Partner alcohol consumption and intimate partner violence against women in sexual unions in sub-Saharan Africa

Introduction: Intimate partner violence is increasingly gaining attention as the leading form of violence against women globally, particularly sub-Saharan Africa. Given that substance abuse, especially alcohol consumption has long been associated with aggressive behaviour, emotional abuse, and sexual misconduct, it is surprising that studies on the potential association between partner’s alcohol consumption and intimate partner violence are scarce. The current study seeks to fill this gap in the literature by examining the association between partner’s alcohol consumption and intimate partner violence among women in sub-Saharan Africa. Methods: Cross-sectional survey data of 89,229 women aged 15 to 49 in sexual unions from 21 sub-Saharan African countries were pooled from the Demographic and Health Surveys. Percentages with their corresponding confidence intervals (CIs) were used to present the results of the prevalence of partner’s alcohol consumption and intimate partner violence. Multivariable binary logistic regression analysis was used to examine the association between partner’s alcohol consumption and intimate partner violence. The regression analysis results were presented using adjusted odds ratio (aOR) with 95% CI. Statistical significance was set at p<0.05. Results: The pooled prevalence of partner alcohol consumption was 36.3% [36.0–36.6]. The highest prevalence of partner alcohol consumption was found in Burundi (67.1%) with Mali (3.9%) recording the lowest prevalence. Similarly, the overall prevalence of physical violence, emotional violence, and sexual violence among the women were 19.7% [19.2–20.2], 25.0% [24.5–25.5], and 9.7% [9.3–10.1], respectively. In the pooled data, women whose partners consumed alcohol were more likely to experience physical violence [aOR = 2.37, 95% CI = 2.24–2.50], emotional violence [aOR = 1.96, 95% CI = 1.86–2.07], and sexual violence [aOR = 2.03, 95% CI = 1.89–2.18] compared to those whose partners did not consume alcohol. In all the 21 countries, women whose partners consumed alcohol had higher odds for physical and emotional violence. The odds of sexual violence was higher among women whose partners consumed alcohol compared to their counterparts whose partners did not in 20 countries, except Namibia. Conclusions: We found that partner’s alcohol consumption increases women’s likelihood of experiencing physical, emotional, and sexual violence in sub-Saharan Africa. There is the need to implement behavioural change interventions targeted at male partners to reduce alcohol consumption. The findings call for the need to effectively create and organize support networks in addressing intimate partner violence among married and cohabiting women

Joint effect of water and sanitation practices on childhood diarrhoea in sub-Saharan Africa

Background: Diarrhoea remains the major cause of morbidity and mortality of children under five years in Africa. Several studies have shown that inadequate and unsafe water, lack of sanitation, and poor hygiene practices are complex issues for different pathogens and accountable for the occurrence of diarrhoea diseases. We assessed the combined effect of household’s source of drinking water and type of toilet facility and residential wellbeing on the incidence of childhood diarrhoea in 33 Sub-Saharan Africa countries while accounting for relevant compositional and contextual factors. Methods: The 2010–2019 datasets from the Demographic and Health Surveys were drawn for analyses. The outcome variable used in this study was the incidence of childhood diarrhoea. Three negative log-log generalized linear regression models were then sequentially fitted to the data to examine the joint effect of household water and sanitation practices on child diarrhoea. The results were presented using crude odds ratios (CORs) and adjusted odds ratios (AORs) at 95% confidence intervals (CIs). Using ArcGIS software, maps were design to unveil the spatial distribution of key variables. Findings: Approximately 16% of the 307,741 mothers interviewed reported an incidence of diarrhoea disease among children under-five years in their households. The results showed that a household depending on an unimproved source of drinking water and with an unimproved type of toilet facility was not significantly associated with childhood diarrhoea. However, those with improved drinking water but an unimproved type of toilet facility had higher odds of reporting childhood diarrhoea (AOR = 1.020, 95% CI = 1.003-1-036) compared to those in households with both improved source of drinking water and type of toilet facility. Across the geographical regions, Eastern (aOR = 1.102, 95% CI = 1.084–1.120) and Central Africa (aOR = 1.102, 95% CI = 1.083–1.121) were more likely to experience child diarrhoea. Conclusion: Water and sanitation practices such as the source of drinking water and toilet facility, and geographic region had significant effects on childhood diarrhoea in sub-Saharan Africax. The findings suggest the need for multi-sectoral actions that recognise the geo-spatial and temporal characteristics identified in the study through regional to national policies. Water and sanitation community-based interventions that seek to improve equitable access to safe water and sanitation in the sub-region should be intensified

Evidence of rational market valuations for home energy efficiency

According to this study, residential real estate markets assign to energy-efficient homes an incremental value that reflects the discounted value of annual fuel savings. The capitalization rate used by homeowners was expected to be 4%-10%, reflecting the range of after-tax mortgage interest rates during the 1990s and resulting in an incremental home value of $10 to around$25 for every $1 reduction in annual fuel bills. Regression analysis of American Housing Survey data confirms this hypothesis for national and metropolitan area samples, attached and detached housing, and detached housing subsamples using a specific fuel type as the main heating fuel

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Monetary policy reaction function and transmission effectiveness: evidence from full-fledged inflation targeting Sub-Saharan African countries

A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Commerce, Law and Management in the Graduate School of Business Administration, Wits Business School, University of the Witwatersrand, Johannesburg, 2020The relevance of monetary policy rules in providing a framework for policy coherence, stability and optimality has long been acknowledged. The eventual impact of optimal monetary policy response on the real economy, dependent on the effectiveness of the channels of transmission of monetary policy impulses, is even more crucial. Much as empirical literature on monetary policy rules and transmission effectiveness abound, substantial limitations still persist. The continuous focus on linear policy rules in the face of observed asymmetry in monetary policy behaviour; the dilemma and constraints posed to monetary policy responses by rising public debt levels; the direct approach to transmission channel exposition that is far from theoretical prescription; the assumption of homogeneity in prices that confront all agents in an economy which is far from reality; and the egregious neglect of the stabilizing effect of monetary policy on food prices despite the colossal role of the latter in the overall inflation dynamics of developing and poor economies are important research gaps in the monetary policy rule and transmission literature. Meanwhile, appropriate policy characterization and succinct comprehension of the dynamics of transmission are critical in shaping optimal and welfare-enhancing monetary policy. This thesis is centred on four thematic areas, with each considering an important gap (as a distinct essay) relating to monetary policy characterization and transmission. The first essay considers a nonlinear Taylor rule for the characterization of the monetary policy responses of the only two full-fledged inflation targeting central banks in Africa (Bank of Ghana and the South African Reserve Bank) and whether the said responses are constrained by rising public debt levels. With the aid of the sample splitting and threshold estimation technique, we find asymmetric reaction to inflation and output gaps when inflation falls below or exceeds our estimated optimal thresholds of 16.4% and 5.2% for Ghana and South Africa respectively, with the South African Reserve Bank being relatively more aggressive in its response to inflation gap above the threshold. The Bank of Ghana is not responsive to output gap on either side of the threshold. Importantly, we find that the monetary policy behaviour of the two central banks is far from the linear characterization and parametrization so common in the literature. For Ghana, we question the logic behind the prevailing upper and lower bounds given the evidence to the contrary. In respect of debt constraint on monetary policy, our estimated threshold level of debt to GDP ratio for Ghana and South Africa are respectively 35.1% and 33.7%. For Ghana, although policy response to inflation gap exhibits relative aggression above the estimated debt to GDP threshold of 35.1%, the extent of response is woefully disproportionate, a key indication of debt constraint and inflation accommodation. For South Africa, we find that the policy response in the low debt regime to inflation gap is negative, on the back of accommodative monetary policy when inflation exceeded the upper limit of the announced target in the midst of challenging growth path. Although the response to inflation gap in the high debt regime is positive, it is substantially constrained. The extent to which monetary policy decisions exact the desired results in the real economy is essentially a function of the effectiveness of the channels of monetary policy transmission. Comprehending the architecture and dynamics of the workings of these channels is thus critical for the monetary policymakers, as it helps them to determine how and when their decisions eventually impact the real economy and the nature of instruments to adopt. We revisit, in the second essay, the workings of the interest rate and bank lending channels in an indirect and systematic approach anchored on the theoretical prescriptions and a major departure from empirical literature. With the aid of the three stage least square technique (3SLS) in a system of equations, we find that the interest rate and the lending channels are operative in Ghana and South Africa. We find that whiles the lending channel is more effective relative to the interest rate channel in South Africa, the reverse is the case in Ghana. The fact that different regions/provinces have different economic structures and endowments is an ample reason to expect that price developments in these regions/provinces and their responses to monetary policy would necessarily be distinct. Literature has largely assumed homogeneity in the prices that confront economic agents with dire consequences for welfare. The third essay, therefore, looks at asymmetric effect of monetary policy on regional and provincial inflation in Ghana and South Africa. Using wavelet-based quantile regression for the first time in this strand of the literature, we provide a multi-layered asymmetric exposition on regional inflation-monetary policy relationship. We find that regions/provinces respond differently to changes in monetary policy. For Ghana, we find that for Central, Eastern, Greater Accra, Northern and Western regions, a restrictive monetary policy exacts mixed effect. Whiles monetary policy delivered stability across distinct quantiles in some scales, it fueled inflationary momentum in other scales, especially the higher scales or longer horizons. The responses are also distinct across scales and quantiles for each of the regions and across regions. In the case of Ashanti, Brong Ahafo and Volta regions, we find that a restriction in monetary policy only destabilizes prices across quantiles and in distinct scales. For South Africa, we find that whiles restrictive monetary policy delivers stability in the prices of Gauteng, Mpumalanga and North West provinces, it is destabilizing for prices in Eastern Cape, KwaZulu-Natal, Limpopo, Northern Cape and Western Cape provinces. For Free State province, the effect of a restrictive monetary policy on prices is mixed, depending on the horizon and the quantile involved. Food prices continue to play an important role in the overall inflation dynamics of many countries. For inflation targeting central banks and monetary policymakers in developing and low-income countries in particular, food prices pose even more challenges both from the perspective of achieving inflation targets and the welfare of the many poor households in these economies. In the fourth essay, we look at the stabilizing effect of monetary policy on food inflation in Ghana and South Africa using the quantile regression analysis. For Ghana, we find that monetary policy exerts positive effect on food prices across all the quantiles but the said effect is only statistically significant at the 25th quantile. For South Africa, monetary policy positively influences prices of food and the effect is significant across all the quantiles and prominently at the right tail. Thus, rising food prices in these countries are destabilized even further when monetary policy response is restrictive. On policy front, the relative inflation accommodation on the part of these central banks is deleterious to their credibility and disastrous for anchoring expectations of inflation which is exacerbated by the observed debt constraint. The findings on the operations of the bank lending and interest rate channels provide policy directions for the authorities to exact the required impact on the real economy and inflation in particular. Such policy directions are enhanced by the invaluable information on the heterogeneous regional responses to policy and the colossal role played by food prices in the African setting.TL (2020

Revisiting interest rate and lending channels of monetary policy transmission in the light of theoretical prescriptions

Although theories on channels of monetary policy transmission emphasize indirect monetary policy effect on inflation and output, empirical literature is surprisingly rooted in a direct approach. The use of variants of vector autoregression, with theoretical ordering of variables, does not only fail to quantify the indirect effect, but are also fraught with disagreements on identification of shocks of monetary policy. We revisit the interest rate and lending channels of monetary policy transmission in an approach that is grounded in theory and elicits step-by-step transmission of monetary policy impulses and the eventual effect on inflation in South Africa. We find interest rate and lending channels to be operative in South Africa. For the interest rate channel, a percentage restriction in monetary policy increases lending rate by 0.29%; a percentage increase in the lending rate reduces investment by 0.063%; and a percentage fall in investment reduces inflation by 0.074%. For the lending channel, a percentage restriction of monetary policy reduces banking sector credit by 0.22%; a percentage fall in private sector credit reduces investment by 0.20%; and a percentage decline in investment reduces inflation by 0.086%. These results are robust to different samples and specifications

Heterogeneous provincial prices and monetary policy in South Africa: A wavelet-based quantile regression analysis

Although economic agents in different parts of a country face heterogeneous prices, empirical literature continue to assume homogeneity in the monetary policy-inflation nexus, with dire consequences for optimal monetary policy and welfare. Using wavelet-based quantile regressions, we provide a multi-layered asymmetric exposition on provincial inflation-monetary policy relationship in South Africa. We find that whiles restrictive monetary policy delivers stability in the prices of Gauteng, Mpumalanga and North West provinces, it is destabilizing for prices in Eastern Cape, KwaZulu-Natal, Limpopo, Northern Cape and Western Cape provinces. The findings are mixed, for Free State province, depending on the time horizon and quantiles. Our findings present enormous policy and welfare implications, given the inflation targeting status of South Africa and the economic disparities among the provinces of the country

Estimating bank of Ghana's policy responses in the context of Taylor rule: Is the inflation target realistic?

Although literature acknowledges the nonlinearity in monetary policy behaviour of central banks, the appropriateness of the models used to capture the nonlinearity remains questionable. Moreover, the paucity of research on nonlinear monetary policy rules in the context of Africa and Ghana in particular is worrying, given the numerous breaches of the publicly announced inflation targets. The study estimates the Bank of Ghana's policy responses over the inflation targeting period using the Taylor rule. We find that the Bank of Ghana reacts asymmetrically to inflation gap below and above the estimated inflation threshold of 16.4% with considerable inflation accommodation instead of targeting it. We question the logic behind the prevailing upper and lower bounds inflation target given the evidence to the contrary. The average inflation over the targeting period, the estimated inflation threshold and the structure of the Ghanaian economy raise questions of feasibility of achieving the inflation target on sustainable basis. Policy implications are discussed

Foreign Direct Investment and child health outcomes in Africa

AbstractWhile several studies have examined the effect of Foreign Direct Investment (FDI) on economic development indicators, most of these studies focused on economic growth with very little attention paid to health outcomes. Moreover, among the studies that took account of health outcomes, none of them investigated the effect of FDI on child health outcomes across a sample of African countries. However, focusing on African countries is very important because sub-Saharan Africa (SSA) has the highest rate of child mortality in the world. This study, therefore, investigates the effect of FDI on child health outcomes in 39 African countries from 1980 to 2018. Neonatal and infant mortality rates are used to proxy child health outcomes. The baseline estimation technique employed is the Fixed Effects (FE) regression. However, to deal with potential endogeneity, we employ the system Generalised Method of Moments (GMM) regression as the robustness estimation technique. Our findings show that, FDI improves child health outcomes, especially through economic growth after controlling for endogeneity. Thus, in African governments’ quest to reduce child mortality, a major useful strategy could be attracting more FDI inflows

Are senior high school students in Ghana meeting WHO's recommended level of physical activity? Evidence from the 2012 Global School-based Student Health Survey Data.

INTRODUCTION:Physical activity (PA) has both short- and long-term importance. In this study we sought to assess the prevalence and correlates of PA among 1,542 Senior High School (SHS) students. METHODS:A cross-sectional study was conducted in Ghana among SHS students using the 2012 version of the Ghana Global School-based Student Health Survey (GSHS) data, which utilised two-stage cluster sampling technique. The population for the study comprised SHS students. The outcome variable was physical activity. The data were analysed using STATA version 14.2 for Mac OS. Both bivariate and multivariate analyses were employed. At the bivariate level, Pearson chi-square test between each independent variable and PA was conducted and the level of statistical significance was set at 5%. All the significant variables from the chi-square test were selected for the multivariate analysis. In the multivariate analysis, Poisson regression with robust variance was performed to estimate crude and adjusted prevalence ratios (APR). RESULTS:It was found that 25.0% (29.0% males and 21.9% females) of SHS students were physically active. Female students (APR = 0.78, 95% CI = 0.65, 0.94), students in SHS 2 (APR = 0.76, 95% CI = 0.577, 0.941) and SHS3 (APR = 0.79, 95% CI = 0.63, 0.93), and those who went hungry (APR = 0.77, 95% CI = 0.65, 0.92) were less likely to be physically active compared to males, those in SHS1 and those who did not go hungry respectively. On the other hand, students who actively commuted to school (APR = 2.40, 95% CI = 1.72, 2.42) and got support from their peers were more likely to be physically active (APR = 1.62, 95% CI = 1.09-2.41). CONCLUSION:Only a quarter of SHS students who participated in the 2012 version of the GSHS met the WHO's recommended level of physical activity. Sex, grade/form and experience of hunger are associated with physical activity. Physical activity is a major component of any health promotion program. Policies and programmes targeting improvement in physical activity among SHS students should take these associated factors into consideration