Effect of the Mchinji Social Cash Transfer Pilot Scheme on Children's Schooling, Work and Health Outcomes: A Multilevel Study using Experimental Data

This dissertation examines whether the Mchinji Social Cash Transfer Pilot Scheme (SCTPS), implemented in a rural district in central Malawi, improved schooling, work and health outcomes for children ages 6-17. Effects of individual level (orphan status and child's gender) and household level factors (working-age adults and sick adults) on the outcomes are also studied. The study uses panel data collected in 2007-2008 from a randomized controlled evaluation study. This dissertation is unique in its use of multilevel methods. Also, this is the first study to report on the impact of an unconditional cash transfer program on health outcomes for school-age children. The first paper shows that the Mchinji SCTPS increased school enrollment, decreased days missed from school and reduced children's time spent in economic work activities. Although, transfers increased the number of and time spent in domestic work activities, the number of hours worked remained relatively low. While girls were more advantaged in education they were disadvantaged in child work compared to boys. A larger number of working-age adults in a household was associated with reduced work burden on children. Contrary to other research, orphans in this study were not disadvantaged in schooling and work outcomes relative to non-orphans. The second paper shows that compared to children in non-beneficiary households, those in beneficiary households had lower odds of child illness and serious illness that stopped normal activities. An increase in the household number of working-age adults was associated with lower odds of child illness and health care use. An increase in the household number of sick adults increased the odds of child illness, serious illness and health care use. No statistically significant differences were observed by orphan status and child's gender. Study findings suggest that unconditional programs have the potential to improve outcomes for older children in sub-Saharan Africa. Further research is needed to understand the causal pathways or mechanisms through which Mchinji SCTPS impacts children's outcomes. Going forward, in addition to poverty, unconditional cash transfer programs in Malawi and other sub-Saharan countries should consider other factors that reflect household vulnerabilities or constraints as eligibility criteria, such as adult morbidity.Doctor of Philosoph

BAYESIAN HERDERS: ASYMMETRIC UPDATING OF RAINFALL BELIEFS IN RESPONSE TO EXTERNAL FORECASTS

Temporal climate risk weighs heavily on many of the world's poor. Recent advances in model-based climate forecasting have expanded the range, timeliness and accuracy of forecasts available to decision-makers whose welfare depends on stochastic climate outcomes. There has consequently been considerable recent investment in improved climate forecasting for the developing world. Yet, in cultures that have long used indigenous climate forecasting methods, forecasts generated and disseminated by outsiders using unfamiliar methods may not readily gain the acceptance necessary to induce behavioral change. The value of model-based climate forecasts depends critically on the premise that forecast recipients actually use external forecast information to update their rainfall expectations. We test this premise using unique survey data from pastoralists and agropastoralists in southern Ethiopia and northern Kenya, specifying and estimating a model of herders updating seasonal rainfall beliefs. We find that those who receive and believe model-based seasonal climate forecasts indeed update their priors in the direction of the forecast received, assimilating optimistic forecasts more readily than pessimistic forecasts.Agribusiness, O1, D1, Q12,

Gender equality and education: Increasing the uptake of HIV testing among married women in Kenya, Zambia and Zimbabwe

Gender equality and education are being promoted as strategies to combat the HIV epidemic in Africa, but few studies have looked at the role of gender equality and education in the uptake of a vital service - HIV testing. This study looks at associations between education (a key input needed for gender equality) and key gender equality measures (financial decision-making and attitudes towards violence) with ever tested for HIV and tested for HIV in the past year. The study focused on currently married women ages 15–24 and 25–34 in three countries - Kenya, Zambia and Zimbabwe. The data came from the Demographic and Health Surveys (DHS). Logistic regression was used to study the role of gender equality and education on the HIV testing outcomes after controlling for both social and biological factors. Results indicated that education had a consistent positive relationship with testing for both age groups, and the associations were always significant for young women 15–24 (p<0.01). The belief that gender-based violence is unacceptable was positively associated with testing for women 25–34 in all three countries though the associations were only significant in Kenya (among women reporting ever being tested: OR 1.58, p<0.00; among women reporting being tested in the past year: OR 1.34, p<0.05) and Zambia (among women reporting ever being tested: OR 1.24, p<0.10; among women reporting being tested in the past year: OR 1.29, p< 0.05). High financial decision-making was associated with testing for women 25–34 in Zimbabwe only (among women reporting ever being tested: OR 1.66, p< 0.01). Overall the findings indicate that education and the promotion of gender equality are important strategies for increasing uptake of a vital HIV service, and thus are important tools for protecting girls and young women against HIV

Bayesian Herders: Asymmetric Updating of Rainfall Beliefs in Response to External Forecasts

Temporal climate risk weighs heavily on many of the world\u27s poor. Model-based climate forecasts could benefit such populations, provided recipients use forecast information to update climate expectations. We test whether pastoralists in southern Ethiopia and northern Kenya update their expectations in response to forecast information and find that they indeed do, albeit with a systematic bias towards optimism. In their systematic optimism, these pastoralists are remarkably like Wall Street\u27s financial analysts and stockbrokers. If climate forecasts have limited value to these pastoralists, it is due to the flexibility of their livelihood rather than an inability to process forecast information

Bayesian Herders: Optimistic Updating of Rainfall Beliefs In Response To External Forecasts

Temporal climate risk weighs heavily on many of the world\u27s poor. Model based climate forecasts could benefit such populations, provided recipients use forecast information to update climate expectations. We test whether pastoralists in southern Ethiopia and northern Kenya update their expectations in response to forecast information and find that they indeed do, albeit with a systematic bias towards optimism. In their systematic optimism, these pastoralists are remarkably like Wall Street\u27s financial analysts and stockbrokers. If climate forecasts have limited value to these pastoralists, it is due to the flexibility of their livelihood rather than an inability to process forecast information

Assessing the value of climate forecast information for pastoralists: Evidence from southern Ethiopia and northern Kenya

Climatic variability exerts tremendous influence on the livelihoods and well-being of pastoralists who inhabit the arid and semi-arid lands of the Horn of Africa. Recent advances in climate forecasting technologies have raised the intriguing prospect of reasonably accurate forecasts of coming seasons' rainfall patterns. Several donors and governments in the region are keenly interested in these technologies and in developing forecast delivery channels on the assumption that this information will prove valuable to the vulnerable populations it is meant to help not only indirectly, as an input into top-down early warning systems, but also directly, as a basis for improving choice under uncertainty. We explore the value of such external climate forecast information to pastoralists in a large study area spanning southern Ethiopia and northern Kenya using original data collected using both open-ended qualitative methods to identify and understand indigenous climate forecasting methods and quantitative data collected using survey instruments fielded in two rounds, one before and one after the long rains of 2001. The data show that pastoralists rely heavily on indigenous forecasting methods — in terms of having both access to and confidence in these methods — while external forecasts are less commonly received or believed. We elicited pastoralists' subjective, probabilistic expectations of the coming season's rainfall and find that neither use of nor belief in external forecasts causes any appreciable change in respondents' seasonal rainfall expectations. Moreover, relatively few pastoralists act on their own climate expectations, no matter how formed. In sum, climate forecast information does not seem a limiting factor at present in pastoralist communities in the Horn of Africa, not least of which because of the existence of a vibrant and still-relevant tradition of indigenous forecasting

The Measurement of Condom Use in Four Countries in East and Southern Africa

Measurement of condom use is important to assess progress in increasing use. Since 2003, the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) have included new measures of self-reported condom use. We use data from Namibia, Swaziland, Tanzania, and Zambia to compare measures of condom use accounting for type of sexual partner. Condom use at last sex ranged from 20% in Tanzania to 57% in Namibia for men, and from 12% in Tanzania to 41% in Namibia for women. Reported condom use was lower in response to questions about condom use every time with last partner (from 13% to 47% for men and from 8% to 33% for women). Condom use was highest among people with two or more partners in the last year and lowest with marital partners. Overall, the prevalence of condom use was low, and there was wide variability across the various measures, countries, sexes, and types of partner. Promotion of condom use in all partnerships, but especially in non-marital relationships and among individuals with multiple partners, remains a critical strategy. New condom use questions in the DHS and AIS expand options for measuring and studying condom use

Consistent condom use among men with non-marital partners in four sub-Saharan African countries

Data from the Demographic and Health Surveys (DHS) for Namibia, Swaziland, and Zambia and the AIDS Indicator Survey (AIS) from Tanzania were used to examine the influence of marital status and number of partners on consistent condom use among men with casual sexual partnerships in four generalized HIV epidemic settings. We restrict the sample to the 26% (Zambia), 29% (Tanzania), 35% (Swaziland), and 42% (Namibia) of men, who, in the last 12 months before the survey, had any non-marital/non-cohabiting (i.e., casual) sexual partners. We use “condom always used with any partner in the last 12 months” as a dichotomous dependent measure of consistent condom use. Analyses were stratified by country. Of men with casual partners, 41% (Zambia) to 70% (Namibia) used a condom every time with at least one partner. The majority of men were unmarried/non-cohabiting with one casual partner in the last year. In Swaziland and Zambia, multivariate results suggest that unmarried/non-cohabiting men with one casual partner had significantly lower odds than married/cohabiting men with casual partners to use condoms consistently (Odds ratio [OR] = 0.56, p=0.01 and OR = 0.41, p<0.001, respectively.). In Namibia, unmarried/non-cohabiting men with two or more casual partners had significantly greater odds than married/cohabiting men with casual partners to use condoms consistently (OR = 2.80, p<0.01). With some exceptions by country, higher education, religious group, wealth, having no children, knowing HIV results, having an STI, having one lifetime partner, and positive condom knowledge and beliefs also were significantly associated with using a condom every time with any partner. We conclude that consistent condom use remains an elusive goal even among men with casual sexual relationships. Condom use messages should be refined and targeted to men based on their number and types of relationships and combined with other messages to decrease concurrent relationships

'I thought if I marry the prophet I would not die': The significance of religious affiliation on marriage, HIV testing, and reproductive health practices among young married women in Zimbabwe

Published ArticleThis study examines the association between religious affiliation and reasons for marriage, perceived church attitudes, and reproductive health-seeking behaviors, including HIV testing, among young women in eastern rural Zimbabwe. The sample comprised women (N ¼ 35) who had married by 2012 while participating in a larger randomized controlled trial (RCT) to test the effects of school support on HIV-related risk. The RCT sample was identified in 2007 as all female sixth graders in 25 rural eastern Zimbabwe primary schools whose parents, one or both, had died (N ¼ 328). In our previous RCT analyses, we found that participants who affiliated with an Apostolic church were more than four times more likely to marry than those from non- Apostolic churches and that control group participants were twice as likely to marry as those in the intervention group. Other studies had found that marriage greatly increased the odds of HIV infection among adolescent women. Given the link between Apostolic affiliation and marriage, we conducted semi-structured interviews to explore type of marriage, reasons for marrying, church affiliation and attitudes, family planning, HIV testing, schooling, and family life. We were interested in differences, as perceived by our sample of young married women congregants, among Apostolic sects and other denominations in their attitudes about marriage and health-seeking behaviors. We were also interested in the influence of church affiliation on intervention participants’ decision to marry, since they had comprehensive school support and education is highly valued in Zimbabwe, but costly and often out of financial reach. Interviews were conducted from October 2012 through November 2013; data were analyzed using a general inductive approach. We found that pressure or perceived deception for coitus or marriage was reported only by intervention participants affiliated with Apostolic denominations. Other reasons for marriage were similar between Apostolic and non-Apostolic adherents, as well as intervention and control conditions. All participants believed HIV testing was important, but while all non-Apostolic denominations encouraged HIV testing and clinic/hospital care, there was considerable heterogeneity in attitudes among Apostolics, with ultraconservative denominations most likely to proscribe nonreligious health care. We conclude that some, but not all, Apostolic-affiliated women are afforded discretion in their healthseeking behaviors. Since HIV screening and treatment depend on access to clinic/hospital care, continued public health efforts to engage Apostolic leaders is needed, along with monitoring of progress in access and outcomes

Pastoralist Livestock Marketing Behavior in Northern Kenya and Southern Ethiopia: An Analysis of Constraints Limiting Off-take Rates

Pastoralists in East Africa\u27s arid and semi-arid lands (ASAL) regularly confront climatic shocks that plunge them into massive herd die-offs and loss of scarce wealth. One of the most puzzling features of pastoralist behavior in times of stress has been their relatively low and non-responsive rate of marketed off-take of animals when faced with likely losses to herd mortality. As Figure 1, from Desta (1999), finds in 17-year herd history data from Borana pastoralists in southern Ethiopia, mortality always exceeds net sales as a share of beginning period herd size, with the latter never exceeding three percent and moving hardly at all in response to shocks to rangeland carrying capacity that cause regular spikes in mortality rates. This case might be more pronounced than others, but the basic pattern is widely believed representative of herd dynamics and marketing patterns among east African ASAL pastoralists