Health insurance for HIV prevention & treatment: predictors of health insurance enrollment among HIV+ women in Kenya

Background: The global push to achieve the 90-90-90 targets designed to end the HIV epidemic has called for the removing of policy barriers to prevention and treatment, and ensuring financial sustainability of HIV programs. Universal health insurance is one tool that can be used to this end. In sub-Saharan Africa, where HIV prevalence and incidence remain high, the use of health insurance to provide comprehensive HIV care is limited. This study looked at the factors that best predict social health insurance enrollment among HIV positive pregnant women using data from the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Methods: Cross-sectional clinical encounter data were extracted from the electronic medical records (EMR) at AMPATH. We used univariate and multivariate logistic regressions to estimate the predictors of health insurance enrollment among HIV positive pregnant women. The analysis was further stratified by HIV disease severity (based on CD4 cell count ) to test the possibility of differential enrollment given HIV disease state. Results: Approximately 7% of HIV infected women delivering at a healthcare facility had health insurance. HIV positive pregnant women who deliver at a health facility had twice the odds of enrolling in insurance [2.46 Adjusted Odds Ratio (AOR), Confidence Interval (CI) 1.24-4.87]. They were 10 times more likely to have insurance if they were lost to follow-up to HIV care during pregnancy [9.90 AOR; CI 3.42-28.67], and three times more likely to enroll if they sought care at an urban clinic [2.50 AOR; 95% CI 1.53-4.12]. Being on HIV treatment was negatively associated with health insurance enrollment [0.22 AOR; CI 0.10-0.49]. Stratifying the analysis by HIV disease severity while statistically significant did not change these results. Conclusions: The findings indicated that health insurance enrollment among HIV positive pregnant women was low mirroring national levels. Additionally, structural factors, such as access to institutional delivery and location of healthcare facilities, increased the likelihood of health insurance enrollment within this population. However, behavioral aspects, such as being lost to follow-up to HIV care during pregnancy and being on HIV treatment, had an ambiguous effect on insurance enrollment. This may potentially be because of adverse selection and information asymmetries. Further understanding of the relationship between insurance and HIV is needed if health insurance is to be utilized for HIV treatment and prevention in limited resource settings.Othe

Analysis of Financial Transactions using Machine Learning

Many people want to know the socio-ecological impact of the goods they purchase. In this thesis, we describe a system that computes the socio-ecological impact of those goods by analyzing uncategorized financial transactions. The computation is made possible by extending a system that can computate socio-ecological impact from categorized transactions. The extension further includes visualizations on the system’s web GUI using AngularJS and extension of the system’s Node.js API. To compute the socio-ecological impact the report describes a categorization service. To connect the service to the core system a RabbitMQ message queue was used. The service trained supervised machine learning models using Apache Spark’s machine learning library (MLlib) on a dataset containing about 2.4 million categorized transactions. This achieved a categorization accuracy of 82.9%. The main focus for future work is to increase accuracy by using named-entity recognition and splitting up the categorization into two steps using multiple categorizers.Med växande miljöhot så blir det allt mer viktigt att vi alla minimerar vår miljöpåverkan. För att förenkla detta har vi utvecklat en app som kan räkna ut miljöpåverkan genom en användares bankutdrag

Essays on Non-Governmental Organizations and States Relations : Finland and Africa/Kenya in Comparative Perspectives

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.This thesis analyses the relationships between non-governmental organizations (NGOs) and the state in Finland and in Africa with an emphasis on Kenya taking in mind major aspects of State in the cases. In order to realise this objective, a discussion of state, civil society and theories of non-profit organisations (NPOs) has been done. The thesis has traced the historical development of voluntary organisations (VOs), vis a vis that of state, thereby outlining a genuine platform of significant precedent. The thesis is divided into three overall chapters. Chapter one, divided in three sections, captures a theoretical appraisal of the state, civil society, where issues of terminology and concepts are defined, and the theories of NPOS, given that NGOs are accorded an, especially certain, economic, political, social and cultural value; chapter two examines how the relations develop within the Finnish (Scandinavian) welfare state; and chapter three investigates developing democracies and NGOs in the sub-Sahara with special emphasis/cases from Kenya. 'Further perspectives' are added calling on responsible conduct of governmentality. One of the most interesting finding is that state development in both Finland and Africa is closely associated with VOs. Emerging as protest movements prior to independence, VOs helped consolidate cultural-political capital which was instrumental in founding the state, especially in Africa. However, in the event of the founding of the welfare-state project in Finland, and the nationbuilding project in Africa, VOs were hijacked in the name of nationalism. The Scandinavian welfare state mainly displaced civil society with its universal suffrage schemes of 'social security'. The one-party structures of African weak governments mainly produced an underground sector that was terrorised and victimised in the name of 'national/state security'. In the Scandinavian welfare model, however, faced with incompetence and the surfacing of poverty and social exclusion, and new economical/fiscal realities, a dialogue is emerging where NGOs, albeit heavily state-dependent, play a complementary or collaborative role but not as equal partners. In the sub-Sahara, on the other hand, complex relations hang precariously between two extremes: adversarial and collaborative. In both cases, elaborate opportunity structures and circumstances, vulgarised by 'global'/regional processes exist. In both cases, an extensive surveillance/control-of-society mechanism is exacted. State-NGO relations are embryonic of society's primary concern with power, democracy, resources and control. Thus, any understanding of state-society relations must begin here, especially on the delimitation of space, obviously a political issue. The theoretical construct of this work starts with the view that the state is a first, but not necessarily the last, actor. The conduct of society is eschewed in governmental rationality in which an art/technique of State, stealth (welfare) or otherwise (weak), ultimately defines relational frameworks. This thesis is a theoretical apparatus and has resulted from an extensive review of government acts, academic texts, books and articles, a small group of which is published in the Internet. Many authors, eg., Alan Fowler, Michael Bratton, Immanuel Wallerstein, Stephen Ndegwa, Martti Siisiäinen, Tore Modeen, Matti Heikkilä, Henry Hansmann, Lester Salamon, Goran Hyden, Anthony Giddens, Reinhard Bendix, Marvine Olsen, David Hulme and Michael Edwards, and Stein Kuhnle and Per Selle, as well as over two hundred others, are discussed through the pages

The effect of climate change on the pricing of weather index-based crop insurance in Kenya

A Research project submitted in partial fulfillment of the requirements for the degree of Bachelor of Business Science in Actuarial Science at Strathmore UniversityThe Agricultural sector is a pillar of the economies of many developing countries around the world. In Kenya, the sector contributes an average of 24% to the GDP directly and 27% indirectly through connection to other sectors e.g. manufacturing and distribution and accounts for about 60% of the total employment in the country. The agricultural sector also accounts for 70% of export earnings. Small-holder farmers are the main producers of agricultural output in Kenya constituting of 80% of all the farmers. (Ministry of Agriculture, 2009) The Government therefore places a high priority on Agriculture as an important tool for development

HIV prevention cost-effectiveness: a systematic review

BackgroundAfter more than 25 years, public health programs have not been able to sufficiently reduce the number of new HIV infections. Over 7,000 people become infected with HIV every day. Lack of convincing evidence of cost-effectiveness (CE) may be one of the reasons why implementation of effective programs is not occurring at sufficient scale. This paper identifies, summarizes and critiques the CE literature related to HIV-prevention interventions in low- and middle-income countries during 2005-2008.MethodsSystematic identification of publications was conducted through several methods: electronic databases, internet search of international organizations and major funding/implementing agencies, and journal browsing. Inclusion criteria included: HIV prevention intervention, year for publication (2005-2008), setting (low- and middle-income countries), and CE estimation (empirical or modeling) using outcomes in terms of cost per HIV infection averted and/or cost per disability-adjusted life year (DALY) or quality-adjusted life year (QALY).ResultsWe found 21 distinct studies analyzing the CE of HIV-prevention interventions published in the past four years (2005-2008). Seventeen CE studies analyzed biomedical interventions; only a few dealt with behavioral and environmental/structural interventions. Sixteen studies focused on sub-Saharan Africa, and only a handful on Asia, Latin America and Eastern Europe. Many HIV-prevention interventions are very cost effective in absolute terms (using costs per DALY averted), and also in country-specific relative terms (in cost per DALY measured as percentage of GDP per capita).ConclusionThere are several types of interventions for which CE studies are still not available or insufficient, including surveillance, abstinence, school-based education, universal precautions, prevention for positives and most structural interventions. The sparse CE evidence available is not easily comparable; thus, not very useful for decision making. More than 25 years into the AIDS epidemic and billions of dollars of spending later, there is still much work to be done both on costs and effectiveness to adequately inform HIV prevention planning

Knowledge and Awareness of HPV Vaccine and Acceptability to Vaccinate in Sub-Saharan Africa: A Systematic Review

Objectives: We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination. Methods: We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990–2011 were extracted from the World Health Organization database. Findings: The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above. Conclusion: There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support

Erratum to: Estimation of country-specific and global prevalence of male circumcision.

[This corrects the article DOI: 10.1186/s12963-016-0073-5.]