Browsing by Author "Sang, Edna"

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    Beyond Household Socioeconomic Status: Multilevel Modeling of Supply-Side Determinants of LPG Consumption among 5,500 Households in Sub- Saharan Africa
    (Research square, 2021) Shupler, Matthew; Mangeni, Judith; Tawiah, Theresa; Sang, Edna; Baame, Miranda; Anderson de Cuevas, Rachel; Nix, Emily; Betang, Emmanuel; Saah, Jason; Quansah, Reginald; Puzzolo, Elisa; Mbatchou, Bertrand; Asante, Kwaku Poku; Menya, Diana; Pope, Daniel
    Household transition to cleaner cooking fuels (e.g. liquefied petroleum gas (LPG)) has historically been understood as an “energy ladder” with clean energy access resulting from improvements in household socioeconomic status (SES). Recent studies have demonstrated the importance of supply-side determinants in increasing clean cooking, yet few large-scale studies have assessed their significance quantitatively. As part of the CLEAN-Air(Africa) study, a population-based survey was conducted (N = 5,638) assessing cooking practices in peri-urban communities within Cameroon, Kenya and Ghana. Multilevel logistic and log-linear regression were used to assess socioeconomic and supply-side determinants of LPG usage (primary versus secondary fuel) and consumption (kilograms/capita/year), respectively. Supply-side factors (e.g. cylinder refill and transportation costs) and using single versus multi-burner stoves were better predictors of both the probability of primarily cooking with LPG and annual LPG consumption than household SES. These results suggest the need for policies promoting LPG access and stove equipment that meet household needs.
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    Bottlenecks to Intervention Scale Up: Supply and Demand Side Perspectives From a Large, Community-based Trial of Malaria Testing
    (Research square, 2021) Kirui, Joseph; Malinga, Josephine; Sang, Edna; Ambani, George; Abel, Lucy; Nalianya, Erick; Namae, Jane; Boyce, Matthew; Laktabai, Jeremiah; Menya, Diana; O’Meara, Wendy Prudhomme
    Maximizing the impact of community-based programs requires understanding how the supply of and demand for the intervention interact at the point of delivery. We present results from a large-scale community health worker study designed to increase the availability of and demand for malaria diagnostic testing in a rural, malaria-endemic region in western Kenya between 2015 and 2017. Methods: Community Health Workers (CHWs) provided free malaria Rapid Diagnostic Test(mRDT) in the community. Those with a positive malaria test were provided with a discounted first-line antimalarial over-the-counter. We conducted a community-based survey to collect individual study outcomes at 12- and 18-months post-implementation. In addition, we collected monthly testing data from the 244 participating CHWs and also conducted in-depth interviews with a random sample of 70 CHWs. Results: From the survey, 55% (n=948/1738) reported having a malaria test for their recent illness with 38% having been tested by a CHW. Being aware of a local CHW (95% CI:1.10-2.04) and belonging to a wealthy household (95% CI:1.14-2.06) were associated with higher malaria testing uptake from any source. Poorer households were more likely to receive a test from a CHW. School-aged children between 5-17 years were more than twice as likely to be tested by a CHW (95% CI:1.47-4.14). Both confidence in AL treatment (95% CI:1.54-4.92) and perceived accuracy of an RDT performed by a CHW (95% CI:1.12-5.27) were strongly and positively associated with testing by a CHW. In adjusted analyses, specific CHWs attributes were significantly associated with higher testing rates including formal employment (95% CI:0.05-2.70), those serving more than 50 households (95% CI:0.70-2.74) and those serving areas with a higher proportion of positive tests (95% CI:1.05, 3.22). On both the supply side and the demand side, confidence in a test performed by a CHW was strongly correlated with the success of the intervention. Conclusion: Scale-up of community-based malaria testing intervention through CHWs is feasible and effective at reaching the poorest households. In order to maximize the impact of such interventions, it is important to recognize factors that may restrict both delivery and demand for such services.
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    Multiple aspects of energy poverty are associated with lower mental health-related quality of life: A modelling study in three peri-urban African communities
    (SSM-Mental Health, 2022) Shupler, Matthew; Baame, Miranda; Nix, Emily; Tawiah, Theresa; Lorenzetti, Federico; Saah, Jason; Anderson de Cuevas, Rachel; Sang, Edna; Puzzolo, Elisa; Mangeni, Judith; Betang, Emmanuel; Twumasi, Mieks; Amenga-Etego, Seeba; Quansah, Reginald; Mbatchou, Bertrand; Menya, Diana; Poku Asante, Kwaku; Pope, Daniel
    Over 900 million people in sub-Saharan Africa (SSA) live in energy poverty, relying on cooking polluting fuels (e.g. wood, charcoal). The association between energy poverty and mental/physical health-related quality of life (HRQoL) among women in SSA, who are primarily tasked with cooking, is unknown. Methods: Females (n ¼ 1,150) from peri-urban Cameroon, Kenya and Ghana were surveyed on their household energy use and mental/physical health status using the standardized Short-Form 36 (SF-36) questionnaire. Random effects linear regression linked household energy factors to SF-36 mental (MCS) and physical component summary (PCS) scores. A binary outcome of ‘likely depression’ was derived based on participants' MCS score. Random effects Poisson regression with robust error variance assessed the relationship between household energy factors and odds of likely depression. Results: The prevalence of likely depression varied by a factor of four among communities (36%-Mbalmayo, Cameroon; 20%-Eldoret, Kenya; 9%-Obuasi, Ghana). In the Poisson model (coefficient of determination (R2) ¼ 0.28), females sustaining 2 or more cooking-related burns during the previous year had 2.7 (95%CI:[1.8,4.1]) times the odds of likely depression as those not burned. Females cooking primarily with charcoal and wood had 1.6 times (95%CI:[0.9,2.7]) and 1.5 times (95%CI:[0.8,3.0]) the odds of likely depression, respectively, as those primarily using liquefied petroleum gas. Women without electricity access had 1.4 (95%CI:[1.1,1.9]) times the odds of likely depression as those with access. In the MCS model (R2 ¼ 0.23), longer time spent cooking was associated with a lower average MCS score in a monotonically increasing manner. In the PCS model (R2 ¼ 0.32), women injured during cooking fuel collection had significantly lower ( 4.8 95%CI:[-8.1,-1.4]) PCS scores. Conclusion: The burden of energy poverty in peri-urban communities in SSA extends beyond physical conditions. Experiencing cooking-related burns, using polluting fuels for cooking or lighting and spending more time cooking are potential risk factors for lower mental HRQoL among women.