Asymmetric Impact of Real Effective Exchange Rate Shocks on Economic Growth in Africa: Evidence From Symmetric and Asymmetric Panel ARDL-PMG Model

This paper examines the effects of the real effective exchange rate on economic growth in 11 African countries from 1990 to 2022 using linear and nonlinear panel ARDL estimators. The linear panel ARDL-PMG results indicate that broad money supply and general government consumption positively impact economic growth in the short and long term, while the real effective exchange rate has an insignificant effect. The negative and statistically significant error correction term (ECTt-1) suggests a long-term relationship between the variables. Similarly, the nonlinear panel ARDL-PMG results show that broad money supply and general government consumption have positive and significant effects on economic growth in both the short and long term. Negative shocks in the real effective exchange rate hinder economic growth in the short and long term, while positive shocks do not significantly affect economic growth. The paper discusses the policy implications of these findings

Reducing barriers to accessing fistula repair: Implementation research in Katsina

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Katsina state

Reducing barriers to accessing fistula repair: Implementation research in Ebonyi

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Ebonyi state

Reducing barriers to accessing fistula repair in Nigeria and Uganda: An implementation research study

Female genital fistula predominately affects women who are marginalized within their societies and lack access to quality maternal health care. While efforts to promote fistula identification and treatment exist, systematic knowledge about the barriers women face in accessing fistula treatment is lacking, in addition to rigorous evidence about interventions that effectively respond to these barriers. A partnership between the Population Council and the USAID Fistula Care Plus project implemented by EngenderHealth sought to understand and address critical barriers to fistula care in Nigeria and Uganda. The study examined whether a comprehensive information, screening, and referral intervention reduced transportation, communication, and financial barriers to preventive fistula care and improved its detection and treatment. A complex social behavior change (SBC) intervention was implemented featuring a single screening algorithm applied through multiple channels, in addition to free transportation, to promote women’s improved access to fistula centers for diagnosis and treatment. As noted in this report, implementation of a complex SBC intervention is feasible in a controlled setting with sufficient resources, and effective when integrated within local, community-based health systems and partners

Feasibility and acceptability of community health extension workers to identify and treat hypertension associated with pregnancy: Implementation research report

Hypertensive disorders in pregnancy, experienced by 10 percent of women globally, are major contributors to maternal and newborn mortality, morbidity, and disability. Task shifting essential health services to mitigate insufficient human resources is recommended to strengthen and expand the health workforce and rapidly increase access to quality services. Nigeria’s task-shifting policy recommends that community health extension workers administer a loading dose of magnesium sulphate for severe pre-eclampsia or eclampsia prior to referral to a higher-level facility. This study tested the feasibility and acceptability of community health extension workers at primary health care facilities in Ebonyi state in detecting and managing pregnancy-associated hypertension using alpha methyldopa and magnesium sulphate, where appropriate, and referring for follow-up. Although challenges remain in ensuring that sufficient commodities and supplies are continuously available, this endline report details how ministries of health might use these missed opportunities to detect pre-eclampsia and prevent deterioration by providing anti-hypertensives and magnesium sulphate to stabilize and refer women

A cost-effectiveness analysis of provider and community interventions to improve the treatment of uncomplicated malaria in Nigeria: study protocol for a randomized controlled trial.

BACKGROUND: There is mounting evidence of poor adherence by health service personnel to clinical guidelines for malaria following a symptomatic diagnosis. In response to this, the World Health Organization (WHO) recommends that in all settings clinical suspicion of malaria should be confirmed by parasitological diagnosis using microscopy or Rapid Diagnostic Test (RDT). The Government of Nigeria plans to introduce RDTs in public health facilities over the coming year. In this context, we will evaluate the effectiveness and cost-effectiveness of two interventions designed to support the roll-out of RDTs and improve the rational use of ACTs. It is feared that without supporting interventions, non-adherence will remain a serious impediment to implementing malaria treatment guidelines. METHODS/DESIGN: A three-arm stratified cluster randomized trial is used to compare the effectiveness and cost-effectiveness of: (1) provider malaria training intervention versus expected standard practice in malaria diagnosis and treatment; (2) provider malaria training intervention plus school-based intervention versus expected standard practice; and (3) the combined provider plus school-based intervention versus provider intervention alone. RDTs will be introduced in all arms of the trial. The primary outcome is the proportion of patients attending facilities that report a fever or suspected malaria and receive treatment according to malaria guidelines. This will be measured by surveying patients (or caregivers) as they exit primary health centers, pharmacies, and patent medicine dealers. Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes, including changes in provider and community knowledge. Costs will be estimated from both a societal and provider perspective using standard economic evaluation methodologies. TRIAL REGISTRATION: Clinicaltrials.gov NCT01350752

Engaging community women’s groups to improve maternal health care delivery in Cross River: Implementation research report

Ending Eclampsia’s main objective is to improve access to underutilized interventions and commodities by training community health extension workers in preventing, detecting (screening), and managing pre-eclampsia and eclampsia. While the broader project emphasizes primary health care interventions, this implementation research (IR) study focused on a community intervention in one state, in areas where the facility interventions were active. This final research report describes IR testing the feasibility and utility of employing women’s groups as community platforms to increase women’s access to quality antenatal service utilization, using pre-eclampsia screening as the entry point. The study was conducted in 48 communities in 12 local government areas of Cross River state in southern Nigeria. IR shows that community women’s group platforms play an important role in educating women on their health and improving access to and utilization of quality maternal and child health services in Nigeria. The training and mentoring of women’s group leaders was effective at improving knowledge of maternal health and increasing antenatal care service uptake

Post-intervention analysis of pre-eclampsia and eclampsia in three Nigerian states

In the last three decades, global maternal mortality has decreased by almost 45 percent, but approximately 830 women still die daily from largely preventable pregnancy complications. Since 2015, the Ending Eclampsia project, with support from USAID, has been working to expand proven, underutilized interventions and commodities for pre-eclampsia/eclampsia (PE/E) prevention, early detection, and treatment, and to strengthen global partnerships for care of hypertensive disorders in pregnancy (HDP), of which PE/E are the severest forms. A systematic review of the literature identifies a number of articles reporting PE/E burdens within set populations, common risk factors, adverse outcomes, and mortality rates, but few discuss implementation research (IR) to improve PE/E prevention, detection, and timely management. Following the literature review and subsequent analysis of antenatal care and PE/E in seven Nigerian states in 2015, the project intensified its activities and IR in Cross River, Ebonyi, and Kogi states, emphasizing task sharing with primary health-care providers for the detection and management of HDP. This endline report describes the IR approach of the Population Council in Nigeria from 2016 to 2018 and its results

Treatment of uncomplicated malaria at public health facilities and medicine retailers in south-eastern Nigeria

Background: At primary care facilities in Nigeria, national treatment guidelines state that malaria should be symptomatically diagnosed and treated with artemisinin-based combination therapy (ACT). Evidence from households and health care providers indicates that many patients do not receive the recommended treatment. This study sought to determine the extent of the problem by collecting data as patients and caregivers leave health facilities, and determine what influences the treatment received. Methods: A cross-sectional cluster survey of 2,039 respondents exiting public health centres, pharmacies and patent medicine dealers was undertaken in urban and rural settings in Enugu State, south-eastern Nigeria. Results: Although 79% of febrile patients received an anti-malarial, only 23% received an ACT. Many patients (38%) received sulphadoxine-pyrimethamine (SP). A further 13% of patients received an artemisinin-derivative as a monotherapy. An estimated 66% of ACT dispensed was in the correct dose. The odds of a patient receiving an ACT was highly associated with consumer demand (OR: 55.5, p < 0.001). Conclusion: Few febrile patients attending public health facilities, pharmacies and patent medicine dealers received an ACT, and the use of artemisinin-monotherapy and less effective anti-malarials is concerning. The results emphasize the importance of addressing both demand and supply-side influences on malaria treatment and the need for interventions that target consumer preferences as well as seek to improve health service provision. © 2011 Mangham et al; licensee BioMed Central Ltd