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Background: Approximately 20.5 million infants were born weighing 150 cm) (adjusted Odds Ratio (aOR) = 0.42 (95% CI = 0.24, 0.72)), multigravida (aOR = 0.62 (95% CI = 0.39, 0.97)), or with adequate birth spacing (>24 months) (aOR = 0.60 (95% CI = 0.39, 0.92)) had lower odds of delivering a LBW infant Mothers with severe household food insecurity (aOR = 1.84 (95% CI = 1.22, 2.79)) or who tested positive for malaria during pregnancy (aOR = 2.06 (95% CI = 1.10, 3.85)) had higher odds of delivering a LBW infant. In addition, in multivariable analysis, mothers who resided in the Southwest (aOR = 0.64 (95% CI = 0.54, 0.76)), were ≥20 years old (aOR = 0.76 (95% CI = 0.61, 0.94)), with adequate birth spacing (aOR = 0.76 (95% CI = 0.63, 0.93)), or attended ≥4 antenatal care (ANC) visits (aOR = 0.56 (95% CI = 0.47, 0.67)) had lower odds of delivering a preterm infant; mothers who were neither married nor cohabitating (aOR = 1.42 (95% CI = 1.00, 2.00)) or delivered at home (aOR = 1.25 (95% CI = 1.04, 1.51)) had higher odds. Conclusions: In rural Uganda, severe household food insecurity, adolescent pregnancy, inadequate birth spacing, malaria infection, suboptimal ANC attendance, and home delivery represent modifiable risk factors associated with higher rates of LBW and/or preterm birth. Future studies on interventions to address these risk factors may be warranted.

Background: With the greatest burden of infant undernutrition and morbidity in low and middle income countries (LMICs), there is a need for suitable approaches to monitor infants in a simple, low-cost and effective manner. Anthropometry continues to play a major role in characterising growth and nutritional status. Methods: We developed a range of models to aid in identifying neonates at risk of malnutrition. We first adopted a logistic regression approach to screen for a composite neonatal morbidity, low and high body fat (BF%) infants. We then developed linear regression models for the estimation of neonatal fat mass as an assessment of body composition and nutritional status. Results: We fitted logistic regression models combining up to four anthropometric variables to predict composite morbidity and low and high BF% neonates. The greatest area under receiver-operator characteristic curves (AUC with 95% confidence intervals (CI)) for identifying composite morbidity was 0.740 (0.63, 0.85), resulting from the combination of birthweight, length, chest and mid-thigh circumferences. The AUCs (95% CI) for identifying low and high BF% were 0.827 (0.78, 0.88) and 0.834 (0.79, 0.88), respectively. Conclusions: These models display potential for further development and evaluation in LMICs to detect infants in need of further nutritional management, especially where traditional methods of risk management such as birthweight for gestational age percentiles may be variable or non-existent, or unable to detect appropriately grown, low fat newborns.

Marketing, Production Economics, and Public Economics

The Forum for Agricultural Research in Africa (FARA) commissioned a pilot study to understand the role of markets and marketing systems in African agriculture and to test the Integrated Agricultural Research for Development (IAR4D) and its innovation platforms (IPs) as a new strategy for wealth creation. This was in response to the fact that Sub-Saharan Africa’s small-scale farmers seem to have been trapped in cycles of poverty, and that the regional economy has stagnated. Using a market baseline survey in Uganda, Rwanda and the Democratic Republic of Congo (DRC), the Sub-Saharan Africa Challenge Programme (SSACP) found that disorganised markets and marketing were major factors in perpetuating poverty cycles and subsistence agriculture. These markets are characterised, among others, by too many players within a value chain, a lack of collective marketing and collective purchasing, poor transport infrastructure, a lack of value addition, poor market information, poor access to market information or a total lack of market information, and unfavourable trade policies and/or a lack of any. Although smallholder farmers are the highest investors in terms of land, tools, time, labour, inputs and transport along the value chains, they benefit least when it comes to earnings. Hence it is not economical to produce surpluses in the absence of assured markets, good market policies and reliable marketing strategies. The results show that gender is an important component in the value chains, depending on the historical realities. In the DRC, for example, a country that has been in crisis for long, women have ventured into long- and short-distance trade. In Uganda, a country that has been at peace for at least 20 years, men trade more and further away from home. In Rwanda, where there has been 15 years of peace, men and women seemed to share the trading space in the country equally. It was also observed that the IAR4D approach may be the most relevant and appropriate one for addressing poverty in SSA through its integration of markets as core ingredients in agriculture, and the formation of innovation platforms (IPs) with stakeholders interested in the plight of farmers in their localities.

quick response programs, applicability, acceptability, and home care services

Objectives: This collaborative project between two community hospitals, a Metropolitan Home Care Program and the University, was designed to quantify the applicability (who is eligible for) and acceptability (who will likely comply with) Home Care services, provided through a Quick Response Program (QRP) initiative as compared to usual hospital care services, to patients, families and physicians. Methods: During a 6 week period of sampling (5 days per week, 8 hours per day) in two Emergency Departments (ED) in moderately sized community hospitals in a major metropolitan city, all patients triaged to the urgent category were assessed for eligibility for QRP services by on-site Home Care Coordinators using specific criteria. Patients meeting the criteria initially were reviewed by the ED physician for approval for QRP services and then randomized to experimental and control conditions. Patients not meeting the eligibility criteria were managed by the usual ED services procedures. Demographic and clinical data were obtained on all urgent category patients at presentation to the ED. Additionally, the nature and cost of all health care services used by the ED patients during the ED event and 10 days follow up, were obtained through hospital and Home Care record abstraction and compared among the different sample groups. Results: The QRP Initiative was applicable to 2% of the total ED patient population and 5% of the urgent category of patients triaged in the ED. It was acceptable to 97% of this eligible group. One hundred and fifty-five patients who initially qualified for QRP were excluded from eligibility at a subsequent assessment. Ninety of these patients were admitted to hospital and 65 were discharged home. In the total “exclusion” group, 37 refused Home Care services including the QRP. Health care practice implications: The sampling results raise important questions about broader system issues concerning the role of the hospital and community in providing health care services and the social value or utility that guides the allocation of health care funds. What level of applicability and acceptability would justify priority services for certain target groups. In the future, policy makers will need to be able to show that it is in the best interest of patients and society to prioritize mixtures of services to certain target groups. Copyright Kluwer Academic Publishers 1999

No abstract is available for this item.

No abstract is available for this item.

A series of studies investigate the decision processes of actuaries, underwriters, and reinsurers in setting premiums for ambiguous and uncertain risks. Survey data on prices reveal that all three types of these insurance decision makers are risk averse and ambiguity averse. In addition, groups appear to be influenced in their premium-setting decisions by specific reference points such as expected loss and the concern with insolvency. This behavior is consistent with a growing analytical and empirical literature in economics and decision processes that investigates the role that uncertainty plays on managerial choices. Improved risk-assessment procedures and government involvement in providing protection against catastrophic losses may induce insurers to reduce premiums and broaden available coverage. Copyright 1993 by Kluwer Academic Publishers