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The STREAM stage 2 trial assessed two bedaquiline-containing regimens for rifampicin-resistant tuberculosis: a 9-month all-oral regimen and a 6-month regimen containing an injectable drug for the first 2 months. We did a within-trial economic evaluation of these regimens.STREAM stage 2 was an international, phase 3, non-inferiority randomised trial in which participants with rifampicin-resistant tuberculosis were randomly assigned (1:2:2:2) to the 2011 WHO regimen (terminated early), a 9-month injectable-containing regimen (control regimen), a 9-month all-oral regimen with bedaquiline (oral regimen), or a 6-month regimen with bedaquiline and an injectable for the first 2 months (6-month regimen). We prospectively collected direct and indirect costs and health-related quality of life data from trial participants until week 76 of follow-up. Cost-effectiveness of the oral and 6-month regimens versus control was estimated in four countries (oral regimen) and two countries (6-month regimen), using health-related quality of life for cost-utility analysis and trial efficacy for cost-effectiveness analysis. This trial is registered with ISRCTN, ISRCTN18148631.300 participants were included in the economic analyses (Ethiopia, 61; India, 142; Moldova, 51; Uganda, 46). In the cost-utility analysis, the oral regimen was not cost-effective in Ethiopia, India, Moldova, and Uganda from either a provider or societal perspective. In Moldova, the oral regimen was dominant from a societal perspective. In the cost-effectiveness analysis, the oral regimen was likely to be cost-effective from a provider perspective at willingness-to-pay thresholds per additional favourable outcome of more than US$4500 in Ethiopia, $1900 in India, $3950 in Moldova, and $7900 in Uganda, and from a societal perspective at thresholds of more than $15 900 in Ethiopia, $3150 in India, and $4350 in Uganda, while in Moldova the oral regimen was dominant. In Ethiopia and India, the 6-month regimen would cost tuberculosis programmes and participants less than the control regimen and was highly likely to be cost-effective in both cost-utility analysis and cost-effectiveness analysis. Reducing the bedaquiline price from $1·81 to $1·00 per tablet made the oral regimen cost-effective in the provider-perspective cost-utility analysis in India and Moldova and dominate over the control regimen in the provider-perspective cost-effectiveness analysis in India.At current costs, the oral bedaquiline-containing regimen for rifampicin-resistant tuberculosis is unlikely to be cost-effective in many low-income and middle-income countries. The 6-month regimen represents a cost-effective alternative if injectable use for 2 months is acceptable.USAID and Janssen ResearchDevelopment.

ObjectiveTo investigate cost changes for health systems and participants, resulting from switching to short treatment regimens for multidrug-resistant (MDR) tuberculosis.MethodsWe compared the costs to health systems and participants of long (20 to 22months) and short (9 to 11months) MDR tuberculosis regimens in Ethiopia and South Africa. Cost data were collected from participants in the STREAM phase-III randomized controlled trial and we estimated health-system costs using bottom-up and top-down approaches. A cost-effectiveness analysis was performed by calculating the incremental cost per unfavourable outcome avoided.FindingsHealth-care costs per participant in South Africa were 8340.7 United States dollars (US$) with the long and US$6618.0 with the short regimen; in Ethiopia, they were US$6096.6 and US$4552.3, respectively. The largest component of the saving was medication costs in South Africa (67%; US$1157.0 of total US$1722.8) and social support costs in Ethiopia (35%, US$545.2 of total US$1544.3). In Ethiopia, trial participants on the short regimen reported lower expenditure for supplementary food (mean reduction per participant: US$225.5) and increased working hours (i.e. 667 additional hours over 132weeks). The probability that the short regimen was cost-effective was greater than 95% when the value placed on avoiding an unfavourable outcome was less than US$19 000 in Ethiopia and less than US$14 500 in South Africa.ConclusionThe short MDR tuberculosis treatment regimen was associated with a substantial reduction in health-system costs and a lower financial burden for participants.

This chapter looks at the role of monetary policy in enhancing Africa’s structural transformation. It emphasizes for monetary policy to go beyond the basics of stability to implement monetary policy frameworks that better anchor inflation and promote macroeconomic stability as well as growth. This being the case, the chapter advocates for the implementation of strategies towards the implementation of frameworks that could create room for discretionary changes in monetary policy to accommodate shocks hitting the real economy, impacting on output and growth, hence the countries’ structural transformation. The chapter calls for some important policy insights to properly undertake exchange rate policies, taking into consideration potential trade-offs between inflation and exchange rate based on country-specific characteristics. It stresses the need for African countries to be cautious in accessing non-concessional debt (e.g. sovereign bonds) which might lead to unsustainable levels of debt. The chapter also recognizes that the absence of deep and efficient financial markets constrains Africa’s economic growth and transformation. Overall, ensuring central bank independence, effective management of inflationary pressures and improving policy coordination between monetary and fiscal policy would lead to better macroeconomic management in the continent and enhance its structural transformation process.

Introduction:\ud Multidrug-resistant tuberculosis (MDR-TB) poses a serious financial challenge to health systems and patients. The current treatment for patients with MDR-TB takes up to 24 months to complete. Evidence for a shorter regimen which differs from the standard WHO recommended MDR-TB regimen and typically lasts between 9 and 12 months has been reported from Bangladesh. This evaluation aims to assess the economic impact of a shortened regimen on patients and health systems. This evaluation is innovative as it combines patient and health system costs, as well as operational modelling in assessing the impact.\ud \ud Methods and analysis:\ud An economic evaluation nested in a clinical trial with 2 arms will be performed at 4 facilities. The primary outcome measure is incremental cost to the health system of the study regimen compared with the control regimen. Secondary outcome measures are mean incremental costs incurred by patients by treatment outcome; patient costs by category (direct medical costs, transport, food and accommodation costs, and cost of guardians/accompanying persons and lost time); health systems cost by category and drugs; and costs related to serious adverse events.\ud \ud Ethics and dissemination:\ud The study has been evaluated and approved by the Ethics Advisory Group of the International Union Against Tuberculosis and Lung Disease; South African Medical Research Ethics Committee; Wits Health Consortium Protocol Review Committee; University of the Witwatersrand Human Research Ethics Committee; University of Kwazulu-Natal Biomedical Research Ethics Committee; St Peter TB Specialized Hospital Ethical Review Committee; AHRI-ALERT Ethical Review Committee, and all participants will provide written informed consent. The results of the economic evaluation will be published in a peer-reviewed journal.\ud \ud Trial registration number: ISRCTN78372190.

Climate related risks highly influence crop performance and thus water productivity in different eco-regions of Ethiopia. In view of its low rainfall and short growing period, the semi-arid eco-regions like the Central Rift Valley of Ethiopia (CRV) are the most affected. A study was conducted in Bofa, CRV to utilize climate information in guiding cropping and water management decisions. Tercile probability was computed to characterize rainy seasons into best (April), expected (May) and worst case (June) planting scenarios. Three independent experiments were designed to fit planting scenarios. In each set, one improved and one local maize cultivars (best: BH660 and Bolonde; medium: A511 and Limat; worst: Melkassa-1 and Shaye) were combined with three tillage practices: Modified-Moldboard Plow (MMP), Wing-Plow (WP) and local Maresha. Rainwater productivity and grain yield were compared. The results illustrate differences among planting scenarios and suggesting early planting decision is a possible practice in semi-arid CRV when soil water conserving tillage is integrated to escape climate associated risks. BH660 shows higher water productivity (9.46 kgmm-1 of rainfall) under 2*MMP tillage than late plantings in experimental years. About 84 % of the variability in grain yield (BH660), 88% (Bolondie), 76% (A-511) and 70% (Limat) can be explained by the available soil water in crop root zone at planting. Hence, integration of climate information, tillage practices and cultivar choice enabled not only successful aversion of climate related risks for long duration maize but also increased yield and rain water productivity in semi-arid areas. Furthermore, tailored rainfall forecast can help in selection of planting scenarios, tillage practices and crop cultivars in advance and further increase probability of success.Keywords: Climate risk, tercile probability, tillage, planting scenario

The existing evidences support that some eighty percent of the world’s agricultural land is rainfed, contributing to the tune of sixty percent to food production worldwide. This empirical research was conducted on-station during June to September main growing season over two years (2000 and 2001) to substantiate that, managing dry spell risks through development of compatible technologies can improve rainfed maize productivity in the semi-arid zones of Ethiopia. Firstly, two soil water conserving tillage practices i.e a metal handled-Erf and Mofer attached MB plough and Tie Ridger (TR) both of which are simple tillage tools were used. Secondly, varying plant population level was linked to the inseason dry spell length for 5, 7, 10, 15, 20 and more, as well as to the crop water requirement and plot soil water content at land preparation stage. The result revealed that the shorter dry spells have higher probability of occurrence, compared to the longer dry spells in general. On the other hand, the probability of dry spells is higher during the early parts of the growing season, with a declining trend until the peak of the rainy season and slopping up towards the end of the rainy season. The result on water requirement information under Melkassa climate shows that a total of 315 mm of soil water is required for maize throughout June/July to September growing period. MB plowing realized significantly highest grain yield at 5% alpha level (1849 Kg.ha-1) at the recommended plant population (53,333 plants ha-1), whereas, TR resulting in nearly similar yield for the same population. Although the study area is known for water scarcity and hence lower plant population is preferred, it was possible to achieve high yield at this population level. This could be because, the crop water requirement was met at physiological maturity stage in both seasons and at flowering in one (2000) of the two seasons. The water requirement for vegetation was met in both seasons; however, it was followed by lower WRSI at least in one of the seasons, which could have caused a reduction in yield at this plant population level. Further, 70% of the variability in maize grain yield was explained by the root zone available soil water at planting. For instance, grain yield was 1480 kg ha-1 at 119 mm of available soil water at planting; while the same was 1845 kg ha-1 at 136.5 mm of soil water. Overall, the paper provided empirical evidence that management of dry spell risks is possible, but it demands for the innovative management practices that outsmart the business as usual (BAU) approach i.e. the miraculous drought tolerant or drought escape crop cultivar development strategy.Keywords: Dry spell, Plant population, Risk, Soil water, Tillage, WRSI

The knowledge of future climate information at local level has enormous advantage in Ethiopia, where the driver of the economy is agriculture. This study was conducted to downscale the climate change scenarios for Miesso station for the year 2011-2099. Daily climate data and normalized large scale Hadley Centre coupled Model version 3 (HadCM3) model predictors were used for downscaling climate change scenarios. The change for rainfall, minimum and maximum temperatures were developed using the HadCM3 A2a and B2a Emission Scenarios by Statistical Downscaling Model (SDSM) version 4.1software. The SDSM analysis showed an increasing trend for both annual precipitation and temperatures. Accordingly, the average monthly and annual minimum and maximum temperatures were found to rise in 2020, 2050 and 2080s for A2a and B2a emission scenarios. Nevertheless in 2080s, the average annual maximum temperature increment would be high for both A2a and B2a scenarios. Therefore the use of seasonal climate outlook information and introduction of new crops, varieties and management practices that goes in line with the changing climate patterns is suggested for the study area., Journal of Science and Sustainable Development, Vol. 2 No. 2 (2014)