Climate finance and women-hunger alleviation in the global south: Is the Sub-Saharan Africa case any different?

To unearth the influence of climate finance (CF) on women-hunger alleviation in Sub-Saharan Africa (SSA), the study used unbalanced panel data for 43 SSA countries for the period 2006-2018. Data was analysed using system-GMM to deal with the endogeneity problem inherent in the model, among other panel regression estimators. Also, the sensitivity of the estimates was carried out using panel fixed effect quantile regression. The findings showed that CF and its components have a significant effect on women-hunger alleviation in SSA, apart from FDI. Further, control of corruption also showed a significant women-hunger alleviation impact. For the climate variables, areas in SSA with higher temperature are more likely to experience worsened women-hunger. Based on the findings, the study recommends that SSA countries need to strengthen their fight against corruption. More so, donors should extend CF as financial aid or support to government budget, due to their potential of alleviating women-hunger.

Co-movement between Covid-19 and G20 stock market returns: A time and frequency analysis

In our study, we employ DCC-GARCH and Wavelet coherence analysis to examine the co-movement between global covid-19 indicators (cases, recoveries and deaths) and stock returns of main equity markets in G20 countries using daily data spanning between February 2, 2020 and August 28, 2021. Our empirical results show that the co-movement between COVID-19 and G20 stock returns has been switching between negative and positive correlations across the entire time window. The wavelet coherence analysis further reveal that negative (positive) co-movements predominantly exist as lower (higher frequencies) for cases and deaths and are more mixed for recoveries. The findings also show that the short-frequency components correspond to periods around the initial announcement of the initial pandemic and also around the announced of subsequent variants of the COVID-19 virus. Policy and market implications from our study are also discussed.

Causes of pre-treatment loss to follow-up in patients with TB

SETTING

Five urban TB diagnostic centres in Lusaka, Zambia.

OBJECTIVE

To determine the proportion of bacteriologically confirmed pre-treatment lost to follow-up (LTFU) patients with TB found at the study settings in 2020.

DESIGN

This was a retrospective cohort study in which the TB laboratory and treatment registers at the study sites were cross-matched.

RESULTS

A total of 1,085 bacteriologically confirmed patients with TB were found in the laboratory TB registers at the study settings. Of these, 809 (74.6%) were males, whereas 8 (0.7%) were children, 1,005 (92.6%) were diagnosed using Xpert, 78 (7.2%) by microscopy. A total of 91 (8.4%, 95% CI 6.8-10.2) were determined to be pre-treatment LTFU. Those who had very low (14.0%, 95% CI 8.5-21.2) and low (11.8%, 95% CI 8.4-16.0) results on Xpert were respectively 3.1 (95% CI 1.6-6.0) and 2.6 (95% CI 1.4-4.8) times more likely to become pre-treatment LTFU than those who had medium (4.5%, 95% CI 2.5-7.4) results. The proportions of pre-treatment LTFU varied among the study sites from 0.7% to 16.1%.

CONCLUSION

Health facilities should strive to account for every patient with TB, with particular attention to those who are bacteriologically confirmed.

Fisher's hypothesis in time-frequency space: a premier using South Africa as a case study

Fisher hypothesis is universally accepted as an integral portion of monetary theory and practice, and yet the empirical evidence confirming a full Fisher effect remains scarce and the relationship has been challenged on several theoretical grounds referred to as 'puzzles'. Our paper suggests the use of continuous wavelet transforms as a unified analytical framework for confronting the different Fisher puzzles in a harmonious way. Taking South Africa as a case study, we focus on the inflation targeting period of 2002:01-2021:02 and use signal-image conversion tools such as wavelet power spectrum, wavelet coherence spectrum and phase-difference dynamics to extract signal features of nominal interest rates and inflation expectations and further explore their dynamic synchronization across a time-frequency plane/domain. Three unique findings emerge from our study. Firstly, across a time domain a full Fisher effect only holds in the pre-financial crisis period. Secondly, across the frequency spectrums, higher frequency oscillations gradually lose relevance to lower frequency oscillations providing evidence of volatility transfer in the Fisher effect. Lastly, the phase-dynamics indicate a consistent positive synchronization throughout the sample period which is line with the traditional Fisher effect. Overall, these findings highlight the success of the South African Reserve Bank in using inflation targeting to steer the expectations of economic agents under the tenures of the last three governors and provide important lessons for other Central banks.

Changing efficiency of BRICS currency markets during the COVID-19 pandemic

This paper studies the information efficiency of BRICS currency markets during the COVID-19 pandemic using daily data spanning 3rd February 2020–31st August 2021. In our preliminary analysis, which consists of tests for random walk and martingale processes, we provide evidence of time-varying weak-form market efficiency in the currency markets. In our main empirical analysis, we use wavelet coherence tools to examine the time–frequency relationship between COVID-19 death rates and BRICS currency returns, and we find higher frequency components dominate periods of panic and financial turmoil. However, subsequent to government intervention in financial markets and the more recent rollout of mass vaccination programmes, we find that higher frequency oscillations disappear, and only very low-frequency co-movements remain. Important academic, market and policy implications derived from our study are discussed.

Re-evaluated treatment outcomes of bacteriologically positive TB patients registered at a clinic in Lusaka, Zambia in 2018

SETTING

An urban TB diagnostic centre in Lusaka, Zambia.

OBJECTIVE

To re-evaluate treatment outcomes of all bacteriologically confirmed TB patients registered in 2018.

DESIGN

This was a retrospective cohort study on TB patients. Treatment outcomes of patients who were transferred out were retrieved.

RESULTS

A total of 182 patients were registered, 26 of whom had missing documents; these were excluded from the study. Of the remaining 156 patients who were reviewed, 86 (55.1%) were correctly evaluated by the centre, 35 (22.4%) were incorrectly evaluated and 35 (22.4%) were 'transferred out' (not evaluated). As a result of this review, the number of evaluated patients increased from 86 (55.1%) to 150 (96.2%). The cure and treatment success rates rose from 43.6% and 44.2%, respectively, to 57.7% and 73.1%, respectively. Of note, 14 of the 35 patients who were initially declared 'transferred out' did not actually reach their treatment facilities and ended up being lost to follow-up.

CONCLUSION

This study shows that it is possible to evaluate almost all TB patients. Re-evaluation of treatment outcomes of TB patients revealed the problems in the TB services that need to be improved in the future.

Surveillance of invasive infection in children and adults admitted to QECH, Blantyre, 1996-2002

This is a report of blood CSF isolates from the adults medical and paediatric of wards QECH, Blantyre, cultured and identified at the Welcome Trust Research Laboratories during 1996-2002. The commonest causes of adults and children bacteraemia were non-typhoidal Salmonella (35% of all blood isolates for adults and children) and Streptococcus pneumoniae (14% and 13% respectively). Cryptococcus neoformans was the commonest isolates from CSF of adults with meningitis(67%) but was very rare in children. S.pneumoniae was the commonest cause of bacterial meningitis in children and adults (38% and 28% of all CSF isolates respectively). Haemophilus influenzae type b was also a common cause of meningitis in children (27%). Data of in vitro antibiotic sensitivity are also reported. A major concern is the recent marked rise of chloramphenicol resistance among Salmonella enteritidis and Salmonella typhimurium to over 80% resistance.

Non-invasive ventilation with bubble CPAP is feasible and improves respiratory physiology in hospitalised Malawian children with acute respiratory failure

BACKGROUND

In low-income countries and those with a high prevalence of HIV, respiratory failure is a common cause of death in children. However, the role of non-invasive ventilation with bubble continuous positive airway pressure (bCPAP) in these patients is not well established.

METHODS

A prospective observational study of bCPAP was undertaken between July and September 2012 in 77 Malawian children aged 1 week to 14 years with progressive acute respiratory failure despite oxygen and antimicrobial therapy.

RESULTS

Forty-one (53%) patients survived following bCPAP treatment, and an HIV-uninfected single-organ disease subgroup demonstrated bCPAP success in 14 of 17 (82%). Compared with children aged ≧60 months, infants of 0-2 months had a 93% lower odds of bCPAP failure (odds ratio 0·07, 95% confidence interval 0·004-1·02, P  =  0·05). Following commencement of bCPAP, respiratory physiology improved, the average respiratory rate decreased from 61 to 49 breaths/minute (P  =  0·0006), and mean oxygen saturation increased from 92·1% to 96·1% (P  =  0·02).

CONCLUSIONS

bCPAP was well accepted by caregivers and patients and can be feasibly implemented into a tertiary African hospital with high-risk patients and limited resources.

Wildlife snaring – an indicator of community response to a community-based conservation project

The use of wire snares for catching wildlife to support household needs was treated as an indicator to evaluate community support and understanding for a community-based resource management project. Data were based on snare counts in areas surrounding the targeted community as well as from interviews with individuals purported to have had a history of snaring. The high use of snares conflicted with expected behaviour for a community benefiting from the project. Snaring levels were high enough to threaten the viability of the safari industry and the derived revenues that were meant to be shared with the community. These contradictions suggested flaws in the project: an overdependence on external donor-supported management and lack of real community involvement and leadership in management of the resource. This study underscores the critical importance for monitoring land-use behaviour as an indicator of the success of community-based management projects.

Brain abscesses in Malawian children: value of CT scan

The clinical presentation and management of brain abscess in three HIV-uninfected Malawian children are reported. One case was associated with staphylococcal empyema and severe malarial anaemia and another case with chronic suppurative otitis media and mastoiditis. The third case had no identified extracranial focus of infection. These cases illustrate the difficulties of diagnosis and management of brain abscesses in the resource-poor setting where other causes of encephalopathy caused by infection are common, and highlight the value of neuroradiological imaging.

A case series of brain abscesses in Malawian children

We report three cases of brain abscess in children admitted to QECH in 2006. All children were HIV-uninfected. One case was associated with staphylococcal empyema, another with chronic suppurative otitis media and mastoiditis, and the third case had no identified extracranial focus of infection. These cases illustrate the difficulties of diagnosis and management of brain abscesses in the resource-poor setting where other causes of infection of the central nervous system are common. The typical clinical presentation of brain abscess of altered mental state and seizures is also characteristic of cerebral malaria and meningitis and it is likely that many cases of brain abscess in Malawian children are not diagnosed. The value of cranial CT scan, ideally with contrast, for diagnosis and management of brain abscess is highlighted by these cases.

Aetiology of neonatal sepsis in Blantyre, Malawi: 1996-2001

AIM

The aim of this retrospective study was to report causes, antibiotic resistance and outcome of neonatal sepsis (often fatal in developing countries) in Malawi.

METHODS

All blood and cerebrospinal fluid isolates collected between January 1996 and December 2001 from inpatients aged 0-30 days with suspected sepsis at Queen Elizabeth Central Hospital, Blantyre, Malawi were reviewed. In vitro resistance to antibiotics commonly used in Malawi was assessed. Case fatality rate was analysed with respect to age, bacterial pathogen and infection site.

RESULTS

A total of 801 bacteria were isolated from 784 neonates over 6 years-599 isolates from blood and 202 from cerebrospinal fluid. Overall, 54% of bacteria were gram-positive and 46% gram-negative. The commonest causes of neonatal sepsis were group B Streptococcus (17%) and non-typhoidal Salmonella (14%). In vitro antibiotic susceptibility to the first-line antibiotic combination of penicillin and gentamicin was 78% for all isolates, but in vitro sensitivities to gentamicin for Klebsiella spp and non-typhoidal Salmonella were only 33% and 53%, respectively. In-hospital case fatality rate was known for only 301 cases and was high at 48%. Group B Streptococcus was associated with the best outcome. Mortality was significantly higher if presentation was in the 1st week of life or if sepsis was caused by gram-negative bacteria. The causes of neonatal sepsis in this population show a different pattern from other studies in developing countries.

Reflections on the health workers' strike at Malawi's major tertiary hospital, QECH, Blantyre, 2001: a case study

Health workers and support staff at Malawi's major referral hospital, the Queen Elizabeth Central Hospital, Blantyre, were on strike between 5th and 19th October 2001. The health workers' grievances included: lack of risk allowances; poor professional allowances; low salaries; and low housing allowances. The strike resulted in almost total closure of the 1500-bed hospital; only the burns and orthopaedic wards continued to serve patients. Volunteer staff, comprising the Red Cross, and nursing and medical students provided services. Verbal and written threats by the authorities had minimal effect on terminating the strike; rather, they encouraged the resolve to continue with the industrial action. We report aspects of the genesis, progress and resolution of the strike. Although not much seems to have been achieved, both the employer and the workers need to draw lessons from the experience.

Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996-97

To design appropriate interventions, we collected clinical and demographic data prospectively on all children aged one day to 14 years admitted with a diagnosis of bacterial meningitis (BM) from April 1st 1996 to March 31st 1997 to the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. During the study period 267 children (2.7% of all paediatric admissions) were found to have BM; 83% were under 5 years of age, 61% under one year and 23% under one month. The most common causative organisms in the post neonatal period (n=206) were Streptococcus pneumoniae (27%), Haemophilus influenzae type b (Hib) 21%, and Salmonella typhimurium (6%). In the neonatal group (< 1 month, n=61) the most common causes were Streptococcus agalactiae (23%), S. typhimurium (15%), S. pneumoniae (11.5%) and other Gram negative rods (11.5%). Nineteen of 21 salmonella infections were in children under one year of age and all S. agalactiae were in infants under three months. There was delay on presentation: the average length of fever was 4.6 days, 39.5% had convulsed prior to arrival and 57% had an altered level of consciousness. An initial diagnosis of malaria had probably contributed to the delay in 22.5% (42 of 186 tested). 48% were < 80% weight for age, with 18% < 60%) weight for age. The overall mortality was 40%. The outcome was worst in salmonella infections, particularly neonatal salmonella BM with a case fatality rate (CFR) of 89% (8 of 9 cases). Coma on presentation worsened prognosis (mortality 64% if Blantyre Coma Score < 3, 26% if > 3). 15% of survivors had sequelae on discharge. 20% of Hib isolates were resistant to chloramphenicol, but all salmonellae were sensitive. 5% of S. pneumoniae were resistant to penicillin and 8% to chloramphenicol. Earlier access to adequate health care and awareness of BM in a malaria-endemic area would reduce mortality and morbidity. Vaccination against Hib infection would have reduced death by 18 (17%) and prevented sequelae in 7 cases.

Provider attitudes toward IUD provision in Zimbabwe: perception of HIV risk and training implications

This study was conducted to assess providers' attitudes toward the provision of long-term methods of contraception, in particular the IUD, and provider concerns about human immunodeficiency virus (HIV) in the context of family planning (FP) services. The data were collected using self-administered structured questionnaires. Between 65% and 80% of the public and private providers thought that the IUD is a good contraceptive method for Zimbabwean women. In addition, the majority of these two provider groups felt that neither the IUD nor tubal sterilization (TL) posed much risk of HIV infection to the client. A significant number of providers (especially the public nurses), however, thought that the provision of TL put the provider at high risk of HIV infection and a significant proportion of public nurses were also concerned about provider risk associated with providing IUD and injectables. To address such concerns, future training interventions should emphasize appropriate infection prevention practices associated with surgical FP method provision. Nurses, in particular, should be informed about the magnitude of risk associated with FP service provision and ways to protect themselves. Logistic activities also need to be strengthened so that legitimate concerns among providers regarding lack of adequate infection prevention supplies (e.g. gloves) in the field can be addressed.

Bloody diarrhoea of adults in Malawi: clinical features, infectious agents, and antimicrobial sensitivities

In a prospective study, 132 hospital out-patients presenting with bloody diarrhoea ('cases') were evaluated in Malawi, Central Africa; 73 out-patient tuberculosis suspects acted as controls. Most (100/132, 76%) subjects reported an illness lasting < or = 5 d with > 5 bowel actions in the preceding 12 h; 39/132 (30%) reported use of systemic antimicrobial drugs in the preceding week; 57% (74/130) had a body mass index < 20; 4% (5/131) were febrile; and 18/130 (13%) had one or more sign(s) of dehydration. The 73 controls reported no diarrhoea and more systemic antimicrobial drug use (P = 0.0003), but were otherwise comparable to the subjects. All stool samples from controls and 38/124 (31%) from cases were macroscopically normal. Only 32% (40/124) of the cases had blood visible in the stool. Parasitic gut infections were found in 42/124 (34%) cases compared with 1/60 (2%) controls (P < 0.0001). The commonest parasite was Schistosoma mansoni. Bacterial cultures were positive in 32/124 (26%) of the subjects. Shigella dysenteriae (Sd) 1 accounted for 53% (17/32) of these. All bacterial isolates were sensitive in vitro to nalidixic acid and ciprofloxacin, while only 18% were sensitive to cotrimoxazole. Sd 1 with significant antimicrobial resistance continues to cause seasonal epidemics of dysentery in Malawi. During these, approximately two-thirds of patients presenting with bloody diarrhoea have no blood visible in the stool. Nalidixic acid remains the drug of choice but its use should be restricted to patients at greatest risk of complicated shigellosis.