Effects of Ill Health and Weather Variability on Savings

This paper examines the effects of households’ shocks on saving behaviour. It investigates the possibility that households save ex ante to buffer against adverse weather and health shocks. The relatively high prevalence rate of HIV/AIDS in Kenya combined with rain fed agriculture implies great uncertainty for rural livelihoods. Adopting a methodology previously used on cross-sectional data (Paxson, 1992), the paper examines the level of households precautionary behaviour. This is done by estimating the marginal propensity to save out of transitory income over a period of 18 months. The results show that while households may exhibit some level of prudence, the marginal propensity to save out of transitory income is about a third of what the permanent income hypothesis postulates. Seasonality influences prudence behaviour, with stressful seasons likely to depress substantially the level of precautionary saving. The presence of HIV/AIDS illness lowers savings and raises per capita consumption. While reduced savings may seem to jeopardize future investments, the rise in consumption when the human asset is threatened, is in accordance with behaviour of forward-looking agents when future income is endogenous to current asset shock. The desire to smooth the health (asset) stock outweighs the desire (ability) to smooth future consumption and therefore savings decline. As a consequence, consumption for the HIV-afflicted households is relatively more volatile. While these findings are in agreement with a buffer stock model, they go against previous predictions that, AIDS medical costs will be met by reducing both consumption and savings in a balanced manner, and not necessarily be drawn disproportionately from own savings. A rise in consumption and a drop in savings may be a signal that the relationship is likely to be disproportionate.Household, Shocks, Savings, HIV/AIDS, Agricultural and Food Policy, Community/Rural/Urban Development, Demand and Price Analysis, Food Consumption/Nutrition/Food Safety, Food Security and Poverty, International Relations/Trade, Marketing, Productivity Analysis, Research and Development/Tech Change/Emerging Technologies,

The Effects of HIV/Aids on Agricultural Production and Poverty in Kenya

Although HIV/AIDS prevalence in Kenya has shown a downward trend in the recent years, it continues to impact negatively on agricultural production and food security in rural areas. The declining trends in crop production remain a challenge for development efforts. This study examines the extent to which AIDS has impacted on agricultural production, incomes and food security. Using a sample of 212 households, the study examines changes in welfare of households experiencing death and illness associated with HIV/AIDS condition. Poverty incidence and severity are observed to be higher among affected and non-affected households. The higher poverty levels among the affected cohort can partly be explained by lower crop and livestock production. In the absence of formal insurance mechanisms, medical costs take precedence over crop and livestock intensification; any credit that may be available goes to cater for medicare; the few assets available are disposed for purposes of meeting health needs. There is less land under crops and more fallow among the affected households. The effects are worse for farm households in the marginal areas an indication that there may be need for special programmes for arid and semiarid areas. Given that poverty seems to reinforce the spread of the HIV/AIDS and that once AIDS strikes it becomes a driver of poverty, the study adds further support to views that intervention strategies need to deal with poverty and HIV/AIDS problems concurrently.Food Security and Poverty, Health Economics and Policy,

Seasonality, precautionary savings and health uncertainty: Evidence from farm households in central Kenya

The high prevalence of risks in low income economies makes managing uncertainty critical for productivity and survival. This paper analyzes seasonal changes in farm households’ per capita consumption and saving in response to weather and health shocks. Using a sample of 196 households in central Kenya, it tests the notion that people save most of their transitory income, and examines their precautionary saving motives. The results show that the propensity to save out of transitory income is about a fifth of what the permanent income hypothesis postulates. The propensity to save differs by wealth, with the poor exhibiting stronger precautionary motives towards rainfall variability. But the wealth effect is weak, suggesting that the asset base is vulnerable even for the better-off. However, precautionary savings tend to increase with wealth among HIV/AIDS affected households. Since illness is associated with higher consumption, and therefore less investment, we find more volatile consumption for HIV/AIDS affected households

Successful paediatric HIV treatment in rural primary care in Africa

<p>Objective: Clinical outcomes of HIV-infected children on antiretroviral treatment (ART) in a decentralised, nurse/counsellor-led programme.</p> <p>Design: Clinical cohort.</p> <p>Setting: KwaZulu-Natal, South Africa.</p> <p>Patients: HIV-infected children aged <= 15 years on ART, June 2004-2008.</p> <p>Main outcome measures: Survival according to baseline characteristics including age, WHO clinical stage, haemoglobin and CD4%, was assessed in Kaplan-Meier analyses. Hazard ratios for mortality were estimated using Cox proportional hazards regression and changes in laboratory parameters and weight-for-age z scores after 6-12 months' treatment were calculated.</p> <p>Results: 477 HIV-infected children began ART at a median age of 74 months (range 4-180), median CD4 count (CD4%) of 433 cells/mm(3) (17%) and median HIV viral load of log 4.2 copies/ml; 105 (22%) were on treatment for tuberculosis and 317 (76.6%) were WHO stage 3/4. There were significant increases after ART initiation in CD4% (17% vs 22%; p<0.001), haemoglobin (9.9 vs 11.7 g/l; p <= 0.001) and albumin (30 vs 36 g/l; p <= 0.001). 32 (6.7%) children died over 732 child-years of follow-up (43.7 deaths/1000 child-years; 95% CI 32.7 to 58.2), 17 (53.1%) within 90 days of treatment initiation; median age of death was 84 (IQR 10-181) months. Children with baseline haemoglobin <= 8 g/l were more likely to die (adjusted HR 4.5; 95% CI 1.6 to 12.3), as were those aged <18 months compared with >60 months (adjusted HR 3.2; 95% CI 1.2 to 9.1).</p> <p>Conclusions Good clinical outcomes in HIV-infected children on ART are possible in a rural, decentralised service. Few young children are on ART, highlighting the urgent need to identify HIV-exposed infants.</p&gt

Assessing the livelihood impacts of a livestock disease outbreak: An alternative approach

Because of the substantive role played by livestock in the income and asset portfolios of the poor, livestock diseases can be an important threat to livelihoods. Yet for a variety of reasons, there are few applicable methods and consequently scant literature to assess the impacts of livestock diseases on livelihood outcomes. Existing literature comprises small-area studies and computable models with wider geographic focus, both of which have limitations in this specific context. We propose an alternative approach for estimating the impacts of livestock diseases on livelihoods. This proposed approach is an adaptation of a quasi-experimental impact evaluation method, namely propensity score matching, which uses features available in large-scale datasets with wide geographic coverage to create counterfactual scenarios that could mimic outcomes of a disease outbreak. By its construction the method is well suited for ex ante impact assessment. As an illustration we apply the method to the hypothetical case of an avian flu outbreak in Kenya.Impact assessment, Livelihoods, livestock disease, Propensity score matching,

The importance of HIV specialist services for African women living with HIV in Nottingham: results of a qualitative study

This article reports the results of a qualitative study of the experiences of African women living with HIV in Nottingham, UK. Globally, sub-Saharan Africa is the region most severely affected by the HIV pandemic [1]. This pattern is also reflected in the UK where African migrants make up 27% of those diagnosed with HIV despite the fact that they constitute less than 1% of the population [2-4]. Healthcare staff play a central role in meeting the prevention and care needs of people living with HIV/AIDS [5]. In contexts of increasing migration, health workers are called upon to recognise the diverse cultural, social, economic and political histories of their patients, and to understand how these interface with their current living situation, including their HIV-related health and treatment needs [6]. Relatively little research has been conducted to investigate the health experiences of migrant populations living with HIV in the UK, or on their patterns of access to, and utilisation of, HIV treatment and care [7]. Findings from the available, but limited, studies indicate that African migrants tend to present later than other population groups for HIV testing and treatment [8]. This is attributed to a number of obstacles to seeking or accessing care, including individual/community characteristics (such as AIDS-associated stigma, lack of perceived risk and denial), and factors associated with service and welfare provision in the host country--such as perceived discrimination, language and cultural differences, financial constraints and uncertain legal/immigration status [8-10]

Does the environment in which ICT-based market information services (MIS) projects operate affect their performance? Experiences from Kenya

The need to provide agricultural information to farmers has led to emergence of numerous ICTbased MIS projects in developing country. These projects aim at promoting commercialization of smallholder agriculture and subsequently their welfare. This study examines the how the environment in which such ICT-based MIS affect their performance. It specifically uses the DrumNet project, an ICT-based MIS, to assess how the socio-economic, physical, political and physical environment in the project areas affected its performance. The study finds that those transaction-related problems, especially strategic default, deriving from these environmental factors greatly undermined the performance of DrumNet forcing it to relocate severally. It discusses policy implications of these findings.ICT-based MIS projects, the DrumNet model, operational environment, performance, Kenya, Research Methods/ Statistical Methods,

Implementing routine provider-initiated HIV testing in public health care facilities in Kenya: a qualitative descriptive study of nurses\u27 experiences

Routine \u27provider-initiated testing and counselling\u27 (PITC) for HIV has been implemented amidst concern over how consent, confidentiality and counselling (the 3C’s) can be maintained in underresourced health care settings. In Kenya, PITC has been rolled out since 2005, HIV prevalence is 7.1% and over 86% of adults have not been tested. Kenyan nurses are the main cadre implementing PITC but little is known about their experiences of incorporating HIV testing into everyday practice and the challenges faced in maintaining the 3’Cs within their work environments. This study aimed to explore these issues and adopted a qualitative multi-method design using a convenience sampling approach. Two focus group discussions (total n=12) and 13 in-depth individual interviews were undertaken with nurses from 11 different public health care facilities in Nairobi and its surrounding areas (including in- and out-patient settings). Data were analysed thematically. Nurses identified a range of personal, client and health system challenges in the everyday application of PITC. These included: (i) the contradictions of normalising a highly stigmatised disease and the difficulty of providing client centred care within a routinised and target oriented work culture; (ii) the challenge of dealing with ethically complex client situations in which the principles of the 3C’s could be difficult to uphold; and, (iii) lack of time, resources, space and recognition within workplace environments (especially in-patient settings) that, likewise, led to problems with maintaining the 3C’s. In-patient nurses in particular identified problems associated with testing in a multi-disciplinary context, suggesting that other health professionals appeared to routinely flout the PITC guidelines. In conclusion, this study shows that the process of translating policy into practice is invariably complex and that more research is needed to explore PITC practices, particularly in in-patient settings. Nurses require supervision and support to negotiate the challenges and to fulfil their roles effectively

Exploring positive adjustment in HIV positive African women living in the UK

This published version of this article has been made available through Open Access by the Brunel University Open Access Publishing Fund and can be accessed at the link below - Copyright @ 2011 Taylor & FrancisResearch into living with HIV/AIDS has to date mainly focused on quality of life and there is little on the adjustment process for this group. The numbers of African women living with HIV/AIDS in the UK is growing and yet little is known about the adjustment experience for these women. This study explored aspects of positive adjustment to living with HIV/AIDS among a sample of African women living in London, UK. Transcripts of semi-structured interviews with 12 women were analysed using interpretative phenomenological analysis (IPA). Two superordinate themes emerged inductively from the data: positive changes in coping (subthemes: positive interpretation of their situation and positive behavioural changes) and positive growth since the HIV diagnosis (subthemes: changes in the value of life and, changes in goals and opportunities). While these women acknowledged the negative impact of living with HIV/AIDS, all participants mentioned changes in health behaviours to help regain mastery of their lives and comparing with others better-off and worse-off was used to enhance self-esteem and view their situation positively. The data show evidence for Taylor's Cognitive Adaptation Theory