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Addis Ababa, Ethiopia

Scanlon M.L.,Indiana University | Vreeman R.C.,USAID
HIV/AIDS - Research and Palliative Care | Year: 2013

The rollout of antiretroviral therapy (ART) significantly reduced human immune Deficiency virus (HIV)-related morbidity and mortality, but good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world's HIV-infected population resides, data on barriers to treatment are emerging that contribute to low rates of uptake in HIV testing, linkage to and retention in HIV care systems, and suboptimal adherence rates to therapy. A review of the literature reveals limited evidence to inform strategies to improve access and adherence with the majority of studies from sub-Saharan Africa. Data from observational studies and randomized controlled trials support home-based, mobile and antenatal care HIV testing, task-shifting from doctor-based to nurse-based and lower level provider care, and adherence support through education, counseling and mobile phone messaging services. Strategies with more limited evidence include targeted HIV testing for couples and family members of ART patients, decentralization of HIV care, including through home and community-based ART programs, and adherence promotion through peer health workers, treatment supporters, and directly observed therapy. There is little evidence for improving access and adherence among vulnerable groups such as women, children and adolescents, and other high-risk populations and for addressing major barriers. Overall, studies are few in number and suffer from methodological issues. Recommendations for further research include health information technology, social-level factors like HIV stigma, and new research directions in cost-effectiveness, operations, and implementation. Findings from this review make a compelling case for more data to guide strategies to improve access and adherence to treatment in resource-limited settings. © 2013 Scanlon and Vreeman, publisher and licensee Dove Medical Press Ltd.

El Arifeen S.,International Center for Diarrhoeal Disease Research | Hill K.,Harvard Center for Population and Development Studies | Ahsan K.Z.,University of North Carolina at Chapel Hill | Jamil K.,USAID | And 2 more authors.
The Lancet | Year: 2014

Background Bangladesh is one of the only nine Countdown countries that are on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015. It is also the only low-income or middle-income country with two large, nationally-representative, high-quality household surveys focused on the measurement of maternal mortality and service use.Methods We use data from the 2001 and 2010 Bangladesh Maternal Mortality Surveys to measure change in the maternal mortality ratio (MMR) and from these and six Bangladesh Demographic and Health Surveys to measure changes in factors potentially related to such change. We estimate the changes in risk of maternal death between the two surveys using Poisson regressionFindings The MMR fell from 322 deaths per 100 000 livebirths (95% CI 253391) in 19982001 to 194 deaths per 100 000 livebirths (149238) in 200710, an annual rate of decrease of 56%. This decrease rate is slightly higher than that required (55%) to achieve the MDG target between 1990 and 2015. The key contribution to this decrease was a drop in mortality risk mainly due to improved access to and use of health facilities. Additionally, a number of favourable changes occurred during this period: fertility decreased and the proportion of births associated with high risk to the mother fell; income per head increased sharply and the poverty rate fell; and the education levels of women of reproductive age improved substantially. We estimate that 52% of maternal deaths that would have occurred in 2010 in view of 2001 rates were averted because of decreases in fertility and risk of maternal deathInterpretation The decrease in MMR in Bangladesh seems to have been the result of factors both within and outside the health sector. This fi nding holds important lessons for other countries as the world discusses and decides on the post-MDG goals and strategies. For Bangladesh, this case study provides a strong rationale for the pursuit of a broader developmental agenda alongside increased and accelerated investments in improving access to and quality of public and private health-care facilities providing maternal health in BangladeshFunding United States Agency for International Development, UK Department for International Development, Bill and Melinda Gates Foundation. © 2014 Elsevier Ltd.

Fedoroff N.V.,USAID
New Biotechnology | Year: 2010

The introduction of science and technology into agriculture over the past two centuries has markedly increased agricultural productivity and decreased its labor-intensiveness. Chemical fertilization, mechanization, plant breeding and molecular genetic modification (GM) have contributed to unparalleled productivity increases. Future increases are far from assured because of underinvestment in agricultural research, growing population pressure, decreasing fresh water availability, increasing temperatures and societal rejection of GM crops in many countries. © 2010 Elsevier B.V.

Kropp J.D.,Clemson University | Whitaker J.B.,USAID
Agricultural Finance Review | Year: 2011

Purpose – The purpose of this paper is to investigate how decoupled direct payments, paid to farm operators based on historical yields and base acreage, may lead to production distortions by altering a farmer’s access to credit or enabling the farmer to receive more favorable credit terms. The authors estimate the impact of decoupled direct payments under the 2002 Farm Bill on the credit terms of farm operators, specifically the interest rate on short-term operating loans. If farm operators are able to obtain more favorable credit terms and reduce their operating cost, then this offers an additional mechanism through which decoupled payments may distort current production. Design/methodology/approach – The authors estimate the impact of decoupled direct payments on the interest rate on short-term operating loans. In the analysis, the authors control for farm financial characteristics, farm operator characteristics, and other factors. Data from the Agricultural Resource Management Survey for the years 2005-2007, are used in the weighted regression analysis. Jackknifed standard errors are also computed. Findings – As the proportion of base acres to total operated acres increases it is found that interest rates decline by a small but statistically significant amount. This implies that direct payments lead to lower operating costs through better credit terms. Research limitations/implications – Lower operating costs may in turn allow some farmers to expand production or produce on land that would otherwise be unprofitable to operate and hence left idle. Ultimately, this distorts current production. However, the small magnitude of the authors’ results suggests that the reduction in interest rates, though positive, may have limited distortionary impacts. Originality/value – The paper provides evidence that decoupled payments alter a farm operator’s credit terms and hence could lead to current production distortions. The paper contributes to the growing body of research investigating the mechanisms by which decoupled payments have the potential to distort current production. © Emerald Group Publishing Limited.

"We know that Syrian parents are extremely concerned about their children's learning and well-being. That's why we want to develop this game-based learning tool, which can be used wherever the children are," the Norwegian Minister for Foreign Affairs Borge Brende said. "We also know that almost all Syrian households tend to own smartphones and the smartphone is a crucial tool for staying in touch with friends and family and for accessing important news and information," he said in a statement. Over two million Syrian children are out of school because of the war, UNICEF says, adding that the conflict has destroyed one in four of the country's schools. The partnership behind the tender competition includes the United States Agency for International Development (USAID), Australian Aid and the French telecom operator Orange. Proposals for the $1.7 million (1.56 million euros) project must be tendered by April 1, and one or two winning apps will be offered to Syrian families living in their war-ravaged country or abroad as refugees.

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