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Poverty and Health: Defeating poverty by going to the roots
Poverty is dynamic in nature: even as some people move out of poverty, other people simultaneously fall into poverty. The poverty pool is being simultaneously both depleted and refilled. Anirudh Krishna argues that efforts for poverty reduction tend to focus exclusively on raising people out of poverty, and therefore will not be very successful unless poverty creation is also addressed. Ill health and high healthcare expenses are the principal reasons associated with falling into poverty; therefore, reducing poverty requires investing in better healthcare.
Journal Article
A good trade
Early morning in Uganda see a small boy struggle with jerry cans filled with the day's supply of water. At the village square he spies an aid truck filled with something amazing, what can a such a small barefoot boy do to earn the treasure inside that truck?
Book
Uganda: Second Review Under the Policy Support Instrument and Request for Modification of Assessment Criteria-Staff Report; Staff Supplement; Press Release on the Executive Board Discussion; and Statement by the Executive Director for Uganda
In recent years, the IMF has released a growing number of reports and other documents covering economic and financial developments and trends in member countries. Each report, prepared by a staff team after discussions with government officials, is published at the option of the member country.
eBook
Combining satellite imagery and machine learning to predict poverty
Reliable data on economic livelihoods remain scarce in the developing world, hampering efforts to study these outcomes and to design policies that improve them. Here we demonstrate an accurate, inexpensive, and scalable method for estimating consumption expenditure and asset wealth from high-resolution satellite imagery. Using survey and satellite data from five African countries–Nigeria, Tanzania, Uganda, Malawi, and Rwanda–we show how a convolutional neural network can be trained to identify image features that can explain up to 75% of the variation in local-level economic outcomes. Our method, which requires only publicly available data, could transform efforts to track and target poverty in developing countries. It also demonstrates how powerful machine learning techniques can be applied in a setting with limited training data, suggesting broad potential application across many scientific domains.
Journal Article
Unintended socio-economic and health consequences of COVID-19 among slum dwellers in Kampala, Uganda
Background
To reduce the spread of COVID-19, several countries in Africa instituted countrywide lockdowns and other public health measures. Whereas lockdowns contributed to the control of the pandemic, there were concerns about the unintended consequences of these measures especially in the most vulnerable populations. We assessed unintended socio-economic and health consequences due to the COVID-19 pandemic and the mitigation measures among slum dwellers in Kampala to inform the on-going and future pandemic response strategies.
Methods
This was a mixed methods cross-sectional study conducted in Bwaise I and Bwaise III slums of Kawempe division, Kampala Uganda from October to December 2020. We used systematic sampling to randomly select 425 household heads for the face-to-face quantitative interviews. We also conducted six focus group discussions (FGDs) with slum dwellers and used photovoice among eight Community Health Workers (CHWs) to document unintended socio-economic and health consequences. Quantitative data were imported into STATA version 14.0 for analysis, while qualitative data were analysed thematically using NVivo version 12. Modified Poisson regression analysis was conducted to establish factors associated with impact on access to food.
Results
Most respondents reported limited access to food (71.1%; 302/425); disruption in education (77.1%; 270/350); drop in daily income and wages (86.1%; 329/382) and loss of employment (63.1; 125/198). Twenty five percent of the respondents (25.4%; 86/338) reported domestic violence as one of the challenges. Seven themes emerged from the qualitative findings on the impact of COVID-19 including: limited access to food; negative impact on children’s rights (child labour and teenage pregnancies) and education; poor housing and lack of accommodation; negative social behaviours; negative impact on family and child care; reduced income and employment; and negative impact on health and access to health care services.
Conclusion
The slum dwellers of Bwaise I and Bwaise III experienced several negative socio-economic and health consequences of COVID-19 and its prevention measures that severely affected their wellbeing. Children experienced severe consequences such as child labour and teenage pregnancies among the girls. Response activities should be contextualised to different settings and protocols to protect the vulnerable groups in the community such as children and women should be developed and mainstreamed in response activities.
Journal Article
Social and Economic Equity and Family Cohesion as Potential Protective Factors from Depression Among Adolescents Living with HIV in Uganda
Adolescents living with HIV in Uganda are impacted by poverty and face a number of health and social challenges including access to medication, health complications, and social stigma. These stressors have been linked to depression, which can lead to lower HIV treatment adherence. This study seeks to determine how social and economic equity, family cohesion, and social supports may be related to depression among adolescents living with HIV. We used baseline data from the Suubi + Adherence study, a 5-year longitudinal randomized controlled trial among adolescents living with HIV in southwestern Uganda (n = 675; ages 10–16 years). Hierarchical logistic regression models were conducted separately among in-school adolescents and out-of-school adolescents to assess the hypothesized associations between economic and social equity, social support, and depression. About half of the participants meet the criteria for depression. Adolescents with depression were found to have fewer economic and social supports. Our findings indicate that social and economic equity [odds ratio (OR) = 0.85, 95% confidence interval (CI) 0.74, 0.99], family cohesion (OR = 0.94, 95% CI 0.91–0.96), and social support from friends (OR = 0.95, 95% CI 0.91–0.998) are associated with depression for in-school HIV infected adolescents and could be protective factors. The results of this study suggest that social and economic equity may play a protective role against depression and other poor mental health outcomes. Potential interventions for adolescents living with HIV should consider these social and familial factors as they may be protective of depression in this population.
Journal Article
Impact of savings groups on the lives of the poor
Savings-led microfinance programs operate in poor rural communities in developing countries to establish groups that save and then lend out the accumulated savings to each other. Nonprofit organizations train villagers to create and lead these groups. In a clustered randomized evaluation spanning three African countries (Ghana, Malawi, and Uganda), we find that the promotion of these community-based microfinance groups leads to an improvement in household business outcomes and women’s empowerment. However, we do not find evidence of impacts on average consumption or other livelihoods.
Journal Article
Impact of Family-Based Economic Empowerment Intervention, Suubi+Adherence (2012–2018) on Multidimensional Poverty for Adolescents Living with HIV (ALWHIV) in Uganda
Children growing up in poverty are disproportionately affected by diseases, including HIV. In this study, we use data from Suubi+Adherence, a longitudinal randomized control trial (2012–2018) with 702 adolescents living with HIV (ALWHIV), to examine the effectiveness of a family-based multifaceted economic empowerment (EE) intervention in addressing economic instability and multidimensional poverty among ALWHIV in Southern Uganda. We constructed a Multidimensional Poverty Index of individual and household indicators, including health, assets, housing and family dynamics. We computed the proportion of multidimensionally poor children (H), estimated poverty intensity (A) and adjusted headcount ratio (M0). Using repeated measures at five-time points (baseline, years 1, 2, 3 and 4-post baseline) across two study arms: treatment (receiving the EE intervention) vs. control arm (not receiving EE), we find that both the incidence and proportion of multidimensional poverty decreased in the treatment arm vs. the control arm. Given that there is a direct link between economic instability and poor health outcomes, these findings are informative. They point to the potential for family EE interventions to decrease multidimensional poverty among vulnerable children, including ALWHIV, impacting their overall wellbeing and ability to meet their treatment needs and improve HIV care continuum outcomes.
Journal Article
Resource-oriented interventions for patients with severe mental illnesses in low- and middle-income countries: trials in Bosnia-Herzegovina, Colombia and Uganda
Background
Severe mental illness (SMI) presents a major burden to societies worldwide. Low- and middle-income countries (LMICs) often do not have sufficient financial resources and qualified staff to provide extensive specialised services for outpatients with SMI. Our research therefore aims to explore and test low-cost interventions that use existing resources in routine patient-clinician meetings, families and communities.
Methods
In Bosnia-Herzegovina, Colombia and Uganda, three psychosocial interventions will be tested, i.e. making patient-clinician meetings therapeutically effective through DIALOG+, family involvement in multi-family group meetings, and support for patients in befriending schemes with volunteers. All interventions will be provided to patients with SMI, delivered over a six-month period and evaluated with assessments at baseline and after six and 12 months. We will conduct nine trials including non-controlled trials, non-randomised controlled trials and randomised controlled trials (RCTs). Core outcome criteria will be used across all studies. However, details of study delivery and additional outcome criteria vary to accommodate local contexts, interests and priorities. The studies will be analysed separately, but with the option to compare and combine findings.
Discussion
The approach provides the opportunity to learn from commonalities and differences in the results and experiences across the three resource-oriented approaches and the three countries. If successfully implemented the studies can lead to more extensive research and are expected to inform health policies and clinical practice of community care for patients with SMI in the three participating countries and other LMICs.
Trial registration
All RCTs were registered prospectively and non-randomised trials retrospectively within the ISRCTN Registry.
DIALOG+ in Uganda:
ISRCTN25146122
(Date of Registration: 20/11/2018, prospective); DIALOG+ in Colombia:
ISRCTN83333181
(Date of Registration: 20/11/2018, prospective); DIALOG+ in Bosnia-Herzegovina:
ISRCTN13347129
(Date of Registration: 20/11/2018, prospective); Volunteer Support in Uganda:
ISRCTN86689958
(Date of Registration: 04/03/2019, retrospective); Volunteer Support in Colombia:
ISRCTN72241383
(Date of Registration: 04/03/2019, retrospective);Volunteer Support in Bosnia-Herzegovina:
ISRCTN51290984
(Date of Registration: 20/11/2018, prospective); Family Involvement in Uganda:
ISRCTN78948497
(Date of Registration: 04/03/2019, retrospective); Family Involvement in Colombia:
ISRCTN11440755
(Date of Registration: 04/03/2019, retrospective); Family Involvement in Bosnia-Herzegovina:
ISRCTN13347355
(Date of Registration: 20/11/2018, prospective).
Journal Article