Assessing the impacts of cassava technology on poverty reduction in Africa

In Africa, there have been successes in cassava research in terms of the development of production technologies, particularly improved varieties with high yield potential. The study addresses the question of whether and to what extent adoption of improved cassava varieties has led to rural poverty reduction in four African countries, namely Tanzania, Democratic Republic of Congo, Sierra Leone and Zambia. Data for the study come from a household survey conducted in the above-mentioned countries through a multinational-CGIAR support to agricultural research for development of strategic crops (SARD-SC) project in Africa. Given the observational nature of the data, a parametric approach (endogenous switching regression model) is applied. The results indicate that the model detects selectivity bias. Accounting for the bias, we find that adoption of cassava technology has resulted in an approximately 10 percentage point reduction in the poverty rate. Given an adoption rate of 34 per cent and a 10 percentage point reduction in the poverty rate, an estimated 24,309 households (equivalent to 194,469 individuals) have managed to move out of poverty in these four countries as a result of adoption of the technology. We also find that adoption of the technology has benefitted non-poor and female-headed households, relative to poor and male-headed households. The results present important evidence in favour of promoting cassava technology in a targeted fashion as part of an effective poverty reduction and sustained agricultural growth strategy in Africa. Considering the large realised and even more pronounced potential impacts of the adoption of cassava technology on poverty reduction, it is vital that regional and global development organisations should continue supporting the existing cassava improvement programme to sustain the technology development efforts in the continent

The speed of postharvest technology adoption in Tanzania: the role of social learning and agricultural extension services

This study examines the impacts of social learning and extension services on the time it takes to adopt an improved postharvest technology called Purdue Improved Crop Storage (PICS) bag in Tanzania. We utilized the doubly robust multivalued inverse probability weighted regression (MIPWRA) model in a survival treatment effects framework to estimate the impact. We also applied the Laplace regression model to evaluate the heterogeneous effects of the two information sources. Overall, results from the MIPWRA indicate that social learning and extension services reduce the time to adopt PICS bags by 51% and 49%, respectively. The results further show that the speed at which farmers adopted the technology was faster when using the two information sources jointly (61%) than individually. The results from the Laplace regression model also show that the impacts of social learning and extension services vary significantly across the time to adoption distribution. The marginal impacts of the two information sources are more meaningful for the households in the upper quantiles of the distribution, compared to the lower quantiles representing the early adopters. Designing policies that account for the complementarity of the two sources of information is essential to increasing the adoption of PICS bags in Tanzania

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Cluster randomized trial assessing the effects of rapid ethical assessment on informed consent comprehension in a low-resource setting

Background Maximizing comprehension is a major challenge for informed consent processes in low-literacy and resource-limited settings. Application of rapid qualitative assessments to improve the informed consent process is increasingly considered useful. This study assessed the effects of Rapid Ethical Assessment (REA) on comprehension, retention and quality of the informed consent process. Methods A cluster randomized trial was conducted among participants of HPV sero-prevalence study in two districts of Northern Ethiopia, in 2013. A total of 300 study participants, 150 in the intervention and 150 in the control group, were included in the study. For the intervention group, the informed consent process was designed with further revisions based on REA findings. Informed consent comprehension levels and quality of the consent process were measured using the Modular Informed Consent Comprehension Assessment (MICCA) and Quality of Informed Consent (QuIC) process assessment tools, respectively. Result Study recruitment rates were 88.7 % and 80.7 % (p = 0.05), while study retention rates were 85.7 % and 70.3 % (p < 0.005) for the intervention and control groups respectively. Overall, the mean informed consent comprehension scores for the intervention and control groups were 73.1 % and 45.2 %, respectively, with a mean difference in comprehension score of 27.9 % (95 % CI 24.0 % - 33.4 %; p < 0.001,). Mean scores for quality of informed consent for the intervention and control groups were 89.1 % and 78.5 %, respectively, with a mean difference of 10.5 % (95 % CI 6.8 -14.2 %; p < 0.001). Conclusion Levels of informed consent comprehension, quality of the consent process, study recruitment and retention rates were significantly improved in the intervention group. We recommend REA as a potential modality to improve informed consent comprehension and quality of informed consent process in low resource settings

Global, regional, and national burden of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study

Background Although a preventable and treatable disease, tuberculosis causes more than a million deaths each year. As countries work towards achieving the Sustainable Development Goal (SDG) target to end the tuberculosis epidemic by 2030, robust assessments of the levels and trends of the burden of tuberculosis are crucial to inform policy and programme decision making. We assessed the levels and trends in the fatal and non-fatal burden of tuberculosis by drug resistance and HIV status for 195 countries and territories from 1990 to 2016. Methods We analysed 15 943 site-years of vital registration data, 1710 site-years of verbal autopsy data, 764 site-years of sample-based vital registration data, and 361 site-years of mortality surveillance data to estimate mortality due to tuberculosis using the Cause of Death Ensemble model. We analysed all available data sources, including annual case notifications, prevalence surveys, population-based tuberculin surveys, and estimated tuberculosis cause-specific mortality to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how the burden of tuberculosis differed from the burden predicted by the Socio-demographic Index (SDI), a composite indicator of income per capita, average years of schooling, and total fertility rate. Findings Globally in 2016, among HIV-negative individuals, the number of incident cases of tuberculosis was 9·02 million (95% uncertainty interval [UI] 8·05–10·16) and the number of tuberculosis deaths was 1·21 million (1·16–1·27). Among HIV-positive individuals, the number of incident cases was 1·40 million (1·01–1·89) and the number of tuberculosis deaths was 0·24 million (0·16–0·31). Globally, among HIV-negative individuals the age-standardised incidence of tuberculosis decreased annually at a slower rate (–1·3% [–1·5 to −1·2]) than mortality did (–4·5% [–5·0 to −4·1]) from 2006 to 2016. Among HIV-positive individuals during the same period, the rate of change in annualised age-standardised incidence was −4·0% (–4·5 to −3·7) and mortality was −8·9% (–9·5 to −8·4). Several regions had higher rates of age-standardised incidence and mortality than expected on the basis of their SDI levels in 2016. For drug-susceptible tuberculosis, the highest observed-to-expected ratios were in southern sub-Saharan Africa (13·7 for incidence and 14·9 for mortality), and the lowest ratios were in high-income North America (0·4 for incidence) and Oceania (0·3 for mortality). For multidrug-resistant tuberculosis, eastern Europe had the highest observed-to-expected ratios (67·3 for incidence and 73·0 for mortality), and high-income North America had the lowest ratios (0·4 for incidence and 0·5 for mortality). Interpretation If current trends in tuberculosis incidence continue, few countries are likely to meet the SDG target to end the tuberculosis epidemic by 2030. Progress needs to be accelerated by improving the quality of and access to tuberculosis diagnosis and care, by developing new tools, scaling up interventions to prevent risk factors for tuberculosis, and integrating control programmes for tuberculosis and HIV

The effects of foreign direct investment on youth unemployment in the Southern African Development Community

Open Access ArticleThis paper examines the effect of foreign direct investment (FDI) on youth unemployment in the Southern African Development Community (SADC) region using panel data from the World Bank World Development Indicators for the period 1994–2017. Results from the Feasible Generalized Least Squares (FGLS-Parks) technique show that FDI has an insignificant effect on reducing youth unemployment in the SADC region. This could be because the type of FDI in the region is partly mergers and acquisitions, which has fewer jobs creating capacity compared to Greenfield investment. This suggests the need for governments in the region to pursue labour-absorbing FDI policies and also ensure that foreign investment inflows are channelled towards labour-intensive sectors that have high labour absorptive capacity such as horticulture and floriculture

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations

Rural schools as effective hubs for agricultural technology dissemination: experimental evidence from Tanzania and Uganda

Increasing agricultural productivity by promoting high-yielding and micronutrient-rich crop varieties has the potential to reduce poverty and malnutrition. However, getting these technologies into the hands of smallholders remains a challenge. This paper presents results from a randomised field experiment that uses rural primary schools as dissemination hubs for improved orange-fleshed sweet potato (OFSP) vines and nutrition information in rural Tanzania and Uganda. Two years after the initial vine distribution, we find that households in treatment villages are 21 percentage points more likely to report growing OFSP and 27 percentage points more likely to correctly state the nutritional benefits of OFSP compared to those in control villages. We also find up to 16 percentage point increase in the likelihood of OFSP consumption by children under 5 years of age in treatment villages compared to that in control villages. Furthermore, we find suggestive evidence that increased knowledge on the nutritional benefits of OFSP mediated up to a third of the total treatment effect on OFSP adoption and consumption. Our findings suggest that rural primary schools can be effective channels for promoting and accelerating the diffusion of micronutrient-rich crop varieties in rural areas

Gender differences in technology adoption and agricultural productivity: evidence from Malawi

Open Access Article; Published online: 21 Jul 2022It is widely recognized that female farmers have considerably less access to productive assets and support services than male farmers. There is limited evidence of gender gaps in technology adoption and agricultural productivity after accounting for the differential access to factors of production between males and females. This study investigates the gender differences in the adoption of improved technologies and agricultural productivity in Malawi using nationally representative data collected from 1600 households and 5238 plots. We used a multivariate probit model to analyze the gender differences in the adoption of improved technologies, including intercropping, use of improved varieties, crop rotation and residue retention, manure use, and minimum tillage. To analyze gender differences in agricultural productivity, we used an exogenous switching regression (ESR) model and recentered influence function decomposition. We found that female plot managers were more likely to adopt intercropping and minimum tillage but less likely to adopt crop rotation and use improved varieties than male plot managers. The ESR model estimation results showed that female-managed plots were 14.6–23.1% less productive than male-managed plots. The gender productivity gaps also indicated that female plot managers had an 8.2% endowment advantage but a 23.1% structural disadvantage than male plot managers. The importance of structural effects in accounting for the gender productivity gap highlights the need for policies and agricultural development programs that consider the underlying factors shaping gender productivity gaps rather than focusing solely on agricultural production factors