Institute for Policy Research Policy Brief: Biofuels, development and sustainability in sub-Saharan Africa

In sub-Saharan Africa, biofuels have been hailed as a new form of green capitalism. But are they really able to deliver ‘win-win’ outcomes for communities, governments and companies, mitigate climate change and promote ‘pro poor’ development? At a time of global recession and soaring food prices, the large scale diversion of land from the production of food crops to the production of ‘feedstocks’ for biofuels processors has placed the industries’ ‘sustainability’ at the centre of controversy.Qualitative research carried out by Dr Roy Maconachie (University of Bath) and Dr Elizabeth Fortin (University of Bristol) explores corporate strategies to promote biofuel sustainability. It focuses on Sierra Leone, and considers the importance of global, national and local agendas in the development of its emerging biofuel sector. EU policies sustaining markets for alternative fuels have promoted the production of biofuels in Africa. Such production is further buttressed by views that poverty in developing countries will be best alleviated by the provision of emloyment opportunities in rural areas. The research considers how these agendas, rather than local concerns, have influenced national environment-development policies and corporate social responsibility (CSR) strategies. Finally, it looks at the implications of biofuels production for local sustainability. The research informs key policy debates relating to: a) CSR and community development; and b) land investment and ‘green’ development in sub-Saharan Africa

Artisanal and small-scale mining (ASM) in sub-Saharan Africa: Re-conceptualizing formalization and ‘illegal’ activity

This article contributes to the debate on the formalization of artisanal and small-scale mining (ASM) – low-tech, labour-intensive mineral extraction and processing – in developing countries. A unique sector populated by an eclectic group of individuals, ASM has expanded rapidly in all corners of the world in recent years. Most of its activities, however, are informal, scattered across lands which are not officially titled. But growing recognition of the sector's economic importance, particularly in sub-Saharan Africa, has forced donors, and to some extent, policymakers, to ‘rethink’ development strategies for ASM. As part of broader moves to improve the regulation of, and occasionally intensify the delivery of assistance to, the sector, many are now searching frantically for fresh ideas on how to bring operations into the legal domain, where, it is believed, they can be regulated, monitored and supported more effectively. A challenging exercise, this entails first determining, with some degree of precision, why people choose to operate informally in this sector. Drawing on analysis from the literature and findings from research conducted in Ghana and Niger, it is argued that the legalist school (on informality) in part explains how governments across sub-Saharan Africa are ‘creating’ bureaucracies which are stifling the formalization of ASM activities in the region. A more nuanced development strategy grounded in local realities is needed if formalization is to have a transformative effect on the livelihoods of those engaged in ASM in the region and elsewhere in the developing world. © 2017 Elsevier Lt

The cost-effectiveness of NT-proBNP for assessment of suspected acute heart failure in the emergency department.

AIMS: When relying on clinical assessment alone, an estimated 22% of acute heart failure (AHF) patients are missed, so clinical guidelines recommend the use of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for AHF diagnosis. Since publication of these guidelines, there has been poor uptake of NT-proBNP testing in part due to concerns over excessive false positive referrals resulting from the low specificity of a single 'rule-out' threshold of <300 pg/mL. Low specificity can be mitigated by the addition of age-specific 'rule-in' NT-proBNP thresholds. METHODS AND RESULTS: A theoretical hybrid decision tree/semi-Markov model was developed, combining global trial and audit data to evaluate the cost-effectiveness of NT-proBNP testing using age-specific rule-in/rule-out (RI/RO) thresholds, compared with NT-proBNP RO only and with clinical decision alone (CDA). Cost-effectiveness was measured as the incremental cost per quality-adjusted life year (QALY) gained and incremental net health benefit. In the base case, using UK-specific inputs, NT-proBNP RI/RO was associated with both greater QALYs and lower costs than CDA. At a willingness-to-pay threshold of £20 000/QALY, NT-proBNP RO was also cost-effective compared with CDA [incremental cost-effectiveness ratio (ICER) of £8322/QALY], but not cost-effective vs. RI/RO (ICER of £64 518/QALY). Overall, NT-proBNP RI/RO was the most cost-effective strategy. Sensitivity and scenario analyses were undertaken; the conclusions were not impacted by plausible variations in parameters, and similar conclusions were obtained for the Netherlands and Spain. CONCLUSIONS: An NT-proBNP strategy that combines an RO threshold with age-specific RI thresholds provides a cost-effective alternative to the currently recommended NT-proBNP RO only strategy, achieving greater diagnostic specificity with minimal reduction in sensitivity and thus reducing unnecessary echocardiograms and hospital admissions

Familial hypercholesterolaemia: identification and management. Evidence reviews for case-finding, diagnosis and statin monotherapy

This guideline covers identifying and managing familial hypercholesterolaemia (FH), a specific type of high cholesterol that runs in the family, in children, young people and adults. It aims to help identify people at increased risk of coronary heart disease as a result of having FH. In November 2017, we reviewed the evidence for case finding and diagnosis, identification using cascade testing, and management using statins. We amended recommendations in sections 1.1, 1.2 and 1.3

Oil and Cocoa in the Political Economy of Ghana-EU Relations: Whither Sustainable Development?

Oil and cocoa represent strategic export commodities for the Ghanaian economy, prioritised within the Ghana Shared Growth and Development Agenda. This article examines these sectors in the context of Ghana’s relations with the European Union (EU). Notably, the EU constitutes the most important market for Ghanaian exports. The European Commission, moreover, has pledged to tangibly assist private sector development in Ghana, with particular reference to the UN Sustainable Development Goals (SDGs). Through its focus on oil and cocoa, the article problematises certain aspects of EU aid and trade interventions with respect to normative SDG development pledges

Extended optical treatment versus early patching with an intensive patching regimen in children with amblyopia in Europe (EuPatch): a multicentre, randomised controlled trial

Background Amblyopia, the most common visual impairment of childhood, is a public health concern. An extended period of optical treatment before patching is recommended by the clinical guidelines of several countries. The aim of this study was to compare an intensive patching regimen, with and without extended optical treatment (EOT), in a randomised controlled trial. Methods EuPatch was a randomised controlled trial conducted in 30 hospitals in the UK, Greece, Austria, Germany, and Switzerland. Children aged 3–8 years with newly detected, untreated amblyopia (defined as an interocular difference ≥0·30 logarithm of the minimum angle of resolution [logMAR] best corrected visual acuity [BCVA]) due to anisometropia, strabismus, or both were eligible. Participants were randomly assigned (1:1) via a computer-generated sequence to either the EOT group (18 weeks of glasses use before patching) or to the early patching group (3 weeks of glasses use before patching), stratified for type and severity of amblyopia. All participants were initially prescribed an intensive patching regimen (10 h/day, 6 days per week), supplemented with motivational materials. The patching period was up to 24 weeks. Participants, parents or guardians, assessors, and the trial statistician were not masked to treatment allocation. The primary outcome was successful treatment (ie, ≤0·20 logMAR interocular difference in BCVA) after 12 weeks of patching. Two primary analyses were conducted: the main analysis included all participants, including those who dropped out, but excluded those who did not provide outcome data at week 12 and remained on the study; the other analysis imputed this missing data. All eligible and randomly assigned participants were assessed for adverse events. This study is registered with the International Standard Randomised Controlled Trial Number registry (ISRCTN51712593) and is no longer recruiting. Findings Between June 20, 2013, and March 12, 2020, after exclusion of eight participants found ineligible after detailed screening, we randomly assigned 334 participants (170 to the EOT group and 164 to the early patching group), including 188 (56%) boys, 146 (44%) girls, and two (1%) participants whose sex was not recorded. 317 participants (158 in the EOT group and 159 in the early patching group) were analysed for the primary outcome without imputation of missing data (median follow-up time 42 weeks [IQR 42] in the EOT group vs 27 weeks [27] in the early patching group). 24 (14%) of 170 participants in the EOT group and ten (6%) of 164 in the early patching group were excluded or dropped out of the study, mostly due to loss to follow-up and withdrawal of consent; ten (6%) in the EOT group and three (2%) in the early patching group missed the 12 week visit but remained on the study. A higher proportion of participants in the early patching group had successful treatment (107 [67%] of 159) than those in the EOT group (86 [54%] of 158; 13% difference; p=0·019) after 12 weeks of patching. No serious adverse events related to the interventions occurred. Interpretation The results from this trial indicate that early patching is more effective than EOT for the treatment of most children with amblyopia. Our findings also provide data for the personalisation of amblyopia treatments. Funding Action Medical Research, NIHR Clinical Research Network, and Ulverscroft Foundation