Intramarital Status Differences Across Africa’s Educational Expansion

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154246/1/jomf12632_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154246/2/jomf12632.pd

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Household investments in children amid rapid development: Ibo Island, Mozambique

While much of the Global South has undergone sizable fertility declines in recent decades, many Sub Saharan African countries maintain fertility rates that are among the world’s highest, averaging over five children per woman. High fertility in these regions often coincides with poverty, promoting a stable steady state in which large, low-income families invest little in their children, which makes large families affordable; these “low-quality” children grow up to themselves earn low incomes and have large families. When African countries undergo economic change, growth does not always translate into higher investments in children’s human capital. In a rapidly developing African community, what are the household characteristics associated with increasing investments in children over time, giving them access to the resources to ultimately make quality investments in future generations? I use two waves of panel census data (that is, a longitudinal survey of the entire population) from Ibo Island in Northern Mozambique to investigate this question from three perspectives: household economic circumstances, farming practices, and paternal absence. I collected the second wave of data in 2012, retrospectively linking individuals and households with their data from three years prior. With child stunting rates upwards of 40%—falling above the cutoff for “very high” prevalence of malnutrition— Northern Mozambique is an ideal location in which to investigate dietary investments in children. Likewise, recent data from Ibo Island provide valuable information with which to study the effects of rapid economic development. Between 2009 and 2012, for example, the island experienced enormous changes in its living conditions (e.g. arrival of electricity, growing ubiquity of mobile phones, sizeable declines in child stunting), as it began to transition from fishing village to tourism hub. Using demographic, economic, and nutritional data, I examine circumstances and decisions that may be characteristic of household conditions in the broader Sub-Saharan African region. I begin by investigating household economic change and children’s stunting, using longitudinal census data that link individuals and households over time. Rapid economic change led to dramatic increases in the number of Ibo Island’s salaried positions between 2009 and 2012. A household’s livelihood transition from agriculture and/or fishing to an emerging salaried position is taken to represent improved income owing to the community’s economic growth. Children in fishing and agricultural households that underwent livelihood transitions experienced above-average improvements in their height-for-age Z-scores over time, indicating that income improvements are associated with investments in nutrition. These results demonstrate potential for continued investments in children’s human capital, as development proceeds and as expanded employment opportunities emerge. Turning next to household farming practices, I investigate associations between farm composition and children’s dietary outcomes. In the Global South, many food-insecure individuals have diets that rely heavily on cereals and starchy roots without nutritionally sufficient consumption of vegetables, fruits, or proteins. While the relationship between dietary diversity and health is well documented in the literature, the role for crop diversity in promoting dietary diversity is less understood. I identify a strong link between household crop diversity and children’s dietary diversity, which I confirm to be a strong predictor of child height. The positive relationship between household crop diversity and child dietary diversity verifies that household-level small-farming practices have the potential to improve access to diverse foods in the absence of markets. While educational attainment is associated with reduced rates of household farming, crop composition varies meaningfully with education, and high rates of fruit production among educated farming households may explain strong links between household education, children’s dietary diversity, and child height: fruit production allows households to supplement their diets with nutritious foods not widely available for purchase. Finally, the research focuses on investments in children as a function of the presence of their biological father in the household. Father absence from the household is expected to reduce paternal investments in children, but do other household members make investments that close the gap? I investigate educational investments on Ibo, where only one third of school-aged children live with their fathers. Results demonstrate a strong relationship between schooling and presence of the biological father, with educational participation rates over 10% higher for children who live with their fathers. Dropout rates were over a third higher for children whose fathers left the home between survey waves than for children whose fathers remained in the home. A household fixed effects model identifies higher educational participation among individuals who lived with their fathers than for cohabitants (step siblings, half siblings, etc.) whose fathers were absent. The results are aligned with family structure theory (in which traditional two-parent household structure promotes positive outcomes) and kin selection theory (in which familial altruism is driven by genetic relatedness)

From privilege to prevalence: contextual effects of women's schooling on African marital timing

In Africa and elsewhere, educated women tend to marry later than their less educated peers. Beyond being an attribute of individual women, education is also an aggregate phenomenon: the social meaning of a woman’s educational attainment depends on the educational attainments of her agemates. Using data from 30 countries and 246 birth cohorts across sub-Saharan Africa, we investigate the impact of educational context (the percent of women in a country cohort who ever attended school) on the relationship between a woman’s own educational attainment and her marital timing. In contexts where access to education is prevalent, the marital timing of uneducated and highly-educated women is more similar than it is in contexts where attending school is limited to a privileged minority. This across-country convergence is driven by no-education women marrying later in high-education contexts, especially through lower rates of very early marriages. However, within countries over time, the marital ages of women from different educational groups tend to diverge as educational access expands. This within-country divergence is most often driven by later marriage among highly-educated women, although some countries’ divergence is driven by earlier marriage among women who never attended school

Dynamics of population growth in secondary cities across southern Africa

Context Two-fifths of Africans reside in urban areas with populations of less than 250,000. Projections estimate that by 2050 an additional one billion people will live in urban areas, causing an acceleration of growth for these smaller urban areas. While research and development have focused on primary cities with large populations, less is known about the dynamics of urban growth in smaller, "secondary" urban areas (SUA's). Objectives We document the spatial distribution and temporal patterns of SUA's in eight countries across Southern Africa between 1975 and 2015. We further explore the relationships between SUA's growth rates and climate, land use and geographic proximity to other urban areas. Methods Our analysis integrates spatially explicit gridded population, land use, infrastructure and climate datasets. We use descriptive statistics and spatial lag and ordinary least squares regression models to quantify SUA growth rates across three periods and explore factors that are associated with the SUA growth patterns. Results Average SUA growth rates are 2.44% between 1975 and 1990. We show that the climate, distance and land use significantly relate to urbanization trajectories. In addition, we find that the proximity of SUA to the largest cities also significantly relates to urban growth. Conclusions Our results highlight the importance of SUA's within broader African urbanization trends. SUA are undergoing rapid population changes and are important components of economic development processes and livelihoods. Quantifying patterns of SUA urbanization is important for elevating these small but critically important urban areas into the broader context of sustainable urbanization in Africa.National Science Foundation12 month embargo; published 08 August 2020This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Environmental heterogeneity and commodity sharing in smallholder agroecosystems

Smallholder farmers undertake a number of strategies to cope with climate shocks in a community. The sharing of resources across households constitutes one coping mechanism when environmental shocks differentially impact households. This paper investigates commodity sharing dynamics among households in eight communities in an environmentally heterogeneous highland-lowland area in central Kenya. We use survey data and meteorological data to test whether commodity sharing, measured at the household level by net inflow of commodities, varies across a regional precipitation gradient, and we reveal how sharing fluctuates with rainfall over the course of a year. We find both precipitation and income to be significant predictors of households' net value of shared commodities. Specifically, farmers who live in drier areas with less income are more likely to receive more commodities than they give. We also find that the length of time a household has been established in the area is significantly related to commodity sharing. Further, commodity sharing follows the pattern of harvest and food storage over the course of the year, with households giving the most commodities at times when food storage levels are higher, that is, post-harvest. The study sheds light on the relationship between commodity sharing as a coping mechanism and environmental heterogeneity in a region prone to seasonal food insecurity.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Perceived links between climate change and weather forecast accuracy: new barriers to tools for agricultural decision-making

The accuracy of weather forecasts has experienced remarkable improvements over the recent decades and is now considered important tools for developing the climate resilience of smallholder farmers, particularly as climate change upends traditional farming calendars. However, the effect of observations of climate change on the use of weather forecasts has not been studied. In an analysis of smallholder farming in Zambia, Kenya, and Jamaica, we document low weather forecast use, showing that perceptions of changes in the climate relate to views on forecast accuracy. Drawing on detailed data from Zambia, we show that weather forecast use (or not) is associated with perceptions of the accuracy (or inaccuracy) of the forecast, with rates of weather forecast use far lower among those who believe climate change impacts forecast accuracy. The results suggest a novel feedback whereby climate change erodes confidence in weather forecasts. Thus, in a changing climate where improvements in weather forecasts have been made, farmers thus experience a double disadvantage whereby climate change disrupts confidence in traditional ways of knowing the weather and lowers trust in supplementary technical forecasting tools

Survey examines the adoption of perceived best management practices for almond nutrition

Fertilizer use in California agriculture has been under recent scrutiny regarding its impacts on air, surface water and groundwater quality. In June 2007, we surveyed almond growers to assess their plant nutrition practices, identify opportunities for improvement, and target research and extension needs. The majority of respondents, particularly those with large almond acreages, used fertigation to apply nitrogen; applied nitrogen coincident with periods of maximal plant demand; and collected annual tissue samples for analysis. While the survey results suggested broad compliance with the best-available management practices and are likely to indicate good nutrient-use efficiency, they also suggested that growers are uncertain about current practices to monitor orchard nutrient status and would value additional information to enable greater precision in fertilization rates and timing

Farmer forecasts: Impacts of seasonal rainfall expectations on agricultural decision-making in Sub-Saharan Africa

Seasonal climate variability frequently undermines farm yields, reduces food availability, and lowers income. This is particularly evident among small-scale agricultural producers in both irrigated and non-irrigated agroecosystems in the Global South where maize cultivars constitute a critical component of food production. In these systems, farmers make climate-sensitive decisions that include the selection of late- and/or early-maturing seed varieties, the diversity of seed varieties sown, and when to plant. Farmers’ expectations of future rainfall would therefore seem to be critical determinants of agricultural outcomes and foreshadow climate impacts. However, few studies have quantified the linkages between on-farm decisions and farmer seasonal predictions. We report on detailed household and phone surveys of 501 smallholder farmers in central Kenya based on the 2018 growing seasons and expectations for the 2019 March-April-May growing season. We show that farmers’ expectations of the upcoming seasonal rainfall have important associations with selections of seed maturity varieties and the number of maturing varieties farmers expect to plant and less important associations with the seeds’ planting dates. Furthermore, we show that 79% of the farmers form an expectation of the future seasonal climate and about two-thirds of them formed expectations based on a heuristic that connects the past climate to future seasonal conditions. More problematically, one-third of the farmers formed their rainfall expectation based on the prior season, and we show that no such correlation exists in observational data nor is correlation of seasonal rainfall supported by current understanding of climate variability. These results highlight the challenges farmers face in anticipating seasonal rainfall, which has implications for crop diversification and choices to adopt drought tolerant cultivars. The results suggest that farmers’ expectations of upcoming seasonal climate are important measures of farm decision-making.</p