Risk-sharing in Rural Pakistan

Risk-sharing is a fundamental form of economic behaviour. It can occur through formal insurance markets, informal family arrangements, community support, legal institutions (such as bankruptcy), or government tax-transfer programmes. Whatever the mechanism used to share risk, the extent of risk mitigation can greatly influence the welfare of all members of society. Understanding the degree of risk-pooling in society is important for policy-makers, since insufficient risk pooling may provide a basis for government intervention. Alternatively, if risks are being pooled adequately without the help of the government, government risk-sharing may be redundant. This study explores the implications of the risk-sharing model, namely, that households which pool risks, either through formal markets or informal personal arrangements, experience correlated changes in their consumption through time. It conducts tests of within-village, across-village, within-district, and across-district risksharing using a new Pakistani panel data set—the Pakistan Food Security Management Survey—collected by the International Food Policy Research Institute (IFPRI), Washington, D. C. Unlike studies for other Less Developed Countries (LDCs), these tests find very little or almost no evidence of risk-sharing among unrelated individuals within- and across-villages in the rural sector of Pakistan.

Risk-sharing in Rural Pakistan

Risk-sharing is a fundamental form of economic behaviour. It can occur through formal insurance markets, informal family arrangements, community support, legal institutions (such as bankruptcy), or government tax-transfer programmes. Whatever the mechanism used to share risk, the extent of risk mitigation can greatly influence the welfare of all members of society. Understanding the degree of risk-pooling in society is important for policy-makers, since insufficient risk pooling may provide a basis for government intervention. Alternatively, if risks are being pooled adequately without the help of the government, government risk-sharing may be redundant. This study explores the implications of the risk-sharing model, namely, that households which pool risks, either through formal markets or informal personal arrangements, experience correlated changes in their consumption through time. It conducts tests of within-village, across-village, within-district, and across-district risksharing using a new Pakistani panel data set—the Pakistan Food Security Management Survey—collected by the International Food Policy Research Institute (IFPRI), Washington, D. C. Unlike studies for other Less Developed Countries (LDCs), these tests find very little or almost no evidence of risk-sharing among unrelated individuals within- and across-villages in the rural sector of Pakistan

Causes of death and factors associated with early mortality of HIV-infected adults admitted to Korle-Bu Teaching Hospital

Introduction: This study sought to identify common causes of death as well as the factors associated with the high inpatient mortality rate of HIV-infected patients at the Korle-Bu Teaching Hospital (KBTH).Methods: The retrospective study reviewed the medical records of 547 HIV infected adults aged 18 years or older admitted to the KBTH between the months of January 2012 and October 2013. Using standardized abstraction forms, clinical and demographic data of eligible patients was collected. Data was summarized using descriptive statistics. Demographic and clinical characteristics of patients who died within 7 days (early) and after (late) admission were compared using Rank Sum tests or Chi-square tests.Results: Of 547 eligible patients during the period, 222 (40.6%) died during hospitalization, with 124 (55.9%) of them dying within a week of admission. Of the 222 patients who died, 190 (85.6%) were previously known HIV-positive. Yet, 141 (63.5%) of the 222 patients who died had no prior highly active antiretroviral therapy (HAART). The most common admitting diagnoses were anemia (34.2%), cerebral toxoplasmosis (29.3%), and pneumonia (25.7%); the most common causes of death were tuberculosis (34.7%), anemia (30.2%) and cerebral toxoplasmosis (27.5%). Tuberculosis was the only factor significantly associated with early death (P<0.05).Conclusion: The inpatient mortality rate among HIV infected adults admitted to the KBTH is high. A majority of the patients were not receiving HAART despite known HIV diagnosis. Earlier initiation of HAART may lower the risk of opportunistic infections and HIV mortality rates. Additionally, a high index of suspicion and initiation of empiric treatment for TB may reduce early deaths.Keywords: Cause of Death, HIV/AIDS, HAART, Ghana, Tuberculosi

Elasticity and Buoyancy of Federal Taxes in Pakistan

This paper focuses on the revenue-expenditure activities of the federal government and evaluates the performance of the fiscal system on the basis of estimates of revenue productivity. Two methodologies for the estimation of the short-run and long-run elasticity and buoyancy for tax revenue are evaluated. It is found that the Divisia Index method is superior on both theoretical and practical grounds and the results obtained are substantiated by the proportional - adjustment method. The study finds that the built-in elasticity of Pakistan's tax system was greater than unity

The Changing Face of HIV in Pregnancy in Rhode Island 2004–2009

Meeting the needs of HIV-infected pregnant women requires understanding their backgrounds and potential barriers to care and safe pregnancy. Foreign-born women are more likely to have language, educational, and economic barriers to care, but may be even more likely to choose to keep a pregnancy. Data from HIV-infected pregnant women and their children in Rhode Island were analyzed to identify trends in demographics, viral control, terminations, miscarriages, timing of diagnosis, and adherence to followup. Between January 2004 and December 2009, 76 HIV-infected women became pregnant, with a total of 95 pregnancies. Seventy-nine percent of the women knew their HIV status prior to becoming pregnant. Fifty-four percent of the women were foreign-born and 38 percent of the 16 women who chose to terminate their pregnancies were foreign-born. While the number of HIV-infected women becoming pregnant has increased only slightly, the proportion that are foreign-born has been rising, from 41 percent between 2004 and 2005 to 57.5 percent between 2006 and 2009. A growing number of women are having multiple pregnancies after their HIV diagnosis, due to the strength of their desire for childbearing and the perception that HIV is a controllable illness that does not preclude the creation of a family

Predictors of severity and mortality among patients hospitalized with COVID-19 in Rhode Island.

BackgroundIn order for healthcare systems to prepare for future waves of COVID-19, an in-depth understanding of clinical predictors is essential for efficient triage of hospitalized patients.MethodsWe performed a retrospective cohort study of 259 patients admitted to our hospitals in Rhode Island to examine differences in baseline characteristics (demographics and comorbidities) as well as presenting symptoms, signs, labs, and imaging findings that predicted disease progression and in-hospital mortality.ResultsPatients with severe COVID-19 were more likely to be older (p = 0.02), Black (47.2% vs. 32.0%, p = 0.04), admitted from a nursing facility (33.0% vs. 17.9%, p = 0.006), have diabetes (53.9% vs. 30.4%, pConclusionsCertain patient characteristics and clinical features can help clinicians with early identification and triage of high-risk patients during subsequent waves of COVID-19

Evaluation of Longitudinal Clinical Outcomes and Adherence to Care among HIV-Infected Refugees

Background: HIV-infected refugees resettled in the United States face many challenges. Longitudinal data regarding HIV-specific outcomes in this population are limited. Methods: We reviewed charts of 51 HIV-infected sub-Saharan African refugees matched to 102 nonrefugees. Outcomes analyzed included CD4 counts, viral loads (VLs), antiretroviral treatment (ART) use, appointment adherence, opportunistic infections, and resistance mutations. Results: The ART initiation was similar. Appointment adherence was similar in year 1, but refugees were significantly less adherent beyond year 3. Refugees and nonrefugees spent similar amounts of time in care suppressed (83% vs 80%, P = .93). Refugees had higher odds of viremia following undetectable VL (OR 2.3, P \u3c .05). Discussion: Initially, sub-Saharan African HIV-infected refugees have comparable appointment adherence, ART use, and VL suppression to nonrefugees. Overtime refugees were less adherent to appointments and more likely to have postsuppression viremia. The support services provided to refugees early in care may be important for retention in care and treatment success