Archive for the ‘Uganda’Category

Uganda is beautiful

I’ve been in Uganda the last few weeks helping with the implementation of a large scale survey: a representative national household survey and survey of drug retailers and healthcare providers, all focused on the availability and usage of essential medicines for childhood illness. The system we’ve set up is pretty cool, with data collection on Android tablets via ODK meta and real time checks for data quality (by teams, individual interviewers, and individual interviews) and feedback to the survey group, which I hope to write up at a later date.

In the meantime, I wanted to share some photos of Uganda, which is really, really beautiful. There’s a whole album here, and below are some highlights:

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25

10 2014

Why did HIV decline in Uganda?

That’s the title of an October 2012 paper (PDF) by Marcella Alsan and David Cutler, and a longstanding, much-debated question in global health circles . Here’s the abstract:

Uganda is widely viewed as a public health success for curtailing its HIV/AIDS epidemic in the early 1990s. To investigate the factors contributing to this decline, we build a model of HIV transmission. Calibration of the model indicates that reduced pre-marital sexual activity among young women was the most important factor in the decline. We next explore what led young women to change their behavior. The period of rapid HIV decline coincided with a dramatic rise in girls’ secondary school enrollment. We instrument for this enrollment with distance to school, conditional on a rich set of demographic and locational controls, including distance to market center. We find that girls’ enrollment in secondary education significantly increased the likelihood of abstaining from sex. Using a triple-difference estimator, we find that some of the schooling increase among young women was in response to a 1990 affirmative action policy giving women an advantage over men on University applications. Our findings suggest that one-third of the 14 percentage point decline in HIV among young women and approximately one-fifth of the overall HIV decline can be attributed to this gender-targeted education policy.

This paper won’t settle the debate over why HIV prevalence declined in Uganda, but I think it’s interesting both for its results and the methodology. I particularly like the bit on using distance from schools and from market center in this way, the idea being that they’re trying to measure the effect of proximity to schools while controlling for the fact that schools are likely to be closer to the center of town in the first place.

The same paper was previously published as an NBER working paper in 2010, and it looks to me as though the addition of those distance-to-market controls was the main change since then. [Pro nerd tip: to figure out what changed between two PDFs, convert them to Word via pdftoword.com, save the files, and use the ‘Compare > two versions of a document’ feature in the Review pane in Word.]

Also, a tip of the hat to Chris Blattman, who earlier highlighted Alsan’s fascinating paper (PDF) on TseTse flies. I was impressed by the amount of biology in the tsetse fly paper; a level of engagement with non-economic literature that I thought was both welcome and unusual for an economics paper. Then I realized it makes sense given that the author has an MD, an MPH, and a PhD in economics. Now I feel inadequate.

03

01 2013

Another way to help in Somalia

One of the best ways to address the severe acute malnutrition seen during famines — like the one in Somalia now — is a Ready-to-Use Therapeutic Food (RUTF). They’re basically nutritionally fortified peanut butter manufactured to certain quality standards, and they’re incredibly effective.

Which brings me to MANA, or Mother-Administered Nutritive Aid (and yes, a Biblical reference). They’re on a long list of things I’ve been meaning to write about, but my memory was jogged by their Somalia email blast. I’m a natural skeptic about start-up nonprofits, but over time they’ve won me over with their idea. The model is relatively simple: for now they’re manufacturing RUTFs in the US and selling them to UNICEF and large NGOs that have established distribution networks. I like that aspect — they’re not trying to be all things to all men by distributing it themselves, as they’ve recognized that role is better done by others.

But the US manufacturing is just a stop-gap. For one, it’s helping them learn the ropes on producing high quality RUTFs  and supplying these badly needed and under-produced goods to organizations with complicated purchasing requirements. Their end goal is to establish a self-sustaining (ie, profitable) manufacturing plant in Rwanda, and they’re making progress on it.  A donation now will help them make more RUTFs and help them establish the Rwanda facility until it gets to a point where it no longer requires ongoing help.

One reason I think MANA is the right sort of group to establish such a business in Rwanda is that it’s co-founded by Mark Moore, and he’s well situated to work on both the problems of small enterprises in east Africa and international politics and supply chains. Like me, Mark is a Harding alum. He’s a smart guy who spent ten years in eastern Uganda as a missionary (and started the Kibo Group development org), but he also has a Masters in development studies from Georgetown and served as Mary Landrieu’s Africa specialist in the Senate. His work was the sort of evangelical aid I thought of when I read Dave Algo’s recent post on how secular aid and development workers should be less hostile to good aid work done by evangelicals. Well, this it: in my opinion it’s a smart business model run (an being an aspiring development professional, I’d welcome critical feedback in the comments as well) by people who can provide some necessary help to get things set up, and then step back out of the way. Once the facility is up and running in Rwanda it will mean more of our aid money can actually go into the east African economy as NGOs buy RUTFs from MANA and pay its local workers’ wages.

Those who know me well or read this blog know that I have ambivalent feelings about Harding. I went there planning on being a medical missionary, and while I lost my faith I also made many friends, and my experiences there led me to my current interests in global health. So I have good things to say and bad things to say. One of the good things — that I don’t say enough — is that there are a lot of incredibly sincere, hard-working people who come out of the school and do work that I couldn’t find fault with if I tried. This is one of them, and I’m sure they’d appreciate your support.

From the front lines of public health

Rashida is a Peace Corps volunteer in Uganda teaching “teaching life skills/health/whatever at a local secondary school,” as well as a blogger. She also happens to be in the same Hopkins global health Masters program as me (but a year or two ahead, so we’ve never met). Her latest post starts with this:

Since the kids are often shy around the muzungu (and in front of their classmates), I thought it would better to set up an anonymous questions box, where students can ask questions about health, etc. without having to ask them in front of everyone. Well, no one else seemed as excited about this idea as I was, so I thought the box would just be forgotten about, or maybe even stolen by a trouble-making student. Imagine my surprise when I came back to the school two days after setting up the box to find it overstuffed with questions. I was a bit overwhelmed by the volume of questions posed to me, so I told the students to let me take them home and prepare my answers for next week. Well, here are some of the questions that I got:
  • If you have sex during your menstruation, do you get pregnant?
  • Is it true that if you kiss someone who has HIV, you’ll also get HIV?
  • There are some boys who disturb me during my leisure time, but if I see them I feel like vomiting. What can I do, please help me?
  • Is it true that if young people play sex before menstruation begins you can still get pregnant?
  • How can I know when playing sex that sperm is coming through the penis?
  • Is it true that if you delay having sex you become an abnormal person?
  • Is it bad to practice homosexuality?
  • People usually tell us to have sex when we are still young in order to become perfect in sex. What is the meaning of perfect in sex?

There are quite a few more in the rest of the post,  and they just get more disturbing. Personally I wouldn’t know where to start, and I greatly admire those who have the patience, courage, and tact to do this badly needed work. It must be especially difficult to do this sort of work as a foreigner.  Alas, I described this post — and the sample questions — to a friend who does sex ed in New York City and was told that the questions are remarkably similar to what you get asked here.

28

06 2011

"A baby was born in my Land Rover today"

….so writes my friend Bobby Garner, a missionary in Uganda. Worth a read.

10

06 2011

Outbreak in Northern Uganda

Julian Jamison, writing on Chris Blattman’s blog, notes an outbreak of an unknown disease in northern Uganda. There’s also a note in Kenya’s Daily Nation. Hard to say what it is without more definitive information, but definitely worth watching.

In other Ugandan outbreak news, there’s an outbreak of “jiggers” (tungiasis) as well.

01

12 2010