Urbanization effects on welfare and income diversification strategies of peri-urban farm households in Tigray, Northern Ethiopia: An empirical analysis

Urban areas in many developing countries are expanding rapidly by incorporating nearby subsistence farming communities. This has a direct effect on the consumption and production behaviours of the farm households but empirical evidence is sparse. This thesis investigated the effects of rapid urbanization and the associated policies on welfare of subsistence farm households in peri-urban areas using a panel dataset from Tigray, Ethiopia. The study revealed a number of important issues emerging with the rapid urban expansion. Firstly, private asset holdings and consumption expenditure of farm households, that have been incorporated into urban administration, has decreased. Secondly, factors that influence the farm households’ welfare and vulnerability depend on the administration they belong to, urban or rural. Gender and literacy of the household head have significant roles for the urban farm households to fall back into and/or move out of poverty. However, livestock holding and share of farm income are the most important factors for rural households. Thirdly, the study discloses that farming continues to be important source of income and income diversification is the principal strategy. Participation in nonfarm employment is less for farm households in urban than rural areas. Adult labour, size of the local market and past experience in the nonfarm sector improves the likelihood of engaging in skilled nonfarm employment opportunities. But money, given as compensation for the land taken away, is not crucial for the household to engage in better paying nonfarm employments. Production behaviour of the better-off farm households is the same, regardless of the administration they belong to. However, the urban poor participate less in nonfarm employment compared to the rural poor. These findings signify the gradual development of urban-induced poverty in peri-urban areas. In the case of labour poor households, introducing urban safety net programmes could improve asset productivity and provide further protection.

Optimizing perioperative analgesia for patients undergoing operative fixation of hip fractures

This PhD thesis describes work carried out on investigation of various interventions with the aim to optimise the anaesthetic management of patients scheduled to undergo operative fixation of hip fractures. We analysed the perioperative effects of continuous femoral nerve block, single preoperative dose of i.v. dexamethasone, the intention to deposit local anaesthetic in different locations around the femoral nerve during ultrasound guided femoral nerve block, continuous spinal anaesthesia and peri-surgical site infiltration with local anaesthetic after surgical fixation of hip fractures. Continuous femoral nerve block provided more effective preoperative analgesia six hours after the insertion of the perineural catheter compared to a standard opiate-based regimen in patients undergoing operative fixation of fractured hip. A single low dose of preoperative dexamethasone in the intervention group decreased pain scores by 75% six hours after the surgery. Both interventions had no major effect on the functional recovery in the first year after the surgical fixation of fractured hip. The results of the ultrasound guided femoral nerve block trial showed no clinical advantage of intending to deposit local anaesthetic circumferentially during performing femoral nerve block. Using the Dixon and Massey’s “up- and-down” method, we demonstrated that intrathecal 0.26 ml of 0.5% bupivacaine provided adequate surgical anaesthesia within 15 minutes in 50% of patients undergoing operative fixation of hip fracture. Finally, we demonstrated that local anaesthetic infiltration had no effect on pain scores 12 hours after the surgical fixation of fractured neck of femur. In addition to this original body of work, a review article was published on femoral nerve block highlighting the use of ultrasound guidance. In conclusion, the results of this thesis offer an insight into interventions aimed at optimising perioperative analgesia in patients scheduled to undergo operative fixation of hip fractures.