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Master of Arts / Department of Sociology, Anthropology, and Social Work / Matthew R. Sanderson / Food crises in Kenya are recurring phenomena. Despite widespread and perennial famines, Kenya is exporting food while importing food aid. This study focuses on the concept and question of food security in Kenya. If Kenya can produce and even export food products, why does the country still import food aid every year? Why is the country classified as food insecure? And why does the country still suffer from recurrent famines? Drawing on social science theory from the political economy of food and agriculture, this study postulates that the contradiction between exporting food and importing food aid is related to Kenya‟s subordinate position in the world economy. Using a comparative-historical, in-depth case study research design, this research descriptively explores the relationship between trends in food aid, trade, production and food security. The study finds that the relationship between food trade and aid with food security is mixed in Kenya. Aid and trade have not strongly enhanced food security in Kenya, but food insecurity in Kenya has not gotten markedly worse.

<p> <b>Background:</b> As the world becomes more urban and slums continue to grow in developing countries, research is needed to measure utilization of health services, health outcomes, and access to health care providers among urban slum residents. Estimating trends in urban health among slum residents relative to other urban inhabitants provides evidence of health disparities for priority-setting by program implementers and policy-makers. Research on the negative effects of slum environments on human health has started to emerge, yet there remains a paucity of evidence on morbidity trends over time and inequalities between slum residents and other urban residents. The goal of this study is to quantify maternal and child health care access, utilization and outcomes among urban slum dwellers in selected countries in sub-Saharan Africa and South Asia over time. These three areas are addressed in three separate dissertation manuscripts. </p><p> <b>Methods:</b> This dissertation offers an in-depth analysis of household and health facility data to measure trends in maternal and child health care utilization and health outcomes among slum residents over time, as well as inequalities in access, utilization and outcomes between other urban and rural populations. Manuscripts 1 and 2 apply a unique spatial inequality approach to existing population-based household data from the Demographic and Health Surveys (DHS) to identify a sample of slum residents. Manuscript 1 assesses trends in maternal and child health care (MCH) utilization and health outcomes using DHS data in Bangladesh, Ethiopia, Kenya, Malawi, Nepal, Nigeria and Tanzania between 2003 and 2011. In Manuscript 2, a trend analysis is performed in Kenya to examine diarrheal disease and acute respiratory infection (ARI) in children under-five in both slums and other urban and rural areas during the roll-out of a national slum upgrading program. Manuscript 3 further explores local-level dimensions of health care access from two slums in Kenya, generating evidence on service availability and readiness in slums. In this section, we analyze health facility data collected using a modified version of the World Health Organization&rsquo;s (WHO) Service Availability and Readiness Assessment (SARA). </p><p> <b>Results:</b> Manuscript 1 reports significant disparities between slum dwellers and other urban residents&rsquo; utilization of key maternal health interventions&mdash;appropriate antenatal care (ANC), tetanus toxoid vaccination, and skilled delivery&mdash;in Bangladesh, Ethiopia, Kenya and Nigeria. In addition, child health outcomes examined in Manuscript 1 suggest that the prevalence of diarrheal disease in children under-five is declining among other urban and rural residents, but not significantly among slum residents. Nigeria was the only exception, with significant declines in diarrheal disease prevalence in slums over the study period. Because ARI improvements are found across populations, the data suggests this condition is not unique to slum settings. The trend analysis in Manuscript 2 supports these findings&mdash;ARI is declining steadily over time not only among slum residents, but also among other urban and rural residents as well. Diarrheal disease prevalence, on the other hand, has not changed significantly over time, with stable levels among slum dwellers between 1993 and 2014. In Manuscript 3, analysis of general service availability and readiness in two locations&mdash;the Nyalenda slum of Kisumu and the Langas slum of Eldoret&mdash;reveals that slums perform far below recommended benchmarks set by WHO. When we compare service availability and readiness indicators with regional, urban, and national averages, in general slums in Kisumu and Eldoret perform poorly. However, there were some instances&mdash;typically involving standard precautions for infection control&mdash;where Kenyan slums actually performed better than comparison sites. </p><p> <b>Conclusions:</b> This research provides a comprehensive view of health systems dimensions in urban slums in sub-Saharan Africa and South Asia. Manuscript 1 confirms evidence of an urban penalty and emphasizes a need to focus on maternal health care utilization in slums. Manuscript 2 detects little improvement in child health outcomes among slum dwellers in Kenya during the roll-out of the country&rsquo;s national slum upgrading program. An integrated approach to health and urban policy development is recommended based on these results. Manuscript 3 identifies areas of service availability and readiness in two Kenyan slums that fall below global targets and are in need of improvement in order to achieve desired health outcomes. Taken together, this study makes a significant contribution to the crucial demand for research on growing marginalized urban populations in developing countries.</p>

<p> Men in sub-Saharan Africa are less likely than women to use HIV services and, thus, are more likely to die from AIDS. While much of the literature argues that men&rsquo;s views of masculinity keep them from services, I use the theory of gendered organizations to provide another perspective. In this dissertation, I use a mixed methods approach to examine the gendered organization of facility-based HIV testing services in southern Malawi and how the organization of services creates additional barriers to men&rsquo;s use of care. </p><p> I combine four types of data: (1) survey data with facility clients to assess if quality of care differs by sex of client; (2) in-depth interviews with healthcare providers and policy makers to examine perceptions of men as clients; (3) participant observation in health facilities to understand how institutional protocols are enacted at the local level; and (4) international and national policy documents to situate local health institutions within broader global constructs of gender and HIV priorities. </p><p> I find that heterosexual men have become an invisible category within both international and national HIV policy. When they are included, they are described as the problem, not part of the solution to HIV epidemics. On the ground, the organization of HIV testing services has followed suit. </p><p> Health institutions, like other organizations, are not gender-neutral. Men in southern Malawi were not recruited for health services, were less likely than women to receive health education when they did attend a facility, and were less likely to have access to HIV testing because services were, at times, only offered during hours for antenatal services. Furthermore, HIV testing was often located near antenatal services, again contributing to the perception that testing was designed for women &ndash; because it was. Based on these findings, I argue that HIV testing is gendered across three levels of the health institution: (1) the organizational HIV policies; (2) the physical environment in which testing occurs; and (3) interactions within facilities that require clients to enact qualities typically viewed as feminine in order to successfully receive care (e.g., waiting long hours, being compliant, and being a caregiver).</p>

<p> Biomedical and behavioral interventions can virtually eliminate the risk of vertical (i.e., mother-to-child) HIV transmission. Pregnant and breastfeeding women&rsquo;s adherence to prevention of mother-to-child transmission (PMTCT) interventions, however, remains a challenge across sub-Saharan Africa. Using a concurrent mixed methods approach, including a survey and semi-structured interviews, I test whether a relationship exists between women&rsquo;s low power within married couples (based on domains from the Theory of Gender and Power) and adherence across the PMTCT cascade of care, including drug adherence during and after pregnancy, safe infant feeding practices, and pediatric HIV testing. The results of this study indicate that intimate partner violence is particularly detrimental to PMTCT adherence. Certain PMTCT protocols are also affected by partner controlling behaviors, participation in household decisions, and economic dependence, but not to the same extent as violence. Women with low power cite a lack of partner support and an unwillingness to disclose their HIV status to the husband due to fear of violence or abandonment as reasons for low PMTCT adherence. Conversely, women with high power cite partner support and the ability to prioritize PMTCT, sometimes even over the marriage, as enabling adherence. Based on these results, augmented efforts to address gender power dynamics both in society and within the home are recommended to promote the health of HIV-positive women and their families.</p>

Thesis (MPA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: The principles and characteristics of peacekeeping, as the United Nations (UN) in its search towards global peace and stability originally intended, are not adhered to in Sub-Saharan African countries. In this context, peacekeeping operations are perceived to be synonymous with biased armed intervention and the enforcement of peace through the application of force, often without the consent of the parties involved in conflict. As the political situation in many Sub-Saharan African states deteriorates, a greater need for peacekeeping and even peace enforcement operations has arisen. Mounting pressure on South Africa from regional forces, as well South Africa's own national interest to become involved in peacekeeping, calls for an evaluation of 'Sub-Saharan African peacekeeping' per se. This situation creates a dilemma as regards both the responses by regional organs and the reaction of states to the endemic and escalating conflicts in collapsing states. Can what is currently happening in Sub-Saharan African still be referred to as peacekeeping? Do we need a fresh approach to conflict resolution in Sub- Saharan Africa? Are the UN principles, set in a post-World War " global context, still applicable in a deteriorating intra-state context? In an attempt to find answers to these questions, this research focuses on the nature of peacekeeping operations from an analytical, comparative perspective with the aim of identifying commonalities and differences in the approaches and practices of countries that have participated in peacekeeping operations. Could it be that 'classical' UN peacekeeping has simply become historically outdated and that modern peacekeeping operations are dictated by the socio-political environment and thus requires a new approach? It would appear that the concept of peacekeeping needs to be re-defined from an African perspective in order to equip regional organs with a firm theoretical foundation for possible future involvement in Sub-Saharan African peacekeeping and peace enforcement endeavours. The UN's peacekeeping performance on the African continent over the past decade has raised serious doubts as to whether the UN has the capacity or will to deal effectively with inter-state and more specifically, intra-state conflict. Consequently, Sub-Saharan African peacekeeping is currently standing at a crossroad. It is also evident that a transition needs to be made from 'classical' UN peacekeeping principles to a 'modern' African approach in touch with Africa's prevailing circumstances and demands. From the research findings and case studies, a conclusion is drawn concerning how 'modern' peacekeeping practices compare to 'classical' peacekeeping, as envisaged in Chapter VI of the UN Charter. In addition, a model is proposed for dealing with the unique challenges of Sub-Saharan African intra-state conflict. / AFRIKAANSE OPSOMMING: Die beginsels en kenmerke van vredebewaring, soos die Verenigde Nasies (VN) in sy soeke na wêreldvrede en stabiliteit oorspronklik beoog het, word nie in Afrika suid van die Sahara eerbiedig nie. In die konteks, word vredebewaringsoperasies geag as sinoniem te wees met partydige gewapende inmenging en die afdwing van vrede deur die aanwending van mag, dikwels sonder die toestemming van diegene wat in die konflik betrokke is. Die verslegtende politieke situasie in vele lande in Afrika suid van die Sahara bring mee dat 'n groter behoefte bestaan vir vredebewaring en selfs operasies om vrede af te dwing. Toenemende druk op Suid-Afrika deur streeksmagte sowel as Suid-Afrika se eie nasionale belang om by vredebewaring in Afrika betrokke te raak, noodsaak juis 'n evaluasie van vredebewaring in Afrika suid van die Sahara. Hierdie situasie veroorsaak 'n dilemma in sover dit die reaksie betref van streeksorganisasies sowel as dié van mislukkende state wat toenemend by inheemse konflik betrokke raak. Kan dit wat tans in Afrika suid van die Sahara aan die gebeur is steeds beskou word as vredebewaring? Word 'n nuwe benadering tot die beslegting van inheemse konflik in Afrika suid van die Sahara vereis? Is die VN beginsels soos gestel binne 'n globale na-tweedewêreld- oorlogse konteks steeds van toepassing op 'n verslegtende intra-staat konflik konteks? In 'n poging om antwoorde te vind op dié vrae, fokus die navorsing op die aard van vredebewaringsoperasies vanuit 'n analitiese, vergelykende perspektief. Hierdie fokus het ten doel om ooreenkomste en verskille in die benaderings tot en toepassings van vrede in lande wat aan vredebewaringsoperasies deelgeneem het, te identifiseer. Is dit dalk moontlik dat 'klassieke' vredebewaring histories verouderd is en dat 'moderne' vredebewaringsoperasies deur die sosio-politiese omgewing dikteer word en as sulks, 'n nuwe benadering vereis? Dit wil voorkom asof die konsep van vredebewaring vanuit 'n Afrika perspektief her-definieer behoort te word sodat streeksorganisasies toegerus kan word met stewige teoretiese grondbeginsels waarop toekomstige vredebewaringsoperasies in Afrika suid van die Sahara gebaseer kan word. Die VN se vertoning in die bewaring van vrede en meer spesifiek, dié se vertoning die afgelope dekade, laat ernstige twyfel ontstaan oor dié organisasie se vermoë of wil om effektief met konflik binne en tussen state te handel. As gevolg hiervan, bevind Afrika suid van die Sahara haar by 'n kruispad wat die bewaring van vrede aanbetref. Dit is ook duidelik dat daar 'n verskuiwing behoort plaas te vind vanaf 'klassieke' vredebewaringsbeginsels na 'n meer 'moderne' Afrika benadering wat in pas is met Afrika se eiesoortige omstandighede en eise. Vanuit die navorsingsbevindinge en gevallestudies word daar in die gevolgtrekkings gekyk in hoe 'n mate 'moderne' vredebewaring in die praktyk met 'klassieke' vredebewaring, soos beoog in Hoofstuk VI van die VN Handves, vergelyk. Aansluitend hierby, word 'n model voorgestel vir die hantering van die intra-staat vraagstukke wat voortspruit uit konflik binne state in Afrika suid van die Sahara.

Thesis (MDF)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: In light of the 2007/2008 global financial crisis, as well as pre- and post-crisis banking reform, this research investigated changes in competitive behaviour among banks in Sub-Saharan Africa, thus adding new insights to the current debate. The main findings from the empirical test were as expected and suggested conditions of monopolistic competition. In order to validate sufficient conditions for observing competition, an empirical test conducted to measure a state of general market equilibrium, had the expected outcome. Specifically, the research methodology applied the Panzar-Rosse model, a non-structural approach in the manner of the New Empirical Industrial Organisation. In the first instance, the model derived a continuous measure of a static H-statistic with a value of 0.57, using 481 bank-year observations from an unbalanced panel of 83 banks from six countries over the period 2008–2013. The H-statistic measured the degree of competition by explaining how changes in market power or unit factor input prices of funds, labour and capital expenditure influenced the pricing output of banks. A computed E-statistic, which was statistically equivalent to zero, validated the significance of the H-statistic, as the result implied that, in equilibrium, market power of a bank does not influence its returns. Overall, the findings were consistent with the pricing and strategy theories, such as contestable markets theory, which indicates that pricing power is associated with neither industry structure nor concentration, but instead with changes in input prices. In addition, the findings were consistent with relevant prior studies, which concluded that banking systems in parts of Europe, Asia, Latin America and Sub-Saharan Africa were monopolistic, and that banking reform influenced market discipline.

The literature investigating the relationship between stock market returns and inflation is long and has produced diverse findings. This thesis examines the nature of stock–inflation relations in Sub-Saharan countries whose stock markets were established before 1992. Evidence in this thesis shows that in the short term there is a positive relationship between stocks and inflation. Using the Johansen (1988) evidence, a long-run stock–inflation relationship is confirmed only in Nigeria and South Africa, where it is found to be negative. However, accounting for structural breaks provides evidence for a long-run relationship in Botswana, Ghana and Kenya. The evidence of the effects of regimes in the relationship is further supported by a nonparametric cointegration analysis which finds a long-run relation in countries where the Johansen (1988) method had failed. Unexpected inflation is also found to be related to stock returns in Botswana, Ghana, Kenya, Nigeria and Mauritius, which raises concerns about the use of month-end stock data in analysing this relationship. The thesis confirms the existence of hidden inflation in Kenya, Mauritius, Nigeria and Zimbabwe. Imported inflation, interest rates and the exchange rate are found to have useful information about inflation movements in Sub-Saharan Africa.

This thesis examines the effects of overconsumption of clothing in the Global North on African textile industries through increased donations to secondhand stores. I begin by explaining how the growth of the fast fashion industry has increased the purchase and production of clothing over the recent decades. As an industry built on trends that quickly go in and out of style, fast fashion has resulted in massive amounts of unworn clothing. Consumers either throw away or donate their clothing, each of which result in either environmental or economic challenges. I explore post-consumer clothing’s donation route. Most donated clothing goes to secondhand stores such as Goodwill and The Salvation Army. However, with increasing amounts of donations going to these stores, they’ve reached a point in which they can no longer sell as quickly as they receive. Leftovers are sent overseas as a philanthropic action, but are met with concern from economists. Foreign aid to developing countries has been a topic of debate, critiqued as a lazy way of providing a short-term benefit with possibly detrimental long-term results. Introducing post-consumer clothing into African clothing markets raises the concern that they will replace local textile industries. I look at existing literature and fieldwork on this issue in order to examine the effects on textile industries in several countries. While the effects vary in differing countries and there are several other variables involved, such as market and political conditions, collective research shows that used-clothing donations account for 40% of the decline in apparel and textile production in an average African country.

The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV/AIDS) continues to have enormous implications on the health, economic and psychosocial well-being of individuals, family structures, and communities. Sub-Saharan Africa is the region most affected by the HIV/AIDS. The purpose of this study is to investigate the social and cognitive factors associated with HIV test uptake in the general population of Kenya. Data from the 2009/2010 Kenya Demographic Health Survey were utilized. Univariate, bivariate and multivariate analyses were conducted using STATA/SE software. Results showed that there were statistically significant differences between men and women in previous HIV testing status and HIV test uptake. Over 90% of participants reported knowing a place to seek testing. The mean HIV related knowledge was higher in men than women (x =0.1; 95% CI 0.04-0.16) than women (x = 0.04; 95% CI [0.01- 0.1]). Differences were found in expressed HIV stigmatizing attitudes, with women reporting more stigmatizing attitudes than men. For example 9.9% of women compared to 4.7% of men reported very high HIV stigmatizing attitudes. Weighted multinomial regression analyses were conducted with individuals who had not been previously tested and unwilling to be tested utilized as the reference group. Among the factors found to be significantly associated with HIV uptake include: HIV related knowledge- higher levels of HIV related knowledge were associated with increased HIV test uptake for men and women, HIV related stigma- lower levels of HIV related stigma were significantly associated with HIV test uptake for women but not men, acceptance to teach condoms to children and knowledge of someone infected with HIV/AIDS was positively associated with HIV test uptake, gender- compared to men, women were significantly less likely to agree to be take the HIV/AIDS test if not previously tested (OR 0.79; 95% CI [0.64, 0.97]) but significantly more likely to accept the HIV/AIDS test when offered (OR 1.341; 95% CI [1.02, 1.76]). Other significant associations included: Age, education attainment, sex of head of household, and wanting to keep a family member's tuberculosis infection a secret.