Social interactions, aspirations, and agricultural innovations : Linkages with income and food security in rural Ethiopia

The persistence of poverty in some parts of the society across the globe inspired recent studies in development economics to embrace the use of multidisciplinary tools and concepts to better understand the situation of the poor. This thesis employs one of the recent conceptual tools, the aspirations-failure framework, which links the situation of the poor and their (under)investment behavior to aspirations failure. Based on individual and household level data collected from a sample of farm households in rural Ethiopia, the thesis first econometrically examines the effect of social interactions on aspirations (with respect to income, wealth, social status and education). The findings are in line with the theory which suggests that aspirations are socially determined through observations and social interactions. In particular, results indicate that social network size is an important determinant of aspirations and especially that of women’s, attesting to the importance of widening the ‘aspirations window’ – a person’s cognitive world that shapes their aspirations. One of the channels in which aspirations may affect behavior is through their effect on risk aversion. The thesis finds that the ‘aspirations-gap’ (AG) – the difference between the aspired and present status – indeed relaxes risk aversion, and the association is non-linear. Results also indicate that the effect of AG on risk preferences is stronger for women. Social interactions may also enhance diffusion of innovations and productivity. Based on social networks data collected using ‘random matching within sample’ procedure, the thesis identifies strong evidence of network externalities in the adoption of row-planting and also in farm productivity. The novelty of the thesis is also the identification of aspirations (or AG) as one of the key determinants of farmer innovativeness or the adoption of innovation products such as chemical fertilizers. The main goal of the thesis is ultimately to try to understand the implications of aspirations by examining their interactions not only with the underlying drivers of well-being (such as the adoption of agricultural innovations and risk behavior) but also their interactions with the well-being outcomes themselves. The thesis uses various outcome indicators including income and consumption expenditure, various triangulating measures of food security, and subjective well-being defined in terms of life satisfaction and happiness. In nearly all outcome indicators, the thesis finds suggestive evidence that aspirations are important predictors of household well-being in rural Ethiopia. The overall findings of the thesis clearly demonstrate that beyond the resource-related deprivations, low aspirations also play a role in rural households’ decision-making in Ethiopia, with consequences on well-being outcomes. Targeting the determinants of aspirations may therefore be a useful policy strategy.Soziale Interaktionen, Bestrebungen und landwirtschaftliche Innovationen : Zusammenhänge zwischen Einkommen und Nahrungsmittelsicherheit im ländlichen Äthiopien Entwicklungsökonomische Studien greifen immer häufiger auf multidisziplinäre Methoden und Konzepte zurück, um ein besseres Verständnis über die anhaltende Armutssituation in Teilen der Welt zu erhalten, greifen. Die vorliegende Arbeit verwendet ein solches Konzept, das aspirations-failure framework, das die Situation der Armen und ihr Investitionsverhalten mit dem „aspiration failure“ verknüpft. Anhand von Individualdaten und Haushaltsdaten von landwirtschaftlichen Betrieben in Äthiopien wird der Effekt von sozialen Beziehungen auf Aspirationen (in Bezug auf Einkommen, Wohlstand, sozialer Status und Bildung) ökonometrisch analysiert. Die Theorie besagt, dass Aspirationen gesellschaftlich bedingt sind, beispielsweise durch gegenseitige Beobachtung und durch soziale Interaktionen. Die ökonometrischen Ergebnisse bestätigen dies. Tatsächlich deuten die Ergebnisse an, dass die Größe der sozialen Netzwerke eine wichtige Determinante für Aspirationen insbesondere von Frauen ist. Auch die Relevanz des aspiration window wird bestätigt – dies ist die individuelle kognitive Welt, die Aspirationen formt. Ein Wirkungskanal, durch den Aspirationen das individuelle Verhalten beeinflussen können, sind die Effekte auf das Risikoverhalten. Die Analyse macht deutlich, dass der aspiration-gap – die Differenz zwischen angestrebten und gegenwärtigen Status – das Risikoverhalten in einer nichtlinearen Weise beeinflusst. Die Ergebnisse deuten auch an, dass der Effekt des aspiration-gap auf die Risikopräferenz bei Frauen stärker ausgeprägt ist als bei Männern. Darüberhinaus können soziale Interaktionen die Verbreitung von Innovationen und die Produktivität fördern. Die Analyse von sozialen Netzwerken, die die Methode „random matching within sample“ nutzt, zeigt einen starken Einfluss von Netzwerkexternalitäten auf die Adoption von Sätechniken sowie auf die landwirtschaftliche Produktivität. Entsprechend trägt diese Arbeit maßgeblich zur wissenschaftlichen Diskussion bei, indem Aspirationen (und deren Lücke) als Schlüsselvariable für die Innovationsfähigkeit der Bauern identifiziert werden und diese die Adoption von innovativen Produkten wie zum Beispiel chemischen Düngemitteln erklären können. Das Ziel dieser Arbeit ist es, die Implikationen von Aspirationen zu verstehen. Dazu werden die Interaktionen mit den grundlegenden Determinanten des Wohlbefindens untersucht (beispielsweise die Adoption von landwirtschaftlichen Innovationen und das individuelle Risikoverhalten) und die Interaktionen mit den direkten Folgen des jeweiligen Wohlbefindens. Verschiedene Outcome-Indikatoren werden verwendet, wie unter anderem Einkommen und Konsumausgaben, verschiedene triangulierte Food Security Indikatoren, sowie subjektives Wohlbefinden, das als Zufriedenheit und Glücksempfinden definiert ist. Für fast alle Outcome-Indikatoren wird ein Einfluss von Aspirationen auf das Wohlbefinden von ländlichen Haushalten in Äthiopien gefunden. Diese Arbeit zeigt auf, dass neben Ressourcenengpässen insbesondere auch nicht vorhandene Aspirationen eine entscheidende Rolle im Entscheidungsverhalten von ländlichen Haushalten in Äthiopien spielen, mit entsprechenden Konsequenzen für das Wohlbefinden. Folglich kann es eine erfolgreiche Policy Strategie sein, die Determinanten von Aspirationen zu berücksichtigen

Magnitude of Cryptococcal Antigenemia among HIV Infected Patients at a Referral Hospital, Northwest Ethiopia

BACKGROUND: Cryptococcosis is one of the common opportunistic fungal infections among HIV infected patients living in Sub-Saharan Africa, including Ethiopia. The magnitude of thedisease at Felege Hiwot Referral Hospital (FHRH) in particular and in Ethiopia at large is not well explored.METHODS: A retrospective document review and analysis was done on records of 137 HIV infected patients who visited FHRH ART clinic from 1 Sep to 30 Dec 2016 and had registered data on their sex, age, CD4 count and cryptococcal antigen screening result. The cryptoccocal antigen (CrAg) detection was done by the IMMY CrAg® LFA (Cryptococcal Antigen Lateral Flow Assay) kit from patient serum as per the manufacturer’s instruction. All data were entered, cleared, and analyzed using SPSS v20. Descriptive data analysis and cross tabulation were done to assess factors associated with cryptococcal antigenemia. Statistical significance was set at p-value less than or equal to 0.05.RESULTS: More than half of the participants, 54.7% (75/137), included in the study were females. The median age of the participants was 32.0 years (ranged: 8-52 years). The mean CD4 count was 51.8 with SD of 26.3 (range 3-98). All the patients were HIV stage IV. The proportion of positive cryptococal antigen from serum test was at 11.7% (95% CI: 7.3-18.1%). The IMMYCrAg® LFA result was found statically associated with patient sex (p= 0.045). However, it was not associated with patient age group and the CD4 count (P>0.05)CONCLUSIONS: This study provided baseline data on the magnitude of cryptococcal antigenemia among HIV positive patients that is not touched before in the studied area. The results of the study showed that this opportunistic fungal infection is an important health concern among HIV patients. Further studies with sound design employing adequate sample size should be considered.

Impact of farmer field schools on agricultural productivity and poverty in East Africa

Farmer field schools (FFSs) are a popular education and extension approach worldwide. Such schools use experiential learning and a group approach to facilitate farmers in making decisions, solving problems, and learning new techniques. However, there is limited or conflicting evidence as to their effect on productivity and poverty, especially in East Africa. This study is unique in that it uses a longitudinal impact evaluation (difference in difference approach) with quasi-experimental methods (propensity score matching and covariate matching) together with qualitative approaches to provide rigorous evidence to policymakers and other stakeholders on an FFS project in Kenya, Tanzania, and Uganda. The study provides evidence on participation in FFSs and on the effects of FFSs on various outcomes. The study found that younger farmers who belong to other groups, such as savings and credit groups, tended to participate in field schools. Females made up 50 percent of FFS membership. Reasons for not joining an FFS included lack of time and information. FFSs were shown to be especially beneficial to women, people with low literacy levels, and farmers with medium-size land holdings. FFS participants had significant differences in outcomes with respect to value of crops produced per acre, livestock value gain per capita, and agricultural income per capita. FFSs had a greater impact on crop productivity for those in the middle land area (land poverty) tercile. Participation in FFSs increased income by 61 percent when pooling the three countries. FFSs improved income and productivity overall, but differences were seen at the country level. Participation in FFSs led to increased production, productivity, and income in nearly all cases: Kenya, Tanzania, and at the project level (all three countries combined). The most significant change was seen in Kenya for crops (80 percent increase) and in Tanzania for agricultural income (more than 100 percent increase). A lack of significant increases in Uganda was likely due to Uganda’s National Agricultural Advisory Services. When disaggregating by gender, however, female-headed households benefited significantly more than male-headed households in Uganda.farmer field schools, agricultural productivity, adoption, extension services,

In-depth assessment of the public agricultural extension system of Ethiopia and recommendations for improvement:

Eighty-three percent of the population of Ethiopia depends directly on agriculture for their livelihoods, while many others depend on agriculture-related cottage industries such as textiles, leather, and food oil processing. Agriculture contributes about 46.3 percent of gross domestic product (GDP) (World Bank 2008) and up to 90 percent of total export earnings. As part of the current five-year (2006–2011) Plan for Accelerated and Sustained Development to End Poverty (PASDEP), the government is continuing to invest heavily in agriculture. A core part of the government's investment in agriculture is the public agricultural extension system. This study was conducted to assess the strengths and constraints of the public extension system and to provide suggestions on “best fit” solutions and their scale-up opportunities. The review used a variety of analytical tools to develop the overall findings, including extensive field visits to six of nine regions in Ethiopia; interviews with farmer trainees at farmer training centers (FTCs), more than 100 extension personnel, extension experts, nongovernmental organization (NGO) groups, and government representatives; and a literature review on Ethiopian extension. The study assessed strengths and constraints in the field-level extension system, the ATVET system, and the extension institutional environment. The researchers also considered the overall enabling environment within which extension operates. The field-level extension service has a strong foundation of FTCs and trained development agents (DAs) already in place in the field. Roughly 8,489 FTCs have been created throughout Ethiopia, and about 62,764 DAs have been trained in total, with a reported 45,812 staffed on location. Woreda (district) and regional offices are adequately staffed. DAs and woreda staff have strong technical skills and theoretical knowledge, and are generally trained as specialists. Pockets of entrepreneurialism and innovation exist in specific FTCs and woredas. While acknowledging these strengths, the researchers also identified several sets of constraints within the field-level extension system that will require attention. Basic infrastructure and resources at the FTC and woreda level remain a major constraint, particularly in relation to operating funds: the vast majority of FTCs and kebeles do not have operating equipment or inputs to pursue typical extension activities on the demonstration farm. There are major “soft” skill gaps for DAs and subject matter specialists (SMSs) in the FTCs and woredas, and their ability to serve farmers is limited given a lack of practical skills. Finally, the overall field-level system is often limited in its ability to meet farmer needs and demands; mechanisms to make it more farmer-driven and market-oriented would yield greater results. The authors employed a similar approach at the ATVET level to identify strengths and constraints. Strengths at the ATVET level include a strong record of training broad groups of DAs, a strong technical curriculum, and some pockets of innovation and practical training, including linkages to markets and farmers. Constraints include limited success in enabling DAs to gain practical experience, particularly related to their internships at the woreda level; limited linkages to the broader educational system and research system in Ethiopia; and a general lack of resources to effectively transmit the required skill set to DAs. The countrywide enabling environment in which extension operates is critical to extension efforts. Various aspects of the enabling environment were considered, including seed and other inputs, water management, and credit systems, as well as producer groups. Constraints were also assessed, leading to the conclusion that the enabling environment requires strengthening, particularly in the areas of seed and credit, if extension is to achieve its full potential impact.trained development agents (DA), farmer training centers (FTC), ATVET system, Extension, Agriculture,

Characteristics of fruit and vegetable MSMEs in Ethiopia: Case of Addis Ababa and Ziway/Batu

This study documents the characteristics and functioning of fruit and vegetable (FV) value chains in select places in Ethiopia. The case study employed a mixed methods approach, including a survey of 340 FV traders, six focus group discussions (FGDs), and analysis of the policy environment with respect to food and nutrition, the business climate, and the role of micro, small, and medium enterprises (MSMEs) in delivering safe, affordable, and nutritious foods to consumers. Among the nine types of actors that participate in the FV market and were interviewed, the majority (more than 73 percent) were retailers operating either within or outside of wet markets

Xpert MTB/RIF assay for the diagnosis of Mycobacterium tuberculosis and its Rifampicin resistance at Felege Hiwot and Debre Tabor Hospitals, Northwest Ethiopia: A preliminary implementation research

Background: The World Health Organization endorsed GeneXpert MTB/RIF (Xpert) assay for the diagnosis of tuberculosis (TB) and multidrug resistant tuberculosis (MDR-TB) in 2010. However, the practice of using this novel diagnostic method is still limited in a high TB and human immunodeficiency virus (HIV) burden settings, including Ethiopia. Therefore, we conducted this study aimed at describing the first implementation status of Xpert assay in the diagnosis of TB and MDR-TB at Felege Hiwot Referral Hospital (FHRH) and Debre Tabor General Hospital (DTGH), Northwest Ethiopia.Methods: We analyzed the records of 1922 (FHRH=544 and DTGH=1378) presumptive TB patients diagnosed using Xpert test from 1 November 2015 to 30 April 2016 at FHRH and DTGH, Northwest Ethiopia. All patients who had registered data on their sex, age, HIV status, presumptive MDR-TB status and Xpert results were included for analysis. Data were retrieved directly from GeneXpert result registration log book using data extraction sheet. Data were entered, cleaned, and analyzed using SPSS statistical software package; p < 0.05 was considered to be significant.Results: Overall Xpert assay properly diagnosed 14.6% of the cases (258/1922). Among these, rifampicin (RIF) resistance was detected at 9.3% (24/258). In the studied settings, clinical data showed that 81.0% (1556/1922) of the cases were MDR- TB. Among the study subjects, 888 (46.2 %) of them were HIV positive. However, TB-HIV co-infection rate was at 41.9% (108/258). Of the total patients registered, 1005 (52.3%) of whom were males. The mean age of patients was 31.1 years with SD of 17.5. Significant predictors of the Xpert test were: age (p=0.000), sex (p=0.009), HIV status (p=0.003) and presumptive MDR-TB (p=0.000).Conclusions: In the studied areas, large proportion of clinically TB suspected patients were wrongly diagnosed with MDR-TB. Therefore, the use of Xpert assay in health settings with no culture facility will decrease the unnecessary use of anti-TB drugs and improve rapid TB, and MDR-TB detection and proper management of the cases. [Ethiop. J. Health Dev. 2016;30(2):60-65]Keywords: TB, GeneXpert, MTB/RIF assay, Northwest Ethiopi

The COVID-19 pandemic and healthcare systems in Africa:A scoping review of preparedness, impact and response

BACKGROUND: The COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic. METHODS: We conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O’Malley’s methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed. RESULTS: Twenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings. CONCLUSIONS: The health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised

The COVID-19 pandemic and healthcare systems in Africa : a scoping review of preparedness, impact and response

Funding Information: Funding GAT was supported with funding from the Australia National Health and Medical Research Council (NHMRC) Investigator Grant #1195716.Peer reviewedPublisher PD