Poverty and health

Can integration of legume trees increase yield stability in rainfed maize cropping systems in southern Africa?
Sileshi GW, Debusho LK and Akinnifesi FK: Agronomy Journal 104(5): 1392-1398, September 2012

To keep its mostly maize-growing small farms productive through cycles of drought, Malawi spends 60% of its agricultural budget subsidizing fertilisers. But the findings of this 12-year study suggest farmers in Malawi and elsewhere could increase yields consistently without applying fertilisers, using instead 'fertiliser trees'. To thrive, maize requires phosphorus and nitrogen, large quantities of which have been depleted from African soils. The 'fertiliser tree' or gliricidia, a leguminous tree, has the ability to draw nitrogen from the air and fix it into soil, changing it into a form that plants can use. The trees also restore some amount of phosphorus to the soil, according to the study. In addition, the leaves shed by gliricidia return organic matter to the soil, increasing its structural stability, erosion resistance and capacity to store water. Three consecutive experiments, begun in 1991 in Malawi and Zambia, showed that when gliricidia was planted in rows between maize plants, maize yields were good year after year.

Can social network analysis help to include marginalised young women in structural support programmes in Botswana? A mixed methods study
Loutfi D; Andersson N; Law S; Salsberg J; et al: International Journal for Equity in Health 18(12) 1-11, 2019

This paper investigated social networks of young women in Botswana to see if an approach based on an understanding of these networks could help with recruitment into support programmes. A national HIV trial was testing an intervention to assist young women to access government programs for returning to education and improving livelihoods. Structural factors such as poverty, poor education, strong gender inequalities and gender violence render many young women unable to act on choices to protect themselves from HIV. Social network analysis was used to identify key young women in four communities and to describe the types of people that marginalised young women turn to for support. In discussion groups, the same young women helped explain results from the network analysis. Most marginalised young women went to other women, usually in the same community and with children, especially if they had children themselves. Rural women were better connected with each other than women in urban areas, though there were isolated young women in all communities. Peer recruitment contributed most in rural areas; door-to-door recruitment contributed most in urban areas. The authors argue that since marginalised young women seek support from others like themselves, outreach programs could use networks of women to identify and engage those who most need help from government structural support programs. while this alone may be insufficient, a combination of approaches, including, for instance, peers, door-to-door recruitment and key community informants could be explored as a strategy for reaching marginalised young women for supportive interventions.

Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis
Watkins D; Olson Z; Verguet S; Nugent R; Jamison D: Health policy and planning 31(1) 75-82, 2015

The South African Government recently set targets to reduce cardiovascular disease (CVD) by lowering salt consumption. The authors conducted an extended cost-effectiveness analysis to model the potential health and economic impacts of this salt policy. They used surveys and epidemiologic studies to estimate reductions in CVD resulting from lower salt intake; the reduction in out-of-pocket (OOP) expenditures and government subsidies due to the policy and the financial risk protection (FRP) from the policy. The authors found that the salt policy could reduce CVD deaths by 11%, with similar health gains across income quintiles. It could save households US$ 4.06 million (2012) in OOP expenditures (US$ 0.29 per capita) and save the government US$ 51.25 million in healthcare subsidies (US$ 2.52 per capita) each year. The cost to the government would be only US$ 0.01 per capita, so the policy would be cost saving. If the private sector food reformulation costs were passed on to consumers, food expenditures would increase by <0.2% across all income quintiles. Preventing CVD could avert 2000 cases of poverty yearly. The authors concluded that, in addition to health gains, population salt reduction can have positive economic impacts—substantially reducing OOP expenditures and providing financial protection, particularly for the middle class. The policy could also provide large government savings on health care.

Causing hunger: An overview of the food crisis in Africa
Oxfam Briefing Paper 91, July 2006

For people to be hungry in Africa in the 21st century is neither inevitable nor morally acceptable. The world’s emergency response requires an overhaul so that it delivers prompt, equitable, and effective assistance to people suffering from lack of food. More fundamentally, governments need to tackle the root causes of hunger, which include poverty, agricultural mismanagement, conflict, unfair trade rules, and the unprecedented problems of HIV/AIDS and climate change. The promised joint effort of African governments and donors to eradicate poverty must deliver pro-poor rural policies that prioritise the needs of marginalised rural groups such as small-holders, pastoralists, and women.

Central African farmers gear up to influence future agricultural policy in their region
Van Seters J: ECDPM Talking Points, 9 August 2012

Food security in Central Africa has been worsening over the last two decades. To address this challenge, Central African states have embarked on a process to develop a common agricultural policy and to put the Comprehensive Africa Agriculture Development Programme (CAADP) into practice. Farmers’ organisations from all member states are now shaping up to influence these policy-making processes at national and regional level in the coming months. The main challenge for them is to identify proposals that respond to the needs and priorities of all the farmers they represent, and to ensure that policy makers will take them into account during negotiations. In doing so, they could learn from their counterparts in West Africa, argues the writer of this blog, the Deputy Programme Manager for Food Security at ECDPM. West African farmers managed to play an important role in the formulation of the region’s common agricultural policy through their regional farmers’ network ROPPA. Key to ROPPA’s success was its participation in decision-making organs and meetings, but more so, its preparations for these events, which included consultations of ROPPA’s members at regional, national and local levels, analytical work to check and back their arguments, and a continuous search for allies among national and regional authorities and non-state actors.

Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services
Mutebi A; Kananura R; Ekirapa-Kiracho; et al.: Global Health Action 10(S4)82-91, 2017

Data on the characteristics of community-based savings groups were collected from 247 community-based savings group leaders in the districts of Kamuli, Kibukuand Pallisa using a self-administered open-ended questionnaire, and in-depth interviews with seven community-based savings group leaders. Ninety-three percent of the community-based savings groups said they elected their management committees democratically to select the group leaders and held meetings at least once a week. Eighty-nine percent used metallic boxes to keep their money, while 10% kept their money in mobile money and banks. The community-based savings groups were formed mainly to increase household income, to develop the community and to save for emergencies. The community-based savings groups faced challenges of high illiteracy among the leaders, irregular attendance of meetings, and lack of training on management and leadership. Saving groups in Uganda are reported to have the basic required structures, but with challenges in relation to training and management of the groups and their assets, calling for technical support in these areas.

Characteristics of households experiencing under- five deaths: A case of Tropical Institute of Community Health and Development (TICH) partnership districts
Oindo C, Otieno C, Okeyo N, Olayo R, Muga R and Kaseje C: African Journal of Food, Agriculture, Nutrition and Development: 2009

In this paper, child mortality and its relationship to specific variables relating to background and proximate factors were considered. Between 2006 and 2007, proportions of households with child deaths declined in all the districts and the proportions of health facility deliveries decreased in households that experienced under-five deaths. Measles vaccination coverage was lower among households with child deaths and so was use of insecticide-treated nets (ITNs). Households living in poor conditions experienced the highest proportions of child mortality. Education of mothers remains a significant determinant of child mortality along with health facility delivery. No difference in child mortality was realized between mothers having primary education and those that had none. Better health-seeking behaviour should be encouraged to help stem the high child mortality rates.

Child disability screening, nutrition, and early learning in 18 countries with low and middle incomes: Data from the third round of UNICEF's Multiple Indicator Cluster Survey (2005–2006)
Gottlieb CA, Maenner MJ, Cappa C and Durkin P: The Lancet 374(9704): 1831–1839, 28 November 2009

This study examined child disability screening and its association with nutrition and early learning in countries with low and middle incomes. Cross-sectional data for the percentage of children screening positive for or at risk of disability were obtained for 191,199 children aged 2–9 years old in 18 countries. Screening results were descriptively analysed according to social, demographic, nutritional, early-learning and schooling variables. A median 23% of children aged 2–9 years old screened positive for disability. For children aged 2–4, screening positive for disability was significantly more likely in children who were not breastfed and who did not receive vitamin A supplements. Children aged 6–9 who did not attend school screened positive for disability more often than did children attending school. These results draw attention to the need for improved global capacity to assess and provide services for children at risk of disability. Further research on childhood disabilities is needed in countries with low and middle incomes to understand and address the role of nutritional deficiencies and restricted access to learning opportunities.

Child health now: Together we can end preventable deaths
World Vision: October 2009

The epicentre of the child health emergency is sub-Saharan Africa and South Asia but, without a concerted and sustained effort in their countries, there’s little prospect of Millennium Development Goal 4 being met at a global level. The causes of this emergency vary according to the local context, and will require tailored responses by governments, donors and international institutions. Examples of good leadership exist in countries like Liberia, where President Ellen Johnson Sirleaf has used the peace dividend to triple health spending, withdraw user charges and focus on the prevention of malaria. The first tier of healthcare for children is the household level, and beyond that the immediate community. Yet relatively little attention is paid by most governments to low-cost and easy-to-deliver measures that can be taken at this level, which can have a decisive impact on child health, from hand washing and breastfeeding to early identification of pneumonia. World Vision estimates that a comprehensive package of family and community care alone could prevent 2.5 million child deaths each year. What’s needed is a redefinition of health systems to incorporate family- and community-level care, in tandem with a fundamental rebalancing of public spending placing much greater emphasis on prevention. Safe water and sanitation and basic hygiene are necessary to achieve this aim – the World Health Organization estimates that they could together save US$7 billion in health care costs each year.

Child Nutritional Status And Household Patterns In South Africa
Bomela N: African Journal of Food, Agriculture, Nutrition and Development 7(5): 1684-5374, 2007

The influence of person-related and household related characteristics on the nutritional status of children were assessed, taking into account variables such as, gender of household head, de jure and de facto household head, relationship of child to household head, size of household, type of toilet facility and type of dwelling. Chronic malnutrition and underweight were significantly pronounced in children from households with de jure household heads.

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