Deborah Johnston

Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper

Much has been written about the measurement of socio-economic position (SEP) in high-income countries (HIC). Less has been written for an epidemiology, health systems and public health audience about the measurement of SEP in low- and middle-income countries (LMIC). The social stratification processes in many LMIC—and therefore the appropriate measurement tools—differ considerably from those in HIC. Many measures of SEP have been utilized in epidemiological studies; the aspects of SEP captured by these measures and the pathways through which they may affect health are likely to be slightly different but overlapping. No single measure of SEP will be ideal for all studies and contexts; the strengths and limitations of a given indicator are likely to vary according to the specific research question. Understanding the general properties of different indicators, however, is essential for all those involved in the design or interpretation of epidemiological studies. In this article, we describe the measures of SEP used in LMIC. We concentrate on measures of individual or household-level SEP rather than area-based or ecological measures such as gross domestic product. We describe each indicator in terms of its theoretical basis, interpretation, measurement, strengths and limitations. We also provide brief comparisons between LMIC and HIC for each measure.

Linking migration mobility and HIV.

Population mobility is commonly identified as a key driver of the HIV epidemic, both linking geographically separate epidemics and intensifying transmission through inducing riskier sexual behaviours. However, beyond the well‐known case studies of South African miners and East African truck drivers, the evidence on the links between HIV and mobility is nuanced, contradictory and inconclusive and is in part attributed to the abstract definitions of mobility used in different studies. This problematic conception of mobility, with no reference to who moves, their motivations for moving, or the characteristics of sending and receiving areas, can have a dramatic impact on how one understands the influence which this structural factor has on HIV risk in different settings. Future research on mobility and HIV transmission must incorporate an understanding of migration and mobility as dynamic processes and link different patterns and forms of mobility with location‐specific sexual networks and HIV epidemiology.

Feeding the world healthily: the challenge of measuring the effects of agriculture on health

Agricultural production, food systems and population health are intimately linked. While there is a strong evidence base to inform our knowledge of what constitutes a healthy human diet, we know little about actual food production or consumption in many populations and how developments in the food and agricultural system will affect dietary intake patterns and health. The paucity of information on food production and consumption is arguably most acute in low- and middle-income countries, where it is most urgently needed to monitor levels of under-nutrition, the health impacts of rapid dietary transition and the increasing ‘double burden’ of nutrition-related disease. Food availability statistics based on food commodity production data are currently widely used as a proxy measure of national-level food consumption, but using data from the UK and Mexico we highlight the potential pitfalls of this approach. Despite limited resources for data collection, better systems of measurement are possible. Important drivers to improve collection systems may include efforts to meet international development goals and partnership with the private sector. A clearer understanding of the links between the agriculture and food system and population health will ensure that health becomes a critical driver of agricultural change.

Value chains of herbal medicines—Research needs and key challenges in the context of ethnopharmacology

BACKGROUND Value chain analyses are commonly used to understand socioeconomic and power relationships in the production chain from the initial starting material to a final (generally high value) product. These analyses help in terms of understanding economic processes but also have been used in the context of socioeconomic and socioecological research. AIMS OF THE STUDY However, there is a gap in the ethnopharmacological literature in terms of understanding what relevance a critical analysis of value chains of herbal medicines could have. Here we provide a research framework for achieving such an analysis. METHODS An extensive review of the literature available on value chains and their analysis was conducted, based both on a systematic online search of the relevant literature and a hand search of bibliographies and discussions with experts in value chain analysis RESULTS While the concept of value chains is commonly used in the relevant industries, very few studies investigate the value chains of herbal medicines and products derived from them. The studies identified mostly look at socio-ecological aspects, especially in the context of sustainable resource use. We suggest an analytical framework which can help in understanding value chains in the context of ethnopharmacology and can serve as a basis for addressing questions related to value chains and their relevance in ethnopharmacology. CONCLUSIONS We identified a crucial gap in current ethnopharmacological and medicinal plant research which impacts on a wide-range of factors relevant for a sustainable, socio-culturally equitable and safe supply of herbal medicines.

Current and planned research on agriculture for improved nutrition: A mapping and a gap analysis

Despite the clear potential for agricultural change to improve nutrition in low and middle income countries (LMIC), the evidence base for this relationship is poor. Recent systematic reviews of studies which have evaluated agricultural interventions for improved nutrition reveal little strong evidence of impact and a need for more and better designed research. The study aimed to assist the development of a more coherent framework for research in this area to ultimately improve the overall quality of research on agriculture for improved nutrition. A conceptual framework linking agriculture, food, and nutrition was developed by an expert panel making use of existing concepts for interactions between agriculture and health. It was used to define the domain of research on agriculture for improved nutrition, to establish inclusion criteria for research to be considered, and to characterise that research in a comparative way, relative to the different impact pathways. Mapping of current and planned research projects using snowballing and following specified inclusion and exclusion criteria was conducted from information obtained from the informants themselves and/or from project websites. A gap analysis was conducted to identify more poorly researched areas. The study characterized 151 research projects, most of which are part of broader research programmes. A significant majority concern Sub-Saharan Africa, with a particular focus on nutritional impacts on women and children. Current research is of a range of types, with the majority (58%; n=88) involving research on some form of active intervention into agriculture and the rest (n=63) involving research on existing datasets and 3 systematic reviews. The gap analysis on 100 of the projects with sufficient information identified eight clear research gaps: Full pathway of change especially not value chain; Indirect effect of changes in agriculture on nutrition; Effects of agricultural policy on nutrition; Governance, policy processes and political economy for development of agriculture-for-nutrition policies and programmes; Development of methodologies and appropriate metrics; Consumers as a broader target group especially rural workers and non-rural populations; Rural and urban poor at risk from nutrition-related noncommunicable diseases and Cost-effectiveness. Most projects did not consider the value chain and few measure nutritional status. Very few projects considered indirect effects acting through economic outcomes. There is limited research underway on the development of new methodologies and metrics to measure effects along the different impact pathways, or to evaluate cost effectiveness of interventions.

Agriculture for Improved Nutrition: The Current Research Landscape

Background Concern about food security and its effect on persistent undernutrition has increased interest in how agriculture could be used to improve nutritional outcomes in developing countries. Yet the evidence base for the impact of agricultural interventions targeted at improved nutrition is currently poor. Objective To map the extent and nature of current and planned research on agriculture for improved nutrition in order to identify gaps where more research might be useful. Methods The research, which was conducted from April to August 2012, involved developing a conceptual framework linking agriculture and nutrition, identifying relevant research projects and programs, devising and populating a “template” with details of the research projects in relation to the conceptual framework, classifying the projects, and conducting a gap analysis. Results The study identified a large number of research projects covering a broad range of themes and topics. There was a strong geographic focus on sub-Saharan Africa, and many studies were explicitly concerned with nutritional impacts on women and children. Although the study revealed a diverse and growing body of research, it also identified research gaps. Few projects consider the entire evidence chain linking agricultural input or practice to nutritional outcomes. There is comparatively little current research on indirect effects of agriculture on nutrition, or the effect of policies or governance, rather than technical interventions. Most research is focused on undernutrition and small farmer households, and few studies target consumers generally, urban populations, or nutrition-related non-communicable diseases. There is very little work on the cost-effectiveness of agricultural interventions. Conclusions On the basis of these findings, we make suggestions for research investment and for broader engagement of researchers and disciplines in developing approaches to design and evaluate agricultural programs for improved nutrition.

How to do (and how not to do) fieldwork on Fair Trade and rural poverty

Abstract The Fair Trade, Employment and Poverty Reduction (FTEPR) project investigated poverty dynamics in rural Ethiopia and Uganda. When designing fieldwork to capture poor people often missing from standard surveys, several methodological challenges were identified and, in response, four decisions were made. First, FTEPR focused on wage workers rather than farmers and improved on standard questionnaires when collecting labour market information. Second, researchers adopted contrastive venue-based sampling. Third, sampling was based on clearly identifiable “residential units” rather than unreliable official registers of “households”. Fourth, an economic definition of “household” was used rather than the more common definition based on residential criteria.

Counting Heads or Counting Televisions: Can Asset-based Measures of Welfare Assist Policy-makers in Russia?

There has been a vigorous debate about poverty measurement in Russia, where both the poverty line and poverty data have been subject to criticism. We outline some of the issues raised and discuss the use of an alternative welfare measure based on household assets. Asset indices have mostly been constructed for low‐income countries, supported by two arguments: first, the asset index appears to have a number of empirical advantages in terms of data collection; and second, it may be better at capturing long‐term welfare than either income or expenditure data. We show that the asset index approach is useful in Russia, and may present policy‐makers with a superior means of determining household welfare. However, our discussion raises a number of methodological issues that must be confronted by those constructing asset indices.

Statistical Tragedy in Africa? Evaluating the Data Base for African Economic Development

Abstract Measurement is increasingly at the centre of debates in African economic development. Some remarkable upward revisions of GDP, which are signs of statistical systems improving, caused the declaration of a statistical tragedy in Africa. This special issue evaluates the database for African economic development with articles on the quality of the data on GDP, health and education, poverty, labour, agriculture and income distribution.

Bias, Not Error: Assessments of the Economic Impact of HIV/AIDS Using Evidence from Micro Studies in Sub-Saharan Africa

Abstract Economists struggle to understand the macroeconomic impact of HIV/AIDS. To this end, they have constructed macro models that utilize simplified pictures of the working of the economy and then factor in channels by which HIV/AIDS will have an effect. These models have considerable influence on HIV/AIDS policy; however, they do have their critics. Criticisms in the literature have focused on the simplifications in the construction of the economy that seem most misleading. Using micro studies of sub-Saharan Africa as examples, this contribution argues that there are other important simplifications used by models that need to be reconsidered. Rather than a series of unconnected errors in the modeling process, the approaches show pervasive gender bias, which means that many of the impacts of greater female mortality and morbidity in sub-Saharan Africa are ignored. Gender-aware modeling is crucial to improving assessment of the aggregate impact of the pandemic both in sub-Saharan Africa and elsewhere.