Poverty and health

Effectiveness of a brief behavioural intervention on psychological distress among women with a history of gender-based violence in urban Kenya: A randomised clinical trial
Bryant R; Schafer A; Dawson K; et al.: Public Library of Science Medicine( PLOS Med) 14(8) https://doi.org/10.1371/journal.pmed.1002371, 2017

Gender-based violence (GBV) represents a major cause of psychological morbidity worldwide, and particularly in low- and middle-income countries). Although there are effective treatments for common mental disorders associated with GBV, they typically require lengthy treatment programs that may limit scaling up in low- and middle-income countries. This study tested the effectiveness of a new 5-session behavioural treatment called Problem Management Plus (PM+) that lay community workers can be taught to deliver. In this single-blind, parallel, randomised controlled trial, adult women who had experienced GBV were identified through community screening for psychological distress and impaired functioning in Nairobi, Kenya. Participants were randomly allocated in a 1:1 ratio either to PM+ delivered in the community by lay community health workers provided with 8 days of training or to facility-based enhanced usual care (EUC) provided by community nurses. Participants were aware of treatment allocation, but research assessors were blinded. The primary outcome was psychological distress as measured by the total score on the 12-item General Health Questionnaire (GHQ-12) assessed at 3 months after treatment. Between 15 April 2015 and 20 August 2015, 1,393 women were screened for eligibility on the basis of psychological distress and impaired functioning. Of these, 37% screened positive, of whom 81% were women who had experienced GBV. Of these women, 209 were assigned to PM+ and 212 to EUC. Follow-up assessments were implemented. The study found that among a community sample of women in urban Kenya with a history of GBV, a brief, lay-administered behavioural intervention, compared with EUC, resulted in moderate reductions in psychological distress at 3-month follow-up.

World poverty could be cut in half if all adults completed secondary education
United Nations Educational, Scientific and Cultural Organisation: UNESCO Policy Paper 32, Fact sheet 44, New York, 2017

This UNESCO policy paper reports that the global poverty rate could be more than halved if all adults completed secondary school. Yet, new data from the UNESCO Institute for Statistics (UIS) show persistently high out-of-school rates in many countries, making it likely that completion levels in education will remain well below that target for generations to come. The paper demonstrates the importance of recognising education as a core lever for ending poverty in all its forms, everywhere. The analysis of education’s impact on poverty shows that nearly 60 million people could escape poverty if all adults had just two more years of schooling. Despite education’s potential, new UIS data show that there has been virtually no progress in reducing out-of-school rates in recent years. Globally, 9% of all children of primary school age are still denied their right to education, with rates reaching 16% and 37% for youth of lower and upper secondary ages, respectively. In total, 264 million children, adolescents and youth were out of school in 2015. UNESCO argues that education must reach the poorest households to maximise its benefits and reduce income inequality.

Determining baselines for human-elephant conflict: A matter of time
Pozo R; Coulson T; McCulloch G; Stronza A; Songhurst A: PLOS One, doi: https://doi.org/10.1371/journal.pone.0178840, 2017

Northern Botswana holds the largest population of African elephants in the world, and in the eastern Okavango Panhandle, 16,000 people share and compete for resources with more than 11,000 elephants. Hence, it is not surprising this area represents a human-elephant conflict (HEC) ‘hotspot’ in the region. Crop-raiding impacts lead to negative perceptions of elephants by local communities, which can strongly undermine conservation efforts. The authors investigated the trend in the number of reported raiding incidents as one of the indicators of the level of HEC, and assessed its relationship to trends in human and elephant population size, as well as land-use in the study area from the 1970s to 2015. They found that the level of reported crop raiding by elephants in the eastern Panhandle appears to have decreased since 2008, which seems to be related more to the reduction in agricultural land allocated to people in recent years, more than the human and elephant population size. Although the study represents a first step in developing a HEC baseline in the eastern Panhandle, it highlights the need for additional multi-scale analyses that consider progress in conservation conflict to better understand and predict drivers of HEC in the region.

‘These are not luxuries, it is essential for access to life’: Disability related out-of-pocket costs as a driver of economic vulnerability in South Africa
Hanass-Hancock J; Nene S; Deghaye N; Pillay S: African Journal of Disability 6(0), a280, 2017

Middle-income countries are home to a growing number of persons with disabilities but with limited evidence on the factors increasing economic vulnerability in people with disabilities in these countries. This article presents data related to elements of this vulnerability in one middle-income country, South Africa. Focusing on out-of-pocket costs, it uses focus group discussions with 73 persons with disabilities and conventional content analysis to describe these costs. A complex and nuanced picture of disability-driven costs evolved on three different areas: care and support for survival and safety, accessibility of services and participation in community. Costs varied depending on care and support needs, accessibility (physical and financial), availability, and knowledge of services and assistive devices. The development of poverty alleviation and social protection mechanisms in middle-income countries like South Africa should, the authors argue, better consider diverse disability-related care and support needs not only to improve access to services such as education and health but also to increase the effect of disability-specific benefits and employment equity policies

Palm Wine Collectors
Weeks K: Lens Culture, June 2017

In Namibia, a generations-long tradition of tapping the sap of palm trees runs counter to recent environmental protection efforts. Is this an essential cultural practice or merely destructive? These striking portraits investigate. The images in this series portray the Himba men who select, prepare and maintain Makalani palms during the sap tapping process. The Himba people from this area have utilised this plant family for generations, passing down the knowledge and technique needed to carry out the process of obtaining the liquid. Although the Makalani palm is a protected tree in Namibia and the tapping of palms a banned practice, the Himba firmly believe that it is their right to continue the tradition. They argue against Western law and instead follow ancient cultural traditions that respect these palms through their utilisation. In turn, they promote their conservation on a local, cultural level.

Tobacco use among people living with HIV: analysis of data from Demographic and Health Surveys from 28 low-income and middle-income countries
Mdege N; Shah S; Ayo-Yusuf O; Hakim J; Siddiqi K: The Lancet Global Health 5(6), e578-e592, 2017

Tobacco use among people living with HIV results in excess morbidity and mortality. However, very little is known about the extent of tobacco use among people living with HIV in low-income and middle-income countries (LMICs). The authors assessed the prevalence of tobacco use among people living with HIV in LMICs. The authors used Demographic and Health Survey data collected between 2003 and 2014 from 28 LMICs where both tobacco use and HIV test data were made publicly available. They estimated the country-specific, regional, and overall prevalence of current tobacco use (smoked, smokeless, and any tobacco use) among 6729 HIV-positive men from 27 LMICs (aged 15–59 years) and 11 495 HIV-positive women from 28 LMICs (aged 15–49 years), and compared them with those in 193 763 HIV-negative men and 222 808 HIV-negative women, respectively. The authors estimated prevalence separately for males and females as a proportion, and the analysis accounted for sampling weights, clustering, and stratification in the sampling design. They computed pooled regional and overall prevalence estimates through meta-analysis with the application of a random-effects model. They computed country, regional, and overall relative prevalence ratios for tobacco smoking, smokeless tobacco use, and any tobacco use separately for males and females to study differences in prevalence rates between HIV-positive and HIV-negative individuals. The overall prevalence among HIV-positive men was 24·4% for tobacco smoking, 3·4% for smokeless tobacco use, and 27·1% for any tobacco use. The authors found a higher prevalence in HIV-positive men of any tobacco use (risk ratio [RR] 1·41 and tobacco smoking than in HIV-negative men (both p<0·0001). The difference in smokeless tobacco use prevalence between HIV-positive and HIV-negative men was not significant. The overall prevalence among HIV-positive women was 1·3% for tobacco smoking, 2·1% for smokeless tobacco use, and 3·6% for any tobacco use. The authors found a higher prevalence in HIV-positive women of any tobacco use, tobacco smoking and smokeless tobacco use than in HIV-negative women. The high prevalence of tobacco use in people living with HIV in LMICs mandates targeted policy, practice, and research action to promote tobacco cessation and to improve the health outcomes in this population.

Women who live on the margin of society: A dialogue with Tshepo Jamillah Moyo
Mogami G: Africa In Dialogue, 7 June 2017

Born 1994, Tshepo Jamillah Moyo (TJ) is an unapologetic black Pan African Inter-sectional Feminist performance artist. Her work centres on the exploration of black African womanhood. In this conversation, she discusses her provocation at a recent march in Botswana on the 3rd of June where human rights and gender activists, and fellow women marched in the RIGHT TO WEAR WHAT I WANT walk, which aimed to highlight that no one has the right to violate another human being based on what they are wearing. Moyo argues that there is a need for an intersectional feminism that thinks about every single woman, and all the intersections of her life where oppression derives from.

“If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing”: The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda
Flax V; Yourkavitch J; Okello E; Kadzandira J; Katahoire A; Munthali A: PLOS One, doi: https://doi.org/10.1371/journal.pone.0178298, 2016

The role of gender in prevention of mother-to-child transmission (PMTCT) participation under Option B+ has not been adequately studied, but it is critical for reducing losses to follow-up. This study used qualitative methods to examine the interplay of gender and individual, interpersonal, health system, and community factors that contribute to PMTCT participation in Malawi and Uganda. The authors conducted in-depth interviews with women in PMTCT, women lost to follow-up, government health workers, and stakeholders at organisations supporting PMTCT as well as focus group discussions with men. They analysed the data using thematic content analysis. The authors found many similarities in key themes across respondent groups and between the two countries. The main facilitators of PMTCT participation were knowledge of the health benefits of ART, social support, and self-efficacy. The main barriers were fear of HIV disclosure and stigma and lack of social support, male involvement, self-efficacy, and agency. Under Option B+, women learn about their HIV status and start lifelong ART on the same day, before they have a chance to talk to their husbands or families. Respondents explained that very few husbands accompanied their wives to the clinic, because they felt it was a female space and were worried that others would think their wives were controlling them. Many respondents said women fear disclosing, because they fear HIV stigma as well as the risk of divorce and loss of economic support. If women do not disclose, it is difficult for them to participate in PMTCT in secret. If they do disclose, they must abide by their husbands’ decisions about their PMTCT participation, and some husbands are unsupportive or actively discouraging. To improve PMTCT participation, the authors propose that Ministries of Health use evidence-based strategies to address HIV stigma, challenges related to disclosure, insufficient social support and male involvement, and underlying gender inequality.

South Africa sets up program to break the link between HIV and violence
Westcott L: Newsweek, April 2017

South Africa has piloted a new program, 'Safe and Sound' to reduce the common risk of violence against pregnant women in South Africa. Most women were found to not speak about the violence they endure. In addition to rape and sexual violence, coercive or controlling behaviour, such as a man refusing to use a condom or restricting other forms of birth control, is argued to increase the risk of contracting HIV. Women who are HIV-positive and experience intimate partner violence are reported by the author to be half as likely to take their HIV medications as women in nonviolent relationships, leaving them in much poorer health. The author urges that countries adopt programs like Safe and Sound because violence against women, including HIV positive women, can lead to a deterioration in their mental health, with some women stopping their medication and developing suicidal tendencies.

Economic burden of family caregiving for elderly population in southern Ghana: the case of a peri-urban district
Nortey S; Aryeetey G; Aikins M; Amendah D; Nonvignon J: International Journal Equity Health 16(16), 2017, doi: 10.1186/s12939-016-0511-9.

Close-to-client community-based approaches are argued by the authors to be a low-cost way of providing basic care and social support for elderly populations in such resource-constrained settings and that family caregivers play a crucial role in that regard. However, family caregiving duties are often unpaid and their care-related economic burden is often overlooked, despite this knowledge being important in designing or scaling up effective interventions. This study, therefore, estimated the economic burden of family caregiving for the elderly in southern Ghana. It used a retrospective cross-sectional cost-of-care design in 2015 among family caregivers for elderly registered for a support group in a peri-urban district in southern Ghana. A simple random sample of 98 respondents representative of the support group members completed an interviewer-administered questionnaire. Costs were assessed over a 1-month period. Direct costs of caregiving (including out-of-pocket costs incurred on health care) as well as productivity losses (i.e. indirect cost) to caregivers were analysed. The estimated average cost of caregiving per month was US$186.18, 66% of which was a direct cost. About 78% of the family caregivers in the study reported a high level of caregiving burden with females reporting a relatively higher level than males. Further, about 87% of the family caregivers reported a high level of financial stress as a result of caregiving for their elderly relative. The study shows that support/caregiving for elderly populations imposes economic burden on families, potentially influencing the economic position of families with attendant implications for equity and future family support for such vulnerable populations.