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The African Development Bank, structural adjustment, and child mortality: a cross-national analysis of Sub-Saharan Africa.
International Journal of Health Services. 2013; 43(2):337-61.We conduct a cross-national analysis to test the hypothesis that African Development Bank (AfDB) structural adjustment adversely impacts child mortality in Sub-Saharan Africa. We use generalized least square random effects regression models and two-step Heckman models that correct for selection bias using data on 35 nations with up to four time points (1990, 1995, 2000, and 2005). We find substantial support for our hypothesis, which indicates that Sub-Saharan African nations that receive an AfDB structural adjustment loan tend to have higher levels of child mortality than Sub-Saharan African nations that do not receive such a loan. This finding remains stable even when controlling for selection bias on whether or not a Sub-Saharan African nation receives an AfDB structural adjustment loan. We conclude by discussing the methodological implications of the article, policy suggestions, and possible directions for future research.
Washington, D.C., World Bank, 1992. 36 p.This atlas presents social, economic, and environmental statistics for 200 economies throughout the world, including statistics for 15 economies throughout the world, including statistics for 15 economies of the former Soviet Union. The following social/demographic indices are presented: population growth rate, 1980-1991; under-5 mortality rate, 1991; daily calorie supply/capita, 1989; illiteracy rate, 1990; and female labor force, 1991. GNP/capita, 1991; GNP/capita growth rate, 1980-91; and shares of agriculture, exports, and investment in GDP in 1991 comprise the economic data. Finally, GDP output/kilogram energy used, 1990; annual water use and annual water use/capita, 1970-87; forest coverage, 1989; and change in forest coverage, 1980-89, are presented as economic indicators. All figures are reported in color graphic format. Technical notes and World Bank structure and functions are discussed in closing sections. The text also cautions that the differing statistical systems and data collection methods and capabilities employed internationally demand that caution be taken against directly comparing statistical coverages and definitions.
In: AIDS and associated cancers in Africa, edited by G. Giraldo, E. Beth-Giraldo, N. Clumeck, Md-R. Gharbi, S.K. Kyalwazi, G. de The. Basel, Switzerland, Karger, 1988. 6-10.The global acquired immunodeficiency syndrome (AIDS) epidemic has, in fact, been comprised of 3 successive epidemics. The 1st of these epidemics is infection with human immunodeficiency virus (HIV), which has already affected 5-10 million people worldwide. The 2nd epidemic, following the 1st but with a delay of several years, is the epidemic of AIDS and other related conditions. By September 1987, a total of 59,563 cases of AIDS had been reported to the World Health Organization (WHO) from 123 countries. However, given the reluctance of some countries to report AIDS and underrecognition of the syndrome, WHO believes the actual number of global AIDS cases is closer to 100,000. 10-30% of HIV-infected persons appear to develop AIDS within a 5-year period, suggesting that 500,000-3 million new cases of AIDS will emerge during the next 5 years. The 3rd epidemic is the wave of economic, social, and political reaction to the 1st 2 epidemics. Since AIDS most often affects individuals in the most economically and socially productive age groups, it can be expected to have a devastating effect on social and economic development in Third World countries. In areas where 10% or more of pregnant women are infected with HIV, projected gains in infant and child health anticipated through child survival initiatives will be cancelled out. AIDS is also having a devastating effect on the health care system in Third World countries as AIDS patients consume limited supplies of drugs, require costly diagnostic tests, and occupy limited numbers of hospital beds. Fear and ignorance about AIDS has threatened free travel between countries and open international exchange and communication. WHO believes the spread of AIDS can be stopped, but only through a sustained, longterm commitment that extends beyond the boundaries of individual countries. AIDS control will require both committed national AIDS programs and strong international leadership, coordination, and cooperation.
BACKGROUND NOTES. 1988 Mar; 1-6.Uganda occupies 94,354 square miles in central Africa, bounded by Kenya, Tanzania, Rwanda, Zaire, and Sudan. It includes part of Lake Victoria, and the Ruwenzori mountains are on its border with Zaire. The country is largely on a plateau and thus has a pleasant climate. 12% of the land is devoted to national parks and game preserves. The northeast is semiarid; the southwest and west are rainy. The population of 15,900,896, growing at 3.7% a year, is mostly rural and is composed of 3 ethnic groups: The Bantu, including the Buganda, the Banyankole and the Basoga; the Nilo-Hamitic Iteso; and the Nilots. There are also some Asians and Arabs. The official language is English, but Luganda and Swahili are widely used. The majority of the people are Christian. Literacy is about 52%, and 57% of school-age children attend primary school. Infant mortality rate is 108/1000, and life expectancy is 49 years. The 1st Englishman to see Uganda was Captain John Speke in 1862. The Kingdom of Buganda became a British protectorate in 1894, and the protectorate was extended to the rest of the country in 1896. In the 1950s the British began an africanization of the government prior to formal independence, but the 1st general elections in 1961 were boycotted by the Bugandans, who wanted autonomy. In the 2nd election, in March, 1962, the Democratic Party, led by Benedicto Kiwanuka, defeated the Uganda People's Congress (UPC), led by Apollo Milton Obote; however, a month later, the UPC allied with the Buganda traditionalists, the Kabaka Yekka, and formed a collision government under Obote. Uganda became independent in 1962 with the King of Buganda, Sir Edward Frederick Mutesa II as president. Political rivalries continued, and in 1966 Prime Minister Obote suspended the constitution, and the Buganda government lost its semiautonomy. Obote's government was overthrown in 1971 by Idi Amin Dada, under whose 8-year reign of terror 100,000 Ugandans were murdered. Amin was ousted by an invading Tanzanian army, and various governments succeeded one another in Uganda, including one headed by Obote from 1980-85, which laid waste a large section of the country in an attempt to stamp out an insurgency led by the National Resistance Army (NRA). Obote was overthrown by an army brigade, but the insurgency continued until, in 1986, the NRA seized power and established a transitional government with Yoweri Museveni as president. The transitional government has established a human rights commission and has instituted wide-ranging economic reforms with the help of the International Monetary Fund (IMF) to rehabilitate the economy, restore the infrastructure of destroyed transportation and communications facilities, and bring the annual inflation rate of 250% under control. Uganda has ample fertile land and rich deposits of copper and cobalt, but, due to economic mismanagement and political instability, is one of the world's poorest countries. The gross domestic product in 1983 was $5.9 billion. Exports totalled $380 million, 90% of which was accounted for by coffee. Most industry is devoted to the processing of agricultural produce and the manufacture of agricultural tools, but production of construction materials is resuming. Uganda has 800 miles of railroad, linking Mombasa on the Indian Ocean with the interior, and 20,000 miles of roads, radiating from Kampala, the capital. There is an international airport at Entebbe, built with Yugoslav assistance. The army, i.e., the National Resistance Army, receives military aid from Libya and the Soviet Union. The United States broke off diplomatic relations with Uganda during the Amin regime, but has provided roughly $43 million of aid and development assistance during the 1980s.
BACKGROUND NOTES. 1988 Mar; 1-8.The Republic of Kuwait occupies an area of 6,880 square miles at the head of the Persian Gulf, bounded on the north and west by Iraq and on the south by Saudi Arabia. 1.7 million people live in Kuwait, of whom 680,000 are Kuwaitis; the rest are expatriate Arabs, Iranians, and Indians. The annual growth rate of Kuwaitis is 3.8%. The Kuwaitis are 70% Sunni and 30% Shi'a Muslims. Arabic is the official language, but English is widely spoken. Kuwait is a highly developed welfare state with a free market economy. Education is free and compulsory, and literacy is 71%. Infant mortality among Kuwaitis is 26.1/1000, and life expectancy is 70 years. Medical care is free. Kuwait was first settled by Arab tribes from Qatar. In 1899 the ruler, Sheikh Mubarak Al Sabah, whose descendents still rule Kuwait, signed a treaty with Britain; and Kuwait remained a British protectorate until it became independent in 1961. A constitution was promulgated in 1962, and a National Assembly was elected by adult male suffrage in 1963. However, the Assembly has since been suspended due to internal friction. Kuwait and Iraq have been disputing Kuwait's northern border since 1913, and the southern border includes a Divided Zone, where sovereignty is disputed by Kuwait and Saudi Arabia. Despite the fall in oil prices in 1982 and the loss of trade due to the Iran-Iraq war, Kuwait is one of the world's wealthiest countries with a per capita gross domestic product of $10,175. Oil accounts for 85% of Kuwait's exports, which total $7.42 billion; income from foreign investments (about $60 billion) makes up most of the balance. All petroleum-related activities are managed by the Kuwait Petroleum Corporation (KPC), which includes the nationalized Kuwait Oil Company, petrochemical industries, the 22-vessel tanker fleet, and refineries and service stations in Europe, where Kuwaiti oil is marketed under the brand name Q8. Kuwait has more than 66 billion barrels of recoverable oil but limits production to 999,000 barrels per day. Other industrial products include ammonia, chemical fertilizers, fishing and water desalinization (215 million gallons a day). Kuwait imports machinery, manufactured goods, and food. Nevertheless exports exceed imports by $2 billion, and the Kuwaiti dinar is a strong currency (1 KD=US$3.57). About $75 billion is kept in 2 reserve funds: the Fund for Future Generations and the General Reserve Fund. In addition to domestic expenditures and imports, Kuwait has extended $5 billion worth of loans to developing countries, made through the Kuwait Fund for Arab Economic Development. Kuwait has been engaged in continuing border disputes with Iraq since 1961, but the most immediate threat to Kuwait has been the Iran-Iraq war. Kuwait lent Iraq $6 billion, in retaliation for which Iran bombed a Kuwaiti oil depot, and Shi'a Muslim terrorists bombed the French and US embassies and hijacked a Kuwaiti airliner in 1984. Iran also attacked Kuwaiti tankers. In 1987 the US reflagged 11 Kuwaiti tankers to protect them from Iranian attacks. Kuwait has been modernizing its own military forces as well as purchasing sophisticated weapons from the UK, the US, France, and the USSR. In 1981 Kuwait, Saudi Arabia, Bahrain, Qatar, the United Arab Emirates and Oman formed the Gulf Cooperation Council (GCC) for mutual defense, and in 1987 Kuwait was elected chairman of the Organization of the Islamic Conference (OIC). Kuwait has diplomatic relations with the USSR and the People's Republic of China, as well as with the US, which has supplied Kuwait with $1.5 billion of sophisticated weaponry from foreign military sales (FMC). The US is Kuwait's largest supplier (after Japan), and Kuwait is the 5th largest market in the Middle East for US goods, despite the disincentives brought about by the Arab boycott of Israel.
BACKGROUND NOTES. 1988 Feb; 1-7.The Republic of Djibouti, an area of 9,000 square miles on the Horn of Africa, is bounded on 3 sides by Ethiopia and Somalia and on the 4th by the Gulf of Aden, where the capital city, Djibouti, with its good natural harbor, is located. The population of 387,000, growing at 5.1% a year, is divided between the majority Somalis (of the Issa, Ishaak and Gadaboursi tribes) and the Afars and Danakils. All are Cushite-speaking, although the official language is French. Almost all of the people are Muslim. The country became independent of France in 1977; it had been the French Territory of Afars and Issas from 1966-77 and French Somaliland from 1884 to 1966. During the Second World War, Djibouti was governed from Vichy until 1942, when the country joined the Free French, and a Djibouti battalion participated in the liberation of France. The country is governed by a president (Mr. Hassan Gouled Aptidon), a prime minister (Mr. Barkat Gourad Hammadou), and a 65-member parliament, elected by universal suffrage. There is only 1 permitted political party, the Rassemblement Populaire Pour le Progres (RPP), which is dominated by the Issas. There are no women in high government positions, but the status of women is somewhat higher than in most Islamic countries. Djibouti has a small army, navy, and air force, supplemented by 4000 French troops. The level of socioeconomic development is not good. The economy is stagnant, and the country is afflicted with recurring drought. Only 20% of the people are literate; infant mortality is 114/1000, and life expectancy is 50 years. Per capita income is $450. Malaria is prevalent; there is only 1 hospital; and drinking water is unsafe. There are no natural resources, no industry, and very little agriculture. Most of the country's gross domestic product of $339 million is derived from servicing the port's facilities for container shipment and transshipment and maintaining the Addis Ababa-Djibouti railroad. The unit of currency is the Djibouti franc, and the official exchange rate is 177 DF to US$1. Djibouti's imports amount to $230 million, most of which are consumed in the country and paid for by French economic assistance and $3 million a year from the US. Djibouti is a member of the UN, the Organization of African Unity, the Arab League, the Nonaligned Movement, the Organization of the Islamic Conference (OIC), and the Intergovernmental Authority for Drought and Development (IGADD).
In: The 1984 International Conference on Population: the Liberian experience, [compiled by] Liberia. Ministry of Planning and Economic Affairs. Monrovia, Liberia, Ministry of Planning and Economic Affairs, . 232-47.This paper summarizes those aspects of the 1984 World Development Report which deal with population prospects and policies in Liberia. Sub-Saharan Africa is the only area of the world where there has not yet been any decline in the rate of growth of the population, and Liberia with a population of 2 million and growing at the rate of 3.5%/year has 1 of the highest growth rates in that area. The birth rate is 50/1000 of the population, and the death rate is 14/1000. The fertility rate is nearly 7 children/woman and is not expected to decline to replacement level before year 2030. Infant mortality is 91/1000, and half of all deaths occur among children under 5. Projecting these demographic trends into the future leads to the conclusion that the population will double in 20 years and exceed 6 million by 2030. Although fertility will begin to decline in the 1990s, the population will continue to increase for a few years with the growth rate declining to 2%/year by 2020 and 1.2%/year by 2045. Such rapid population growth will cause great stress on the country's ability to provide food, schools, and health care. For the children themselves, large, poor families, with births spaced too close together, means malnutrition, poor health , and lower intellectual capacity. And the cycle of poverty continues over the generations as the families save less and expend more on the immediate needs of their children. In macroeconomic terms, a growth rate of l2%/year means a massive explosion of need for food, water, energy, housing, health services and education, with a gross domestic product (GDP) growth of only 2%/year; and this projection is probably optimistic. The rural sector will not be able to support the 23% additional rural labor force, which will migrate to the towns, adding to the already high urban growth rate of 5.7%/year from natural increase. In this society, where literacy is only 20% and secondary education completed by only 11% of the girls, it is estimated that only %5 of eligible couples practice birth control despite the fact that it costs less than $1.00 per capita. Government must step in to ensure that resources exist for population planning at county and local levels. Government is responsible for making demographic data accessible and for coordinating population program inputs. Government should also make sure that family planning programs can be implemented through integration with existing health services. A project including restructuring of health care management, financing and delivery, as well as development of a national population policy, has been proposed for World Bank and other international agencies' support.
Oxford, England, Oxford University Press, 1988. , 86 p.The 1988 UNICEF report on the world's children contains chapters describing the multi-sectorial alliance to support child health, the current emphasis on ORT and immunization, the effect of recession on vulnerable children, family rights to knowledge of basic health facts, and support for women in the developing world. Each chapter is illustrated by graphs. There are side panels on programs in specific countries, including Senegal, Syria, Colombia, Bangladesh, Turkey, India, Honduras, Japan and Southern Africa, and highlighted programs including immunization, AIDS, ORT, breast-feeding and tobacco as a test of health. The SAARC is a new regional organization of southern Asian countries committed to immunization and other health goals. Tables of health statistics of the world's nations, divided into 4 groups by "Under 5 Mortality Rate" present basic indicators, nutrition/malnutrition data, health information, education, literacy and media data, demographic indicators, economic indicators and data pertaining to women. The absolute numbers of child deaths had fallen to 16 million in 1980, from 25 million in 1950. Saving children's lives will not exacerbate the population problem because, realizing that their children will survive, families will have fewer children. Furthermore, the methods used to reduce mortality, such as breast feeding and empowerment of families to control their lives, are known to reduce fertility.
Causes of mortality change: observations based on the experience of selected countries in the ESCAP Region.
In: Mortality and health issues: review of current situation and study guidelines. Bangkok, Thailand, U.N. Economic and Social Commission for Asia and the Pacific, 1985. 93-97. (Asian Population Studies Series No. 63.)In the past 30 years or so, mortality has declined in all countries, and the member countries of Economic and Social Commission for Asia and the Pacific (ESCAP) are no exception to this general trend. Standardization is most often used in a limited fashion to account for the effect on demographic indices of a changing age and sex structure of the population; this chapter uses it to examine the fast decline in mortality. A decline in mortality may be due to any of the following processes: 1) reduction of exposure to risk, or an increased proportion of the population protected from the risk by immunization or other preventive measures; 2) introduction of effective treatment may result in the considerable reduction of case fatality, and hence of mortality from a given disease; and 3) intervention along both lines. Foremost among the studies of variation of mortality levels among the countries at various stages of socioeconomic development are those associating measures of national income and life expectancy at birth. Economic advance appears not to be a major factor in more recent mortality reductions; a large part of the decline has resulted from the application of broad-based public health programs of insect control, environmental sanitation, and immunization. Mother's educational level, family income, family size, and pattern of child spacing have demonstrable effects on the probability of child survival. Further advancement to understand the complex fabric of social and bioligical processes involved in health protection and health impairments that often lead to death requires joint formulation at the planning stage of methodologies and concepts combining suitable factors from different disciplines. The multidisciplinary approach to research in mortality would lend assurance to the results of studies and would provide a firmer basis for the development of relevant policies to reduce morbidity and mortality.
[Unpublished] 1986. Presented at the All-Africa Parliamentary Conference on Population and Development, Harare, Zimbabwe, May 12-16, 1986. 7 p.The Second African Conference on Population and Development, held early in 1984, marked a decisive stage in African thinking about population. During the 12 years between the 1972 and 1984 conferences, African nations learned in detail about their demographic situation and confronted the ever-increasing costs of development and their lack of physical and administrative infrastructure. In the midst of these and other concerns came the drought, which for over a decade in some parts of the continent has reduced rainfall, dried up rivers, lakes, and wells, and forced millions into flight. It is in this context that population became an African issue. African countries on the whole are not densely populated nor do they yet have very large concentrations in cities. Yet, population emerges as more than a matter of numbers, and there are features which give governments cause for concern. First, the population of most African countries, and of the continent as a whole, is growing rapidly and could double itself in under 25 years. Second, mortality among mothers and children is very high. Third, life expectancy generally is lower in African than in other developing countries. Fourth, urbanization is sufficiently rapid to put more than half of Africa in cities by 2020 and 1/3 of the urban population in giant cities of over 4 million people. The 1984 conference recognized these and other uncomfortable facts and their implications for the future, and agreed that attention to population was an essential part of African development strategy. Strategy is considered in terms of the 4 issues mentioned. First, high rates of growth are not in themselves a problem, but they mean a very high proportion of dependent children in the population. About 45% of Africa's population is under age 14 and will remain at this level until the early years of the 21st century. Meeting the needs of so many children and young adults taxes the ability of every African nation, regardless of how rapidly its economy may expand. Understanding this, a growing number of African leaders call for slower growth in order to achieve a balance in the future between population and the resources available for development. Reducing mortality requires innovation. Among the new approaches to health care are the use of traditional medicine and practitioners in conjunction with modern science and the mobilization of community groups for preventive care and self-help. Health care and better nutrition also are keys to improvement in life expectancy and call for ingenuity and innovation on the part of African governments and communities. Part of the solution to the impending urban crisis must be attention to the viability of the rural sector. The role of the UN Fund for Population Activities in addressing the identified issues is reviewed.
[Unpublished] 1984 Jul. , 520, 20 p.This 2-volume, 520-page report represents the 1st attempt at a situation analysis of Ghana. Its focus is the effect of Ghana's economic crisis on women and children. Volume I characterizes the macroeconomic situation in Ghana, the dimensions of poverty in the country, recent demographic trends, and the factors affecting infant, child, and maternal nutrition and mortality. Volume II discusses environmental sanitation, Ghana's health sector, education, general living conditions of families, and social services available for children. It is concluded that external assistance is needed to address the massive and widespread problems created by poverty in Ghana. Since the immediate problems of children and mothers are social, assistance is particularly needed in the form of outright grants or official development assistance. It is suggested that UNICEF should support both local and national interventions. There must be clear indications that all projects or programs are within government priorities. In the case of area-specific projects, local support should be assured and the main beneficiaries should be women and children. Finally, 4 possible areas of interventions are outlined: health, water and sanitation, education, and programs for slums. In the area of health, it is recommended that UNICEF devote particular attention to nutrition, immunization, oral rehydration, growth monitoring, and infection control within the context of general support to the development of primary health care.
[Unpublished] 1984 Aug 13. 40 p. (E/CONF.76/L.3; M-84-718)This report of the International Conference on Population, held in Mexico City during August 1984, includes: recommendations for action (socioeconomic development and population, the role and status of women, development of population policies, population goals and policies, and promotion of knowledge and policy) and for implementation (role of national governments; role of international cooperation; and monitoring, review, and appraisal). While many of the recommendations are addressed to governments, other efforts or initiatives are encouraged, i.e., those of international organizations, nongovernmental organizations, private institutions or organizations, or families and individuals where their efforts can make an effective contribution to overall population or development goals on the basis of strict respect for sovereignty and national legislation in force. The recommendations reflect the importance attached to an integrated approach toward population and development, both in national policies and at the international level. In view of the slow progress made since 1974 in the achievement of equality for women, the broadening of the role and the improvement of the status of women remain important goals that should be pursued as ends in themselves. The ability of women to control their own fertility forms an important basis for the enjoyment of other rights; likewise, the assurance of socioeconomic opportunities on a equal basis with men and the provision of the necessary services and facilities enable women to take greater responsibility for their reproductive lives. Governments are urged to adopt population policies and social and economic development policies that are mutually reinforcing. Countries which consider that their population growth rates hinder the attainment of national goals are invited to consider pursuing relevant demographic policies, within the framework of socioeconomic development. In planning for economic and social development, governments should give appropriate consideration to shifts in family and household structures and their implications for requirements in different policy fields. The international community should play an important role in the further implementation of the World Population Plan of Action. Organs, organizations, and bodies of the UN system and donor countries which play an important role in supporting population programs, as well as other international, regional, and subregional organizations, are urged to assist governments at their request in implementing the reccomendations.