Search

Establish the incidence, burden and characteristics of paediatric safeguarding concerns in rural Australian emergency department practice.Retrospective cohort study of burns, injury and poisoning presentations across 16 months involving 1472 paediatric cases.Five per cent of presentations had confirmed safeguarding concern. These were highest during the 2200-0600 staffing period. Mean age was 7.7 years, 43.8% were female. Multivariable regression models show age 2-6 years (odds ratio (OR), 3.27; 95% confidence interval (CI), 1.35-7.93); delayed presentation (OR, 2.3; 95% CI, 1.47-3.59); and police accompaniment (OR, 9.46; 95% CI, 2.61-34.26) are associated with increased safeguarding concerns. Most concerns (91.8%) related to injuries, largely musculoskeletal, wounds and head injuries. Thermal burns were more common than chemical and electrical.Children aged 2-6 are at higher risk for harm than previously recognised and children aged 0-2 years were over-represented in staff-suspected concerns. Those accompanied by police had significant association with confirmed safeguarding concerns which were under-suspected by staff or assumed to have been already reported. In rural practice, 'unreasonable delay' was found to be a better measure of concern than a discrete time value. Transient family arrangements, unsecured accommodation, geographical isolation, cultural safety and unique home environments must be taken into when completing injury assessments. For regional health services to successfully identify children at risk, interagency collaboration, staff education and local patterns of concern should be targeted. Rostering changes should increase after-hours assessment capacity by specialty paediatric staff.

The SARS-CoV-2 pandemic has revolutionised our lives, bringing with it the twin crises of illness and the need for an optimal mix of policies to alleviate its impact on the population. There needs to be more evidence on the effects of the pandemic on livelihood outcomes, including an understanding of whether female-headed families in low-income countries fare worse than their male-headed counterparts during pandemics. Using high-frequency phone surveys conducted in Ethiopia and Kenya, we examine the aggregate impact of the pandemic on income and consumption losses, as well as food insecurity. The empirical analysis estimates linear probability models that relate livelihood outcomes with household headship and other socioeconomic characteristics as controls. Overall, the pandemic increased the likelihood of food insecurity while decreasing income and consumption, particularly among female-headed households. In Kenya, living in a female-headed home increased the possibility of an adult going without food by about 10%, an adult skipping a meal by about 9.9%, and a child missing a meal by about 17% in the seven days preceding the telephone survey. In Ethiopia, living in a female-headed household increased the likelihood of an adult going hungry, skipping a meal, and running out of food by about 24.35%, 18.9%, and 26.7%, respectively. Salient pre-existing socioeconomic inequalities further exacerbated the effects of the pandemic on livelihoods. The findings have important implications for public policy and preparations by governments and other organisations interested in developing suitable gender-sensitive measures to lessen the impact of future pandemics in low- and middle-income countries.

This paper aims to provide insights on the association between exposure to rural general practice vocational training placements and subsequent rural practice location in Western Australia. We further explore the possibility that the observed associations might depend on an individual's rural upbringing and or an individual's exposure to general practice during medical school. To this end, a cross-sectional analysis of practice location of 353 general practitioners who completed their vocational training through WA General Practice Education and Training between 2010 and 2017 was conducted. The empirical analysis uses a fully recursive conditional mixed process estimator to jointly estimate the probabilities that a general practitioner (GP) completes their vocational training placement at a rural location and subsequently practices at a rural location. The results show that GPs who chose rural locations for their first and last vocational training placements are more likely to practice at a rural location compared to their counterparts choosing metropolitan locations. Also, the probability of subsequent rural practice is further strengthened by having a rural background and having exposure to general practice during medical school even after controlling for potential confounders. The results also indicate that GPs stay in rural locations for reasons linked to their career, family and lifestyles. This evidence underscores the importance of vocational training organisations in WA and reinforces the need for ongoing rural opportunities in training to ameliorate location-based disparities in the distribution of the GP workforce in Western Australia.

Sufficient knowledge on the work productivity impact of the health of fly-in fly-out (FIFO) workers in the mining sector in Australia is lacking. This study examined the impact of health and lifestyle behaviours on the work productivity of FIFO workers in the mining industry in Australia. FIFO workers completed an online questionnaire on health and work productivity loss measures. Linear regressions were used to model annual work productivity losses through absenteeism, presenteeism and total productivity loss. Workers with a high risk for health conditions were, on average, associated with 3.87% more productivity loss (absenteeism: 1.27% and presenteeism: 2.88%) than those with low risk. Workers who had multiple health risks classified as medium (3–4 health conditions) and high (5 or more health conditions) reported 1.75% and 7.46% more total productivity loss, respectively, than those with fewer multiple health risks (0–2 health conditions). Health conditions were estimated to account for an annual additional productivity cost due to absenteeism of AUD 8.82 million, presenteeism of AUD 14.08 million and a total productivity loss of AUD 20.96 million per 1000 workers. FIFO workers with high health risks experience more absenteeism, presenteeism and overall productivity loss. These measures provide strong economic justifications that could support the need for targeted workplace health interventions.

Background Late-stage breast cancer (BC) is commonly diagnosed in limited-resource countries such as Indonesia. The lack of information for decision-making emphasizes the need for efforts to support evidence-informed practice for improving BC early detection in Indonesia. This study attempts to understand the local context evidence on policy implementation, challenges, and plans for enhancing BC early detection programs in Indonesia. The evidence gained from this study will help harness the power of scientific reasoning that shapes theories of how BC early detection intervention works and its operationalization in practice. Methods This study engaged three interrelated phases of qualitative methods. Phase I involved a document analysis in determining the predominant strategy and approach to the landscape of BC early detection programs. Phase II was an in-depth interview to clarify the operationalization of the technical aspect, eliciting stakeholder experiences and their perceptions about the factors supporting or hindering goal achievement. In phase III, two consecutive collaborative expert workshops and a collaborative learning process nested with the Indonesia Project ECHO team for Knowledge Summaries for Comprehensive Breast Cancer Control. Results Current BC early detection strategies to downstage women's symptomatic breast abnormalities are considered an essential preparatory step before starting a screening program at the enhanced or maximal level of resources. However, the absence of an integrated cancer registry system renders it impossible to measure the full effect of the program implementation as a public health policy. Emphasis on improving structural barriers during the follow-up of abnormalities, patient navigation for referrals, and a surveillance system to track the times from presentation to diagnosis and diagnosis to treatment is needed for Indonesia's early detection services continuum. Conclusion The local context presented in this research increased the usability and usefulness of relevant evidence for decision-makers, thus bridging the gap in translating research findings into healthcare practice for BC early detection in Indonesia. Importantly, attention to providing a clear national guideline, developing a highly interoperable screening registry system, and ensuring the sustainability of pilot sites on mammography screening is critical to the success of expected outcomes.

Background Globally, about 50 million people were living with dementia in 2015, with this number projected to triple by 2050. With no cure or effective treatment currently insight, it is vital that factors are identified which will help prevent or delay both age-related and pathological cognitive decline and dementia. Observational data have suggested that hearing loss is a potentially modifiable risk factor for dementia, but no conclusive evidence from randomised controlled trials is currently available. Methods The HearCog trial is a 24-month, randomised, controlled clinical trial aimed at determining whether a hearing loss intervention can delay or arrest the cognitive decline. We will randomise 180 older adults with hearing loss and mild cognitive impairment to a hearing aid or control group to determine if the fitting of hearing aids decreases the 12-month rate of cognitive decline compared with the control group. In addition, we will also determine if the expected clinical gains achieved after 12 months can be sustained over an additional 12 months and if losses experienced through the non-correction of hearing loss can be reversed with the fitting of hearing aids after 12 months. Discussion The trial will also explore the cost-effectiveness of the intervention compared to the control arm and the impact of hearing aids on anxiety, depression, physical health and quality of life. The results of this trial will clarify whether the systematic correction of hearing loss benefits cognition in older adults at risk of cognitive decline. We anticipate that our findings will have implications for clinical practice and health policy development. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR: 12618001278224), registered on 30.07.2018.

Objectives HealthPathways, pioneered in Canterbury, New Zealand, in 2008, is a web-based tool designed to promote health care integration and patient management in primary care and to reduce fragmentation in the delivery of health services. This cross-sectional study evaluated the utilisation and perceptions of this tool among health professionals in Australia and New Zealand. Methods A cross-sectional survey was administered online through Research Electronic Data Capture (REDCap) to general practitioners (GPs), practice nurses and managers, nurse practitioners, specialist and community nurses, hospital clinicians, nurses, managers, and allied health professionals between April and September 2018. The frequency of HealthPathways use in the previous month was modelled as an ordered response using an ordered logistic regression model after adjusting for the possible effects of sex, age, years in clinical practice, location and time spent in practice. Results Health professionals perceived HealthPathways to be useful in primary care management and referral, as well as in the prereferral treatment of patients. GPs in New Zealand, New South Wales and Victoria were 73%, 47% and 27% more likely to have used HealthPathways ≥10 times in the previous month respectively. Conclusion The results suggest that HealthPathways is having a positive effect on healthcare systems in New Zealand and Australia. However, differences in uptake suggests the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. What is known about the topic? Early evaluations suggest that HealthPathways is a useful tool for health professionals, although uptake and utilisation may be limited. However, there is no comparative evidence regarding uptake and implementation of the tool. What does the paper add? This study is among the first to provide a comparative narrative of the literature assessing the implementation and uptake of HealthPathways across Australia and New Zealand. It is also among the first to compare the perceptions of allied health professionals in the use of HealthPathways across Australia and New Zealand. What are the implications for practitioners? The results of this study suggest the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change.

PurposeMobile money, a service permitting monetary value to be digitally stored in a mobile phone and transacted to others through text messaging, is increasingly becoming available in several African countries including Eswatini. This study examines the factors associated with mobile money usage and the extent to which mobile money accelerates financial inclusion in Eswatini.Design/methodology/approachData were collected from the nationally representative FinScope Consumer Survey for Eswatini conducted in 2014. The authors use a quasi-experimental method in propensity score matching (PSM) with bootstrapped standard errors to alleviate the possibility of selection bias associated with mobile money use and bank account ownership. As a sensitivity check, the authors calculate the average treatment effect (ATE) using kernel-based matching methods, as well as estimate a multilevel model that accounts for the hierarchical structure of data.FindingsThe authors found that higher education, entrepreneurship, being female, improvement in work situation in the past year and living in urban area and in the Lubombo region all positively influence the probability to use mobile money. The results also show that individuals who use mobile money are 19% more likely to own a bank account at a formal financial institution with a higher probability estimate observed amongst rural residents.Originality/valueThis study examines whether mobile money accelerates financial inclusion in Eswatini. On analysing data from the 2014 FinScope Consumer Survey, the results show that mobile money does not seem to be accelerating the reach of financial services to those who are structurally excluded from the formal financial system and suggest the need for ongoing review of the financial inclusion strategies of the country to enhance access to financial services in underserved areas.Peer reviewThe peer review history for this article is available at:https://publons.com/publon/10.1108/IJSE-12-2019-0723

The ability of farmers to acquire inputs through purchase from available markets empowers them with the autonomy and capacity to diversify inputs, consequently enhancing the resilience of their cropping activities to various shocks. This paper investigates whether climate shocks, particularly rainfall shocks, influence commercial input purchase decisions by smallholder farmers in contrasting geographic regions in Malawi, with a particular emphasis on fertilizer, agrochemicals, seed, and labor. The empirical approach integrates historical weather information, climate shock perceptions with a longitudinal household survey data set to model commercial input purchasing decisions using appropriate latent variable models. The findings suggest that exposure to recent rainfall shocks, especially droughts, stimulates commercial input purchasing across regions, especially in drier central and southern regions of Malawi. This result holds true for general input purchase decisions and for specific inputs such as agrochemicals, fertilizer, seed, and labor. Although drought shocks considerably increase the probability of acquiring inputs through purchase, they occasionally diminish the intensity of purchases. Both objective and subjective measures of lagged rainfall shocks are revealed as significant determinants of commercial input purchases across regions in Malawi. In addition to regional heterogeneity findings, further analysis shows that the relatively wealthier, male-headed families and those with access to information are more likely to invest in purchased inputs in response to drought shocks. Scaling up policies that remove demand- and supply-side barriers to smallholder farmers’ access to commercial inputs from available markets is necessary for adaptation to rainfall shocks.

This paper concerns Drought-Tolerant Maize (DTM) and Conservation Agriculture (CA) practices that were introduced into smallholder maize-based farming systems in Zimbabwe to enhance the productivity of maize and food security under a changing climate. Although these technologies are technically appropriate, there are difficulties with their use by smallholder farmers of relatively low socio-economic status, as measured through ownership of farm or household assets and endowments. Thus, we sought to quantify and explain wealth-related inequalities in the adoption of DTM and CA in smallholder farming communities and discuss their implications for food security. The analysis used cross-sectional household-level data gathered from 601 smallholder farmers from four districts in Zimbabwe. We found evidence of a pro-rich distribution of inequalities in the adoption of DTM and CA that were mostly explained by differences in household wealth, access to agricultural extension services and size of farm land. No meaningful differences in DTM adoption disparities were found across districts. Significant gender differences were observed for CA, and meaningful differences by district were noted. Results suggest the need for decision makers to consider implementing policies that focus on the poorer segments of the farming society to alleviate differences in the adoption of such agricultural technologies. For example, subsidizing the uptake of improved maize varieties including DTM and prioritizing equitable land distribution, coupled with specialised extension services for the poor in a cereal-based CA farming system, could reduce the observed gap between rich and poor in the uptake of these innovations and consequently improve food security.

Introduction To identify studies reporting costs arising from tobacco use and detail their (1) economic approaches, (2) health outcomes, and (3) other cost areas included. Methods We searched PubMed, Scopus, Cochrane Library, EconLit, and Google Scholar for studies published between 2008 and April 2018 in English. Eligible articles reported tobacco-related costs and included all tobacco-using populations (multinational, national, subpopulations, and involuntary smokers). All economic approaches that resulted in monetary outcomes were included. We reported USD or converted local currencies to USD. Two health economists extracted and two researchers independently reviewed the data. Results From 4083 articles, we reviewed 361 abstracts and examined 79 full-texts, with 63 (1.6%) deemed eligible. There were three multinational, thirty-four national, twenty-one subpopulation or condition(s)-specific analyses, and five evaluating involuntary smoking. The diverse approaches and outcomes precluded integrating costs, but these were substantial in all studies. For instance, about USD 1436 billion in global health expenditures and productivity losses in 2012 and USD 9 billion in lost productivity in China, Brazil, and South Africa in 2012. At the national level, costs ranged from USD 4665 in annual per respondent health expenses (Germany 2006–2008) to USD 289–332.5 billion in medical expenses (United States 1964–2014). Conclusions Despite wide variations in the methods used, the identified costs of tobacco are substantial. Studies on tobacco cost-of-illness use diverse methods and hence produce data that are not readily comparable across populations, time, and studies, precluding a consistent evidence-base for action and measurement of progress. Recommendations are made to improve comparability. Implications In addition to the health and financial costs to individual smokers, smoking imposes costs on the broader community. Production of comparable estimates of the societal cost of tobacco use is impaired by a plethora of economic models and inconsistently included costs and conditions. These inconsistencies also cause difficulties in comparing relative impacts caused by differing factors. The review systematically documents the post-2007 literature on tobacco cost-of-illness estimations and details conditions and costs included. We hope this will encourage replication of models across settings to provide more consistent data, able to be integrated across populations, over time, and across risk factors.

The study investigates whether access to agricultural extension services enhances the well-known positive impact of adopting Drought Tolerant Maize (DTM) technology on livelihood outcomes; maize yield, output per capita, consumption and sales using a representative dataset of smallholder farming households from Zimbabwe. The empirical analysis adopts an instrumental variable regression model that incorporates an endogenous interaction term to capture the intermediary role of institutional extension services. Results reveal that access to agricultural extension services enhances the relationship between DTM adoption and maize yield, output per capita, and consumption but appears to weaken the association between DTM adoption and the amount of maize set aside for sale. In exploring the potential reasons why access to institutional extension services might enhance the DTM adoption-livelihood outcomes relationship, the results suggest mechanisms related to the use of basal fertilizers, use of organic manure, access to agricultural credit, use of certified DTM seed, access to general production and marketing information, weeding frequency and disease control which are more likely to be influenced by access to agricultural extension services. The findings suggest that policies targeted at improving DTM adoption as a climate-smart agricultural technology to improve resilience of smallholder maize farming households to climate variability and change must be complemented by revitalized agriculture extension services. Revitalization of extension services may come through capacity building of extension institutions, and their personnel, improving agricultural extension infrastructure, mobility of extension personnel, and increased financing to such institutions.

Conservation agriculture, drought tolerant maize, and improved legume varieties are key climate change management strategies for smallholder farmers in southern Africa. Their complementary efforts in adaptation to climate change are sternly important for farm productivity and income. This study evaluates factors explaining individual and multiple adoption of climate change management strategies and their differential impacts on productivity and income using a sample of 1172 smallholder farmers from Malawi and Zimbabwe. The study employs multinomial logistic regression to evaluate factors of individual and multiple adoption and regression adjustment with inverse probability weighting to evaluate impacts of the different adoption regimes on farm productivity and income. The results show that multiple adoption of innovations is mostly explained by access to key resources (credit, income and information), level of education and size of land owned by the farmer. More so, the concurrent adoption of conservation agriculture, stress adapted legume varieties and drought tolerant maize has far greater dividends on productivity and income than when considered individually. However, impacts of multiple adoption of the practices are not entirely uniform across different geographic regions and gender. Results suggest that effective institutional and policy efforts targeted towards reducing resource constraints that inhibit farmers' capacity to adopt complementary climate-smart agriculture packages such as conservation agriculture, drought tolerant maize and improved legume varieties must be gender sensitive and context specific.

Enhancing adoption rates of climate-smart agriculture practices and their impact on livelihoods requires promotional persistence, complemented by a thorough socioeconomic analysis that recognizes t...

Purpose The role of increased schooling on teenage childbirth has been expansively studied especially in developed countries. However, caveats remain in the case of low-income countries especially Sub-Saharan Africa. The purpose of this paper is to ascertain the impact of increased schooling on the probability of first childbirth at 15 years or younger, 16-17, 18-19, and 20 years or older, in the important context of Uganda – a country with one of the highest adolescent fertility rates in Africa. Design/methodology/approach The empirical analysis uses recent data from the nationally representative Demographic and Health Survey for Uganda conducted in 2011. The authors then adopt a fuzzy regression discontinuity design, estimated using instrumental variables techniques that exploit the exogenous change in schooling impelled by the universal primary education policy enacted in 1997 in Uganda. The empirical approach compares the fertility outcomes for women born in 1984-1992 (i.e. exposed to the policy) to those born in 1973-1981 (i.e. non-exposed). Findings The authors find that a one-year increase in schooling lowers the probability of first childbirth at age the age of 15 years or younger, 16-17, 18-19, and 20 years or older by nearly 8.2, 9.2, 9.4, and 9.5 percentage points, respectively. Also, pathways through which education impacts teenage motherhood included information access through the media, increased literacy, prenatal care utilization, marital status, and unhealthy sexual behavior. Originality/value The paper uses nationally representative survey data to scrutinize the causal influence of schooling on the probability of first childbirth using the 1997 universal primary education in Uganda as a natural experiment to identify the impact of schooling. The study recommends that expanding primary schooling opportunities for girls may be an effective strategy toward accelerated reductions in teenage fertility in Uganda.

Purpose Improving the adoption rates of proven innovative practices in bean farming and their impacts on livelihoods requires persistent promotion of practices, complemented by rigorous socioeconomic analysis that recognises the diversity of smallholder farmers. The purpose of this paper is to typify farm households in Angonia district of Mozambique, based on their socioeconomic characteristics prompting the adoption of proven innovative practices in bean production, management, and marketing. Design/methodology/approach The authors use a multivariate statistical analysis approach that combines principal component analysis, and cluster analysis to clearly identify five distinctive farm household types with respect to the adoption of proven innovative practices in smallholder bean farming using socio-economic factors. Findings The study findings show that various socioeconomic factors define clusters and can be associated with the adoption and use of innovative practices in smallholder bean farming. The five farm types identified are: female landowners with small farm sizes (29.52 per cent); educated farmers with access to credit (6.63 per cent); relatively rich male land owners with large farm sizes and low education (8.73 per cent); youthful, inexperienced and poor male farmers (6.33 per cent); and experienced female farmers with high labour endowments (8.43 per cent). The respective farm types seemed to have different patterns in the adoption of proven innovative practices in bean farming. Originality/value The authors recommend that policy makers promote strategies meant to raise adoption of innovative practices in bean production, management and marketing in Mozambique that takes into account household diversity. The farm types identified by this study can be a good starting point for guiding such future efforts.

This paper assesses the importance of community-level factors on prenatal care utilization in Zimbabwe. The analysis is performed using data from the two most recent rounds of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 2005/06 and 2010/11 linked with other community-level data. We use logistic, generalized linear regressions as well as multilevel mixed models to examine the factors associated with the frequency, timing and quality of prenatal care. Our results suggest that contraceptive prevalence, religious composition, density of nurses, health expenditures per capita and availability of government hospitals in communities are important predictors of prenatal care use in Zimbabwe. These findings have important implications for public health policy in Zimbabwe - a country with unfavorable maternal and child health outcomes.

Climate variability and change threaten and impact negatively on biodiversity, agricultural sustainability, ecosystems, and economic and social structures – factors that are all vital for human resilience and wellbeing. To cope with these challenges, embracing sustainability in food production is therefore essential. Practising sustainable agriculture is one way of ensuring sustainability in pro-poor farming communities in low-income countries. Sustainable agricultural practices are those practices enabling farmers to meet current and future societal needs for food, fibre, ecosystem services and healthy lives. This study evaluates the dynamics of farm-level adoption of sustainable agriculture practices and their effects on maize productivity, crop income and food adequacy, using data from the Chinyanja Triangle in southern Africa. We apply joint estimation techniques to estimate consistently the impact of sustainable agriculture practices on maize productivity, crop income and food adequacy. We establishe...

Background Socioeconomic inequality in maternity care is well-evident in many developing countries including Bangladesh, but there is a paucity of research to examine the determinants of inequality and the changes in the factors of inequality over time. This study examines the factors accounting for the levels of and changes in wealth-related inequality in three outcomes of delivery care service: health facility delivery, skilled birth attendance, and C-section delivery in Bangladesh. Methods This study uses from the Bangladesh Demographic and Health Survey of 2011 and 2014. We apply logistic regression models to examine the association between household wealth status and delivery care measures, controlling for a wide range of sociodemographic variables. The Erreygers normalised concentration index is used to measure the level of inequalities and decomposition method is applied to disentangle the determinants contributing to the levels of and changes in the observed inequalities. Results We find a substantial inequality in delivery care service utilisation favouring woman from wealthier households. The extent of inequality increased in health facility delivery and C-section delivery in 2014 while increase in skilled birth attendance was not statistically significant. Wealth and education were the main factors explaining both the extent of and the increase in the degree of inequality between 2011 and 2014. Four or more antenatal care (ANC4+) visits accounted for about 8% to 14% of the observed inequality, but the contribution of ANC4+ visits declined in 2014. Conclusion This study reveals no progress in equity gain in the use of delivery care services in this decade compared to a declining trend in inequity in the last decade in Bangladesh. Policies need to focus on improving the provision of delivery care services among women from poorer socioeconomic groups. In addition, policy initiatives for promoting the completion of quality education are important to address the stalemate of equity gain in delivery care services in Bangladesh.

Background Recent evidence shows that sport settings can act as a powerful draw to engage men in weight loss. The primary objective of this pilot study was to test the feasibility of delivering and to evaluate preliminary efficacy of Aussie-FIT, a weight-loss program for men with overweight/obesity delivered in Australian Football League (AFL) settings, in preparation for a future definitive trial. Methods and findings This 6-month pilot trial took place in Perth, Australia. Participants were overweight/obese (Body Mass Index [BMI] ≥ 28 kg/m2), middle-aged (35–65 years old) men. Participants were recruited in May 2018, and the intervention took place between June and December 2018. The intervention involved 12 weekly 90-min face-to-face sessions, incorporating physical activity, nutrition, and behaviour change information and practical activities delivered by coaches at 2 clubs. Data were collected at baseline and immediately postintervention. For trial feasibility purposes, 6-month follow-ups were completed. Outcomes were differences in weight loss (primary outcome) and recruitment and retention rates, self-reported measures (for example, psychological well-being), device-measured physical activity, waist size, and blood pressure at 3 months. Within 3 days of advertising at each club, 426 men registered interest; 306 (72%) were eligible. Men were selected on a first-come first-served basis (n = 130; M age = 45.8, SD = 8; M BMI = 34.48 kg/m2, SD = 4.87) and randomised by a blinded researcher. Trial retention was 86% and 63% at 3- and 6-month follow-ups (respectively). No adverse events were reported. At 3 months, mean difference in weight between groups, adjusted for baseline weight and group, was 3.3 kg (95% CI 1.9, 4.8) in favour of the intervention group (p < 0.001). The intervention group’s moderate-to-vigorous physical activity (MVPA) was higher than the control group by 8.54 min/day (95% CI 1.37, 15.71, p = 0.02). MVPA among men attracted to Aussie-FIT was high at baseline (intervention arm 35.61 min/day, control arm 38.38 min/day), which may have limited the scope for improvement. Conclusions Aussie-FIT was feasible to deliver; participants increased physical activity, decreased weight, and reported improvements in other outcomes. Issues with retention were a limitation of this trial. In a future, fully powered randomised controlled trial (RCT), retention could be improved by conducting assessments outside of holiday seasons. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12617000515392., Eleanor Quested and colleagues report the findings from a pilot, football-based randomised controlled trial aimed at men with overweight/obesity., Author summary Why was this study done? The prevalence of overweight and obesity is higher in men than in women in Australia (71% versus 56%). Provision of weight-loss programs suitable for men is limited, and men are less likely than women to take part in weight-loss programs. Use of sport settings, such as Australian Football League (AFL) club facilities, can be used as a powerful way to encourage men to participate in weight-loss programs. What did the researchers do and find? 130 men took part in the Aussie-FIT program. This men-only weight-loss program included 12 weekly 90-min sessions that included weight-loss education and coach-led physical activity. The AFL themed program was delivered in 2 Australian football club settings. After all of the men’s initial weight and health measures were taken, half of the group received the program, and the other half waited for 3 months to receive it. At 3 months, the measurements were repeated so that we could compare differences in weight (and other indicators of health) between men who had already completed the program and the men who were waiting to receive the program. We found that the men who had participated in the program lost on average 3.33 kg more than the men who had not. Men who had completed Aussie-FIT did, on average, 8.54 min more moderate-to vigorous physical activity per day than their counterparts who had not yet received the program. What do these findings mean? Aussie-FIT is feasible to deliver in Australian football settings. This study provides some initial evidence that Aussie-FIT may be appealing and effective as a weight-loss program for men with overweight and obesity in Australia. This study was relatively small (130 men took part). In order to make definitive policy recommendations regarding program scale out, a follow-up study involving more participants and more football clubs is needed. Also, studies with longer follow-up are needed. A limitation of this study was that the program did not attract men from culturally or linguistically diverse backgrounds or indigenous Australians; future studies should explore how the program can be made more appealing and acceptable to men from more diverse backgrounds.

Increased frequency of droughts (especially mid-season dry spells), higher than normal temperatures and altered patterns of precipitation and intensity are some of the extreme weather events evident in southern Africa. These extreme weather events present a threat to livelihoods and sustainability of agricultural production in the region. However, several climate-smart agricultural technologies (including drought-tolerant maize) believed to offer adaptation to climate variability in maize-based farming systems have been widely adopted. Moreover, empirical work on these technologies is limited. This paper demonstrates how by adopting drought-tolerant maize, a climate-smart agricultural technology impacts on the quantities of maize produced, sold and consumed in Zimbabwe. Using primary data on smallholder farmers collected in 2011 in Zimbabwe’s four districts, we employed propensity score matching techniques to construct a suitable comparison group and calculate the average treatment effect on the t...

The primary objective of this analysis is to investigate the causal effect of mother's schooling on under-five health - and the passageways through which schooling propagates - by exploiting the exogenous variability in schooling prompted by the 1994 universal primary schooling program in Malawi. This education policy, which saw the elimination of tuition fees across all primary schooling grades, creates an ideal setting for observing the causal influence of improved primary school enrollment on the under-five fatality rates of the subsequent generation. Our analysis uses data from three waves of the nationally representative Malawi Demographic and Health Surveys conducted in 2000, 2004/05, and 2010. To address the potential endogeneity of schooling, we employ the mother's age at implementation of the tuition-free primary school policy in 1994 as an instrumental variable for the prospect of finishing primary level instruction. The results suggest that spending one year in school translated to a 3.22 percentage point reduction in mortality for infants and a 6.48 percent reduction for children under age five years. For mothers younger than 19 years, mortality was reduced by 5.95 percentage points. These figures remained approximately the same even after adjusting for potential confounders. However, we failed to find any statistically meaningful effect of the mother's education on neonatal survival. The juvenile fatality estimates we find are weakly robust to several robustness checks. We also explored the potential mechanisms by which increased maternal schooling might help enhance child survival. The findings indicated that an added year of motherly learning considerably improves the prospect of prenatal care use, literacy levels, father's educational level, and alters fertility behavior. Our results suggest that increasing the primary schooling prospects for young women might help reduce under-five mortality in less-industrialized regions experiencing high under-five fatalities such as in sub-Saharan Africa.

The informal sector in Zimbabwe plays a fundamental role in the supply of intermediate agricultural technologies. The seemingly never-ending economic crisis has arguably contributed to the collapse of the formal industrial sector resulting in a shortage of farming technologies especially amongst small-scale farmers whose numbers increased exponentially post the agrarian reform in 2000. However, innovation capabilities by informal entrepreneurs and overall firm performance are critical elements for eventual impact of the sector to the farming community. This study scrutinises the effect of informal entrepreneurial innovations on firm performance using data from 602 randomly selected informal metal industry entrepreneurs clustered across 15 districts from eight provinces in Zimbabwe. An instrumental variable regression method is employed to control for potential endogeneity bias associated with the voluntary nature of the decision to innovate. Results show that firm and firm owner characteristics and policy are important correlates of innovation while entrepreneurial innovations promote firm performance. Overall, these findings highlight the importance of entrepreneurial innovations on firm performance and the need for ensuring continuity of the informal metal businesses. Also, policies that promote acquisition of cheap entrepreneurial skills and a favourable business climate that supports innovation might help to steer Zimbabwe's economy out of trouble.

Institutional credit and extension services are critical inputs that can reduce scaling challenges in agricultural development interventions if accessed by farmers. Using household level survey data from Zimbabwe and Malawi, this article seeks to contribute to the existing literature by examining impacts of separate and joint access to credit and extension services on climate-smart agricultural (CSA) technologies adoption. Using inverse-probability weighting regression adjustment and propensity score matching this study found out that access to either extension or credit significantly progresses CSA technology adoption. However, access to extension services only proved to be more effective in enhancing CSA technology adoption than access to credit alone. More importantly, results show enhanced collective impact of simultaneous access to credit and extension on CSA technology adoption. Further, joint impacts of credit and extension on adoption were found to be less pronounced in youthful and women farmer groups compared to their old and male farmer group counterparts respectively. Results call for prudent policy and institutional strategies in improving access to credit and extension services in Malawian and Zimbabwean smallholder farming that are mindful of disadvantaged groups such as youth and women farmer groups in order to improve adoption and upscaling of CSA technologies. Possible options include; improving number of extension workers at village level, increasing youth and women extension agent numbers, capacity building of extension personnel and institutions, and increasing financial support to national extension programs.

Access to land and other natural resources are key means of driving rural people out of abject poverty. Inequalities in access to land and supportive services that ensure full utilization of land are therefore hurting in rural societies. This article enumerates and explain wealth-related imbalances in land size holding and utilization in Zimbabwe’s smallholder farming sector. It relies on cross-sectional household level data collected from 601 smallholder farming households randomly sampled from four districts. Disparities in land size holding and utilization are measured using the Erreygers corrected concentration index. A decomposition exploration is performed to determine the contributing factors to enumerated inequalities in land size holding and utilization. Results reveal a pro-poor distribution of inequalities in low and very low arable land size holding and also in low land utilization. Conversely, a pro-rich distribution of inequalities is observed in high land size holding and high land utilization. Wealth-related inequalities are evident in both men and women farmer groups, youth and non-youth farmer groups and in different geographic regions. A decomposition analysis show that observed inequalities in both land size holding and utilization are hugely explained by asset wealth. Other factors including access to extension, age of farmer, fulltime-farming status and geographic location were also found to minimally explain measured inequalities. In conclusion, low land size holding and low land utilization are phenomenon highly concentrated within the poorest segments of society in Zimbabwe whilst high land size holding and utilization are found within the more affluent population. Asset holding chiefly explain the disparities. Results suggest the need for decision makers in land allocation, distribution, re-distribution, and agrarian transformation in general, to deliberately concentrate on the most vulnerable and poorer segments of society. Such will have far reaching implications for rural transformation and development.

We scrutinise the causal influence of schooling on child dietary diversity and nutrition in Zimbabwe using the exogenous variability in schooling prompted by the 1980 education policy, a natural trial fitting a fuzzy regression discontinuity design. We established that a one-year of learning promotes dietary diversity and nutrition even after accounting for plausible mediating factors. Also, education is more liable to impact dietary practices and nutrition through improvements in health knowledge, literacy, wealth and prenatal care utilisation. These findings suggest that promoting schooling access to girls in resource-poor nations might have far-reaching implications on feeding practices and consequently child nutrition.

The impact of the quality of prenatal care on child mortality outcomes has received less attention in sub-Saharan Africa. This study endeavoured to explore the effect of the quality of prenatal care and its individual components on neonatal, infant and under-five mortality. The empirical analysis uses data from the three most recent waves of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 1999, 2005/06 and 2010/11. The results indicate that a one-unit increase in the quality of prenatal care lowers the prospect of neonatal, infant and under-five mortality by approximately 42.33, 30.86 and 28.65%, respectively. These findings remained roughly the same even after adjusting for potential mediating factors. Examining the effect of individual prenatal care components on child mortality revealed that women who receive information on possible complications arising during pregnancy are less liable to experience a neonatal death. Similarly, women who had blood pressure checks and tetanus immunizations were less likely to experience an infant or under-five death. We did not find any statistically meaningful impact on child mortality outcomes of blood and urine sample checks, iron tablet consumption, and the receipt of malarial tablets. Overall, our results suggest the need for public health policymakers to focus on ensuring high-quality prenatal care to enhance the survival prospects of Zimbabwe's infants.

This paper demonstrates how crop diversification impacts on two outcomes of climate smart agriculture; increased productivity (legume and cereal crop productivity) and enhanced resilience (household income, food security, and nutrition) in rural Zimbabwe. Using data from over 500 smallholder farmers, we jointly estimate crop diversification and each of the outcome variables within a conditional (recursive) mixed process framework that corrects for selectivity bias arising due to the voluntary nature of crop diversification. We find that crop diversification depends on the land size, farming experience, asset wealth, location, access to agricultural extension services, information on output prices, low transportation costs and general information access. Our results also indicate that an increase in the rate of adoption improves crop productivity, income, food security and nutrition at household level. Overall, our results are indicative of the importance of crop diversification as a viable climate smart agriculture practice that significantly enhances crop productivity and consequently resilience in rural smallholder farming systems. We, therefore, recommend wider adoption of diversified cropping systems notably those currently less diversified for greater adaptation to the ever-changing climate.

Background Inequalities in maternal health care are pervasive in the developing world, a fact that has led to questions about the extent of these disparities across socioeconomic groups. Despite a growing literature on maternal health across Sub-Saharan African countries, relatively little is known about the evolution of these inequalities over time for specific countries. This study sought to quantify and explain the observed differences in prenatal care use and professional delivery assistance in Zimbabwe. Methods The empirical analysis uses four rounds of the nationwide Zimbabwe Demographic and Health Survey administered in 1994, 1999, 2005/06 and 2010/11. Two binary indicators were used as measures of maternal health care utilization; (1) the receipt of four or more antenatal care visits and (2) receiving professional delivery assistance for the most recent pregnancy. We measure inequalities in maternal health care use using the Erreygers corrected concentration index. A decomposition analysis was conducted to determine the underlying drivers of the measured disparities. Results The computed concentration indices for professional delivery assistance and prenatal care reveal a mostly pro-rich distribution of inequalities between 1994 and 2011. Particularly, the concentration index [95% confidence interval] for the receipt of prenatal care was 0.111 [0.056, 0.171] in 2005/06 and 0.094 [0.057, 0.138] in 2010/11. For professional delivery assistance, the concentration index stood at 0.286 [0.244, 0.329] in 2005/06 and 0.324 [0.283, 0.366] in 2010/11. The pro-rich inequality was also increasing in both rural and urban areas over time. The decomposition exercise revealed that wealth, education, religion and information access were the underlying drivers of the observed inequalities in maternal health care. Conclusions In Zimbabwe, socioeconomic disparities in maternal health care use are mostly pro-rich and have widened over time regardless of the location of residence. Overall, we established that inequalities in wealth and education are amongst the top drivers of the observed disparities in maternal health care. These findings suggest that addressing inequalities in maternal health care utilization requires coordinated public policies targeting the more poor and vulnerable segments of the population in Zimbabwe.