Education broadens the life choices and capabilities of those who receive it, and confers external benefits to society as a whole. In sub-Saharan Africa, a major issue concerning school attendance among the poor has been the direct monetary costs represented by primary school “user” fees, which became particularly commonplace in sub-Saharan African countries during the post-colonial period. While fees have been advocated in the past as a way for impoverished governments to fund the improvement and expansion of primary education, in more recent years the position of the international development community has shifted in favour of fee abolition as a means of achieving Universal Primary Education. This thesis examines the long-term relationship between school fees and education quality and access over the past 40 years in seven sub-Saharan African countries. I find that the introduction of fees decreased primary school enrolment, primarily by keeping the poorest children out of school, without achieving significant quality improvements. A fall-off in government spending following the introduction of fees is presented as a possible explanation. I also focus on the quality impacts associated with the major increases in enrolment following fee abolition, and emphasize the importance of government commitment to making up the funding shortfall generated by this policy change.

The past 20 years have witnessed a resurgence of maritime piracy, especially along the East and West coasts of Africa. Much scholarly research has been undertaken on this issue; however a consensus on the primary economic causes of piracy does not exist. This thesis seeks to identify the primary economic causes and consequences of maritime piracy in Somalia and Nigeria specifically, and coastal sub-Saharan Africa more generally. It investigates whether variables such as a lack of employment opportunities, particularly in the fisheries sector, are a causal factor of maritime piracy. These potential causal factors are explored using both case studies and regression analyses. Net exports of fish are found to be a statistically significant predictor of the frequency of piracy, suggesting that a decrease in national fish production and employment in the fisheries sector results in an increase in the occurrence of piracy.

This thesis investigates the affect of non-emergency food aid on producer prices and production quantities for cereal grains within the recipient country’s economy. The decision to evaluate developmental or non-emergency food aid (NEFA) stems from a lack of research on a macro scale of disaggregated food aid categories and their implications on developing country producers. The Sub-Saharan Africa (SSA) region is the world’s largest recipient of direct transfer non-emergency food aid leaving the region most susceptible to the ambiguous affects of these food aid allocations. The results for this research suggests that not only are there no detectable disincentive effects but that there is little explanatory power from non-emergency food aid based on the 12 sample countries within the region. Additionally, an estimation of NEFA’s relationship with imports suggests that rather then an addition to total supply, the international trade composition is flexible.

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<p>The study utilized a qualitative case study design to explore the problem of poor access to ART in Benue State. PLWHAs, policy makers, program managers and health workers were involved in an effort to describe the factors influencing access to ART in the State. Semi structured interviews, exit interviews and focus group discussions were used. To analyse the findings, categorization was done into facilitators and barriers to access, in addition to the ways respondents believe these barriers can be overcome. Other sub-themes were also identified and sorted. Themes were linked to direct quotes from the respondents. Additional literature review was done to review available information on the themes identified. Facilitators of access included free cost and increased number of sites / beneficial effects of ART / disclosure, membership in a support group and having a treatment partner. Barriers included stigma and discrimination / hunger, poverty, transportation and opportunity costs / hospital factors / non-disclosure / inaccurate knowledge and perceptions about HIV and ART / certain religious beliefs and advice / coverage, capping of services and fear of non-availability of ART. In addition to stigma, patients bypass closer ART access points to further away hospitals because of business opportunities / financial assistance / perceived better standard of care and hope that a cure, when found, will be more accessible to patients in bigger hospitals.</p>

<p> <b>Background:</b> HIV testing saves lives. It is fundamental to combating the global HIV epidemic. Key populations at higher risk for HIV in Mozambique, including Men who have Sex with Men (MSM), Female Sex Workers (FSW) and mineworkers, are in urgent need of effective HIV prevention strategies. This is the first analysis ever conducted in Mozambique to identify levels of HIV testing and associated factors that inform these strategies. </p><p> <b>Methods:</b> This analysis used data from seven cross-sectional surveys conducted between 2011-2012 among MSM, FSW and Mineworkers in Mozambique. Participants completed a questionnaire and provided blood samples for HIV testing. MSM and FSW were recruited used Respondent Driven Sampling in Maputo, Beira and Nampula. Mineworkers were recruited using Time Location Sampling in Ressano-Garcia. Participants with previous HIV-positive tests or missing HIV test histories were excluded (&lt;5% overall). Weighted logistic regression was used to measure associations with recent HIV testing (&lt;12 months). Theory-driven multivariate logistic regression was conducted in R v2.15 using the Health Behavior Model as a conceptual framework. </p><p> <b>Results:</b> The prevalence of recent testing for HIV ranged from 29.8-59.5%, yet 4.4-25.0% had HIV and did not know it. Between 11.9-57.4% had never been tested, and fear was given as the primary barrier. Recent HIV testing was positively associated with knowledge of ARV drugs, knowing the HIV status of a sexual partner, knowing where to go to get tested, and having had contact with a peer educator. It was negatively associated with having had a genital sore or ulcer and unprotected sex. Between 32.1-90.0% of HIV-positive undiagnosed, key population members had used a healthcare service in the previous 12 months and 23.4-47.5% had tested negative for HIV in that time period. </p><p> <b>Conclusion:</b> Routine testing with strengthened post-test counseling encouraging key populations to have annual HIV screenings need to be implemented in Mozambique.</p>

<p> Without exception, healthcare systems in the Sub-Saharan Africa, including Ghana, face many challenges. Difficulties in Ghana&rsquo;s healthcare system stem from many factors, but the most notable one is professional migration, which has crippled the former British colony since 1980. Statistical data demonstrate the yearly migration of healthcare workers from Ghana and its impact on healthcare services (the doctor/nurse population ratio). This study used a quantitative multiple regression research method to examine and empirically analyze the relationship between healthcare workers, technological innovations, and changes in healthcare services in Ghana from 1990 to 2010. The main result was that technological innovations had a significant impact on healthcare services in Ghana during the observed period. Also, regional disparities in the number of medical doctors and nurses were largely explained by the degree of urbanization and economic development. Therefore, the pooled regression analysis from the panel data consistently showed that technological innovations significantly impacted the healthcare system in Ghana during the observed period. However, the numerical impact of the technological innovation coefficients was relatively lower in Ghana during the observed period.</p>

ABSTRACT An Examination of the Differences in Risk Factors and their Association with Variations in HIV Prevalence between Cameroon, Cote d’Ivoire, and Senegal (Under the direction of RICHARD ROTHENBERG, M.D., M.P.H. FACULTY MEMBER) Background: Extensive evidence suggests there are large variations in the prevalence of HIV infection among Sub-Saharan African countries. Some studies associated these variations in HIV prevalence to differences in the rate of HIV spread while others attributed the variations to risky sexual behaviors. The purpose of this study was to examine differences in risk factors for HIV infection between Cameroon, Cote d’Ivoire, and Senegal, to determine the association between HIV status and risk factors within and among countries, and identify best predictive risk factors that help explain variations in HIV prevalence. Methods: A cross-sectional study was conducted using nationally representative data from The Demographic and Health Surveys Program. Population-based samples of adults aged 15-49 representing 21,878 in Cameroon (2011), 14,682 in Cote d’Ivoire (2011-2012), and 20,102 in Senegal (2010-2011) were used in the study. Descriptive analysis and binary logistic regression were performed using IBM Statistical Package for the Social Sciences. Odds ratios and 95% confidence interval were calculated, and models were explored. Results: There are statistically significant (p Conclusion: There are differences in risk factors among the three countries and these differences can explain some of the variations in HIV prevalence. Further research is necessary to help capture variations in HIV prevalence that cannot be explained by differences in risk factors. These findings will help advance prevention efforts. KEYWORDS: HIV, AIDS, risk factors, HIV infection, HIV prevalence, Sub-Saharan Africa

<p> Among the multitude of interventions to address the worst forms of child labor (WFCL), one of the responses to the presence of WFCL has been the institution of child labor monitoring (CLM). While systems to systematically monitor children with respect to their exposure and risks have been implemented, the degree of their efficacy and ultimately their effect on the targeted populations begs academic scrutiny. This dissertation seeks to provide an empirical view of the community-level dynamics that emerge in response to a community-based CLM program and their effects, in turn, on the CLM itself. </p><p> An embedded multiple case study methodology, surveying longitudinally at two points in time using a mix of purposive and probability sampling techniques, was employed for this study. Two communities, Ahokwa in the Western Region, and Dwease in the Ashanti Region of Ghana, were selected as cases. </p><p> The study finds that between the two points of observation &ndash; before and after the introduction of CLM &ndash; a profound reduction of WFCL is observed in Dwease, whereas much less reduction was observed in Ahokwa. A point-by-point analysis within and between the two villages reveals that individual, social and institutional factors worked together to transform behavior in Dwease. The principal change catalysts in Dwease were (a) a heightened awareness of child work hazards and a deepened parental investment in child education working at the individual level, coupled with (b) new norms created by the town's opinion leaders and the emergence of peer accountability at the social level, and (c) monitoring carried out by the Community Data Collection (CDC) and enforcement carried out by the Community Child Protection Committee (CCPC) &ndash; the two new institutions constituting CLM at the community-level. The underlying social dynamic proved to be decisive: a tipping point was crossed in Dwease whereby progressive opinion leaders in the community, who, once sensitized to recognize the pejorative effects of CL/WFCL, created new social norms and spurred a critical mass of community members to rid their community of CL/WFCL. </p><p> This study shows that with sufficient local ownership, and if properly instituted, the tandem operation of child protection committees and child labor monitoring enables a community to effectively detect, police and mitigate the practice of child labor and WFCL.</p>

This study links rural electrification and the transition to modern energy services with poverty reduction and rural development in Ethiopia. Benefits of rural electrification in reducing poverty and accelerating rural development in low-income developing countries have been insufficiently researched. This study analyses available empirical evidence at a local level and examines how electricity access translates into productive use beyond powering radios and lighting. A survey of 336 households was conducted in Northern Ethiopia on impacts of electrification on four rural towns with varying number of years of access to electricity. Evidence at household and community levels shows that access to electricity was followed by an increase in household connectivity rate, and slow transition to modern energy services based on level of household income and number of years of a household’s connection to electricity services. The pace of transition to modern energy services was slow, and household energy poverty and dependence on biomass fuels continued in most rural towns, having little impact on improved environmental management practices. Improvement in rural livelihood, poverty reduction, and delivery of public services was highest for those with more years of access to electricity, and higher income households. The fact that impacts of RE depend on number of years of a household’s electricity connection implies gradual improvements rather than immediate benefits after connection. In the short-term, households improved their quality of life through better lighting and reduced indoor-air pollution. In the medium and longer-term, households and communities diversified their income and received improved public services such as education, health, and potable water. Further benefits were wider off-farm and non-farm employment, increased rural markets, and improved environment for rural development. Very poor households benefited least, while those better-off utilized opportunities created through rural electrification. Though necessary for development, rural electrification alone is insufficient, and requires strong government commitment and political will to invest in public services and infrastructure, and encourage private sector participation. / Graduate