Levels of and changes in socioeconomic inequality in delivery care service: A decomposition analysis using Bangladesh Demographic Health Surveys.

BackgroundSocioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh.MethodsThis study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities.ResultsWe find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014.ConclusionThis study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh

INFLUENCE OF MULTI-STAKEHOLDER INNOVATION PLATFORM APPROACH ON SMALLHOLDER FARMERS MARKETING DECISIONS

One of the very numerous decisions that smallholder farmers face world wide relates to market participation in agricultural markets and, consequently choosing the appropriate marketing channel for their agricultural produce. Such decisions impact on their incomes and subsequently on their welfare. The objective of this study was to determine how a multi-stakeholder innovation platform approach influences pigeon pea ( Cajanus Cajan L.) marketing decisions in smallholder farming in Malawi. The study relied on primary data collected from 115 households in Balaka District in Malawi during an impact survey done in November 2014. Results confirmed that the multi-stakeholder innovation platform approach improves decision making in pigeon pea marketing. Variables such as access to transport services and market information, improved extension, capacity building through farmer training, adoption of conservation agriculture and membership to farmer groups influenced marketing decisions.L\u2019une des plus nombreuses d\ue9cisions auxquelles les petits agriculteurs font face g\ue9n\ue9ralement est relative \ue0 la participation aux march\ue9s entre les march\ue9s agricoles et, par cons\ue9quent choisir les canaux appropri\ue9s de commercialisation pour leur produits agricoles. De telles d\ue9cisions impactent sur leurs revenus et ult\ue9rieurement sur leur bien-\ueatre. L\u2019objectif de cette \ue9tude \ue9tait de determiner comment l\u2019approche de la plate-forme d\u2019innovation multipartite influence les d\ue9cisions de commercialisation du pois d\u2019angole ( Cajanus Cajan L.) chez les petits exploitants agricoles au Malawi. L\u2019\ue9tude s\u2019est bas\ue9e sur des donn\ue9es primaires collect\ue9es sur 115 m\ue9nages dans le district de Balaka au Malawi au cours d\u2019une enqu\ueate d\u2019impact conduit en Novembre 2014. Les r\ue9sultats ont confirm\ue9 que l\u2019approche de la plate-forme d\u2019innovation multipartite am\ue9liore la prise de d\ue9cision de la commercilisation du pois d\u2019angole. Les variables tells que l\u2019acc\ue8s aux services de transport et au march\ue9 d\u2019information, am\ue9liorent la vulgaristaion, le renforcement des capacit\ue9s \ue0 travers la formation des producteurs, l\u2019adoption de l\u2019agriculture de conservation et les groupements de producteurs ont influenc\ue9 les d\ue9cisions de commercilalisation

COLLECTIVE MARKET PARTICIPATION FOR IMPROVED INCOME AMONG SMALLHOLDER FARMING HOUSEHOLDS: A CASE OF BALAKA INNOVATION PLATFORM IN MALAWI

Collective market participation can reduce transaction costs and information asymmetries, which can build up market power. The objective of this study was to evaluate decisions to participate in collective marketing and its effect on household income among smallholder farmers in an Innovation Platform (IP). This study targeted the Balaka IP in Malawi. Collective marketing identified as critical for improving households\u2019 incomes, is one of the activities that Balaka Innovation Platform has been addressing since its formation in 2009. The study involved a sample of 115 randomly selected households from Balaka Innovation Platform. The odds of participating in collective marketing by smallholder farm households in Balaka was significantly influenced by gender, education level, access to social capital through membership in farmer groups that form the Innovation Platform, farming experience, adoption/practice of conservation agriculture and possession of assets e.g. cellphone and bicycle. Moreover, results indicate that functions of IPs such as organising farmers to market collectively, promoting crop diversification, improved extension service, credit access through linkages to microfinance, communication and market linkages, positively influence income. Thus participation in multi-stakeholder IP activities highly influences collective marketing, which in turn impacts positively on smallholder farming households\u2019 income.La participation collective au march\ue9 peut r\ue9duire les co\ufbts de transaction et les assym\ue9tries d\u2019information; lesquelles peuvent constituer un pouvoir du march\ue9. L\u2019objectif de cette \ue9tude \ue9tait d\u2019\ue9valuer les d\ue9cisions \ue0 participer \ue0 la commercialisation collective et leur effet sur le revenu des m\ue9nages entre les petits exploitants agricoles dans une Plate-forme d\u2019Innovation (IP). Cette \ue9tude s\u2019est focalis\ue9e sur le Balaka IP au Malawi. La commercialisation collective identifi\ue9e comme essentielle pour l\u2019am\ue9lioration des revenus de m\ue9nages, est une des activit\ue9s que la Plate-forme d\u2019Innovation de Balaka a toujours abord\ue9 depuis sa mise en place en 2009. Cette \ue9tude a utilis\ue9 un \ue9chantillon de 115 m\ue9nages al\ue9atoirement select\ue9s dans la Plate-forme d\u2019Innovation de Balaka. Les chances de participation des petits exploitants agricoles \ue0 la commercialisation collective au Balaka \ue9tait significativement influenc\ue9es par le genre, le niveau d\u2019\ue9ducation, l\u2019acc\ue8s au capital social \ue0 travers les groupements de producteurs qui forment la Plate-forme d\u2019Innovation, l\u2019exp\ue9rience agricole, l\u2019adoption/la pratique de l\u2019agriculture conservative et la possession d\u2019actifs eg. t\ue9l\ue9phone cellulaire et bicyclette. De plus, les r\ue9sultats montrent que les fonctions des IPs telles que: organiser les agricultures \ue0 commercialiser collectivement, promouvoir la diversification de culture, le service am\ue9lior\ue9 de vulgarisation, l\u2019acc\ue8s au credit en liaison avec la microfinance, la communication et les liens commerciaux, influencent posistivement le revenu. Ainsi, la participation multipartite aux activit\ue9s de l\u2019IP influence la commercialisation collective, qui en cons\ue9quence impacte positvement sur le revenu des petits exploitants agricoles

Household Welfare Effects of Stress-Tolerant Varieties in Northern Uganda

This study assessed the adoption of stress-tolerant varieties and their effect on household welfare, measured by net crop income per capita in Nwoya District, Uganda. The stress-tolerant varieties were considered to be climate-smart because they stabilise and increase crop income in the presence of climatic shocks. However, the uptake of the stress-tolerant varieties was still low in northern Uganda, due to bad past experience in terms of the performance of other improved varieties. Using data from a random sample of 585 households, a logistic model was estimated to assess the drivers for adoption of stress-tolerant varieties. In addition, a propensity score matching model was employed to assess causal effects. The second model was estimated because it controls for unobserved heterogeneity caused by self-selection bias. Results showed that adoption of stress-tolerant varieties was positively influenced by household size, access to information from non-governmental organizations (NGOs), the perception of future climate change, the number of years an individual had lived in the village, and the number and type of assets owned as an indicator of household well-being. Average treatment effect from results showed that stress-tolerant varieties can increase crop income within a range of United States Dollars (USD) 500–864 per hectare per year, representing an 18–32% increase in crop income. The findings offer justification for scaling up stress tolerant varieties among smallholder farmers in northern Uganda to improve their welfare

The evolution of socioeconomic status-related inequalities in maternal health care utilization: evidence from Zimbabwe, 1994-2011

Background: Inequalities in maternal health care are pervasive in the developing world, a fact that has led to questions about the extent of these disparities across socioeconomic groups. Despite a growing literature on maternal health across Sub-Saharan African countries, relatively little is known about the evolution of these inequalities over time for specific countries. This study sought to quantify and explain the observed differences in prenatal care use and professional delivery assistance in Zimbabwe. Methods: The empirical analysis uses four rounds of the nationwide Zimbabwe Demographic and Health Survey administered in 1994, 1999, 2005/06 and 2010/11. Two binary indicators were used as measures of maternal health care utilization; (1) the receipt of four or more antenatal care visits and (2) receiving professional delivery assistance for the most recent pregnancy. We measure inequalities in maternal health care use using the Erreygers corrected concentration index. A decomposition analysis was conducted to determine the underlying drivers of the measured disparities. Results: The computed concentration indices for professional delivery assistance and prenatal care reveal a mostly pro-rich distribution of inequalities between 1994 and 2011. Particularly, the concentration index [95% confidence interval] for the receipt of prenatal care was 0.111 [0.056, 0.171] in 2005/06 and 0.094 [0.057, 0.138] in 2010/11. For professional delivery assistance, the concentration index stood at 0.286 [0.244, 0.329] in 2005/06 and 0.324 [0.283, 0.366] in 2010/11. The pro-rich inequality was also increasing in both rural and urban areas over time. The decomposition exercise revealed that wealth, education, religion and information access were the underlying drivers of the observed inequalities in maternal health care. Conclusions: In Zimbabwe, socioeconomic disparities in maternal health care use are mostly pro-rich and have widened over time regardless of the location of residence. Overall, we established that inequalities in wealth and education are amongst the top drivers of the observed disparities in maternal health care. These findings suggest that addressing inequalities in maternal health care utilization requires coordinated public policies targeting the more poor and vulnerable segments of the population in Zimbabwe

A gender-sensitised weight-loss and healthy living program for men with overweight and obesity in Australian Football League settings (Aussie-FIT): A pilot randomised controlled trial

Background: Recent evidence shows that sport settings can act as a powerful draw to engage men in weight loss. The primary objective of this pilot study was to test feasibility of delivering and evaluating preliminary efficacy of Aussie-FIT, a weight loss program for overweight/obese men delivered in Australian Football League settings, in preparation for a future definitive trial. Methods and Findings: This 6-month pilot trial took place in Perth, Australia. Participants were overweight/obese (BMI > 28 kg/m2), middle-aged (35-65 years old) men. Participants were recruited in May 2018 and the intervention took place between June and December 2018. The intervention involved 12 weekly 90-minute face-to-face sessions, incorporating physical activity, nutrition, and behaviour change information and practical activities delivered by coaches at two clubs. Data were collected at baseline and immediately post-intervention. For trial feasibility purposes, 6-month follow-ups were completed. Outcomes were differences in weight loss (primary outcome), and recruitment and retention rates, self-reported measures (e.g., psychological well-being), device-measured physical activity, waist size, and blood pressure at 3-months. Within three days of advertising at each club, 426 men registered interest; 306 (72%) were eligible. Men were selected on first-come first-served basis (n = 130; M age = 45.8, SD = 8; M 17 BMI = 34.48 kg/m2, SD = 4.87) and randomised by a blinded researcher. Trial retention was 86% and 63% at 3- and 6-month follow-ups (respectively). No adverse events were reported. At 3 months, mean difference in weight between groups, adjusted for baseline weight and group, was 3.3kg (95% CI 1.9, 4.8) in favour of the intervention group (p < 0.001). The intervention group’s moderate-to-vigorous physical activity (MVPA) was higher than the control group by 8.54 mins/day (95% CI 1.37, 15.71, p = 0.02). MVPA among men attracted to Aussie-FIT was high at baseline (intervention arm 35.61 min/day, control arm 38.38 min/day), which may have limited the scope for improvement. Conclusions: Aussie-FIT was feasible to deliver; participants increased physical activity, decreased weight, and reported improvements in other outcomes. Issues with retention were a limitation of this trial. In a future, fully powered randomised controlled trial (RCT), retention could be improved by conducting assessments outside of holiday seasons

Educated Mothers, Well-Fed and Healthy Children? Assessing the Impact of the 1980 School Reform on Dietary Diversity and Nutrition Outcomes of Zimbabwean Children

© 2017 Informa UK Limited, trading as Taylor & Francis Group We scrutinise the causal influence of schooling on child dietary diversity and nutrition in Zimbabwe using the exogenous variability in schooling prompted by the 1980 education policy, a natural trial fitting a fuzzy regression discontinuity design. We established that a one-year of learning promotes dietary diversity and nutrition even after accounting for plausible mediating factors. Also, education is more liable to impact dietary practices and nutrition through improvements in health knowledge, literacy, wealth and prenatal care utilisation. These findings suggest that promoting schooling access to girls in resource-poor nations might have far-reaching implications on feeding practices and consequently child nutrition