed, have wider roads and are generally better planned, Hulene B is largely unplanned. Despite the differences between the two neighbourhoods, the study found no variations in the nature of land ownership and tenure. In both settlements, the vast majority of households do not have formal title. Most land is acquired through mechanisms that are outside the formal land registration system. These findings challenge conventional understandings of the formal and informal sector in African cities. First, informal systems are not always the chaotic mess they are perceived to be. Secondly, although much of the land is accessed and secured verbally or through agreements with social networks, state agents are often critical to lending credibility to informal practices. Thirdly, despite the fact that few households in the study areas have formal title to land or documentation, 68% of households reported that their sense of rights to place were strong because the local land practices had social legitimacy.

Overcoming the barriers: How to ensure future food production under climate change in Southern Africa
Vincent K, Joubert A, Cull T, Magrath J, Johnston P: Oxfam, 9 November 2011

For this report, researchers interviewed 200 farmers in Zambia, Zimbabwe, Mozambique, Malawi and South Africa about their experiences of changes in climate. They found considerable agreement between farmers across countries that they are observing changes in climate. Climate change is likely to reduce yields and increase food prices, with serious effects on both farmers and consumers. But farmers are already actively experimenting and changing agricultural practices and pursuing ways to diversify livelihoods in light of both the new changes to their climate and other multiple stresses. In some cases, these changes can be considered actual or potential successes in adapting to climate change; in other cases they may be simply coping or using maladaptive strategies, particularly where they create environmental degradation. Furthermore, whereas large-scale farmers, in the main, have access to the resources needed to adapt, small-scale farmers face major obstacles. These obstacles may not only prevent adaptation but also lead farmers into maladaptation, for want of other choices. Major new resources must be raised from domestic, regional and international levels to focus on and build the adaptive capacity of small-scale farmers and sustain levels of food production into the future, the report concludes.

Alcohol consumption in relation to maternal deaths from induced-abortions in Ghana
Asamoah BO and Agardh A: Reproductive Health 9:10, 6 August 2012

According to this paper, in Ghana, alcohol consumption and unwanted pregnancies are on the ascendancy. The authors examined the association between alcohol consumption and maternal mortality from induced-abortion, as well as the factors that lie behind the alcohol consumption patterns in the study population. They extracted data from the Ghana Maternal Health Survey 2007, identifying 4,203 female deaths through verbal autopsy, among which 605 were maternal deaths in the 12 to 49 year-old age group. Alcohol consumption was significantly associated with abortion-related maternal deaths. Women who had ever consumed alcohol, frequent consumers and occasional consumers were about three times as likely to die from abortion-related causes compared to those who abstained from alcohol. Maternal age, marital status and educational level were found to have a confounding effect on the observed association. The authors recommend that policy actions directed toward reducing abortion-related deaths should consider alcohol consumption, especially among younger women. Policy makers in Ghana should also consider increasing the legal age for alcohol consumption. In addition, information on the health risks posed by alcohol and abortion be disseminated to communities in the informal sector where vulnerable groups can best be reached.

Early cessation of breastfeeding amongst women in South Africa: An area needing urgent attention to improve child health
Doherty T, Sanders D, Jackson D, Swanevelder S, Lombard C, Zembe Wanga et al: BMC Pediatrics 12:105, 24 July 2012

Despite being a critical component of interventions to reduce child mortality, exclusive breastfeeding practice is extremely low in South Africa. This paper investigates why. The authors conducted a sub-group analysis of a community-based cluster-randomised trial (PROMISE EBF) promoting exclusive breastfeeding in three South African sites between 2006 and 2008. By 12 weeks postpartum, results showed that 20% of HIV-negative women and 40% of HIV-positive women had stopped breastfeeding. About a third of women introduced other fluids, most commonly formula milk, within the first three days after birth. Antenatal intention not to breastfeed and being undecided about how to feed were most strongly associated with stopping breastfeeding by 12 weeks. Self-reported breast health problems were also associated with a three-fold risk of stopping breastfeeding. The authors conclude that early cessation of breastfeeding is common amongst both HIV-negative and positive women in South Africa. There is an urgent need to improve antenatal breastfeeding counselling taking into account the challenges faced by working women as well as early postnatal lactation support to prevent breast health problems.

FAO calls for partnerships in policy research and social inclusion
Food and Agricultural Organisation: 30 July 2012

Speaking at the World Congress of Rural Sociology, the Director-General of the Food and Agricultural Organisation (FAO) José Graziano da Silva challenged academics to get involved in essential and politically important research into rural poverty and the food and agriculture business as it pertains to small-scale producers. He identified the most pressing issues in the fight against hunger and rural underdevelopment as food insecurity, nutrient deficiencies and unsafe food, as well as unequal competition between small-scale and large food producers. He singled out large-scale investments in agriculture or ‘land-grabbing’ as a politically important area where universities could conduct research into principles for responsible agricultural investments. Such research could feed into the work of the Committee on World Food Security, the leading global forum for discussions on food security issues, he said. How to integrate small-scale farmers into the agricultural and food chains should be another area of academic concern. Academics should look into the issue of governance of the food and agriculture sector, both at global and local levels, and how to achieve a fair distribution of benefits.

Malaria in East African highlands during the past 30 years: Impact of environmental changes
Himeidan YE and Kweka EJ: Frontiers in Physiology 3:315, 2 August 2012

With the world's highest population growth rate, the East African highlands have historically undergone extensive transformation to feed a poor population largely dependent on subsistence farming. Most available land has been adapted for agricultural use as dairy pastures or croplands. The lost of forest areas, mainly due to subsistence agriculture, between 1990 and 2010 ranged between 8,000 ha in Rwanda and 2,838,000 ha in Ethiopia. These unmitigated environmental changes in the highlands have led to a rise in temperature and a correlated increase in numbers of malarial mosquitoes, with several epidemics observed in the late 1980s and early 2000s. Although malaria has decreased through intensified interventions from the mid-2000s onwards, the authors of this study argue that environmental changes might further increase the risk of malaria in the region, particularly if the current interventions are not sustained.

More relatively poor people in a less absolutely poor world
Chen S and Ravallion M: World Bank Policy Research Working Paper 6114, 1 July 2012

The authors of this paper argue that the effects of relative deprivation, shame and social exclusion call for a reconsideration of how we assess global poverty. However, the authors do not support use of standard measures of relative poverty. Instead they call for using a weakly relative measure as the upper-bound complement to the lower-bound provided by a standard absolute measure. New estimates of global poverty are presented, drawing on 850 household surveys spanning 125 countries over 1981–2008. The absolute line is US$1.25 a day at 2005 prices, while the relative line rises with the mean, at a gradient of 1:2 above $1.25 a day. The authors show that these parameter choices are consistent with cross-country data on national poverty lines. The results indicate that the incidence of both absolute and weakly relative poverty in the developing world has been falling since the 1990s, but more slowly for the relative measure. While the number of absolutely poor has fallen, the number of relatively poor has changed little since the 1990s, and is higher in 2008 than 1981.

Predictors of chronic food insecurity among adolescents in Southwest Ethiopia: A longitudinal study
Belachew T, Lindstrom D, Gebremariam A, Jira C, Hattori M, Lachat C et al: BMC Public Health 12:604, 3 August 2012

In the context of increased food prices in Ethiopia, the authors of this study hypothesised that adolescents in low income urban households are more likely to suffer from chronic food insecurity than those in the rural areas who may have direct access to agricultural products. They gathered data from the first two rounds of the Jimma Longitudinal Family Survey of Youth (JLFSY) and interviewed a total of 1,911 adolescents aged 13-17 years on their personal experiences of food insecurity both at baseline and at year two. Overall, 20.5% of adolescents were food insecure in the first round survey, while the proportion of adolescents with food insecurity increased to 48.4% one year later. Female sex of adolescents, high dependency ratio and household food insecurity were independent predictors of chronic adolescent food insecurity. The fact that the prevalence of chronic food insecurity increased among adolescents who are members of chronically food insecure urban households as income tertiles decreased suggests that the resilience of buffering is eroded when purchasing power diminishes and food resources are dwindling. Food security interventions should target urban low income households to reduce the level of chronic food insecurity and its consequences, the authors argue.

Public perception of drinking water safety in South Africa 2002-2009: A repeated cross-sectional study
Wright JA, Yang H, Rivett U and Gundry SW: BMC Public Health 12:556, 27 July 2012

The objective of this study was to explore trends in perceived drinking water safety in South Africa and its association with disease outbreaks, water supply and household characteristics. The authors drew on General Household Surveys from 2002-2009, which included a question about perceived drinking water safety. Trends in responses to this question were examined from 2002-2009 in relation to reported cholera cases. The results suggest that perceptions of drinking water safety have remained relatively stable over time in South Africa, once the expansion of improved supplies is controlled for. A large cholera outbreak in 2000-2002 had no apparent effect on public perception of drinking water safety in 2002. Perceived drinking water safety is primarily related to water taste, odour, and clarity rather than socio-economic or demographic characteristics. This suggest that household perceptions of drinking water safety in South Africa follow similar patterns to those observed in studies in developed countries. The stability over time in public perception of drinking water safety is particularly surprising, given the large cholera outbreak that took place at the start of this period.

The state of breastfeeding in 33 countries
Gupta A, Holla R and Dadhich JP: World Breastfeeding Trends Initiative, 2010

This WBTI (World Breastfeeding Trends Initiative) report assesses infant and young child feeding (IYCF) policies and programmes in 33 countries located in Asia, Africa and South and Central America. The authors highlight the fact that universalising the coverage of infant and young child feeding practices is one of the most effective interventions to reduce infant and young child mortality, morbidity and malnutrition. Yet their research points to major gaps in both policies and programmes in all 33 countries, with limited support for breastfeeding women. They argue that the United Nations and external funders should commit substantial financial resources in order to universalise key interventions related to breastfeeding and complementary feeding. This calls for a coordination mechanism for planning and supervising the implementation of relevant policy in an integrated manner at all levels, from policy making to service delivery at the grassroots level. Key breastfeeding and complementary feeding indicators will need to be regularly monitored and the results may be used to make policy and programmes more effective. The authors also call for integration of infant feeding in related comprehensive national policies, as well as building human resources and social welfare for exclusively breastfeeding women.

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