LUNG CANCER IN NEPAL: THE ROLE OF TRADITIONAL TOBACCO PRODUCTS AND COMBUSTION RELATED HOUSEHOLD AIR POLLUTION

The burden of chronic diseases such as cancer is increasing in low and middle income countries around the globe. Nepal, one of the world’s poorest countries, is no exception to this trend, with lung cancer as the leading causes of cancer deaths. Despite this, limited data is available on the environmental and behavioral risk factors that contribute to the lung cancer etiology in Nepal. The objectives of this dissertation are to: 1) investigate the ethnic differences in consumption of local tobacco products and their role in lung cancer risk in Nepal; 2) evaluate urinary metabolite of 1,3-butadiene as a biomarker of exposure to combustion related household air pollution (CRHAP); 3) investigate the association between CRHAP exposure and lung cancer risk using urinary metabolite of 1,3-butadiene as a biomarker of exposure; 4) investigate the association between CRHAP exposure and lung cancer risk using questionnaire based measure of exposure. Lung cancer cases (n=606) and frequency matched controls (N=606) were recruited from B.P. Koirala Memorial Cancer Hospital. We obtained biological samples and information on lifestyles including cooking habits and type of fuels used. We used liquid chromatograph tandem mass spectrometer (LC-MS/MS) to quantify urinary metabolites of 1,3-butadiene in urine samples. We employed a combination of logistic and linear regression models to detect any exposure-disease associations while controlling for known confounding variables. Overall, we found that ethnic groups in Nepal use different tobacco products that have different differing cancer potency -we observed the highest odds ratios for the traditional tobacco products. The biomarker analysis showed strong evidence that monohydroxybutyl mercapturic acid is associated with biomass fuel use among participants. However, we did not find significant association between urinary MHMBA and lung cancer risk. When we used questionnaire based measure of exposure to household air pollution, we observed significant, dose-response associations between CRHAP exposure and lung cancer risk, particularly among never-smokers. Our results show that important role of local tobacco products in lung cancer risk in Nepal. Furthermore, we demonstrate that CRHAP exposure is a risk factor for lung cancer risk, independent of tobacco smoking.

ESSAYS ON THE WTO ACCESSION, HOUSEHOLD INCOME AND MULTIDIMENSIONAL POVERTY: EVIDENCE FROM CHINA

In the course of integrating into the global market, especially since China’s WTO accession, China has achieved remarkable GDP growth and has become the second largest economy in the world. These economic achievements have substantially increased Chinese incomes and have generated more government revenue for social progress. However, China’s economic progress, in itself, is neither sufficient for achieving desirable development outcomes nor a guarantee for expanding peoples’ capabilities. In fact, a narrow emphasis on GDP growth proves to be unsustainable, and may eventually harm the life quality of Chinese citizens. Without the right set of policies, a deepening trade-openness policy in China may enlarge social disparities and some people may further be deprived of basic public services and opportunities. To address these concerns, this dissertation, a set of three essays in Chapters 2-4, examines the impact of China's WTO accession on income distribution, compares China’s income and multidimensional poverty reduction and investigates the factors, including the WTO accession, that predict multidimensional poverty. By exploiting the exogenous variation in exposure to tariff changes across provinces and over time, Chapter 2 (Essay 1) estimates the causal effects of trade shocks and finds that China’s WTO accession has led to an increase in average household income, but its impacts are not evenly distributed. Households in urban areas have benefited more significantly than those in rural areas. Households with members working in the private sector have benefited more significantly than those in the public sector. However, the WTO accession has contributed to reducing income inequality between higher and lower income groups. Chapter 3 (Essay 2) explains and applies the Alkire and Foster Method (AF Method), examines multidimensional poverty in China and compares it with income poverty. It finds that China’s multidimensional poverty has declined dramatically during the period from 1989-2011. Reduction rates and patterns, however, vary by dimensions: multidimensional poverty reduction exhibits unbalanced regional progress as well as varies by province and between rural and urban areas. In comparison with income poverty, multidimensional poverty reduction does not always coincide with economic growth. Moreover, if one applies a single measure ─ either that of income or multidimensional poverty ─ a certain proportion of those who are poor remain unrecognized. By applying a logistic regression model, Chapter 4 (Essay 3) examines factors that predict multidimensional poverty and finds that the major factors predicting multidimensional poverty in China include household size, education level of the household head, health insurance coverage, geographic location, and the openness of the local economy. In order to alleviate multidimensional poverty, efforts should be targeted to (i) expand education opportunities for the household heads with low levels of education, (ii) develop appropriate geographic policies to narrow regional gaps and (iii) make macroeconomic policies work for the poor.

Household language, residential segregation and social mobility: continuity and change in eThekwini, South Africa

This article uses South African census data for 1996, 2001 and 2011 to explore the relationship between language and social mobility in the metropolitan region of eThekwini (including what was previously known as Durban). We focus particular attention on variables selected to shed light on residential segregation and social mobility, such as education level, income, race and in-migration. Data on adults at ward level (using 2011 ward boundaries) in eThekwini is used to develop a comparative spatial context for this analysis. Our main finding is that English appears in eThekwini to be the household language of the social elite as well as the language of upward mobility and empowerment.

The impact of household size on poverty: An analysis of various low-income townships in the Northern Free State region, South Africa

Poverty is a multi-dimensional socio-economic problem in most sub-Saharan African countries. The purpose of this study is to analyse the relationship between household size and poverty in low-income communities. The Northern Free State region in South Africa was selected as the study region. A sample of approximately 2 900 households was randomly selected within 12 poor communities in the region. A poverty line was calculated and 74% of all households were found to live below the poverty line. The Pearson’s chi-square test indicated a positive relationship between household size and poverty in eleven of the twelve low-income communities. Households below the poverty line presented larger households than those households above the poverty line. This finding is in contradiction with some findings in other African countries due to the fact that South Africa has higher levels of modernisation with less access to land for subsistence farming. Effective provision of basic needs, community facilities and access to assets such as land could assist poor households with better quality of life. Poor households also need to be granted access to economic opportunities, while also receiving adult education regarding financial management and reproductive health.

Social and environmental determinants, household food insecurity

Food security is defined as a situation that exists when “all people, at all times, have physical and economic access to sufficient, safe and nutritious food to maintain a healthy and active life. It is a multilevel concept, which includes four main dimensions: availability related to food supply; accessibility in order to ensure the physical and economic access to food; adequacy to meet nutritional needs in quantity and quality while respecting individual food preferences and cultural issues (utilization); and, lastly, stability of the guarantee of food security over time. According to the food security definition, it is abroad concept where all these dimensions are largely affected by a considerable number of factors related to: public policies of different sectors, food production/industry/distribution food systems, marketing and advertising of food, social support networks and individual determinants related to food choice behaviour.

Impact of cost sharing on utilization of primary health care Services: providers versus household perspectives

This study is set to match and compare results of the analysis of impacts of cost sharing on households with those on health-care providers in two selected districts in Tanzania. The setting is intended to establish and compare concurrently the impact of cost sharing on health-care utilization as viewed from both the providers and beneficiary households. The findings of the study indicate that quality of primary health care has improved as a result of the introduction of cost sharing. Attendance and hence utilization in health facilities has also increased. Mortality rate, at least for one district has not worsened. By implication then, cost sharing appears to have a positive impact on the provision of primary health care, except for a few cases that fail to consult because of the fees. An appropriately managed exemption facility is likely to eliminate the negative impact.

The socioeconomic gradient in health: The role of intra-household resource allocation

This paper aims to analyse the impact of different household financial regimes on the health status of males and females in a number of European countries. Using the EU-SILC 2010 on intra-household sharing of resources, we find that each member of the couple is worse off if his/her partner has most decision-making responsibilities. Additionally, the presence of children in the household plays a role in the effect that household financial regimens exert on individual self-assessed health, especially among females. We conclude that family arrangements regarding resource allocation and decision-making have important consequences and should be given some attention in the task of identifying individuals predisposed to health problems.

THE DEVELOPMENT EFFECTIVENESS OF INTERNATIONAL WATER AND SANITATION INFRASTRUCTURE PROJECTS: DEFINING “QUALITY AT ENTRY” OF WORLD BANK PROJECTS.

Over the past 15 years, the number of international development projects aimed at combating global poverty has increased significantly. Within the water and sanitation sector however, and despite heightened global attention and an increase in the number of infrastructure projects, over 800 million people remain without access to appropriate water and sanitation facilities. The majority of donor aid in the water supply and sanitation sector of developing countries is delivered through standalone projects. The quality of projects at the design and preparation stage is a critical determinant in meeting project objectives. The quality of projects at early stage of design, widely referred to as quality at entry (QAE), however remains unquantified and largely subjective. This research argues that water and sanitation infrastructure projects in the developing world tend to be designed in the absence of a specific set of actions that ensure high QAE, and consequently have relatively high rates of failure. This research analyzes 32 cases of water and sanitation infrastructure projects implemented with partial or full World Bank financing globally from 2000 – 2010. The research uses categorical data analysis, regression analysis and descriptive analysis to examine perceived linkages between project QAE and project development outcomes and determines which upstream project design factors are likely to impact the QAE of international development projects in water supply and sanitation. The research proposes a number of specific design stage actions that can be incorporated into the formal review process of water and sanitation projects financed by the World Bank or other international development partners.

An Afriat theorem for the collective model of household consumption

We provide a nonparametric 'revealed preference’ characterization of rational household behavior in terms of the collective consumption model, while accounting for general (possibly non-convex) individual preferences. We establish a Collective Axiom of Revealed Preference (CARP), which provides a necessary and sufficient condition for data consistency with collective rationality. Our main result takes the form of a ‘collective’ version of the Afriat Theorem for rational behavior in terms of the unitary model. This theorem has some interesting implications. With only a finite set of observations, the nature of consumption externalities (positive or negative) in the intra-household allocation process is non-testable. The same non-testability conclusion holds for privateness (with or without externalities) or publicness of consumption. By contrast, concavity of individual utility functions (representing convex preferences) turns out to be testable. In addition, monotonicity is testable for the model that assumes all household consumption is public.

Household epidemic models with varying infection response

This paper is concerned with SIR (susceptible--infected--removed) household epidemic models in which the infection response may be either mild or severe, with the type of response also affecting the infectiousness of an individual. Two different models are analysed. In the first model, the infection status of an individual is predetermined, perhaps due to partial immunity, and in the second, the infection status of an individual depends on the infection status of its infector and on whether the individual was infected by a within- or between-household contact. The first scenario may be modelled using a multitype household epidemic model, and the second scenario by a model we denote by the infector-dependent-severity household epidemic model. Large population results of the two models are derived, with the focus being on the distribution of the total numbers of mild and severe cases in a typical household, of any given size, in the event that the epidemic becomes established. The aim of the paper is to investigate whether it is possible to determine which of the two underlying explanations is causing the varying response when given final size household outbreak data containing mild and severe cases. We conduct numerical studies which show that, given data on sufficiently many households, it is generally possible to discriminate between the two models by comparing the Kullback-Leibler divergence for the two fitted models to these data.

Analysis of a stochastic SIR epidemic on a random network incorporating household structure

This paper is concerned with a stochastic SIR (susceptible-infective-removed) model for the spread of an epidemic amongst a population of individuals, with a random network of social contacts, that is also partitioned into households. The behaviour of the model as the population size tends to infinity in an appropriate fashion is investigated. A threshold parameter which determines whether or not an epidemic with few initial infectives can become established and lead to a major outbreak is obtained, as are the probability that a major outbreak occurs and the expected proportion of the population that are ultimately infected by such an outbreak, together with methods for calculating these quantities. Monte Carlo simulations demonstrate that these asymptotic quantities accurately reflect the behaviour of finite populations, even for only moderately sized finite populations. The model is compared and contrasted with related models previously studied in the literature. The effects of the amount of clustering present in the overall population structure and the infectious period distribution on the outcomes of the model are also explored.

Threshold behaviour and final outcome of an epidemic on a random network with household structure

This paper considers a stochastic SIR (susceptible-infective-removed) epidemic model in which individuals may make infectious contacts in two ways, both within 'households' (which for ease of exposition are assumed to have equal size) and along the edges of a random graph describing additional social contacts. Heuristically-motivated branching process approximations are described, which lead to a threshold parameter for the model and methods for calculating the probability of a major outbreak, given few initial infectives, and the expected proportion of the population who are ultimately infected by such a major outbreak. These approximate results are shown to be exact as the number of households tends to infinity by proving associated limit theorems. Moreover, simulation studies indicate that these asymptotic results provide good approximations for modestly-sized finite populations. The extension to unequal sized households is discussed briefly.

Household portfolio allocation, risk attitudes and credit constraints : evidence from the eurozone

Mestrado em Economia Monetária e Financeira

Increasing the value of household appliances by adding a heat pump system

Historically, domestic tasks such as preparing food and washing and drying clothes and dishes were done by hand. In a modern home many of these chores are taken care of by machines such as washing machines, dishwashers and tumble dryers. When the first such machines came on the market customers were happy that they worked at all! Today, the costs of electricity and customers’ environmental awareness are high, so features such as low electricity, water and detergent use strongly influence which household machine the customer will buy. One way to achieve lower electricity usage for the tumble dryer and the dishwasher is to add a heat pump system. The function of a heat pump system is to extract heat from a lower temperature source (heat source) and reject it to a higher temperature sink (heat sink) at a higher temperature level. Heat pump systems have been used for a long time in refrigerators and freezers, and that industry has driven the development of small, high quality, low price heat pump components. The low price of good quality heat pump components, along with an increased willingness to pay extra for lower electricity usage and environmental impact, make it possible to introduce heat pump systems in other household products. However, there is a high risk of failure with new features. A number of household manufacturers no longer exist because they introduced poorly implemented new features, which resulted in low quality and product performance. A manufacturer must predict whether the future value of a feature is high enough for the customer chain to pay for it. The challenge for the manufacturer is to develop and produce a high-performance heat pump feature in a household product with high quality, predict future willingness to pay for it, and launch it at the right moment in order to succeed. Tumble dryers with heat pump systems have been on the market since 2000. Paper I reports on the development of a transient simulation model of a commercial heat pump tumble dryer. The measured and simulated results were compared with good similarity. The influence of the size of the compressor and the condenser was investigated using the validated simulation model. The results from the simulation model show that increasing the cylinder volume of the compressor by 50% decreases the drying time by 14% without using more electricity.  Paper II is a concept study of adding a heat pump system to a dishwasher in order to decrease the total electricity usage. The dishwasher, dishware and water are heated by the condenser, and the evaporator absorbs the heat from a water tank. The majority of the heat transfer to the evaporator occurs when ice is generated in the water tank. An experimental setup and a transient simulation model of a heat pump dishwasher were developed. The simulation results show a 24% reduction in electricity use compared to a conventional dishwasher heated with an electric element. The simulation model was based on an experimental setup that was not optimised. During the study it became apparent that it is possible to decrease electricity usage even more with the next experimental setup.

Immobilized Microalgae for Nutrient Recovery from Source Separated Urine

Shortages in supply of nutrients and freshwater for a growing human population are critical global issues. Traditional centralized sewage treatment can prevent eutrophication and provide sanitation, but is neither efficient nor sustainable in terms of water and resources. Source separation of household wastes, combined with decentralized resource recovery, presents a novel approach to solve these issues. Urine contains within 1 % of household waste water up to 80 % of the nitrogen (N) and 50 % of the phosphorus (P). Since microalgae are efficient at nutrient uptake, growing these organisms in urine might be a promising technology to concomitantly clean urine and produce valuable biomass containing the major plant nutrients. While state-of-the-art suspension systems for algal cultivation have mayor shortcomings in their application, immobilized cultivation on Porous Substrate Photobioreactors (PSBRs) might be a feasible alternative. The aim of this study was to develop a robust process for nutrient recovery from minimally diluted human urine using microalgae on PSBRs. The green alga Desmodesmus abundans strain CCAC 3496 was chosen for its good growth, after screening 96 algal strains derived from urine-specific isolations and culture collections. Treatment of urine, 1:1 diluted with tap water and without addition of nutrients, was performed at a light intensity of 600 μmol photons m-2 s-1 with 2.5 % CO2 and at pH 6.5. A growth rate of 7.2 g dry weight m-² day-1 and removal efficiencies for N and P of 13.1 % and 94.1 %, respectively, were determined. Pre-treatment of urine with activated carbon was found to eliminate possible detrimental effects of pharmaceuticals. These results provide a basis for further development of the technology at pilot-scale. If found to be safe in terms human and environmental health, the biomass produced from three persons could provide the P for annual production of 31 kg wheat grain and 16 kg soybean, covering the caloric demand in food for almost one month of the year for such a household. In combination with other technologies, PSBRs could thus be applied in a decentralized resource recovery system, contributing to locally close the link between sanitation and food production.