Remittances and poverty alleviation

Abdul Bayes is Professor of Economics at Jahangirnagarr University, Mahabub Hossain is a Distinguished Professor, BRAC University and ANM Mahfuzur Rahman is from Data Management Unit BRAC

Fragile Environment, Seasonality, and Maternal and Childhood Undernutrition in Bangladesh

Spatial distribution of poverty in Bangladesh shows that poverty is concentrated in ecologically unfavourable areas. Recently, the issue of spatial distribution of undernutrition has emerged as a matter of concern as well, considering the growing evidence of the strong persistence of existing inequalities.Therefore, whether ecological differences have affected nutritional outcomes is becoming an important issue for research. This paper aims to understand whether spatial and seasonal variations affect maternal and childhood undernutrition in Bangladesh. The study first tests the hypothesis whether agricultural and household incomes are same across different agro-ecological environments. It then carries out an in-depth analysis of the effect of unfavourable ecologies on maternal and child malnutrition. In the results, panel data analysis showed that household income is not equal across agro-ecology; the fragility of the environment may thus affect the household’s ability to access food, which may have negative influence on the nutritional status of mothers and children. Coastal areas have less dependence on agriculture, particularly on cultivation which diminished over time. Per capita income has been increasing in coastal areas, led by remittance growing at 8 per cent per year against 6 per cent in other areas. Regression analysis shows that a household in coastal zones earns 19 per cent lower than one in favourable zones. Although farm practices are lower in unfavourable areas, the deficiency is compensated by increased non-farm incomes. The results from the Food Security Nutrition Surveillance Projects (FSNSP) data found that overall the rate of stunting and wasting prevalence were 36 per cent and 11.7 per cent respectively. Among the mothers, nearly 28 per cent suffered from chronic energy deficiencies. The study found that highly significant regional heterogeneity in undernutrition exists in Bangladesh; alarmingly high levels prevail in the Haor Basin and coastal belt areas. The study also found significantly higher rates of underweight and wasting prevailing in the monsoon season compared to the two harvest seasons (post-Aman and post-Aus) among children under five. Month of birth failed to show any significant association with the nutrition outcome of the children. In order to determine the most effective strategies for accelerating reduction in undernutrition, it is important that the determinants of undernutrition are known. The findings of this study imply the importance of bringing geographical location and seasonal thinking back into the various current debates on hunger and nutrition

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Crop Diversity, Dietary Diversity and Nutritional Outcome in Rural Bangladesh: Evidences from VDSA Panel Household Surveys

Does crop diversity contribute toward dietary diversity and nutritional status of rural households in Bangladesh? The present study tries to answer this question. It has analysed panel household survey data collected from 500 households by ICRISAT and IRRI (2010/11 to 2014/15) under the Village Dynamics in South Asia (VDSA) project to examine the relationship between crop diversity, dietary diversity and nutritional status. Diversity in crop production has been estimated through the number of crops grown as also using Simpson’s Diversity Index. The study has quantified the level of food intake, dietary diversity and nutritional status of each of the members of all the sample households. Fixed effect panel data regression analysis has been carried out to assess the contribution of relevant factors to diversity in crop production and dietary diversity. Nutritional status of the household members has been examined using the Body Mass Index (BMI). Determinants of nutritional status for individual household members have been identified through panel data analysis. Finally, the study has articulated implications of the research findings for public investment, agricultural policies and nutritional programmes in Bangladesh.UKAIDDFI

Infrastructure and rural development: insights from a Grameen Bank village phone initiative in Bangladesh*

The intention of the present paper is to evaluate the role of telecommunications within the contexts of rural development in general and of poverty reduction in particular. Bangladesh has been selected as a case study due to the uniqueness it displayed in an innovative program for expanded telecom infrastructure, in which Grameen Bank (GB) of Bangladesh, the village-based micro-finance organisation, leased cellular mobile phones to successful members. GB calls these phones village pay phones (VPPs). The effects ofVPPs are assessed from two angles: sellers of services (telephone lessees/owners) and buyers of services (villagers). The findings of the study lead to two basic conclusions: first, pursuance of pragmatic policies can turn telephones into production goods, especially through lowering transaction costs, and second, the services originating from telephones in villages are likely to deliver (even) more benefits to the poor than to the non-poor. The VPPs also seem to have perceptible and positive effects on the empowerment and social status of phone-leasing women and their households. For villagers in general, phones offer additional non-economic benefits such as improved law enforcement, more rapid and effective communications during disasters, stronger kinship bonding, etc. GB's style of managing communications can help significantly to expand access to this vital information input for all segments of the population, reduce inequality and thus enhance the broad-based, pro-poor orientation of rural development activities.© 2001 Elsevier Science B.V. All rights reserved

Changes in Tenancy and Labor Markets and Impact on Livelihoods in Rural Bangladesh: Findings from a Longitudinal Survey 1988-2007

This paper outlines the change in rural factor markets, especially of tenancy and labor markets, to assesses the impact of change on livelihoods. This has been done with household level panel data for 1988 to 2008 period. The paper is based on a longitudinal survey of the same households in a nationally representative sample of 62 villages. The changes in markets are assessed by analyzing participation of households in the markets and the changes in the terms and conditions of the transaction. The impact on livelihoods is assessed by generating household level panel data, and relating changes in some livelihood indicators with the household‟s participation in the market. The land market is found insignificant but the tenancy market is vibrant. The percent of farm households renting land increased from 44 percent in 1988 to 58 percent in 2008, and the percent of holding rented increased from 23 to 36 percent. Sharecropping was predominant tenancy arrangement in 1988; it has given way to fixed rent and medium term lease arrangements. The agricultural labor market has been shrinking, and the mode of labor transactions has changed from seasonal to daily wage contracts and then to piecerated contract. The paper observes that movement of agricultural labor into tenant cultivation fell short of enhancing the probability of exit from poverty partly due to the unfavorable terms of trade of agricultural products over the period under review. Occupational mobility of the labor force from farm to non-farm has traditionally been rewarding in enhancing the growth of rural household income in Bangladesh