Counting the cost of premature mortality with progressively worse aortic stenosis in Australia: a clinical cohort study

Background: Aortic stenosis is the most common cardiac valve disorder requiring clinical management. However, there is little evidence on the societal cost of progressive aortic stenosis. We sought to quantify the societal burden of premature mortality associated with progressively worse aortic stenosis. Methods: In this observational clinical cohort study, we examined echocardiograms on native aortic valves of 98 565 men and 99 357 women aged 65 years or older across 23 sites in Australia, from Jan 1, 2003, to Dec 31, 2017. Individuals were grouped according to their peak aortic valve velocity in 0·50 m/s increments up to 4·00 m/s or more (severe aortic stenosis), using 1·00–1·99 m/s (no aortic stenosis) as the reference group. Sex-specific premature mortality and years of life lost during a 5-year follow-up were calculated, along with willingness-to-pay to regain quality-adjusted life years (QALYs). Findings: Overall, 20 701 (21·0%) men and 18 576 (18·7%) women had evidence of mild-to-severe aortic stenosis. The actual 5-year mortality in men with normal aortic valves was 32·1% and in women was 26·1%, increasing to 40·9% (mild aortic stenosis) and 52·2% (severe aortic stenosis) in men and to 35·9% (mild aortic stenosis) and 55·3% (severe aortic stenosis) in women. Overall, the estimated societal cost of premature mortality associated with aortic stenosis was AU$629 million in men and$735 million in women. Per 1000 men and women investigated, aortic stenosis was associated with eight more premature deaths in men resulting in 32·5 more QALYs lost (societal cost of $1·40 million) and 12 more premature deaths in women resulting in 57·5 more QALYs lost (societal cost of$2·48 million) when compared with those without aortic stenosis. Interpretation: Any degree of aortic stenosis in older individuals is associated with premature mortality and QALYs. In this context, there is a crucial need for cost-effective strategies to promptly detect and optimally manage this common condition within our ageing populations

How does school travel time impact children’s learning outcomes in a developing country?

Nearly 88% of children in sub-Saharan Africa will not be able to read by the time they complete primary school. We explore this phenomenon by using household data from the Ghana Living Standards Survey to examine the link between school travel time and children’s learning outcomes. Using district variations in school density to resolve endogeneity associated with children’s travel time to school and their learning outcomes, we find that more than 90% of children travel on foot to school and this negatively affects their ability to read and write in English or French as well as their ability to read and write in their native languages. We further show that boys, children in rural areas and those who travel more than the 75th percentile travel time (30 minutes) have poorer learning outcomes. Our findings highlight number of class hours missed and poor health as the main channels through which school travel time affects learning outcomes. Policy initiatives to improve children’s learning should consider reducing the costs associated with their school travel time. Considering that governments have limited resources with competing needs, policies aimed at reducing travel time should generally target children who commute more than 30 minutes to school and those in rural locations.</p

Employment status and educational attainment among disabled Ghanaians

People with disabilities in Ghana and other developing economies are discriminated against in many fundamental elements of human empowerment such as education and employment. While some employers are unwilling to hire, the educational systems do not provide enabling environment for a good education.This paper explores employment and educational attainment among people with disabilities. Although, people with disabilities have low employment probabilities, our finding suggests that education increases their chance of employment. Moreover, while women with disabilities are dually disadvantaged in the labour market, educational facilities far from home lead to improvement in disabled children’s educational achievements

How does ethnic diversity affect energy poverty? Insights from South Africa

We examine the effect of ethnic diversity on energy poverty in post-apartheid South Africa after several decades of racial segregation. We use both ethnic fractionalisation and polarisation indexes along with a multidimensional energy poverty measure from a five-year South African household-level panel data. Using historical information on ethnic diversity at the provincial level as an instrument to address endogeneity, we find that one standard deviation increase in ethnic diversity is associated with a 0.272 standard deviation decrease in energy poverty. This finding is robust across several quasi-experimental econometric approaches, different measures of ethnic diversity, and alternative cut-offs used to identify energy poor households in a multidimensional construct. Further analyses reveal that ethnic diversity reduces energy poverty only among people of colour, with the largest effect observed among native Black South Africans. Our mediation analysis highlights enhanced job opportunities and increased household incomes as the potential pathways through which ethnic diversity reduces energy poverty.</p

Can financial inclusion improve children's learning outcomes and late school enrolment in a developing country?

This study uses comprehensive household data from Ghana to examine the link between financial inclusion and children’s learning outcomes and late school enrolment. After resolving endogeneity, we find that a standard deviation increase in financial inclusion is associated with 0.7882 to 0.9504 standard deviations increase in children’s learning outcomes. It also reduces late school enrolment by 0.9493 standard deviation. Financial inclusion enhances learning and schooling outcomes more for girls and urban children. These findings are robust to different indicators of learning outcomes and alternative approaches to addressing endogeneity. Parents’ ability to spend on extra classes and on books and other school-related supplies serve as possible channels through which financial inclusion affects children’s educational outcomes.</p

Saving children's lives through interventions: a quasi-experimental analysis of GAVI

This study evaluates the impact of the Global Alliance for Vaccines and Immunization (GAVI) on children's health outcomes in developing countries. Using a difference-in-differences identification strategy, we find that GAVI has reduced neonatal, infant and under-five mortality rates. The impact of GAVI on children's health outcomes is larger in countries with lower per capita income. Our findings underscore the relevance of health interventions in improving children's health outcomes in developing economies.</p

Unravelling the Health Inequalities in Ghana: An Intersectional Perspective

Intersectionality theory has recently been applied in health research in addressing the complex interlocking social axes of differentiation. Several studies have focused on both single and across country health inequalities in the global North, less is known about health inequalities in the global South. This paper analyses health inequalities by examining how different social groups-categorised by the intersection of different social identities produce or reinforce health inequalities in Ghana. Using Ghana Living Standards Survey data and hierarchical linear regression method, we found that sex, employment status and spatial location drive health inequalities in Ghana. Findings also revealed differential inequalities in health by religious affiliation. The analyses also indicated that female headed households and household size were positively associated with hospital admissions. These findings suggest that health policy planning that centres on paying attention to interlocking social categories such as sex of the household heads, employment status, religious affiliation, and spatial context is a critical starting point for reducing health inequalities and improving the health of all Ghanaians.</p

Malaria infection among children under-five: the use of large-scale interventions in Ghana

Abstract Background Despite the significant investments to control malaria infection rates over the past years, infection rates remain significant in sub-Saharan Africa. This study investigates the association with use of large-scale malaria interventions such as: Indoor Residual Spraying (IRS), Insecticide Treated bed-Nets (ITN), and Behaviour Change Communication (BCC) strategies, and the prevalence of malaria among children under-five in Ghana. Methods Cross-sectional data on 2, 449 children aged 6 to 59 months who were tested for malaria, through Rapid Diagnostic Test (RDT), are drawn from the recent wave of the Ghana Demographic and Health Surveys (GDHS 2014). We use a logit model to analyse the heterogeneous association between control measures and malaria infection among under five children of different age cohorts and household poverty statuses. Results Our estimates suggest that IRS offers much more protection than ITN use. The odds of malaria infection among children who sleep in IRS is significantly lower (odds ratio [OR] = 0.312; 95% CI -1.47 -0.81; p = 0.00) compared to those who are not protected. This association is even high (odds ratio [OR] = 0.372; 95% CI -1.76 -1.02; p = 0.00) among children in poor households protected by IRS compared to those who have no IRS protection. ITN use did not have a significant association with malaria infection among children, except among children whose mothers have at least secondary education. For such children, the odds of malaria infection are significantly lower ([OR] =0.545; 95% CI = − 0.84 -0.11; p = 0.011) compared to those who are not protected. Regarding BCC strategies, we found that malaria education through television is the best strategy to covey malaria education as it significantly reduces the odds of malaria infection ([OR] =0.715; 95% CI = − 0.55 -0.10; p = 0.005) compared to those who do not received malaria education via television. BCC strategy via print media has a significant but limited protection for children of educated mothers. Conclusion Policy makers should direct more resources to IRS, especially in communities where the use of ITN is less likely to be effective, such as poor and rural households. The distribution of ITNs needs to be accompanied with education programs to ensure its best protection

Reforms and education inequality in Ghana

We analyze the evolvement of education inequality and the gender gap in Ghana before and after two major education reforms. Using different measures of inequality, our findings suggest that the gender gap at the basic school level has closed following the introduction of the education expansion policies, but inequalities persist at the postbasic school levels and across regions. We further demonstrate that the educational expansion–schooling inequality nexus is best illustrated by an inverted U-shaped Kuznets curve. We find that after an average of 6 years of schooling has been reached, inequality starts to decline, and gender equality can be achieved when the average years of schooling reach 9.</p