Cost-effectiveness and social outcomes of a community-based treatment for podoconiosis lymphoedema in the East Gojjam zone, Ethiopia

Background Podoconiosis is a disease of the lymphatic vessels of the lower extremities that is caused by chronic exposure to irritant soils. It results in leg swelling, commonly complicated by acute dermatolymphangioadenitis (ADLA), characterised by severe pain, fever and disability. Methods We conducted cost-effectiveness and social outcome analyses of a pragmatic, randomised controlled trial of a hygiene and foot-care intervention for people with podoconiosis in the East Gojjam zone of northern Ethiopia. Participants were allocated to the immediate intervention group or the delayed intervention group (control). The 12-month intervention included training in foot hygiene, skin care, bandaging, exercises, and use of socks and shoes, and was supported by lay community assistants. The cost-effectiveness analysis was conducted using the cost of productivity loss due to acute dermatolymphangioadenitis. Household costs were not included. Health outcomes in the cost-effectiveness analysis were: the incidence of ADLA episodes, health-related quality of life captured using the Dermatology Life Quality Index (DLQI), and disability scores measured using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Results The cost of the foot hygiene and lymphoedema management supplies was 529 ETB (69 I$, international dollars) per person per year. The cost of delivery of the intervention as part of the trial, including transportation, storage, training of lay community assistants and administering the intervention was 1,890 ETB (246 I$) per person. The intervention was effective in reducing the incidence of acute dermatolymphangioadenitis episodes and improving DLQI scores, while there were no significant improvements in the disability scores measured using WHODAS 2.0. In 75% of estimations, the intervention was less costly than the control. This was due to improved work productivity. Subgroup analyses based on income group showed that the intervention was cost-effective (both less costly and more effective) in reducing the number of acute dermatolymphangioadenitis episodes and improving health-related quality of life in families with monthly income <1,000 ETB (130 I$). For the subgroup with family income ≥1,000 ETB, the intervention was more effective but more costly than the control. Conclusions Whilst there is evident benefit of the intervention for all, the economic impact would be greatest for the poorest

Who Benefits from Production Outcomes? Gendered Production Relations among Climate-Smart Agriculture Technology Users in Rural Ethiopia

The use of agricultural technologies is generally expected to increase production and household incomes. Gendered disparities in making use of agricultural outcomes could result in inequitable agricultural develop-ment. However, too little is known about whether the use of agricultural tech-nologies improves gendered production relations, particularly in the Global South. This study investigates the question of gender-equitable production relations by drawing on empirical data from women and men smallholders involved in conservation agriculture and small-scale irrigation schemes in three study areas in Ethiopia. Findings show that the use of agricultural tech-nologies does not improve unequal gendered production relations; rather, gender norms that exist within patriarchal social structures continue to influ-ence production relations in at least three ways. First, societal norms restrict women from asserting their self-interest in gendered bargaining. Second, there is a customary law in all the study areas that allows men (but not women) to inherit land—thus providing men with better bargaining and decision-making positions over production outcomes, as they bring land to the mar-riage. Third, the restricted access of women to rural institutional services further contributes to unequal gendered production relations, as these ser-vices support men more than women in the use of agricultural technologies for enhanced production.acceptedVersio

Who Benefits from Production Outcomes? Gendered Production Relations among Climate-Smart Agriculture Technology Users in Rural Ethiopia

The use of agricultural technologies is generally expected to increase production and household incomes. Gendered disparities in making use of agricultural outcomes could result in inequitable agricultural develop-ment. However, too little is known about whether the use of agricultural tech-nologies improves gendered production relations, particularly in the Global South. This study investigates the question of gender-equitable production relations by drawing on empirical data from women and men smallholders involved in conservation agriculture and small-scale irrigation schemes in three study areas in Ethiopia. Findings show that the use of agricultural tech-nologies does not improve unequal gendered production relations; rather, gender norms that exist within patriarchal social structures continue to influ-ence production relations in at least three ways. First, societal norms restrict women from asserting their self-interest in gendered bargaining. Second, there is a customary law in all the study areas that allows men (but not women) to inherit land—thus providing men with better bargaining and decision-making positions over production outcomes, as they bring land to the mar-riage. Third, the restricted access of women to rural institutional services further contributes to unequal gendered production relations, as these ser-vices support men more than women in the use of agricultural technologies for enhanced production

Gendered constraints for adopting climate-smart agriculture amongst smallholder Ethiopian women farmers

Although Climate-smart agriculture (CSA) can offer economic and food security opportunities for women farmers, success in the uptake of these technologies is contested by gendered constraints. Previous studies that use the household head as a unit of analysis to explain adoption patterns do not adequately demonstrate the extent to which women smallholders are restricted by gendered constraints. This study uses 344 women and men survey respondents involved in conservation agriculture (CA) and small-scale irrigation schemes (SSIS) as data sources for examining the effect of gendered constraints for adopting climate-smart agriculture amongst women in three areas in Ethiopia. Qualitative and quantitative data collections were applied using survey, in-depth interviews and focus group discussions. Quantitative data were analyzed using descriptive statistics, Pearson's chi-square test and binary logistic regression using statistical software for the social sciences (SPSS) version 24. Thematic and narrative analysis methods were used to analyze qualitative data. The findings show that women smallholders uptake is affected by limited access to credit, extension, restricted membership in cooperatives and water user associations, lack of access or user rights to land, skill training, information, and restricted mobility. Agricultural development interventions should be implemented by accepting and considering individual farmer's entitlement to development. Expanding off-farm diversification and rural employment opportunities through changing the land tenure system, which is currently state-owned, are essential to enhance women smallholders’ access to land and other agricultural inputs.publishedVersio

Gendered constraints for adopting climate-smart agriculture amongst smallholder Ethiopian women farmers

Although Climate-smart agriculture (CSA) can offer economic and food security opportunities for women farmers, success in the uptake of these technologies is contested by gendered constraints. Previous studies that use the household head as a unit of analysis to explain adoption patterns do not adequately demonstrate the extent to which women smallholders are restricted by gendered constraints. This study uses 344 women and men survey respondents involved in conservation agriculture (CA) and small-scale irrigation schemes (SSIS) as data sources for examining the effect of gendered constraints for adopting climate-smart agriculture amongst women in three areas in Ethiopia. Qualitative and quantitative data collections were applied using survey, in-depth interviews and focus group discussions. Quantitative data were analyzed using descriptive statistics, Pearson's chi-square test and binary logistic regression using statistical software for the social sciences (SPSS) version 24. Thematic and narrative analysis methods were used to analyze qualitative data. The findings show that women smallholders uptake is affected by limited access to credit, extension, restricted membership in cooperatives and water user associations, lack of access or user rights to land, skill training, information, and restricted mobility. Agricultural development interventions should be implemented by accepting and considering individual farmer's entitlement to development. Expanding off-farm diversification and rural employment opportunities through changing the land tenure system, which is currently state-owned, are essential to enhance women smallholders’ access to land and other agricultural inputs