Digital micro-banking as a health and protection intervention for street-connected children and youth? Analysis from a Togolese pilot.

BACKGROUND: The SaVa pilot offered street-connected children and youth (C&Y) access to digital micro-banking services to help them save money and thus avoid the violence associated with theft at night. It further used the micro-banking service as a gateway to attract C&Y towards other health and protection services. It took place over 12 months in Lomé, Togo and involved one social worker (SW) plus volunteers running 'the bank' in a non-governmental organisation-funded drop-in centre. METHODS: C&Y peer researchers were trained to interview and use collective drawing with peers, which they did on a bi-monthly basis. The SW recorded information about case management, training and additional services offered. He administered a survey to C&Y at the point of entry into the project and after 1 year, asking questions about recent experiences of violence or theft. At the end of 12 months, the author conducted interviews with C&Y using the bank, C&Y researchers who used the bank, project staff and steering committee partners and child protection stakeholders. One focus group was conducted with C&Y participants, alongside limited participant observation of where C&Y sleep and work. RESULTS: Findings suggest that the intervention was successful in encouraging children to open accounts and save money, and in contributing to a reduction in theft and associated violence. The incidence of theft reduced 90%; 95% of C&Y account holders were happy with the service; 200 accounts were opened. The project supported the delivery of additional services, including counselling, school reinsertion and removal from the streets. CONCLUSIONS: Analysis suggests that it is possible to offer street-connected C&Y formal financial services but that this offer has potential as a health and protection intervention, especially in combination with the provision of a safe space, dedicated SW support and add-on services.

Towards ethical good practice in cash transfer trials and their evaluation.

Over the past 20 years, cash transfers have become increasingly widespread within international development and global social policy. Often, their roll out is preceded by a trial or pilot phase aiming to check feasibility and effectiveness. These pilots can involve thousands of people. However, there is limited discussion within the literature (and even less in practice) of how and whether cash transfer trials and the research that they involve can respect ethical standards. This paper represents an initial step towards filling that gap. It does so by reviewing the latest literature pertaining to the ethics of cash transfers and social experimentation. It concludes by advancing a series of proposals that could support cash transfer trials to take place with greater respect for research ethics norms and in the best interests of participants. The paper's findings have relevance for policymakers and development practitioners working with cash transfers and also for the smaller cognate world of Unconditional Basic Income (UBI) piloting.

Effect of ApoE4 Genotype on the Association Between Metabolic Phenotype and Subclinical Atherosclerosis in Postmenopausal Women.

Metabolic profile and ApoE4 genotype have effects on coronary heart disease. We examined the interaction between these factors on subclinical atherosclerosis in postmenopausal women from the Early versus Late Intervention Trial with Estradiol (n = 497). Based on nine metabolic biomarkers (fasting blood glucose, insulin sensitivity, ketones, triglycerides, high-density lipoprotein, low-density lipoprotein, hemoglobin A1c, and blood pressure), K-means clustering categorized women into three distinct phenotypes: healthy, high blood pressure, and poor metabolic. ApoE4 genotype was classified as either ApoE4+ or ApoE4-. General linear models tested whether the cross-sectional association between metabolic phenotypes and common carotid intima media thickness (CIMT) differed by ApoE4 genotype. Mixed effects linear models evaluated the modifying role of ApoE4 genotype on the association of metabolic phenotype with CIMT progression over a median follow-up of 4.8 years. In cross-sectional analysis, ApoE4+ women with poor metabolic phenotype had the highest CIMT compared with all other groups. In ApoE4- women, CIMT was significantly lower in those classified as healthy compared with high blood pressure phenotype (p = 0.004). In ApoE4+ women, CIMT was significantly higher in those with poor metabolic phenotype compared with healthy (p = 0.0003) and high blood pressure (p = 0.001) phenotypes. These results indicate that metabolic phenotype had a negative effect on CIMT in women with ApoE4+ but not ApoE4- (interaction p = 0.001). These effects were not observed on CIMT progression in longitudinal analysis. In conclusion, ApoE4+ women are more likely to have higher levels of subclinical atherosclerosis if their metabolic phenotype is poor compared with ApoE4+ women without poor metabolic profile and ApoE4- women.