Willingness to Pay for Health Insurance in the Informal Sector of Sierra Leone

Purpose: The objective of this project is to study the willingness to pay (WTP) for health insurance (HI) of individuals working in the informal sector in Sierra Leone, using a purposely-designed survey of a representative sample of this sector. Methods: We elicit the WTP using the Double-Bounded Dichotomous Choice with Follow Up method. We also examine the factors that are positively and negatively associated with the likelihood of the respondents to answer affirmatively to joining a HI scheme and to paying three different possible premiums, to join the HI scheme. We additionally analyze the individual and household characteristics associated with the maximum amount the household is willing to pay to join the HI scheme. Results: The results indicate that the average WTP for the HI is 20,237.16 SLL (3.6 USD) per adult but it ranges from about 14,000 SLL (2.5 USD) to about 35,000 SLL (6.2 USD) depending on region, occupation, household and respondent characteristics. The analysis of the maximum WTP indicates that living outside the Western region and working in farming instead of petty trade are associated with a decrease in the maximum premium respondents are WTP for the HI scheme. Instead, the maximum WTP is positively associated to being a driver or a biker; having secondary or tertiary education (as opposed to not having any); the number of pregnant women in the household; having a TV; and, having paid for the last medical requirement. Conclusions: In summary, the various analyses show that a premium for the HI package could be set at approximately 20,000 SLL (3.54 USD) but also that establishing a single premium for all individuals in the informal sector could be risky. The efficient functioning of a HI scheme relies on covering as much of the population as possible, in order to spread risks and make the scheme viable. The impact of the various population characteristics raises the issue of how to rate premiums. In other words, setting a premium that may be too high for a big proportion of the population could mean losing many potential enrollees and might have viability consequences for the operation of the scheme

Socio-Economic Impacts of Computer Viruses in Tanzania

This paper reports on a research project conducted with an objective of identifying and assessing various approaches used by different computer users (Management, System Administrators and end users) in Tanzania to combat computer viruses (CVs), and to assess users' awareness level on CVs. Specifically, the study aimed at assessing the awareness level on CVs to the Tanzanian business community; analyze the socio -economic impact caused by CVs in Tanzania and; assess existing methods, capacity and limitations on controlling CVs in Tanzania. Data was collected using both questionnaires and interview from financial institutions such as NBC and BOT, and telecommunications sector such as TTCL and VODACOM. Other institutions where data was collected included the higher learning institutions such as UDSM, DIT & IFM, Government institutions such as the Government Chemist, and COSTECH and Non-governmental institutions such as REPOA and ESRF. After data analysis, it was found out that majority of the surveyed organisations were aware of CVs and about half of them employ client-server technique to successfully deal with the threat. These organisations spend between US$ 12,000 to 40,000 per year to deal with CVs. This cost is mainly for paying licence fees for anti-viruses and for data back-ups. Some organisations rely on pirated anti-virus which are unreliable and in most cases lead to disasters and losses of data and production time. It was concluded that CVs control should be given the highest priority to all JCT users. Also a policy on CVs should be well written and be instituted. Knowledge exchange on Anti-viruses' configuration should be enhanced among System Administrators within Tanzania. CVs control training should be done frequently to all workers. The use of an inert operating system such as Linux to control the spread of CVs should be promoted for use in workstations and for newly established organizations. Budget for CVs control should be considered at early stages

A Discrete Choice Experiment to Elicit the Willingness to Pay for Health Insurance by the Informal Sector Workers in Sierra Leone

The current health care financing system in Sierra Leone is unsustainable and poses challenges ranging from increased in out of pocket health care expenditure to accessibility problems, particularly in rural areas where living standards are low and health care facilities are scarce. This paper investigates whether privately financed health Insurance can improve the accessibility to formal health care in Sierra Leone and mitigate the effects of OOPs on poor households. To do so, we estimate the Willingness To Pay (WTP) for health insurance among informal sector workers in Sierra Leone using a Discrete Choice Experiment approach. Eight informal sector activities were selected namely – petty trading, subsistence farming, commercial bike riding, cattle rearing, fishing, tailoring, mining and quarrying. A random effect logit model is used to estimate households’ WTP for an improvement in coverage, choice of health care provider and a reduction in waiting time. Our study reveals that households were WTP more to have better attributes (better coverage, less waiting time) and to go to a faith - based provider. Our findings also suggest that location – rural versus urban – matters in determining the WTP since urban households were WTP more for health insurance than their rural counterparts, (SLL 54,348 or $7.34) and (SLL 37,250.5 or$5.03), respectively

Simulating planting date and cultivar effects on dryland maize production using CERESmaize model

Open Access JournalMaize farmers and extension agents in dry sudan savanna need information on how planting date and the choice of variety affect grain yield. This study was conducted to test the ability of model to predict maize yields under varying planting dates. Data on two open-pollinated maize cultivars (TSB-SR and TZE-COMP4) sown on different dates (June 29th, July 13th, July 21st and July 28th) in 2006 and 2007 at Azir (11° 01.820´ N, 12°37.714´ E; 441 m) and Damboa (11° 10.379´; 12° 47.145´E; 396 m) in the Sudan Savanna of Nigeria were used in running the model. Experimental data from Azir in 2006 was used to calibrate the model, while the data for 2007 at Azir 2006 and 2007 at Damboa were used for model validation. The model predicted days to anthesis at Damboa as reasonably well in both 2006 and 2007 (d-index >0.8), while at Azir, the prediction of days to anthesis was very poor in 2007. The match between predicted and observed grain yield were very good in 2007 at both locations. The root mean square error (RMSE) values for grain yield in 2007 were 431.5 and 226.5 kg ha-1 at Azir, and 799.5 and 611.5 kg ha-1 at Damboa for TZB SR and TZE COMP4, respectively, while the d-index values were all greater than 0.94. Generally, the model predicted decrease in grain yield with delay in planting date except for TZB-SR at Azir in 2006 where planting on July 13th gave higher yield than planting on June 29th. The grain yield values from the simulations suggested late June to early July as the optimum planting window for both varieties at both Azir and Damboa

PERCEPTIONS OF HIGH SCHOOL STUDENTS ON THE NEED FOR SEX EDUCATION IN SECONDARY SCHOOLS, ELDORET MUNICIPALITY, KENYA

It is estimated that 23% of the girls in secondary schools in Kenya drop out of school each year as a result of teenage pregnancy. Findings of the Kenya Aids Indicator Survey of 2007 indicate that the HIV and STI prevalence rate is 7 for Rift Valley province, that is, 7 out of every 1000 people have HIV and STI. The drop-out rate for girls in Uasin Gishu district is 2.1% while that of boys’ stands at 2.4%, according to Uasin Gishu development plan 2002 -2007. This is attributed to factors such as HIV, STIs and teenage pregnancies among others. In response to the rising number of HIV, STIs and teenage pregnancies and the resultant dropout rates in schools, the Ministry of Education intended to introduce sex education in secondary schools in Kenya to create awareness on the consequences of sex abuse in order to reduce school dropout rate on teenage pregnancies and STIs related infections. Debates on introduction of Sex Education in schools rages on and a lot of studies have been done on the pros and cons of this. But the opinion of children has not been sought. However, the intentions of the ministry were not realized because religious groups opposed it. In African indigenous culture, children are not consulted in decision making, but according to the United Nations Convention of 1989, children have a right to access information, participate and take responsibility in the society. Hence, need to seek their views. Therefore, this study sought to find out the perception of secondary school students on the need for sex education in secondary schools in Eldoret municipality, Kenya. Perceptions are vital since they shape students behaviour and attitudes towards their sexuality as well as morality. The research design for this study was a cross sectional descriptive survey aimed at collecting qualitative and quantitative primary data from students on their perceptions on the need for sex education. This was done through structured questionnaires and focus group discussions. A sample of 325 students was obtained through stratified and simple random sampling. The findings of the study showed that 53% of the students perceived the need to introduce of Sex Education in schools and so the idea is perhaps worth revisiting. The researcher therefore concludes that many students’ perceptions’ towards introduction of sex education in secondary schools is positive.   Article visualizations

Low efficacy of the combination artesunate plus amodiaquine for uncomplicated falciparum malaria among children under 5 years in Kailahun, Sierra Leone.

OBJECTIVE: In 2004, Sierra Leone adopted artesunate plus amodiaquine as first-line antimalarial treatment. We evaluated the efficacy of this combination in Kailahun, where a previous study had shown 70.2% efficacy of amodiaquine in monotherapy. METHODS: Method and outcome classification of the study complied with WHO guidelines. Children 6-59 months with uncomplicated malaria were followed-up for 28 days. PCR genotyping was used to distinguish recrudescence from reinfection. Reinfections were reclassified as cured. RESULTS: Of 172 children who were referred to the study clinic, 126 satisfied inclusion criteria and were enrolled. No early treatment failures were reported. The day 14, efficacy was 98.2% (95% CI: 93.8-99.8). Of 65 recurrent parasitaemias analysed by PCR, 17 were recrudescences. The PCR-adjusted day 28 efficacy was 84.5% (95% CI: 76.4-90.7). All true failures occurred in the last 8 days of follow-up. Of 110 children who completed the 28-day follow-up, 54 (49.1%) experienced a novel infection. CONCLUSION: The efficacy of this combination was disappointing. The high reinfection rate suggested little prophylactic effect. In Kailahun a more efficacious combination might be necessary in the future. The efficacy of AS + AQ needs to be monitored in Kailahun and in the other regions of Sierra Leone

Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department

Background The Pennine Acute Trust (PAT) Paediatric Observation Priority Score (PAT-POPS) is a specific emergency department (ED) physiological and observational aggregate scoring system, with scores of 0–18. A higher score indicates greater likelihood of admission. The Manchester Children’s Early Warning System (ManChEWS) assesses six physiological observations to create a trigger score, classified as Green, Amber or Red. Methods Prospectively collected data were used to calculate PAT-POPS and ManChEWS on 2068 patients aged under 16 years (mean 5.6 years, SD 4.6) presenting over 1 month to a UK District General Hospital Paediatric ED. Receiver operating characteristics (ROC) comparison, using STATA V.13, was used to investigate the ability of ManChEWS and PAT-POPS to predict admission to hospital within 72 h of presentation to the ED. Results Comparison of the area under the ROC curve indicates that the ManChEWS ROC is 0.67 (95% CI 0.64 to 0.70) and the PAT-POPS ROC is 0.72 (95% CI 0.68 to 0.75). The difference is statistically significant. At a PAT-POPS cut-off of ≥2, 80% of patients had their admission risk correctly classified ( positive likelihood ratio 3.40, 95% CI 2.90 to 3.98) whereas for ManChEWS with a cut off of ≥Amber only 71% of patients were correctly classified ( positive likelihood ratio 2.18, 95% CI 1.94 to 2.45). Conclusions PAT-POPS is a more accurate predictor of admission risk than ManChEWS. Replacing ManChEWS with PAT-POPS would appear to be clinically appropriate in a paediatric ED. This needs validation in a multicentre study

Science-based decision support for formulating crop fertilizer recommendations in sub-Saharan Africa

Open Access Article; Published online: 31 Jan 2020In sub-Saharan Africa, there is considerable spatial and temporal variability in relations between nutrient application and crop yield, due to varying inherent soil nutrients supply, soil moisture, crop management and germplasm. This variability affects fertilizer use efficiency and crop productivity. Therefore, development of decision systems that support formulation and delivery of site-specific fertilizer recommendations is important for increased crop yield and environmental protection. Nutrient Expert (NE) is a computer-based decision support system, which enables extension advisers to generate field- or area-specific fertilizer recommendations based on yield response to fertilizer and nutrient use efficiency. We calibrated NE for major maize agroecological zones in Nigeria, Ethiopia and Tanzania, with data generated from 735 on-farm nutrient omission trials conducted between 2015 and 2017. Between 2016 and 2018, 368 NE performance trials were conducted across the three countries in which recommendations generated with NE were evaluated relative to soil-test based recommendations, the current blanket fertilizer recommendations and a control with no fertilizer applied. Although maize yield response to fertilizer differed with geographic location; on average, maize yield response to nitrogen (N), phosphorus (P) and potassium (K) were respectively 2.4, 1.6 and 0.2 t ha−1 in Nigeria, 2.3, 0.9 and 0.2 t ha−1 in Ethiopia, and 1.5, 0.8 and 0.2 t ha−1 in Tanzania. Secondary and micronutrients increased maize yield only in specific areas in each country. Agronomic use efficiencies of N were 18, 22 and 13 kg grain kg−1 N, on average, in Nigeria, Ethiopia and Tanzania, respectively. In Nigeria, NE recommended lower amounts of P by 9 and 11 kg ha−1 and K by 24 and 38 kg ha−1 than soil-test based and regional fertilizer recommendations, respectively. Yet maize yield (4 t ha−1) was similar among the three methods. Agronomic use efficiencies of P and K (300 and 250 kg kg−1, respectively) were higher with NE than with the blanket recommendation (150 and 70 kg kg−1). In Ethiopia, NE and soil-test based respectively recommended lower amounts of P by 8 and 19 kg ha−1 than the blanket recommendations, but maize yield (6 t ha−1) was similar among the three methods. Overall, fertilizer recommendations generated with NE maintained high maize yield, but at a lower fertilizer input cost than conventional methods. NE was effective as a simple and cost-effective decision support tool for fine-tuning fertilizer recommendations to farm-specific conditions and offers an alternative to soil testing, which is hardly available to most smallholder farmers

Assessment of the Therapeutic Efficacy of Two Artemisinin-Based Combinations in the Treatment of Uncomplicated Falciparum Malaria among Children Under 5 Years in Four District Hospitals in Sierra Leone

Plasmodium falciparum has developed resistance to almost every class of antimalarial compounds. As a result of this, the World Health Organization has recommended artemisinin-based combination therapy as first line treatment for P. falciparum malaria. There is however need for the continuous monitoring of the efficacy of these antimalarials in order to provide timely information on trends of the emergence of resistant strains. We assessed the therapeutic efficacy of oral artesunate – amodiaquine and artemether-lumefantrine combinations in the treatment of uncomplicated P. falciparum malaria in four District Hospitals in Sierra Leone. A total of 320 children under five years partiiccipated in the study sites (Kenema, Rokupa, Bo and Makeni). Oral Artesunate-amodiaquine combination was administered to participants in Kenema and Rokupa whilst Artemetherlumefantrine combination was administered to participants in Bo and Makeni. The new WHO Protocol for recruitment of participants in therapeutic efficacy trials in high transmission zones was adopted for the study with filter paper blood samples taken from each participant on days 0 and 28 to distinguish between treatment failure and new infection. When uncorrected for PCR analysis, 96% (95% CI: 902 – 989) and 100% (95% CI:63.1 – 100) responses were obtained in Kenema and Bo respectively with Artesunate-amodiaquine combination whilst 94.3% (CI 95 : 88.1 – 979) and 100% (95% CI: 96.5 – 100) were obtained with Artemether-lumefantrine combination in Bo and Makeni respectively. When corrected for PCR on the other hand, a 100% (95% CI) Adequate Clinical and Parasitological Response was obtained for the two drugs in all four study sites. Results from this study indicate that both Artesunate-amodiaquine and Artemether-lumefantrine combinations remain highly efficacious in Sierra Leone with presently no observed emergence of resistant strains to both drugs.Keywords: Artemisinin-based combination, uncomplicated falciparum malaria, children, Sierra Leon

CERES-maize model for determining the optimum planting dates of early maturing maize varieties in northern Nigeria

Open Access JournalField trials were carried out in the Sudan Savannah of Nigeria to assess the usefulness of CERES–maize crop model as a decision support tool for optimizing maize production through manipulation of plant dates. The calibration experiments comprised of 20 maize varieties planted during the dry and rainy seasons of 2014 and 2015 at Bayero University Kano and Audu Bako College of Agriculture Dambatta. The trials for model evaluation were conducted in 16 different farmer fields across the Sudan (Bunkure and Garun—Mallam) and Northern Guinea (Tudun-Wada and Lere) Savannas using two of the calibrated varieties under four different sowing dates. The model accurately predicted grain yield, harvest index, and biomass of both varieties with low RMSE-values (below 5% of mean), high d-index (above 0.8), and high r-square (above 0.9) for the calibration trials. The time series data (tops weight, stem and leaf dry weights) were also predicted with high accuracy (% RMSEn above 70%, d-index above 0.88). Similar results were also observed for the evaluation trials, where all variables were simulated with high accuracies. Estimation efficiencies (EF)-values above 0.8 were observed for all the evaluation parameters. Seasonal and sensitivity analyses on Typic Plinthiustalfs and Plinthic Kanhaplustults in the Sudan and Northern Guinea Savannas were conducted. Results showed that planting extra early maize varieties in late July and early maize in mid-June leads to production of highest grain yields in the Sudan Savanna. In the Northern Guinea Savanna planting extra-early maize in mid-July and early maize in late July produced the highest grain yields. Delaying planting in both Agro-ecologies until mid-August leads to lower yields. Delaying planting to mid-August led to grain yield reduction of 39.2% for extra early maize and 74.4% for early maize in the Sudan Savanna. In the Northern Guinea Savanna however, delaying planting to mid-August resulted in yield reduction of 66.9 and 94.3% for extra-early and early maize, respectively