scholarly journals A mathematical model to estimate the incidence of child wasting in Yemen

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Rana A. Hussein ◽  
Mark P. Suprenant ◽  
Najwa Al-Dheeb ◽  
Saul Guerrero ◽  
Eleanor Rogers ◽  
...  
Keyword(s):  
Correction Factor ◽  
Average Duration ◽  
Incidence Rates ◽  
Correction Factors ◽  
Historical Cohort ◽  
Disease Rates ◽  
Effective Decision ◽  
Effective Decision Making ◽  
Context Specific ◽  
Standard Calculation

Abstract Introduction The ongoing civil war in Yemen has severely restricted imports of food and fuel, disrupted livelihoods and displaced millions, worsening already high pre-war levels of food insecurity. Paired with frequent outbreaks of disease and a collapsed health system, this has brought rates of wasting in children under five to the country’s highest recorded levels, which continue to increase as the crisis worsens and aid becomes increasingly limited. In their planning of services to treat and prevent wasting in children, humanitarian agencies rely on a standard calculation to estimate the expected number of cases for the coming year, where incidence is estimated from prevalence and the average duration of an episode of wasting. The average duration of an episode of moderate and severe wasting is currently estimated at 7.5 months—a globally-used value derived from historical cohort studies. Given that incidence varies considerably by context—where food production and availability, treatment coverage and disease rates all vary—a single estimate cannot be applied to all contexts, and especially not a highly unstable crisis setting such as Yemen. While recent studies have aimed to derive context-specific incidence estimates in several countries, little has been done to estimate the incidence of both moderate and severe wasting in Yemen. Methods In order to provide context-specific estimates of the average duration of an episode, and resultingly, incidence correction factors for moderate and severe wasting, we have developed a Markov model. Model inputs were estimated using a combination of treatment admission and outcome records compiled by the Yemen Nutrition Cluster, 2018 and 2019 SMART surveys, and other estimates from the literature. The model derived estimates for the governorate of Lahj, Yemen; it was initialized using August 2018 SMART survey prevalence data and run until October 2019—the date of the subsequent SMART survey. Using a process of repeated model calibration, the incidence correction factors for severe wasting and moderate wasting were found, validating the resulting prevalence against the recorded value from the 2019 SMART survey. Results The average durations of an episode of moderate and severe wasting were estimated at 4.86 months, for an incidence correction factor k of 2.59, and 3.86 months, for an incidence correction factor k of 3.11, respectively. It was found that the annual caseload of moderate wasting was 36% higher and the annual caseload of severe wasting 58% higher than the originally-assumed values, estimated with k = 1.6. Conclusion The model-derived incidence rates, consistent with findings from other contexts that a global incidence correction factor cannot be sufficient, allow for improved, context-specific estimates of the burden of wasting in Yemen. In crisis settings such as Yemen where funding and resources are extremely limited, the model’s outputs holistically capture the burden of wasting in a way that may guide effective decision-making and may help ensure that limited resources are allocated most effectively.

scholarly journals A Mathematical Model to Estimate The Incidence of Child Wasting In Yemen

2021 ◽  
Author(s):  
Rana Hussein ◽  
Mark Suprenant ◽  
Najwa Al-Dheeb ◽  
Saul Guerrero ◽  
Eleanor Rogers ◽  
...  
Keyword(s):  
Correction Factor ◽  
Average Duration ◽  
Incidence Rates ◽  
Correction Factors ◽  
Historical Cohort ◽  
Disease Rates ◽  
Effective Decision ◽  
Effective Decision Making ◽  
Context Specific ◽  
Standard Calculation

Abstract Introduction: The ongoing civil war in Yemen has severely restricted imports of food and fuel, disrupted livelihoods and displaced millions, worsening already high pre-war levels of food insecurity. Paired with frequent outbreaks of disease and a collapsed health system, this has brought rates of wasting in children under five to the country’s highest recorded levels, which continue to increase as the crisis worsens and aid becomes increasingly limited. In their planning of services to treat and prevent wasting in children, humanitarian agencies rely on a standard calculation to estimate the expected number of cases for the coming year, where incidence is estimated from prevalence and the average duration of an episode of wasting. The average duration of an episode of moderate and severe wasting is currently estimated at 7.5 months – a globally-used value derived from historical cohort studies. Given that incidence varies considerably by context – where food production and availability, treatment coverage and disease rates all vary – a single estimate cannot be applied to all contexts, and especially not a highly unstable crisis setting such as Yemen. While recent studies have aimed to derive context-specific incidence estimates in several countries, little has been done to estimate the incidence of both moderate and severe wasting in Yemen. Methods:In order to provide context-specific estimates of the average duration of an episode, and resultingly, incidence correction factors for moderate and severe wasting, we have developed a Markov model. Model inputs were estimated using a combination of treatment admission and outcome records compiled by the Yemen Nutrition Cluster, 2018 and 2019 SMART surveys, and other estimates from the literature. The model derived estimates for the governorate of Lahj, Yemen; it was initialized using August 2018 SMART survey prevalence data and run until October 2019 – the date of the subsequent SMART survey. Using a process of repeated model calibration, the incidence correction factors for severe wasting and moderate wasting were found, validating the resulting prevalence against the recorded value from the 2019 SMART survey.Results:The average durations of an episode of moderate and severe wasting were estimated at 4.86 months, for an incidence correction factor k of 2.59, and 3.86 months, for an incidence correction factor k of 3.11, respectively. It was found that the annual caseload of moderate wasting was 36% higher and the annual caseload of severe wasting 58% higher than the originally-assumed values, estimated with k = 1.6.Conclusion:The model-derived incidence rates, consistent with findings from other contexts that a global incidence correction factor cannot be sufficient, allow for improved, context-specific estimates of the burden of wasting in Yemen. In crisis settings such as Yemen where funding and resources are extremely limited, the model’s outputs holistically capture the burden of wasting in a way that may guide effective decision-making and may help ensure that limited resources are allocated most effectively.

scholarly journals A Model for Improved Estimates of Child Wasting in Yemen: Capturing the Effects of Conflict and Seasonal Variability In Incidence Estimates

2020 ◽  
Author(s):  
Rana Hussein ◽  
Mark Suprenant ◽  
Najwa Al-Dheeb ◽  
Saul Guerrero ◽  
Eleanor Rogers ◽  
...  
Keyword(s):  
Markov Model ◽  
Food Insecurity ◽  
Diarrheal Disease ◽  
Average Duration ◽  
Incidence Rates ◽  
Children Under Five ◽  
Global Estimate ◽  
Under Five ◽  
Context Specific ◽  
Monthly Incidence

Abstract Introduction: Conflict-affected settings - where starvation is often used as a weapon of war and deliveries of food restricted by warring parties, millions are displaced and economies are crippled, and health infrastructure destroyed - have become increasingly linked to high rates of wasting in children. In the case of Yemen, this relationship has become strikingly clear. The country’s ongoing civil war has severely restricted imports of food and disrupted livelihoods, worsening already high pre-war levels of food insecurity. Paired with outbreaks of disease and an overwhelmed and underfunded health system, this has brought rates of wasting in children under five - who are particularly vulnerable to and disproportionately impacted by wasting - to unprecedented levels, which continue to increase as the crisis worsens and aid becomes increasingly limited. In their planning of services to treat and prevent moderate and severe wasting in children, humanitarian agencies estimate expected caseload using a single, standard estimate. This calculation is inapplicable to the context of Yemen both because it is based on a global estimate and rates of incidence vary by context and because it does not capture variations in incidence due to seasonality, disease trends, and the general instability of a crisis setting. To address these limitations and provide more holistic and context-specific estimates of the incidence of wasting among children in Yemen, we developed a predictive Markov model. Computing context-specific values for the average duration of an episode of wasting, the model then considers how changes to other factors in Yemen – food insecurity levels and seasonal disease trends – cause incidence to vary.Methods: We developed a Markov model to estimate the monthly incidence and resultingly, prevalence, of moderate and severe wasting among under-five children in the governorate of Lahj, Yemen. Transition rates were estimated using a combination of monthly treatment analysis compiled by the Yemen Nutrition Cluster and provided by UNICEF, annual SMART survey prevalence estimates and other estimates from the literature. Through model calibration, context-specific values for the average duration of an episode of moderate and severe wasting, and respective incidence correction factors, were found. Local food insecurity levels and diarrheal disease rates – factors directly associated with the incidence of wasting – were introduced as adjustable parameters that would affect monthly incidence rates based on established mathematical relationships.Results: The calculated context-specific incidence correction factor for Yemen showed that previous estimates led to considerable underestimates of the burden of wasting. Adjusted annual caseloads for moderate and severe wasting were 29% and 40% higher, respectively, than the previously assumed values. Baseline values for the estimated duration of an episode of moderate and severe wasting were found to be 5.3 and 4.8 months, respectively. When these values were taken as the average duration of an episode of wasting and the model was run from September 2018 to October 2019, the model’s resulting estimates of the prevalence of moderate and severe wasting matched those recorded in the October 2019 SMART survey. By accounting for changes to underlying factors of wasting, the model produced outputs that reflect the variability of monthly incidence rates of wasting, mirroring the fluctuations seen in treatment admissions data.Conclusion: In this manuscript we propose a Markov model for more accurate and holistic estimates of the burden of wasting in children under five. By generating context specific incidence rates based on levels of food insecurity and seasonal disease trends, our estimates for the duration of an episode and thus caseload more accurately capture changing realities on the ground in Yemen. While we applied our model to Yemen, this model is highly flexible and may be used in other conflict-affected settings to allow health care workers to better predict and plan for expected cases of wasting.

Parliamentarism and the Legislative Branch

2017 ◽  
Author(s):  
András Sajó ◽  
Renáta Uitz
Keyword(s):  
Decision Making ◽  
Political Parties ◽  
Legislative Branch ◽  
Effective Decision ◽  
The Law ◽  
Internal Operations ◽  
Effective Decision Making ◽  
The Relationship ◽  
Law Making

This chapter examines the relationship between parliamentarism and the legislative branch. It explores the evolution of the legislative branch, leading to disillusionment with the rationalized law-making factory, a venture run by political parties beyond the reach of constitutional rules. The rise of democratically bred party rule is positioned between the forces favouring free debate versus effective decision-making in the legislature. The chapter analyses the institutional make-up and internal operations of the legislature, the role of the opposition in the legislative assembly, and explores the benefits of bicameralism for boosting the powers of the legislative branch. Finally, it looks at the law-making process and its outsourcing via delegating legislative powers to the executive.

scholarly journals Corporate Social Responsibility (CSR): motivations and challenges of a Multinational Enterprise (MNE) subsidiary’s engagement with host communities in Ghana

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Lyon Salia Awuah ◽  
Kwame Oduro Amoako ◽  
Stephen Yeboah ◽  
Emmanuel Opoku Marfo ◽  
Peter Ansu-Mensah
Keyword(s):  
Stakeholder Engagement ◽  
Multinational Enterprise ◽  
Cost Savings ◽  
Community Members ◽  
Mining Sector ◽  
High Expectations ◽  
Effective Decision ◽  
Effective Decision Making ◽  
Internal Stakeholders ◽  
Corporate Social

AbstractThis paper aims to explore the motivations and challenges of engaging host communities in CSR practices within the context of Newmont Ahafo Mines (NAM), a subsidiary of a Multinational Mining Enterprise (MNE) operating in Ghana’s mining sector. This paper draws insights from stakeholder theory and interviews conducted with internal stakeholders (management and employees) and stakeholders in host communities (traditional rulers and community members). The findings indicate that effective decision-making, gaining legitimacy, cost savings, management of risks, and accountability are some of the perceived motivations of NAM’s stakeholder engagement in CSR. Nonetheless, the most critical challenges to NAM in improving stakeholder engagement in CSR practices are the lack of community members’ support in CSR projects, communities’ high expectations of NAM on development projects and over-dependency on NAM on the part of host communities. Therefore, it is reasonable for MNEs in emerging economies to attune engagement practices to the host community’s context. This will enable CSR practices and policies to fully exploit the latent benefits of CSR in the mining sector.

scholarly journals Reflections on the Importance of Cost of Illness Analysis in Rare Diseases: A Proposal

2021 ◽  
Vol 18 (3) ◽  
pp. 1101
Author(s):  
Patrizio Armeni ◽  
Marianna Cavazza ◽  
Entela Xoxi ◽  
Domenica Taruscio ◽  
Yllka Kodra
Keyword(s):  
Rare Diseases ◽  
Cost Of Illness ◽  
Fragile X ◽  
Direct Costs ◽  
Medicinal Products ◽  
Novel Treatments ◽  
Decision Making Processes ◽  
Effective Decision ◽  
Cross Country ◽  
Effective Decision Making

In the field of rare diseases (RDs), the evidence standard is often lower than that required by health technology assessment (HTA) and payer authorities. In this commentary, we propose that appropriate economic evaluation for rare disease treatments should be initially informed by cost-of-illness (COI) studies conducted using a societal perspective. Such an approach contributes to improving countries’ understanding of RDs in their entirety as societal and not merely clinical, or product-specific issues. In order to exemplify how the disease burden’s distribution has changed over the last fifteen years, key COI studies for Hemophilia, Fragile X Syndrome, Cystic Fibrosis, and Juvenile Idiopathic Arthritis are examined. Evidence shows that, besides methodological variability and cross-country differences, the disease burden’s share represented by direct costs generally grows over time as novel treatments become available. Hence, to support effective decision-making processes, it seems necessary to assess the re-allocation of the burden produced by new medicinal products, and this approach requires identifying cost drivers through COI studies with robust design and standardized methodology.

Computing an effective decision making group of a society using social network analysis

2013 ◽  
Vol 28 (3) ◽  
pp. 577-587 ◽  
Author(s):  
Donghyun Kim ◽  
Deying Li ◽  
Omid Asgari ◽  
Yingshu Li ◽  
Alade O. Tokuta ◽  
...  
Keyword(s):  
Decision Making ◽  
Social Network ◽  
Social Network Analysis ◽  
Network Analysis ◽  
Effective Decision ◽  
Effective Decision Making

Effective Decision Making in a Life Company

2005 ◽  
Vol 11 (1) ◽  
pp. 133-166
Author(s):  
M. Iqbal
Keyword(s):  
Decision Making ◽  
Decision Theory ◽  
Systematic Approach ◽  
Decision Making Process ◽  
Recent Past ◽  
Past Life ◽  
Effective Decision ◽  
Effective Decision Making ◽  
Value Measurement

ABSTRACTIn the recent past life companies have made many decisions which they have had cause to deeply regret. This paper looks at the range of decision making theories available. It then examines recent examples of decisions that had unfavourable consequences and explores why they were taken, and goes on to describe a systematic approach to decision making which can help management assess more objectively the difficult choices confronting them today. The approach does not require espousal of any specific decision theory or method of value measurement. The focus is on the decision making process and the organisation's capacity to handle change. The paper identifies the three requirements for effective decision making.

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