In-migrants and exclusion in east African rangelands: access, tenure and conflict

East African rangelands have a long history of population mobility linked to competition over key resources, negotiated access, and outright conflict. Both in the literature and in local discourse, in-migration is presented as leading to increased competition, driving poverty and social exclusion on the one hand, and conflict and violence on the other. Current analyses in developing countries identify economic differences, ethnic fault lines, ecological stresses and a breakdown in state provision of human and constitutional rights as factors in driving conflict. The present paper explores this interaction of in-migration and conflict with respect to Kenyan and Tanzanian pastoralist areas and populations. Using quantitative and qualitative methods, patterns of resource access and control in Kenya and Tanzania Maasailand are explored in terms of the ways land and livestock are associated with migration status, ethnicity and wealth or political class. Contrasts and similarities between the two national contexts are used to develop a better understanding of the ways these factors operate under different systems of tenure and access. The conclusion briefly considers implications of these patterns, their potential for exacerbating poverty, and policies for minimising social exclusion and conflict in East African rangelands. / Abstract in French: Les prairies d'Afrique orientale connaissent depuis longtemps une mobilité des populations, liée aux problèmes de concurrence pour les ressources clés, d'accès négocié et de conflits pures et simples. Dans la littérature comme dans le discours local, l'immigration interne est présentée comme cause de concurrence accrue, motrice de pauvreté et d'exclusion sociale d'une part, et de conflit et de violence d'autre part. Des analyses menées actuellement dans les pays en développement identifient comme facteurs moteurs de conflit des écarts économiques, des failles ethniques, des tensions écologiques et une détérioration des droits humains et constitutionnels. Cet article examine l'interaction entre immigration interne et conflit au sein des régions et populations pastorales du Kenya et de la Tanzanie. Il utilise des méthodes quantitatives et qualitatives pour étudier les modèles d'accès et de contrôle des ressources dans le pays masaï du Kenya et de la Tanzanie en termes d'association des terres et du bétail au statut d'immigration, à l'ethnicité et à la catégorie de richesse ou politique. Les contrastes et similarités entre les deux contextes nationaux servent à mieux comprendre le mode de fonctionnement de ces facteurs dans des régimes fonciers et systèmes d'accès différents. La conclusion examine brièvement les implications de ces modèles, leur capacitéà exacerber la pauvreté et les politiques de minimisation de l'exclusion sociale et des conflits dans les prairies d'Afrique orientale

Development of a self-report measure of capability wellbeing for adults: the ICECAP-A

Purpose The benefits of health and social care are not confined to patient health alone and therefore broader measures of wellbeing may be useful for economic evaluation.\ud This paper reports the development of a simple measure of capability wellbeing for adults (ICECAP-A).\ud Methods In-depth, informant-led, interviews to identify the attributes of capability wellbeing were conducted with 36 adults in the UK. Eighteen semi-structured, repeat interviews were carried out to develop a capability-based descriptive system for the measure. Informants were purposively selected to ensure variation in socio-economic status, age, sex, ethnicity and health. Data analysis was carried out inductively and iteratively alongside interviews, and findings were used to shape the questions in later interviews.\ud Results Five over-arching attributes of capability wellbeing were identified for the measure: ‘‘stability’’,‘‘attachment’’, ‘‘achievement’’, ‘‘autonomy’’ and ‘‘enjoyment’’. One item, with four response categories, was developed for each attribute for the ICECAP-A descriptive system.\ud Conclusions The ICECAP-A capability measure represents a departure from traditional health economics outcome measures, by treating health status as an influence over broader attributes of capability wellbeing. Further work is required to value and validate the attributes and test the sensitivity of the ICECAP-A to healthcare interventions

Estimating preferences for a dermatology consultation using Best-Worst Scaling: Comparison of various methods of analysis

Background: Additional insights into patient preferences can be gained by supplementing discrete choice experiments with best-worst choice tasks. However, there are no empirical studies illustrating the relative advantages of the various methods of analysis within a random utility framework. Methods: Multinomial and weighted least squares regression models were estimated for a discrete choice experiment. The discrete choice experiment incorporated a best-worst study and was conducted in a UK NHS dermatology context. Waiting time, expertise of doctor, convenience of attending and perceived thoroughness of care were varied across 16 hypothetical appointments. Sample level preferences were estimated for all models and differences between patient subgroups were investigated using ovariateadjusted multinomial logistic regression. Results: A high level of agreement was observed between results from the paired model (which is theoretically consistent with the 'maxdiff' choice model) and the marginal model (which is only an approximation to it). Adjusting for covariates showed that patients who felt particularly affected by their skin condition during the previous week displayed extreme preference for short/no waiting time and were less concerned about other aspects of the appointment. Higher levels of educational attainment were associated with larger differences in utility between the levels of all attributes, although the attributes per use had the same impact upon choices as those with lower levels of attainment. The study also demonstrated the high levels of agreement between summary analyses using weighted least squares and estimates from multinomial models. Conclusion: Robust policy-relevant information on preferences can be obtained from discrete choice experiments incorporating best-worst questions with relatively small sample sizes. The separation of the effects due to attribute impact from the position of levels on the latent utility scale is not possible using traditional discrete choice experiments. This separation is important because health policies to change the levels of attributes in health care may be very different from those aiming to change the attribute impact per se. The good approximation of summary analyses to the multinomial model is a useful finding, because weighted least squares choice totals give better insights into the choice model and promote greater familiarity with the preference data

Poverty in African Households: the limits of survey representations

National and international statistics on poverty focus almost entirely on measurements at household level despite perspectives which suggest poverty should also be analysed in relation to perceived needs incorporating both material and human dimensions. Indicators calculated from surveys by-pass most notions of wealth in people We analyse what poverty means in a context of modernisation and the tensions and solutions developed by local residence units in order to survive and participate in a rapidly changing society. We compare domestic household strategies in rural and urban settings in Tanzania and Burkina Faso through detailed case studies (n=48 per country) to explore local understandings of household membership, contributions, demands, loyalties and intergenerational support. Across settings and countries we observe two contrasting responses to poverty generated by the changing socio-economic environment including new educational and health care needs and more material goods. Some households manage and mitigate poverty through extreme flexibility, maximising potential resources and managing safety nets through movement, economic diversification, sharing, or depending on kin and others in crisis. For these households wealth remains in people and in the spreading of risk and resources that people provide. The opposite response is isolation and self-containment - unable to request or offer help. Household survey data which measure poverty in terms of assets and material conditions may misrepresent both the resources base and those who can depend on it. Such data may represent the situation of isolated families and households well, but distort those for whom resources in people mitigates poverty

Measuring Health and Broader Well-Being Benefits in the Context of Opiate Dependence: The Psychometric Performance of the ICECAP-A and the EQ-5D-5L

BACKGROUND: Measuring outcomes in economic evaluations of social care interventions is challenging because both health and well-being benefits are evident. The ICEpop CAPability instrument for adults (ICECAP-A) and the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) are measures potentially suitable for the economic evaluation of treatments for substance use disorders. Evidence for their validity in this context is, however, lacking. OBJECTIVES: To assess the construct validity of the ICECAP-A and the EQ-5D-5L in terms of convergent and discriminative validity and sensitivity to change on the basis of standard clinical measures (Clinical Outcomes in Routine Evaluation-Outcome Measure, Treatment Outcomes Profile, Interpersonal Support Evaluation List, Leeds Dependence Questionnaire, and Social Satisfaction Questionnaire). METHODS: A secondary analysis of pilot trial data for heroin users in opiate substitution treatment was conducted. Baseline convergence with clinical measures was assessed using the Pearson correlation coefficient. Discriminative validity was assessed using one-way analysis of variance and stepwise regressions. Sensitivity to changes in clinical indicators was assessed at 3 and 12 months using the standardized response mean statistic and parametric and nonparametric testing. RESULTS: Both measures had the same level of construct validity, except for clinical indicators of well-being, for which the ICECAP-A performed better. The ICECAP-A was sensitive to changes in both health and well-being indicators. The EQ-5D-5L had lower levels of sensitivity to change, and a ceiling effect (27%), particularly evident in the dimensions of self-care (89%), mobility (75%), and usual activities (72%). CONCLUSIONS: The findings support the construct validity of both measures, but the ICECAP-A gives more attention to broader impacts and is more sensitive to change. The ICECAP-A shows promise in evaluating treatments for substance use disorders for which recovery is the desired outcome

A longitudinal assessment of the responsiveness of the ICECAP-A in a randomised controlled trial of a knee pain intervention

PURPOSE: The ICECAP-A is a simple measure of capability well-being for use with the adult population. The descriptive system is made up of five key attributes: Stability, Attachment, Autonomy, Achievement and Enjoyment. Studies have begun to assess the psychometric properties of the measure, including the construct and content validity and feasibility for use. This is the first study to use longitudinal data to assess the responsiveness of the measure. METHODS: This responsiveness study was completed alongside a randomised controlled trial comparing three physiotherapy-led exercise interventions for older adults with knee pain attributable to osteoarthritis. Anchor-based methodologies were used to explore the relationship between change over time in ICECAP-A score (the target measure) and change over time in another measure (the anchor). Analyses were completed using the non-value-weighted and value-weighted ICECAP-A scores. The EQ-5D-3L was used as a comparator measure to contextualise change in the ICECAP-A. Effect sizes, standardised response means and t tests were used to quantify responsiveness. RESULTS: Small changes in the ICECAP-A scores were seen in response to underlying changes in patients' health-related quality of life, anxiety and depression. Non-weighted scores were slightly more responsive than value-weighted scores. ICECAP-A change was of comparable size to change in the EQ-5D-3L reference measure. CONCLUSION: This first analysis of the responsiveness using longitudinal data provides some positive evidence for the responsiveness of the ICECAP-A measure. There is a need for further research in those with low health and capability, and experiencing larger underlying changes in quality of life

An analysis of the complementarity of ICECAP-A and EQ-5D-3L in an adult population of patients with knee pain

BACKGROUND: The ICECAP measures potentially offer a broader assessment of quality of life and well-being, in comparison to measures routinely used in economic evaluation, such as the EQ-5D-3 L. This broader assessment may allow measurement of the full effects of an intervention or treatment. Previous research has indicated that the ICECAP-O (for older people) and EQ-5D-3 L measure provide complementary information. This paper aims to determine similar information for the ICECAP-A (for the entire adult population) in terms of whether the measure is a substitute or complement to the EQ-5D-3 L. METHODS: Data from the BEEP trial - a multi-centre, pragmatic, randomised controlled trial - were used. Spearman rank correlations and exploratory factor analytic methods were used to assess whether ICECAP-A and EQ-5D-3 L are measuring the same, or different, constructs. RESULTS: A correlation of 0.49 (p < 0.01) was found between the ICECAP-A tariff score and the EQ-5D-3 L index. Using the pooled items of the EQ-5D-3 L and the ICECAP-A a two factor solution was optimal, with the majority of EQ-5D-3 L items loading onto one factor and the majority of ICECAP-A items onto another. CONCLUSION: The results presented in this paper indicate that ICECAP-A and EQ-5D-3 L are measuring two different constructs and provide largely different, complementary information. Results showed a similarity to results presented by Davis et al. using the ICECAP-O. TRIAL REGISTRATION: ISRCTN 93634563

UN 'households' and local interpretations in Burkina Faso, Senegal, Uganda and Tanzania

Over the half century since Independence in most African states the UN Statistical Division has played an increasing role in getting member countries to standardise and streamline their data collection and in particular the definitions used for data collection. A key concept in censuses and surveys is the definition of household since this determines the units for which much data are collected and analysed, and thus influences the data which are the basis for many policies. In this paper we analyse the evolution of the UN household definition over this time period and what aspects of the household this definition appears to be trying to capture. Using detailed census and survey documentary data (from questionnaires, enumerator and supervisor manuals etc) for 4 African countries (Burkina Faso, Senegal, Uganda and Tanzania) we examine the extent to which each country has actually implemented this definition in different data collection activities over the last 50 years, highlighting differences between Anglophone and Francophone practice but also noting where country level idiosyncrasies and adaptations to local conditions are priorities. In a final stage perspectives provided from in-depth interviews with key informants from different levels within the hierarchy of statistical offices in each country, demonstrate the variability in the importance accorded to the UN harmonisation aims and the problems which arise when these standardised approaches interact with local norms and living arrangements