Nutrition in agricultural development: Intensive dairy farming by rural smallholders

This study concerns the introduction of intensive dairy farming among rural smallholders in Kilifi District, Kenya. Household surveys were conducted among dairy farmers, dairy customers and a comparison sample from rural locations. Dairy farmers were better off than the rural sample as regards household income, food production, food consumption and nutritional status of young children. These differences resulted from the dairy activities but also from greater involvement in crop cultivation and off‐farm employment.

Local milk purchases by dairy customers were mostly by wealthier households with wage employment. They had higher incomes and higher food consumption than the rural sample, and the children in these households had better nutritional status. Further analysis confirms a positive relation between milk consumption and nutritional status of children, independent of household income, energy intake and level of education. Other notable findings were the high incomes from off‐farm employment of dairy farmers; regular dairy customers are chiefly households with wage employment; milk consumption among the rural population was very low.

The results cast doubt on the importance of intensive dairy production as a means of livelihood for resource‐poor households and the importance of milk as a means to improve nutritional status of children in low‐income households.     

Impacto sobre el consumo en bares,cafeterías y restaurantes de la modificación de la ley del tabaco española

Objectiveto analyze the impact of Spanish smoke-free legislation (Law 42/2010) on the business activity of bars, cafés, and restaurants.Methodswe used the micro-data from the Household Budget Survey for 2010 and 2011. The linking files allowed close follow-up of the households that remained in the sample for 2 consecutive years. Taking the year 2010 as the base reference for our analyses, we quantified how levels of consumption expenses on hospitality venues have changed over the years, differentiating between smoking households and non-smoking households.Resultsthe marginal effects of the first stage of the two-part model showed that the mean probability of expenditure on hospitality venues was 96% in smoking households and was 86% in non-smoking households. There were no statistically significant variations in the probability of expenditure between 2010 and 2011. The proportion of expenditure on hospitality venues in total household consumption expenditure in smoking households was 7.961% and 7.796% in 2010 and 2011, respectively. These proportions were 7.25% in 2010 and 7.272% in 2011 for non-smoking households. The difference in differences estimator, which takes into account both differences between years and households, showed no statistically significant differences in levels of household consumption.Conclusionsthe introduction of the Law 42/2010 has had noimpact on the levels of household consumption expenses on hospitality venues. Changes in consumption expenses could be explained by sociodemographic characteristics (such as the number of children per household) and the impact of the economic crisis (unemployment and a decrease in household income).     

Food-for-work programs in Indonesia had a limited effect on anemia

Indonesia's economic crisis of late 1990s lowered consumption of micronutrient-rich foods, which increased the prevalence of micronutrient deficiencies, including anemia. As a postcrisis response, 5 nongovernmental organizations (NGOs) implemented Food for Work (FFW) programs to protect food consumption levels and nutritional status by providing rice, sometimes combined with oil and/or pinto beans. An independent evaluation assessed the effect of the FFW programs on nutrition outcomes, particularly anemia. A quasi-experimental design was used in which 1500 beneficiary and 1500 control households were randomly selected and followed in each of 3 urban and 2 rural sites. Baseline data were collected before program implementation and subsequently at approximately 6-mo intervals for 2.5 y. The poor were found to be appropriately targeted, and program participation ranged from 4 to 18 mo. The proportion of households with debts ranged from 32 to 70%; although it was higher among beneficiaries than controls, it increased among controls, but not beneficiaries. However, only among urban poor mothers in Surabaya were the odds of anemia at endline lower when participating in the FFW program (0.60, 95%CI [0.40-0.89]). Other risk factors for anemia in mothers and children included nutritional status (anemia at baseline, low BMI, receipt of vitamin A capsule, child age) and socioeconomic status (maternal education, having official residency in the area, income level). Thus, postcrisis FFW programs had limited effect on anemia, the main identified nutritional problem. Closer attention is required to the potential for affecting nutritional outcomes through FFW, including food aid quality and quantity and complementary nonfood interventions. Micronutrient deficiencies should be addressed directly via supplements and fortified foods.     

Microfinance as a tool for financing medical devices in Syria. An assessment of needs and a call for further research

Background

Microfinance is a generally accepted tool for improving the economic situation of the poor in developing countries. However, it has hardly been used to finance medical devices required by the disabled, although the incapability of these groups to buy wheelchairs and other equipment is a major source of poverty.

Aim

This paper analyzes the need for microfinance as a tool for financing wheelchairs for patients suffering from a walking disability and oxygen concentrators for patients with chronic lung diseases. It is not in the scope of this study to present a comprehensive concept of implementing a microfinance instrument, but the paper intends to demonstrate that the disabled in Syria perceive a great need for such a financing tool. In addition, this paper wants to encourage microfinance institutions to go beyond their traditional field of business and start lending to the disabled so that they can buy the equipment necessary to live a productive life of higher quality.

Methodology

Two groups of disabled patients in Syria were asked about their social and economic situation as well as their access to financing tools. The first sample consisted of patients suffering from a walking disability with major constraints concerning their mobility and who are in need of a wheelchair (N?=?100). The second sample consisted of patients with chronic lung diseases (N?=?90) and with a need of additional oxygen. All participants lived below the national poverty line.

Results

Eighty-two percent of the interviewees suffering from a walking disability and 78% of the interviewees with chronic lung diseases were not health-insured. Although there was some knowledge of microfinance among the interviewees, they reported having limited or no access to such programs. Seventy-two percent of the patients with a walking disability and 68% of the patients with chronic lung diseases knew what microfinance is, but the portion of borrowers was 24% of the examined patients with a walking disability and 22% of the patients with chronic lung diseases. Ninety percent of the patients with a walking disability and 73% of the patients with a chronic lung disease are convinced that they could generate income if they could only buy a wheelchair or an oxygen concentrator. The majority, i.e., 89% of the patients with a walking disability and 95% of the patients with a chronic lung disease, believed that microfinance would be an ideal tool for them to finance these devices and that they or their family could pay back the installments.

Conclusion

Microfinance has not been used as a tool for financing medical devices in Syria. However, this study shows that the disabled of this country perceive a great need for this innovative system. The majority of the disabled believe that they could gain some income and pay back the loan if they had the necessary equipment. This is a basic prerequisite for further steps to start microfinance for this group of potential clients. However, a start-up would need some support, e.g., by the government of Syria. It is likely that the financing of medical devices by microfinance can also be used for other groups of patients and needy persons in Syria as well as in comparable countries, but this statement calls for further research.     

农户疾病风险处理策略研究述评

疾病影响农户生计。本文从疾病风险测度、疾病对农户生计影响、农户疾病风险处理策略等方面对现有研究进行述评。疾病对农户生计短期影响表现为减少劳动时间和降低正常消费水平等;大病可能导致10年或更长的严重负面影响,特别是影响农户人力资本发展。面对疾病风险,农户采取诸如计划免疫、安全饮水及参加医保项目等"事前"预防措施;他们还积极采取收入和消费平滑的"事后"风险处理策略来度过难关,例如减少家庭消费、借贷、变卖消费性和生产性资产、向外地移居等策略。不同经济状况的农户会采取适合于自身经济能力的疾病风险处理策略。未来的研究需要在疾病对农户收入的持续影响以及对贫困农户生计的影响,不同特征农户疾病风险处理策略比较等方面进行深入分析。     

Born of war: Protecting children of sexual violence survivors in conflict zones

Abstract

The effects of HIV/AIDS have been far-reaching in Africa. Beyond adverse health outcomes and the tremendous toll on life, AIDS has serious economic impacts on households, increasing livelihood insecurity while simultaneously depleting socio-economic resources. Although microfinance is believed to have the potential to mitigate the economic impacts of HIV by helping affected households and communities better prepare for and cope with HIV-related economic shocks, little empirical research exists on this subject. This qualitative study examines the socio-economic impacts of economic strengthening activities on people living with HIV (PLHIV) in the era of increased access to anti-retroviral therapy to determine if savings-led, community-managed microfinance is a justified activity for HIV programmes. Findings from a village savings and loan programme, implemented by CARE International in Côte d'Ivoire, revealed that when appropriate medical treatment is available PLHIV are capable of participating in and benefit from microfinance activities, which increased HIV-positive clients' access to money and economic self-sufficiency. By bringing individuals with similar experiences together, savings and loan groups also acted as self-support groups providing psychosocial support while reducing stigmatisation and increasing members' sense of dignity and self-worth.     

Constructing socio-economic status indices: how to use principal components analysis

Theoretically, measures of household wealth can be reflected by income, consumption or expenditure information. However, the collection of accurate income and consumption data requires extensive resources for household surveys. Given the increasingly routine application of principal components analysis (PCA) using asset data in creating socio-economic status (SES) indices, we review how PCA-based indices are constructed, how they can be used, and their validity and limitations. Specifically, issues related to choice of variables, data preparation and problems such as data clustering are addressed. Interpretation of results and methods of classifying households into SES groups are also discussed. PCA has been validated as a method to describe SES differentiation within a population. Issues related to the underlying data will affect PCA and this should be considered when generating and interpreting results.     

Microfinance and HIV mitigation among people living with HIV in the era of anti-retroviral therapy: emerging lessons from Cote d'Ivoire

The effects of HIV/AIDS have been far-reaching in Africa. Beyond adverse health outcomes and the tremendous toll on life, AIDS has serious economic impacts on households, increasing livelihood insecurity while simultaneously depleting socio-economic resources. Although microfinance is believed to have the potential to mitigate the economic impacts of HIV by helping affected households and communities better prepare for and cope with HIV-related economic shocks, little empirical research exists on this subject. This qualitative study examines the socio-economic impacts of economic strengthening activities on people living with HIV (PLHIV) in the era of increased access to anti-retroviral therapy to determine if savings-led, community-managed microfinance is a justified activity for HIV programmes. Findings from a village savings and loan programme, implemented by CARE International in Cote d'Ivoire, revealed that when appropriate medical treatment is available PLHIV are capable of participating in and benefit from microfinance activities, which increased HIV-positive clients' access to money and economic self-sufficiency. By bringing individuals with similar experiences together, savings and loan groups also acted as self-support groups providing psychosocial support while reducing stigmatisation and increasing members' sense of dignity and self-worth.     

Ageing in India: Financial hardship from health expenditures

India's rapidly ageing population raises concerns about the burden of health care payments among older individuals who may have both limited income and greater health care needs. Using a nationally representative household survey, we investigate the association between age and financial hardship due to health expenditures. We find that both the probability of experiencing health problems and mean total out‐of‐pocket health expenditures increase with age. Second, the probability of households experiencing catastrophic health expenditures increases with each additional member aged 60 and above—33% of households with one 60+ member and 38% of households with 2 or more 60+ members experienced catastrophic health expenditures, compared to only 20% in households with all members under the age of 60 years. Lastly, we show that individuals aged 60 and above had a much higher probability of becoming impoverished as a result of health expenditures—the probability of impoverishment for 60+ individuals was 3 percentage points higher than for individuals under the age of 60. Overall, around 4.8% of the older population, representing 4.1 million people, fell into poverty. The results suggest that there is an urgent need for public investments in financial protection programs for older people in India.     

The economic impact of chronic diseases: How do households respond to shocks? Evidence from Russia

The epidemiological burden of chronic diseases is increasing worldwide and there is very little empirical evidence regarding the economic impact of chronic diseases on individuals and households. The primary objective of this paper is to explore the evidence on how chronic diseases affect household healthcare expenditure, non-health consumption, labour (earned) income, and to demonstrate how transfers may provide some insurance against shocks from chronic diseases. We have explicated a two-part Heckit model on household level data obtained from the Living Standard Measurement Surveys (LSMS) from Russia to control for nontrivial proportion of zeros in the dependent variables, skewed distribution of expenditure data and endogeneity. The results indicate that chronic diseases are significantly associated with higher levels of household healthcare expenditure in Russia and productivity losses reflected by reduced labour supply and reduced household labour income. Non-healthcare expenditure also increased. Results suggest that households are able to insure non-health consumption against chronic diseases, possibly from transfers, which also increased. In addition, socioeconomic status indicators significantly explained the impact of chronic diseases on households. Insurance and higher average education in households were associated with higher healthcare expenditure. Household transfers were significant in Russia despite an appreciable level of insurance cover. We conclude that households depend on informal coping mechanisms in the face of chronic diseases, irrespective of insurance cover. These results have implications for policies regarding the financing of treatment and control of chronic diseases in the country studied.     

Factors Influencing Nutritional Adequacy among Rural Households in Nigeria: How Does Dietary Diversity Stand among Influencers?

This study examined the influence of food consumption diversity on adequate intakes of food calories, proteins and micronutrients among households in rural Nigeria within the framework of panel data econometrics using a nationally representative data. We found that substantial proportion of households suffered deficiency of calories, proteins and certain micronutrients; with higher percentage of sufferer households occurring in the post-planting season. The different measures of dietary diversity (constructed and used for analysis) consistently indicate significant and positive influence of dietary diversity on the likelihood of adequate consumption of food nutrients. While higher level of income, education and non-farm enterprise engagement may strongly stimulate adequate nutrient intakes, increases in the number of adolescents would substantially diminish it. Although our findings call for renewed attention on diet diverseness, we stress the complementary/synergistic roles of education and rural income improvement, especially through non-farm enterprise diversification in tackling multiple nutritional deficiencies in rural Nigeria.     

The impact of economic crisis on health-care consumption in Korea.

This study uses urban household income-expenditure survey data, national health insurance claims data, and public health centre surveys to examine the impact of economic crisis on the consumption of health services in Korea. The analysis shows that the health-care consumption of Korean households has been adversely affected by the recent economic crisis, as measured by amount of expenditure on health. Distributional implications for health sector use are also found. Whereas the use of medical services by upper income groups is only slightly affected by the economic crisis, lower income groups are spending relatively less on medical services. Of all households, unemployed households are hit hardest by the crisis. Analysis shows that for all households, the rate of expenditure decrease is relatively higher for drug expenditure than for expenditure on medical services. That is, facing declining income, people cut their spending in the area where the need is non-essential or less inevitable.     

Rural Household Food Insecurity among Latino Immigrants during the COVID-19 Pandemic

U.S. food insecurity rates rapidly increased during the COVID-19 pandemic, with disproportionate impacts on Latino immigrant households. We conducted a qualitative study to investigate how household food environments of rural Latino immigrants were affected during the COVID-19 pandemic. Thirty-one respondents (42% from low food security households) completed interviews (July 2020–April 2021) across four rural counties in California. A rural household food security conceptual framework was used to analyze the data. Early in the pandemic, food availability was impacted by school closures and the increased consumption of meals/snacks at home; food access was impacted by reduced incomes. Barriers to access included limited transportation, excess distance, and lack of convenience. Key resources for mitigating food insecurity were the Supplemental Nutrition Assistance Program (SNAP), the Pandemic Electronic Benefits Transfer (P-EBT), school meals, charitable food programs, and social capital, although the adequacy and acceptability of charitable food distributions were noted issues. Respondents expressed concern about legal status, stigma, and the public charge rule when discussing barriers to government nutrition assistance programs. They reported that food pantries and P-EBT had fewer access barriers. Positive coping strategies included health-promoting food substitutions and the reduced consumption of meals outside the home. Results can inform the development of policy and systems interventions to decrease food insecurity and nutrition-related health disparities among rural Latino immigrants.     

Income and consumption effects of milk commercialization in the lukkos area of morocco

Two‐hundred and forty households were interviewed through a survey assessing the impact on various aspects of household welfare of a large‐scale irrigation project in the Lukkos region of Morocco. Installation of milk centers to collect milk from producers for commercial purposes affected households’ economic and dietary patterns. It motivated households to procure genetically improved cattle and hence to increase their milk production. Caring for improved cattle had a positive effect on household income, but no additional effect of access to milk centers on income could be shown. This access negatively affected household consumption of dairy products and calcium intake, particularly during summer, when alternative sources of calcium were less available. A nutrition education program should address the importance of the consumption of dairy products to improve the quality of households’ diet. Expansion of rural markets will also benefit this quality through increase in the frequency of food purchase and the physical and economic access to food markets.     

Income elasticity of education and smoking

The relationships among the income (expenditures) level, expenditure for education and tobacco consumption were analyzed based on the data of workers households reported in Family Income and Expenditure Survey of Japan between 1980 and 1995. For all the observed years, elasticities of tobacco to living expenditure were less than -0.4 and the deviation from zero point had increased (-0.41 in 1980, and -0.95 in 1995). By contrast, elasticities of education to living expenditure were over 1.5 for the observed period. In the case of income elasticity, values of tobacco were negative with the same chronological tendency as in elasticity to living expenditure and those of education were around 1.10. The findings regarding the relationship between income level and tobacco consumption was quite different from most of the studies conducted in western countries, which suggested a positive elasticity between the two. According to the present results, we discussed two strategies in order to reduce the smoking prevalence rate in Japan: education and an increase in the cigarette price by higher cigarette taxes.     

Determinants of Children’s Fruit Intake in Teso South Sub-County,Kenya—A Multi-Phase Mixed Methods Study among Households with Children 0–8 Years of Age

Fruits are micronutrient-rich sources which are often underrepresented in children’s diets. More insights into the determinants of children’s fruit consumption are needed to improve nutrition education in Teso South Sub-County, Kenya. A multiphase mixed method study was applied among 48 farm households with children 0–8 years of age. A market survey together with focus group discussions were used to design a formative research approach including qualitative and quantitative data collection methods. The unavailability of fruits and the inability to plant fruit trees in the homesteads were the main challenges to improve fruit consumption behaviour, although a number of different fruit species were available on the market or in households. Perceived shortage of fruits, financial constraints to purchase fruits and taste were important barriers. Fruits as snacks given between meals was perceived as helpful to satisfy children. The mean number of fruit trees in the homesteads was positively associated with fruit consumption. Field trials are needed to test how best fruit trees within home gardens and on farms can be included, acknowledging limited space and constraints of households with young children. This should be combined with nutrition education programs addressing perceptions about the social and nutrient value of fruits for children.     

The impact of filipino micro health-insurance units on income-related equality of access to healthcare

BACKGROUND: This study aims to assess the impact of being insured by micro-health insurance units (MIUs) on equality of access to health care among groups with inequitable income distribution. We measure equality by relating income with access to healthcare. The analysis is based on a household survey conducted in five regions in the Philippines in 2002. METHODS: We generated concentration curves and indices (CI) for insured and uninsured households (150 for each cohort in each region). We also elaborated a method to retain the relative income rank of households when data were aggregated across regions, as the regions had quite different nominal income levels. RESULTS: We found a significant effect of household income on access to hospitalizations among the uninsured households (a positive CI), but no such effect among the insured households (CI close to zero). As regards professionally attended deliveries, an increased tendency of poorer households to deliver at home (CI slightly negative) and a lower rate of deliveries in hospital (CI slightly positive and statistically significant) were reported by both uninsured and insured households. Access to consultations was unrelated to income among the insured (CI close to 0), but negatively correlated with income among the uninsured (a positive and significant CI). CONCLUSION: We conclude that MIUs in Philippines improve income-related equality of access to hospitalization and medical consultation in cases of illness. The findings of this study strengthen a claim for government support for the operation of MIUs as successful (albeit micro) suppliers of health insurance.     

Integrating microfinance and health strategies: examining the evidence to inform policy and practice

INTRODUCTION: Single solutions continue to be inadequate in confronting the prevalent problems of poverty, ill health and insufficient health system capacity worldwide. The poor need access to an integrated set of financial and health services to have income security and better health. Over 3500 microfinance institutions (MFIs) provide microcredit and financial services to more than 155 million households worldwide. Conservative estimates indicate that at least 34 million of these households are very poor by the definition in the Millennium Development Goals, representing around 170 million people, many in remote areas beyond the reach of health agencies, both private and governmental. A small but increasing number of MFIs offer health-related services, such as education, clinical care, community health workers, health-financing and linkages to public and private health providers. REVIEW OF EVIDENCE: Multiple studies indicate the effectiveness of microfinance and its impact on poverty. A small but growing number of studies also attempt to show that MFIs are capable of contributing to health improvement by increasing knowledge that leads to behavioural changes, and by enhancing access to health services through addressing financial, geographic and other barriers. While these studies are of uneven quality, they indicate positive health benefits in diverse areas such as maternal and child health, malaria and other infectious disease, and domestic violence. While more rigorous research is needed to inform policy and guide programme implementation to integrate microfinance and health interventions that can reliably enhance the well-being of the poor, there is useful evidence to support the design and delivery of integrated programmes now. CONCLUSION: Worldwide, current public health programmes and health systems are proving to be inadequate to meet population needs. The microfinance sector offers an underutilized opportunity for delivery of health-related services to many hard-to-reach populations.     

Credit program outcomes: coping capacity and nutritional status in the food insecure context of Ethiopia

This paper presents findings of a survey that was primarily intended as (1) an assessment of coping capacity in drought and food insecure conditions and (2) a microfinance program outcome study. A three group cross-sectional survey of 819 households was conducted in May 2003 in two predominantly rural sites in Ethiopia. Established clients of the WISDOM Microfinance Institution were compared with similar incoming clients and community controls. No overall pattern of enhanced prevalence of coping mechanisms was observed in any participant group, suggesting that participation in the lending program did not affect coping capacity at the household level. No significant differences in mean mid-upper arm circumference or prevalence of acute malnutrition were found in males or females when the total sample was assessed. In the primary survey site, Sodo, female clients and their children had significantly better nutritional status than other comparison groups: the odds of malnourishment in female community controls compared to established female clients was 3.2 (95% CI: 1.1-9.8) and the odds of acute malnutrition in children 6-59 months of age were 1.6 times greater in children of both male clients and community controls (95% CI: .78-3.32). Household food security among female client households in Sodo was significantly better than in other comparison groups according to a variety of indicators. As compared to female clients, male clients and community controls, respectively, were 1.94 (95% CI: 1.05-3.66) and 2.08 (95% CI: 1.10-4.00) times more likely to have received food aid during the past year. Findings of the present study suggest that microfinance programs may have an important impact on nutritional status and well-being of female clients and their families. That female clients were significantly less likely to be food aid recipients suggests that microfinance programs may be successful in reducing vulnerability to prolonged drought and food insecurity.     

The Impact of Public Transfer Income on Catastrophic Health Expenditures for Households With Disabilities in Korea

ObjectivesPrevious studies have reported that people with disabilities are more likely to be impoverished and affected by excessive medical costs than people without disabilities. Public transfer income (PTI) reduces financial strain in low-income households. This study examined the impact of PTI on catastrophic health expenditures (CHE), focusing on low-income households and households with Medical Aid beneficiaries that contained people with disabilities.MethodsWe constructed a panel dataset by extracting data on registered households with disabilities from the Korea Welfare Panel Study 2012-2019. We then used a generalized estimating equation model to estimate the impacts of PTI on CHE. A subgroup analysis was carried out to assess the moderating effects of family income levels and health insurance types.ResultsAs PTI increased, the odds ratio (OR) of CHE in households that contained people with disabilities decreased significantly (OR, 0.92; 95% confidence interval [CI], 0.89 to 0.94; p<0.001). In particular, PTI effectively reduced the likelihood of CHE for low-income households (OR, 0.85; 95% CI, 0.81 to 0.89; p<0.001) and those who received medical benefits (OR, 0.78; 95% CI, 0.68 to 0.89; p<0.001).ConclusionsThis study highlights the positive effect of PTI on decreasing CHE. Household income and the health insurance type were significant effect modifiers, but economic barriers seemed to persist among low-income households with non-Medical Aid beneficiaries. Federal policies or programs should consider increasing the total amount of PTI targeting low-income households with disabilities that are not covered by the Medical Aid program.