Can subsidized early child care promote women’s employment? : evidence from Kenya

Women’s disproportionate child care responsibilities significantly impede their labor force participation. Subsidizing child care for women in poor urban settings can be a powerful mechanism to improve women's employment outcomes and reduce gender inequalities in Africa. To test whether child care obligations limit African women from engaging in paid work, researchers from McGill University and the African Population and Health Research Center (APHRC) conducted a randomized study that provided subsidized early child care (ECC) to selected mothers living in a slum area of Nairobi, Kenya

Violence, uncertainty, and resilience among refugee women and community workers: An evaluation of gender-based violence case management services in the Dadaab refugee camps.

Reports of gender-based violence (GBV) are common in camps for refugees and displaced populations. In the Dadaab refugee camps in north-eastern Kenya, the International Rescue Committee (IRC) and CARE International (CARE) implement programmes that aim to both respond to and prevent GBV. A cornerstone of this work has been to train refugees, known as refugee community workers, to deliver aspects of GBV prevention and response work in order to develop a broader implementation of traditional GBV outreach, community mobilisation, and case management. To date, there has been limited rigorous research on this broader GBV case management plus task sharing approach in the context of a refugee camp setting. To address this key gap in evidence, the London School of Hygiene and Tropical Medicine (LSHTM) and the African Population and Health Research Centre (APHRC), in collaboration with IRC and CARE, have sought to assess this model to understand its feasibility, acceptability, and influence among female survivors of GBV accessing care. Data for this study, funded by UK aid, were collected in the Dadaab refugee camps between 2014 and 2017, which coincided with a temporary decision to close the camp and repatriate Somali refugees. The research confirms the magnitude and complexity of the violence that women and girls experience in the camps in Dadaab. In the year leading up to this study, 47% of women accessing the GBV centres for case management reported experiencing intimate partner violence and 39% reported experiencing non-partner violence. In addition, the study highlights the specific risks, challenges, opportunities and rewards experienced by refugee community workers in their dual role of community members and GBV activists living side-by-side with survivors and perpetrators of violence. Solely related to their work as GBV caseworkers, one in three refugee community workers reported experiencing non-partner violence in the last 12 months. Despite this, 93% of refugee community workers stated their work was rewarding or extremely rewarding. The majority of women (82%) accessing services reported that their interactions with refugee community workers had a positive effect, and that working with them was useful. However, having refugees deliver services to their own community was not without its challenges, and survivors raised issues on confidentiality, mistranslations, and perceived biases on clan differences. The study also provides an insight into the importance of contextual factors in case management, and the impact of the announcement of the (now-delayed) camp closure in Dadaab. Priorities of both the camp population and service providers (GBV and referral services) shifted greatly during this time of uncertainty and affected when and how women were accessing services

Gender-based violence and its association with mental health among Somali women in a Kenyan refugee camp: a latent class analysis

BACKGROUND: In conflict-affected settings, women and girls are vulnerable to gender-based violence (GBV). GBV is associated with poor long-term mental health such as anxiety, depression and post-traumatic stress disorder (PTSD). Understanding the interaction between current violence and past conflict-related violence with ongoing mental health is essential for improving mental health service provision in refugee camps. METHODS: Using data collected from 209 women attending GBV case management centres in the Dadaab refugee camps, Kenya, we grouped women by recent experience of GBV using latent class analysis and modelled the relationship between the groups and symptomatic scores for anxiety, depression and PTSD using linear regression. RESULTS: Women with past-year experience of intimate partner violence alone may have a higher risk of depression than women with past-year experience of non-partner violence alone (Coef. 1.68, 95% CI 0.25 to 3.11). Conflict-related violence was an important risk factor for poor mental health among women who accessed GBV services, despite time since occurrence (average time in camp was 11.5 years) and even for those with a past-year experience of GBV (Anxiety: 3.48, 1.85-5.10; Depression: 2.26, 0.51-4.02; PTSD: 6.83, 4.21-9.44). CONCLUSION: Refugee women who experienced past-year intimate partner violence or conflict-related violence may be at increased risk of depression, anxiety or PTSD. Service providers should be aware that compared to the general refugee population, women who have experienced violence may require additional psychological support and recognise the enduring impact of violence that occurred before, during and after periods of conflict and tailor outreach and treatment services accordingly

‘They say our work is not halal’: experiences and challenges of refugee community workers involved in gender-based violence prevention and care in Dadaab, Kenya

Notwithstanding the growing centrality of refugee community workers (RCWs) in the current response to gender-based violence (GBV) in the Dadaab refugee camps, they remain poorly studied. Using interview data, we explored the work-related experiences and challenges as well as GBV-related beliefs of RCWs. Whilst they demonstrated elevated knowledge of the forms and drivers of GBV in their community, some of the RCWs did not deem early marriage, female genital mutilation and wife-beating to be GBV acts. In their work, RCWs were motivated by compassion for survivors as well as a sense of community service, but they faced challenges such as insecurity; poor pay; opposition and violence by community members; tense relationships with and suspicion by professional providers; and limited skills and preparation in GBV management. RCWs’ GBV-related beliefs and work experiences underscore the challenges of programming in a complex humanitarian space and offer insights for strengthening their contribution in GBV care and service delivery

Menopause, reproductive life, hormone replacement therapy and bone phenotype at age 60-64: a British birth cohort

CONTEXT: Previous studies of menopausal age and length of reproductive life on bone are limited by retrospective reproductive histories, being cross sectional, or lacking gold standard bone technologies, or information on hormone replacement therapy (HRT) or surgical treatment. OBJECTIVE: To investigate age at menopause, length of reproductive life and HRT use in relation to volumetric and areal bone mineral density (vBMD, aBMD), bone size and strength in women aged 60-64. DESIGN: A birth cohort study followed for 64 years with prospective measures of age at menarche and menopause and monthly HRT histories. SETTING: England, Scotland, Wales Participants: 848 women with known type of menopause and bone measures at 60-64 years Main outcome measures: Peripheral quantitative computed tomography (pQCT) measurements of the distal radius total and trabecular vBMD; diaphyseal radius total and medullary cross sectional area, cortical vBMD and polar strength strain index (SSI); dual energy x-ray absorptiometry (DXA) measurments of aBMD at the lumbar spine and total hip. RESULTS: A ten year increase in age at natural (but not surgical) menopause was associated with 8.2% (95% CI: 1.3,15.1%, p=.02) greater trabecular vBMD and a 6.0% (95% CI 0.51,11.5%, p=.03) greater total vBMD; findings were similar for length of reproductive life. A ten year difference in HRT use was associated with a 6.0% (95% CI 2.6%,9.3%, p<.001) greater polar SSI and a 0.9% (95% CI 0.4%, 1.5%, p=.001) greater cortical vBMD. These estimates changed little on adjustment. Estimates for aBMD were consistent with those for pQCT. CONCLUSIONS: The positive effects on trabecular vBMD of later natural menopause and longer reproductive life persisted into early old age. HRT use was associated with greater radius cortical vBMD and polar SSI, and spine aBMD

Seeking legitimacy through CSR: Institutional Pressures and Corporate Responses of Multinationals in Sri Lanka

Arguably, the corporate social responsibility (CSR) practices of multinational enterprises (MNEs) are influenced by a wide range of both internal and external factors. Perhaps most critical among the exogenous forces operating on MNEs are those exerted by state and other key institutional actors in host countries. Crucially, academic research conducted to date offers little data about how MNEs use their CSR activities to strategically manage their relationship with those actors in order to gain legitimisation advantages in host countries. This paper addresses that gap by exploring interactions between external institutional pressures and firm-level CSR activities, which take the form of community initiatives, to examine how MNEs develop their legitimacy-seeking policies and practices. In focusing on a developing country, Sri Lanka, this paper provides valuable insights into how MNEs instrumentally utilise community initiatives in a country where relationship-building with governmental and other powerful non-governmental actors can be vitally important for the long-term viability of the business. Drawing on neo-institutional theory and CSR literature, this paper examines and contributes to the embryonic but emerging debate about the instrumental and political implications of CSR. The evidence presented and discussed here reveals the extent to which, and the reasons why, MNEs engage in complex legitimacy-seeking relationships with Sri Lankan institutions

Clinicians' attitude towards a placebo-controlled randomised clinical trial investigating the effect of neuraminidase inhibitors in adults hospitalised with influenza

Background: The value of neuraminidase inhibitors (NAIs) in reducing severe clinical outcomes from influenza is debated. A clinical trial to generate better evidence is desirable. However, it is unknown whether UK clinicians would support a placebo controlled trial. A survey was conducted to determine the attitude of clinicians towards a clinical trial and their current practice in managing adults admitted to hospital with suspected influenza. Methods: Senior clinicians (n=50) across the UK actively involved in the care of patients hospitalised with severe respiratory infections and/or respiratory infection research were invited to participate in an on-line survey. Participants were asked their opinion on the evidence for benefit of NAIs in influenza, their current practice in relation to: a) testing for influenza; b) treating empirically with NAIs; and c) when influenza infection is virolologically confirmed, prescribing NAIs. Results: Thirty-five (70%) of 50 clinicians completed the survey. Respondents were drawn mainly from infectious diseases, intensive care and respiratory medicine. Only 11 (31%) of 35 respondents agreed that NAIs are effective at reducing influenza mortality;14(40%)disagreed, 10 (28.6%) neither agreed nor disagreed. When managing adults admitted to non-ICU wards with a respiratory infection during an influenza season, 15 (51.7%) clinicians indicated they would usually perform a test for influenza in greater than 60% of patients but only 9 (31%) would treat empirically with NAIs in greater than 60% of patients. Few clinicians would either test or empirically treat patients presenting with other (non-respiratory infection related) diagnoses. If influenza infection is confirmed, 17 (64.5%) clinicians would prescribe NAIs in greater than 80% of patients with a respiratory infection treated on non-ICU wards Thirty-one (89%) clinicians agreed that a placebo-controlled clinical trial should be conducted and 29 (85%) would participate in such a trial. Conclusions: There is strong support from UK clinicians for a placebo-controlled trial of NAI treatment in adults hospitalised with suspected influenza. Current variation in medical opinion and clinical practice demonstrates collective equipoise, supporting ethical justification for a trial. Low use of NAIs in the UK suggests randomisation of treatment would not substantially divert patients towards placebo

Engaging fringe stakeholders in business and society research: applying visual participatory research methods

Business and society (B&S) researchers, as well as practitioners, have been critiqued for ignoring those with less voice and power (e.g. women, non-literate or indigenous peoples) often referred to as ‘fringe stakeholders’. Existing methods used in B&S research often fail to address issues of meaningful participation, voice and power, especially in developing countries. In this article we stress the utility of visual participatory research (VPR) methods in B&S research to fill this gap. Through a case study on engaging Ghanaian cocoa farmers on gender inequality issues we explore how VPR methods may be used by researchers to achieve more inclusive, and thus more credible, stakeholder research that can improve decision-making within businesses. Furthermore, we argue that ingrained social and environmental problems tackled by B&S research and the unique context in which they occur may open up new opportunities to develop participatory visual methods for social change

Economic burden of cholera in the WHO African region

<p>Abstract</p> <p>Background</p> <p>In 2007, various countries around the world notified 178677 cases of cholera and 4033 cholera deaths to the World Health Organization (WHO). About 62% of those cases and 56.7% of deaths were reported from the WHO African Region alone. To date, no study has been undertaken in the Region to estimate the economic burden of cholera for use in advocacy for its prevention and control. The objective of this study was to estimate the direct and indirect cost of cholera in the WHO African Region.</p> <p>Methods</p> <p>Drawing information from various secondary sources, this study used standard cost-of-illness methods to estimate: (a) the direct costs, i.e. those borne by the health-care system and the family in directly addressing cholera; and (b) the indirect costs, i.e. loss of productivity caused by cholera, which is borne by the individual, the family or the employer. The study was based on the number of cholera cases and deaths notified to the World Health Organization by countries of the WHO African Region.</p> <p>Results</p> <p>The 125018 cases of cholera notified to WHO by countries of the African Region in 2005 resulted in a real total economic loss of US$39 million, US$ 53.2 million and US$64.2 million, assuming a regional life expectancies of 40, 53 and 73 years respectively. The 203,564 cases of cholera notified in 2006 led to a total economic loss US$91.9 million, US$128.1 million and US$156 million, assuming life expectancies of 40, 53 and 73 years respectively. The 110,837 cases of cholera notified in 2007 resulted in an economic loss of US$43.3 million, US$60 million and US$72.7 million, assuming life expectancies of 40, 53 and 73 years respectively.</p> <p>Conclusion</p> <p>There is an urgent need for further research to determine the national-level economic burden of cholera, disaggregated by different productive and social sectors and occupations of patients and relatives, and national-level costs and effectiveness of alternative ways of scaling up population coverage of potable water and clean sanitation facilities.</p