The delivery of housing to low income citizens across South Africa reflects the state's realisation of citizens' social rights to housing and can help to strengthen a citizen's sense of belonging. Additionally, through the very processes of housing delivery, such as decentralised mechanisms with strong community participation, principles of inclusive citizenship are forged and enacted. However, it is argued in this paper that because housing allocation is devolved and power granted to local elites, an important aspect of citizenship-making has also been devolved with insufficient checks and balances. The paper cautions that the decision-making of local elites who determine access to housing and thus the realisation of citizenship rights, is mitigated by their subjectivities. Based on case studies of selected settlements in eThekwini (Durban), the paper examines how residents access housing in slum upgrade programmes. It finds that, beyond national eligibility criteria additional localised criteria are evident which demands that residents use their identity and social relationships to both provide evidence of their eligibility and negotiate access. The paper further cautions that these local processes may be sowing of conflict by propagating existing social tensions, particularly around ethno- and xenophobia, and party political contests. Such conflict ultimately undermines citizenship ideals.
This paper analyses default risk of wage-indexed payment mortgage (WIPM) in Turkey in comparison with other standard mortgage contracts originated in high inflationary economies. Emlak Bank launched WIPM linked to Civil Service employees' wage (CSW) index during high inflationary period of late 1990s. Concurrently, the government introduced a policy linking CSW index to semi-annual expected rate of inflation in an attempt to facilitate housing finance for the fastest growing sector of the population. We find that WIPM protects borrowers against risk of high payment shocks whereas nominal contracts such as ARM and DIM would have resulted in high mortgage defaults. (c) 2005 Elsevier Inc. All rights reserved.
THIS PAPER SEEKS TO FORMALIZE AND TEST DYNAMIC MODELS OF STATES' EDUCATIONAL EXPENDITURES IN INDIA. IN THE ABSENCE OF THEORIES ABOUT SPENDING IN INDIA, THREE THEORETICAL FORMATIONS ARE DERIVED FROM STUDIES OF EXPENDITURES BY THE AMERICAN STATES. ANALYSIS REVEALED THAT THE BUDGETARY PROPORTION THE INDIAN STATES ALLOCATED TO EDUCATION INCREASED AT A DECREASING RATE.
WE HAVE INVESTIGATED THE EXTENT TO WHICH "BORN-AGAIN" CHRISTIANS CONSTITUTE A DISTINCT POLITICAL SUBGROUP. OUR SPECIFIC RESEARCH CONCERNS ARE ESSENTIALLY TWOFOLD. FIRST, WE HAVE EXAMINED THE ATTITUDES OF BORN-AGAIN CHRISTIANS COMPARED TO THOSE WHO ARE NOT BORNAGAIN TOWARD CLERICAL INVOLVEMENT IN POLITICAL ACTIVITY. SECOND, ORIENTATIONS TOWARD FOUR SALIENT ISSUES HAVE BEEN EXAMINED: THE PROPOSED EQUAL RIGHTS AMENDMENT, A BALANCED FEDERAL BUDGET, INCREASED MILITARY SPENDING, AND THE PROPOSED CONSTITUTIONAL AMENDMENT TO BAN ABORTION. IN GENERAL, THE FINDINGS REVEAL THAT BORN-AGAIN CHRISTIANS DO CONSTITUTE A DISTINCT POLITICAL SUBGROUP. THEY ARE INCLINED TO SUPPORT RELIGIOUS LEADERS TAKING A PUBLIC STAND ON POLITICAL ISSUES, ALTHOUGH THERE ARE CLEAR LIMITS ON WHAT THEY PERCEIVE AS LEGITIMATE INVOLVEMENT. POLITICAL CONSERVATISM OF BORN-AGAIN CHRISTIANS IS REVEALED BY THE FACT THAT THEY CONSISTENTLY TAKE A MORE CONSERVATIVE POSITION ON CONTEMPORARY POLITICAL ISSUES COMPARED TO THOSE WHO ARE NOT BORN-AGAIN.
In the UK, national guidelines recommend that all HIV‐positive women should refrain from breastfeeding for prevention of mother to child transmission (PMTCT). However, the World Health Organisation recommends that HIV positive mothers from low income countries should exclusively breastfeed until six months and continue until twelve months with anti‐retroviral therapy (ART) for mother and/or child. In our clinic, a high proportion of HIV positive women are from Africa and mixed messages regarding breast feeding may occur. The decision to not breast feed is sensitive and difficult, particularly where bottle feeding may be associated with HIV. A 2010 BHIVA position statement suggests that in exceptional circumstances breastfeeding may be supported with intense monitoring if the mother has an undetectable viral load. However, there is currently not sufficient evidence regarding transmission or ART toxicity. After a clinic disclosure of breastfeeding at four months post‐delivery, we examined our current practice to investigate how monitoring may need to change if breastfeeding were supported in certain circumstances. A review of notes was undertaken to consider ART and viral load in the post natal‐period to assess potential risks of breastfeeding in our cohort. All HIV‐positive pregnant women who delivered during 2009–10 were eligible. 41 women were identified as having a live delivery of which 30 (73.2%) identified as Black African. 18 (44.0%) were new diagnoses in pregnancy. In total, 28 (68.2%) were on ART, or ART was indicated for the mother, and 13 for PMTCT only (table 1).
BL‐median (IQR) W12‐median (IQR) p
Distance at 6MWT (m) 658 (605–691) 715 (IQR 690–830) <0.0001
A viral load greater than 100 was found in 4 (9.8%) at delivery. All of the babies delivered were HIV negative. The mean time to post‐delivery viral load was 65.4 days (range 24–584). Of those who were meant to be undetectable on ART, 6/28 (21.4%) had a viral load >100 copies/ml. 12(92.3%) of those who took ART for PMTCT were detectable at post‐delivery viral load. Our clinic review suggests that if breast feeding is to be supported in certain circumstances: i) increased frequency of monitoring will be necessary for those on ART; ii) those on ART for PMTCT only would need to continue ART in the post natal period with such monitoring.
The current climate in the UK is that of an 'asylum clampdown'. The current Home Secretary has vowed that asylum legislation will be 'tough' in response to popular perceptions that the UK is 'a soft touch' for applicants (TRAVIS 2003b) . Measures are being taken to make entering the UK more difficult and to make the removal of those who fail with their asylum application easier and quicker. In addi tion, the social support that asylum seekers are entitled to is being reduced, and the use of detention and removal centres is being utilised more frequently.
Background Neonatal mortality remains unacceptably high. Many studies successful at reducing neonatal mortality have failed to realise similar gains at scale. Effective implementation and scale-up of interventions designed to tackle neonatal mortality is a global health priority. Multifaceted programmes targeting the continuum of neonatal care, with sustainability and scalability built into the design, can provide practical insights to solve this challenge. Cambodia has amongst the highest neonatal mortality rates in South-East Asia, with rural areas particularly affected. The primary objective of this study is the design, implementation, and assessment of the Saving Babies' Lives programme, a package of interventions designed to reduce neonatal mortality in rural Cambodia. Methods This study is a five-year stepped-wedge cluster-randomised trial conducted in a rural Cambodian province with an estimated annual delivery rate of 6615. The study is designed to implement and evaluate the Saving Babies' Lives programme, which is the intervention. The Saving Babies' Lives programme is an iterative package of neonatal interventions spanning the continuum of care and integrating into the existing health system. The Saving Babies' Lives programme comprises two major components: participatory learning and action with community health workers, and capacity building of primary care facilities involving facility-based mentorship. Standard government service continues in control arms. Data collection covering the whole study area includes surveillance of all pregnancies, verbal and social autopsies, and quality of care surveys. Mixed methods data collection supports iteration of the complex intervention, and facilitates impact, outcome, process and economic evaluation. Discussion Our study uses a robust study design to evaluate and develop a holistic, innovative, contextually relevant and sustainable programme that can be scaled-up to reduce neonatal mortality. Trial registration ClinicalTrials.gov: NCT04663620. Registered on ...
The COVID-19 pandemic is putting unprecedented pressures on healthcare systems globally. Early insights have been made possible by rapid sharing of data from China and Italy. In the UK, we have rapidly mobilised inflammatory bowel disease (IBD) centres in order that preparations can be made to protect our patients and the clinical services they rely on. This is a novel coronavirus; much is unknown as to how it will affect people with IBD. We also lack information about the impact of different immunosuppressive medications. To address this uncertainty, the British Society of Gastroenterology (BSG) COVID-19 IBD Working Group has used the best available data and expert opinion to generate a risk grid that groups patients into highest, moderate and lowest risk categories. This grid allows patients to be instructed to follow the UK government's advice for shielding, stringent and standard advice regarding social distancing, respectively. Further considerations are given to service provision, medical and surgical therapy, endoscopy, imaging and clinical trials.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.