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Pelling M.,Kings College London | O'Brien K.,University of Oslo | Matyas D.,Save the Children International
Climatic Change

Transformation as an adaptive response to climate change opens a range of novel policy options. Used to describe responses that produce non-linear changes in systems or their host social and ecological environments, transformation also raises distinct ethical and procedural questions for decision-makers. Expanding adaptation to include transformation foregrounds questions of power and preference that have so far been underdeveloped in adaptation theory and practice. We build on David Harvey’s notion of activity space to derive a framework and research agenda for climate change adaptation seen as a political decision-point and as an opportunity for transformation, incremental adjustment or resistance to change in development pathway. Decision-making is unpacked through the notion of the activity space into seven coevolving sites: the individual, technology, livelihoods, discourse, behaviour, the environment and institutions. The framework is tested against practitioner priorities to define an agenda that can make coherent advances in research and practice on climate change adaptation. © 2014, Springer Science+Business Media Dordrecht. Source

Girma T.,Jimma University | Mossie A.,Jimma University | Getu Y.,Save the Children International
BMC Research Notes

Background: Khat (Catha edulis Forsk) is a psychostimulant herb widely cultivated and used in Ethiopia. The link between khat use and body composition is little known. Objective: The aim was to determine the association between body composition and khat use. Methods: We recruited 415 individuals 18-78 years of age from Jimma Town. Sociodemographic and lifestyle data were collected using structured questionnaires. Fat mass (FM, kg) and fat-free mass (FFM, kg) were estimated from whole-body bio impedance. Weight (kg), FM and FFM were indexed to height (m) as BMI (kg/m2), fat mass index (FMI) (kg/m) and fat-free mass index (FFMI) (kg/m), respectively. Independent predictors of BMI, FMI and FFMI were identified using regression analysis. Result: Participants' mean ± SD of age was 37 ± 13 years and 205 (53.2 %) were males. Mean ± SD of BMI, FMI and FFMI were 21.0 kg/m2 ± 4.1, 6.8 kg/m ± 5.2 and 27.9 kg/m ± 3.8, respectively. Multivariable model showed that, compared with non-chewers, khat chewers had a lower BMI (B = -1.56, 95 % CI -0.78, -2.33) and FMI (B = 2.19, 95 % CI -1.32, -3.06). FMI was lower in cigarette smokers than non-smokers by -1.36 kg/m (95 % CI -0.23, -2.49). Concurrently, khat and cigarette users increased FMI by 2.78 (95 % CI 0.11, 5.44). FFMI decreased with age (B = -0.02, 95 % CI -0.05, -0.002). Conclusion: FMI and BMI were lower in khat users than non-users, but there was no difference in lean mass. The consequence of this body composition change should be investigated. © 2015 Girma et al. Source

Fast L.,University of Notre Dame | O'Neill M.,Save the Children International

This paper explores three questions related to acceptance as a security management approach. Acceptance draws upon relationships with community members, authorities, belligerents and other stakeholders to provide consent for the presence and activities of a non-governmental organisation (NGO), thereby reducing threats from these actors. Little is documented about how NGOs gain and maintain acceptance, how they assess and monitor the presence and degree of acceptance, or how they determine whether acceptance is effective in a particular context. Based on field research conducted in April 2011 in Kenya, South Sudan and Uganda, we address each of these three issues and argue that acceptance must be actively sought as both a programme and a security management strategy. In the paper we delineate elements common to all three contexts as well as missed opportunities, which identify areas that NGOs can and should address as part of an acceptance approach. © Overseas Development Institute, 2015. Source

Bergh A.-M.,University of Pretoria | Abwao S.,Save the Children | Abwao S.,Health Integrated | De-Graft Johnson J.,Save the Children | And 17 more authors.
BMC Health Services Research

Background: Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda. Methods. A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress. Results: Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care. Conclusion: The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems. © 2014 Bergh et al.; licensee BioMed Central Ltd. Source

Amone-P'Olak K.,Gulu University | Amone-P'Olak K.,University of Cambridge | Jones P.,University of Cambridge | Meiser-Stedman R.,MRC Cognition and Brain science Unit | And 4 more authors.
Journal of Public Health (United Kingdom)

Background Exposure to war is associated with considerable risks for long-term mental health problems (MHP) and poor functioning. Yet little is known about functioning and mental health service (MHS) use among former child soldiers (FCS). We assessed whether different categories of war experiences predict functioning and perceived need for, sources of and barriers to MHS among FCS. Methods Data were drawn from an on-going War-affected Youths (WAYS) cohort study of FCS in Uganda. Participants completed questionnaires about war experiences, functioning and perceived need for, sources of and barriers to MHS. Regression analyses and parametric tests were used to assess between-group differences. Results Deaths, material losses, threat to loved ones and sexual abuse significantly predicted poor functioning. FCS who received MHS function better than those who did not. Females reported more emotional and behavioural problems and needed MHS more than males. FCS who function poorly indicated more barriers to MHS than those who function well. Stigma, fear of family break-up and lack of health workers were identified as barriers to MHS. Conclusions Various war experiences affect functioning differently. A significant need for MHS exists amidst barriers to MHS. Nevertheless, FCS are interested in receiving MHS and believe it would benefit them. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. Source

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