When the messenger is more important than the message: an experimental study of evidence use in francophone Africa

BackgroundEpistemic injustices are increasingly decried in global health. This study aims to investigate whether the source of knowledge influences the perception of that knowledge and the willingness to use it in francophone African health policy-making context. Methods The study followed a randomized experimental design in which participants were randomly assigned to one of seven policy briefs that were designed with the same scientific content but with different organizations presented as authors. Each organization was representative of financial, scientific or moral authority. For each type of authority, two organizations were proposed: one North American or European, and the other African. ResultsThe initial models showed that there was no significant association between the type of authority or the location of the authoring organization and the two outcomes (perceived quality and reported instrumental use). Stratified analyses highlighted that policy briefs signed by the African donor organization (financial authority) were perceived to be of higher quality than policy briefs signed by the North American/European donor organization. For both perceived quality and reported instrumental use, these analyses found that policy briefs signed by the African university (scientific authority) were associated with lower scores than policy briefs signed by the North American/European university. ConclusionsThe results confirm the significant influence of sources on perceived global health knowledge and the intersectionality of sources of influence. This analysis allows us to learn more about organizations in global health leadership, and to reflect on the implications for knowledge translation practices.</p

Links between poverty and adaptation to climate change : a bidirectionality studied using data from the Niakhar Health and Demographic Surveillance

Cette thèse vise à analyser le lien entre la pauvreté et les stratégies d'adaptation au changement climatique, tout en considérant la relation bidirectionnelle qui existe entre pauvreté et adaptation. Le premier chapitre analyse comment les ménages de Niakhar réagissent aux variations climatiques en termes de migrations et évalue l'impact de ces migrations sur leur niveau de vie. Les résultats montrent que les migrations de courte durée peuvent apparaître comme une réponse défensive aux contraintes climatiques. De plus, lorsque les migrations actuelles sont soutenues par le niveau historique des migrations dans le ménage et dans le village, elles pourraient améliorer les conditions de vie du ménage. Le deuxième chapitre examine l'effet des migrations sur une composante de la dimension sanitaire de la pauvreté, la mortalité des enfants de moins de cinq ans. Le chapitre confirme le rôle des migrations « agricoles saisonnières » sur la mortalité infantile. Il révèle aussi l’importance du réseau de soutien à la famille et le rôle crucial des femmes sur la santé des enfants. Le dernier chapitre, le troisième chapitre, analyse la façon dont les agriculteurs perçoivent l'évolution du climat, les déterminants des efforts d’adaptation et l'effet de l'adaptation au changement climatique sur la pauvreté des ménages à Niakhar. Il montre que la pauvreté est un frein à l'adaptation. Cependant, quand on peut associer la décision des agriculteurs d’adopter une stratégie d’adaptation agricole à leur précision dans la perception du changement climatique, l’adaptation permet d’améliorer les conditions de vie du ménage.This thesis aims to analyze the link between poverty and climate change adaptation strategies, while considering the bidirectionality relationship between poverty and adaptation. The first chapter analyses how households in Niakhar react to climate variations in terms of migrations and evaluates the impact of these migrations on their living standard. The results show that short-term migrations could appear as a defensive response to climate constraints. Besides, when current migrations are supported by the historical level of migrations in the household and in the village, they could improve the living condition of the household. The second chapter looks at the effect of migrations on a component of the health dimension of poverty, the under-five child mortality. The chapter confirms the role of “seasonal agricultural” migration on infant mortality. It reveals also the importance of the family support network and the crucial role of women on children’s health. The final chapter, chapter three, analyses how farmers perceive climate evolution; the determinants of coping efforts; and the effect of adaptation to climate change on household poverty in Niakhar. It shows that poverty is a break to adaptation. However, when one can combine the decision of farmers to adopt an agricultural adaptation strategy with their accuracy in the perception of climate change, adaptation improves the living condition of the household

How do migrations affect under-five mortality in rural areas? Evidence from Niakhar, Senegal

This study analyses the relationship between a household member’s migration and child mortality within the family left behind in rural areas. Exploring the richness of the Niakhar Health and Demographic Surveillance System panel, we use high-frequency migration data to investigate the effects of migration on child mortality at the household level over 16 years. Migrations, particularly short-term migrations, are positively associated with the survival probability of under-five children in the household. Also, we find that working age women's short-term migrations impact child mortality more than working age men's short-term migrations. This observation supports hypotheses in the economic literature on the predominant role of women in rural households in obtaining welfare improvements. Moreover, we detect crossover effects between households of the same compound –in line with the idea that African rural families share part of their migration-generated gains with an extended community of neighbors. Lastly, we investigate the effect of a mother's short-term migration on the survival of her under-5 children. The aggregate effect of a mother’s migration on child survival is still positive, but much weaker. Specifically, mother migration during pregnancy seems to enhance the wellbeing of the child, considered immediately after birth. However, when the child is older (more than one year), the absence of the mother tends to decrease the probability of survival

Comment les migrations affectent-elles la mortalité infanto-juvénile en zone rurale ? L’exemple de Niakhar, Sénégal

International audienceExploring rich panel data from the Niakhar Health and Demographic Surveillance System, this study investigates the effects of migration on child mortality among families left behind in rural areas. Migration, particularly short-term, is positively associated with the survival probability of under-5 children in the household. We also find that the short-term moves of working-age women impact child mortality more than those of working-age men. Moreover, we detect crossover effects between households in the same compound, consistent with the idea that African rural families share part of their migration-generated gains with an extended community of neighbours. Lastly, we investigate the effect of maternal short-term migration on the survival of under-5 children. The aggregate effect is still positive but much weaker. Specifically, maternal migration during pregnancy seems to enhance children’s survival immediately after birth, but the probability of survival tends to decrease after age 1 when the mother is absent.Explorant les riches données longitudinales fournies par l’Observatoire de santé et de population de Niakhar, cette étude examine les effets des migrations sur la mortalité infanto-juvénile dans les familles rurales restées au village. Les migrations, en particulier de courte durée, sont associées de manière positive aux chances de survie des enfants de moins de cinq ans au sein du ménage. On constate également que les déplacements de courte durée des femmes d’âge actif ont plus d’incidences sur la mortalité des enfants que ceux de leurs homologues masculins. De surcroît, des effets croisés sont identifiés entre ménages de la même concession, ce qui est conforme à l’idée que les familles rurales africaines partagent les gains de l’émigration avec une communauté étendue de voisins. Enfin, l’effet des migrations maternelles de courte durée sur la survie des enfants de moins de cinq ans demeure globalement positif, mais nettement plus modeste. L’émigration de la mère, en particulier pendant la grossesse, semble améliorer la probabilité de survie des enfants juste après la naissance, mais celle-ci tend à diminuer après l’âge d’un an et lorsque la mère est absente

Simulating the progression of the COVID-19 disease in Cameroon using SIR models

International audienceThis paper analyses the evolution of COVID-19 in Cameroon over the period March 6-April 2020 using SIR models. Specifically, we 1) evaluate the basic reproduction number of the virus, 2) determine the peak of the infection and the spread-out period of the disease, and 3) simulate the interventions of public health authorities. Data used in this study is obtained from the Cameroonian Public Health Ministry. The results suggest that over the identified period, the reproduction number of COVID-19 in Cameroon is about 1.5, and the peak of the infection should have occurred at the end of May 2020 with about 7.7% of the population infected. Furthermore, the implementation of efficient public health policies could help flatten the epidemic curve

Does Self-Assessed Health Reflect the True Health State?

International audienceSelf-assessed health (SAH) is a widely used tool to estimate population health. However, the debate continues as to what exactly this ubiquitous measure of social science research means for policy conclusions. This study is aimed at understanding the tenability of the construct of SAH by simultaneously modelling SAH and clinical morbidity. Using data from 17 waves (2001–2017) of the Russian Longitudinal Monitoring Survey, which captures repeated response for SAH and frequently updates information on clinical morbidity, we operationalise a recursive semi-ordered probit model. Our approach allows for the estimation of the distributional effect of clinical morbidity on perceived health. This study establishes the superiority of inferences from the recursive model. We illustrated the model use for examining the endogeneity problem of perceived health for SAH, contributing to population health research and public policy development, in particular, towards the organisation of health systems

Do efficiency and equity move together? Cross-dynamics of Health System performance and Universal Health Coverage

International audienceEfficiency within the health system is well recognised as key for achieving Universal Health Coverage (UHC). However, achieving equity and efficiency simultaneously is often seen as a conflicting effort. Using 12 years of data (2003–2014) from the selection of a number of low- and lower middle-income countries (Afghanistan, Bangladesh, Burkina Faso, Ghana, Indonesia, Mongolia, Mozambique, Tajikistan, Togo, Uzbekistan and Yemen Republic), we compute an index of Universal health coverage (UHC), measure the health system’s performance (HSp) and, finally, investigate the cross-dynamics of the resulting HSp and the UHC previously obtained. We find that, with the few exceptions over the statistical sample, the causality between performances of the national health system and the universal health coverage is typically bidirectional. From an empirical standpoint, our findings challenge the idea from economic orthodoxy that efficiency must precede equity in healthcare services. Rather, our findings support the view of simultaneous efforts to improve expansion of the coverage and efficiency of the health system, directing attention towards the importance of organisation of the health system in the country context

Economics of attention: The gender-based bing communication study on depression.

This study examines the impact of personalized gender-based communication to encourage the screening of depression and seeking out mental health care consultation. An internet search engine advertisement was deployed on Bing, Microsoft during the COVID-19 pandemic lockdowns in the Provence-Alpes-Côte d'Azur (PACA) region in France during the month of May 2020, the height of the France lockdowns. A two-armed study was conducted with Arm A containing a non-personalized (control) advertisement and Arm B containing a personalized gender-based advertisement. 53,185 advertisements were shown between the two arms. Results show that receiving a personalized gender-based message increases the probability of clicking on the advertisement. However, upon clicking the advertisement, there was no significant difference in the completion of the depression questionnaire between the two groups. These results suggest that although personalized gender messaging is effective at drawing in a greater click rate, it did not increase, nor decreased, the conversion rate to monitor depression by self-assessment

Economics of attention: The gender-based bing communication study on depression

International audienceThis study examines the impact of personalized gender-based communication to encourage the screening of depression and seeking out mental health care consultation. An internet search engine advertisement was deployed on Bing, Microsoft during the COVID-19 pandemic lockdowns in the Provence–Alpes–Côte d'Azur (PACA) region in France during the month of May 2020, the height of the France lockdowns. A two-armed study was conducted with Arm A containing a non-personalized (control) advertisement and Arm B containing a personalized gender-based advertisement. 53,185 advertisements were shown between the two arms. Results show that receiving a personalized gender-based message increases the probability of clicking on the advertisement. However, upon clicking the advertisement, there was no significant difference in the completion of the depression questionnaire between the two groups. These results suggest that although personalized gender messaging is effective at drawing in a greater click rate, it did not increase, nor decreased, the conversion rate to monitor depression by self-assessment

Individuals’ willingness to provide geospatial global positioning system (GPS) data from their smartphone during the COVID-19 pandemic

International audienceThis study aims to evaluate people’s willingness to provide their geospatial global positioning system (GPS) data from their smartphones during the COVID-19 pandemic. Based on the self-determination theory, the addition of monetary incentives to encourage data provision may have an adverse effect on spontaneous donation. Therefore, we tested if a crowding-out effect exists between financial and altruistic motivations. Participants were randomized to different frames of motivational messages regarding the provision of their GPS data based on (1) self-interest, (2) pro-social benefit, and (3) monetary compensation. We also sought to examine the use of a negative versus positive valence in the framing of the different armed messages. 1055 participants were recruited from 41 countries with a mean age of 34 years on Amazon Mechanical Turk (MTurk), an online crowdsourcing platform. Participants living in India or in Brazil were more willing to provide their GPS data compared to those living in the United States. No significant differences were seen between positive and negative valence framing messages. Monetary incentives of $5 significantly increased participants’ willingness to provide GPS data. Half of the participants in the self-interest and pro-social arms agreed to provide their GPS data and almost two-thirds of participants were willing to provide their data in exchange for$5. If participants refused the first framing proposal, they were followed up with a “Vickrey auction” (a sealed-bid second-priced auction, SPSBA). An average of $17 bid was accepted in the self-interest condition to provide their GPS data, and the average “bid” of$21 was for the pro-social benefit experimental condition. These results revealed that a crowding-out effect between intrinsic and extrinsic motivations did not take place in our sample of internet users. Framing and incentivization can be used in combination to influence the acquisition of private GPS smartphone data. Financial incentives can increase data provision to a greater degree with no losses on these intrinsic motivations, to fight the COVID-19 pandemic