ABSTRACT
In this study, we present Afro-Grid: an integrated, disaggregated 0.5-degree grid-month dataset on conflict, environmental stress, and socioeconomic features in Africa covering 1989-2020, intended to propel research on these issues forward. Afro-Grid offers several important extensions for researchers and policymakers, including: (i) standardizing (using established methods) data sources on conflict, environmental stress, and socio economic factors across spatial and temporal scales; (ii) combining these data into a single, openly-available file, maximizing the accessibility of these data for researchers and policymakers regardless of their software background; and (iii) including NDVI and dual-series harmonized night lights series that have traditionally not been accessible to researchers without advanced computational expertise. Using a series of comparative regressions at the grid-month and grid-year levels, combined with reporting descriptive statistics and visualizations, we illustrate that this temporally and geographically disaggregated dataset provides valuable extensions for research related to the climate-conflict nexus and the role of socioeconomic features in shaping conflict trends, as well as for research and data-driven policy on development and conflict.
ABSTRACT
We sought to compare the costs of a nighttime pediatric telemedicine and medication delivery service per disability-adjusted life year (DALY) averted to the costs of current hospital emergency care per DALY averted from a societal perspective. We studied a nighttime pediatric telemedicine and medication delivery service and hospital emergency care in a semi-urban and rural region of Haiti. Costs of the two services were enumerated to represent the financial investments of both providers and patients. DALYs averted were calculated to represent the "years lives lost" and "years lost to disability" from diarrheal, respiratory, and skin (bacterial and scabies etiologies) disease among children from 0 to 9 years old. The incremental cost-effectiveness ratio was estimated and compared with the per capita gross domestic product (GDP) of Haiti ($1,177). Cost-effectiveness was defined as an incremental cost-effectiveness less than three times the per capita GDP of Haiti ($3,531). The total costs of the nighttime telemedicine and medication delivery service and hospital emergency care to society were $317,898 per year and $89,392 per year, respectively. The DALYs averted by the service and hospital emergency care were 199.76 and 22.37, respectively. Correspondingly, the incremental cost-effectiveness ratio is estimated at $1,288 signifying the service costs an additional $1,288 to avert one additional DALY. A scaled nighttime pediatric telemedicine and medication delivery service is likely a cost-effective alternative to hospital emergency care for preemergency pediatric conditions in Haiti, and possibly in similar lower-middle-income countries.
ABSTRACT
OBJECTIVE: To identify determinants of intended versus actual care-seeking behaviours in a pluralistic healthcare system that is reliant on both conventional and non-conventional providers and discover opportunities to catalyse improved healthcare access. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: In Haiti 568 households (incorporating 2900 members) with children less than 5 years of age were randomly sampled geographically with stratifications for population density. These households identified the healthcare providers they frequented. Among 140 providers, 65 were located and enrolled. OUTCOME MEASURES: Household questionnaires with standardised cases (intentions) were compared with self-recall of health events (behaviours). The connectedness of households and their providers was determined by network analysis. RESULTS: Households reported 636 health events in the prior month. Households sought care for 35% (n=220) and treated with home remedies for 44% (n=277). The odds of seeking care increased 217% for severe events (adjusted OR (aOR)=3.17; 95% CI 1.99 to 5.05; p<0.001). The odds of seeking care from a conventional provider increased by 37% with increasing distance (aOR=1.37; 95% CI 1.06 to 1.79; p=0.016). Despite stating an intention to seek care from conventional providers, there was a lack of congruence in practice that favoured non-conventional providers (McNemar's χ2 test p<0.001). Care was sought from primary providers for 68% (n=150) of cases within a three-tiered network; 25% (n=38/150) were non-conventional. CONCLUSION: Addressing geographic barriers, possibly with technology solutions, should be prioritised to meet healthcare seeking intentions while developing approaches to connect non-conventional providers into healthcare networks when geographic barriers cannot be overcome.
Subject(s)
Health Services Accessibility , Patient Acceptance of Health Care , Catalysis , Child , Cross-Sectional Studies , Haiti , HumansABSTRACT
What drives the formation and evolution of the global refugee flow network over time? Refugee flows in particular are widely explained as the result of pursuits for physical security, with recent research adding geopolitical considerations for why states accept refugees. We refine these arguments and classify them into explanations of people following existing migration networks and networks of inter-state amity and animosity. We also observe that structural network interdependencies may bias models of migration flows generally and refugee flows specifically. To account for these dependencies, we use a dyadic hypothesis testing method-Multiple Regression- Quadratic Assignment Procedure (MR-QAP). We estimate MR-QAP models for each year during the 1991-2016 time period. K-means clustering analysis with visualization supported by multi-dimensional scaling allows us to identify categories of variables and years. We find support for the categorization of drivers of refugee flows into migration networks and inter-state amity and animosity. This includes key nuance that, while contiguity has maintained a positive influence on refugee flows, the magnitude of that influence has declined over time. Strategic rivalry also has a positive influence on refugee flows via dyad-level correlations and its effect on the structure of the global refugee flow network. In addition, we find clear support for the global refugee flow network shifting after the Arab Spring in 2011, and drivers of refugee flows shifting after 2012. Our findings contribute to the study of refugee flows, international migration, alliance and rivalry relationships, and the application of social network analysis to international relations.
