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

The effect of environmental variability on livestock and land-use management: The Borana plateau, southern Ethiopia

The Borana people are the predominant ethnic group on the Borana Plateau in southern Ethiopia. Though traditionally transhumant pastoralists, they have recently increased their reliance on crops. Rainfall in the region averages between 353 mm to 873 mm; variability in rainfall is quite high, with coefficients of variation ranging from.21 to.68. The past decade has witnessed a dramatic increase in land allocated to crops, and land in pastures that are either becoming privatised, or accessible to only a small sub-group of people. In this paper, we derive an empirical model of stocking rates and land allocation, which is then used to estimate the effects of exogenous parameters on stocking densities, land allocated to crops, and land allocated to private pastures. Results indicate the following: a) regions with high coefficients of variation in rainfall have lower livestock densities and less land allocated to crops, b) communities with greater numbers of households and higher population densities have larger indices of non-cooperation, higher stock densities, and more land allocated to crops, c) heterogeneity within a community, measured by the distribution of wealth levels, is positively related to an index of non-cooperation, and to higher stock densities, d) higher relative prices of livestock and shorter distances to market are associated with greater stock densities as well as greater land allocated to crops, e) the greater is mobility into an area, the higher are stock densities, and the lower is the cooperation level, whereas outward mobility by community members has no effect on either stock densities or the level of cooperation reached, f) the proportion of members engaged in wage work outside has a significant negative effect on the ability of the community to cooperate. Outside wage work also increases land allocated to crops, but has a significant negative effect on land allocated to private pastures, and g) the greater is the index of non-cooperation, the higher are stock densities and the greater is land allocated to crops.

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

Foreign Body Ingestion: Three Case Reports

Foreign body ingestion in adults is rarely reported in our environment. While the incident is commonly deliberate in adults, it is often accidental in children. As illustrated in these case reports, diagnosis is often challenging if the act is not witnessed or reported by someone, even at the onset of complications. A seven-week-old boy ingested a used razor blade given to him by his three-year-old sister. The incident was reported and the object removed at laparotomy.A 38year old woman deliberately swallowed a padlock-and-key apparently to attract her husband’s attention. Plain X-rays demonstrated a radio-opaque object first in the chest and then in the stomach. Both padlock-and-key were removed at operation. A 24-year old male with a psychiatric disorder was brought for treatment of an abdominal surgical wound that had failed to heal four months after appendicectomy. Wound treatment failed and exploration of the wound and laparotomy extracted metals and plastic objects.Diagnosis of foreign body ingestion in our environment is achieved by documenting a proper history, physical evaluation and often, plain X-rays. Removal of the ingested object(s) is accomplished mainly by surgical intervention. Recovery and prognosis in most patients are usually satisfactor

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

CASE REPORT: A GIANT URINARY BLADDER STONE IN A FEMALE PATIENT

A vesical calculus weighing more than 100g is categorized as a giant urinary bladder stone. Male preponderance for urinary bladder calculi is well known. A rare case of a giant urinary bladder calculus weighing 1200g and occurring in a female patient is reported. The stone was removed by open vesicolithotomy

Changes in Serum Electrolytes and Lipid Profile in Diabetes Subjects in Freetown Sierra Leone

Background: Measurement of blood electrolytes level and lipid profile usually give good indications of the disease progression in a number of non communicable diseases. Objective: To investigate the effect of diabetes on electrolyte and lipid status of male and female diabetics in Freetown, Sierra Leone. Subjects and Methods: Serum concentrations of electrolytes and lipids in one hundred and twenty (120) adult diabetics attending some diagnostic centers in Freetown Sierra Leone were measured and compared with those of one hundred and twenty (120) non-diabetic individuals. Results: Total cholesterol, LDL-cholesterol, triglycerides and coronary heart disease (CHD) risk ratio in diabetic patients were significantly higher (

Bringing the social into vaccination research: Community-led ethnography and trust-building in immunization programs in Sierra Leone

Background Vaccine hesitancy is a complex, contested social phenomenon and existing research highlights the multifaceted role of trust in strengthening vaccine confidence. However, understanding public engagement with vaccination through the lens of (mis)trust requires more contextual evidence on trust's qualitative determinants. This includes expanding the geographic focus beyond current studies' focus on High Income Countries. Furthermore, obstacles remain in effectively integrating social science findings in the design of vaccine deployment strategies, and in ensuring that those who implement interventions and are affected by them are directly involved in producing knowledge about vaccination challenges. Methods We piloted a community-led ethnographic approach, training Community Health Workers (CHWs) in Kambia District, Sierra Leone, in qualitative social science methods. Methods included participant observation, participatory power mapping and rumour tracking, focus group discussions and key stakeholder interviews. CHWs, with the support of public health officials and professional social scientists, conducted research on vaccination challenges, analysed data, tested new community engagement strategies based on their findings and elicited local perspectives on these approaches. Results Our findings on vaccine confidence in five border communities highlighted three key themes: the impact of prior experiences with the health system on (mis)trust; relevance of livelihood strategies and power dynamics for vaccine uptake and access; and the contextual nature of knowledge around vaccines. Across these themes, we show how expressions of trust centered on social proximity, reliability and respect and the role of structural issues affecting both vaccine access and confidence. The pilot also highlighted the value and practical challenges to meaningfully co-designed research. Conclusion There is scope for broader application of a community-led ethnographic approach will help redesign programming that is responsive to local knowledge and experience. Involving communities and low-cadre service providers in generating knowledge and solutions can strengthen relationships and sustain dialogue to bolster vaccine confidence