Small Family Size Research Articles

Reckoning females’ education as a determinant of fertility control in Pakistan

PurposeThe purpose of this paper is to obtain empirical evidence on the impacts of socio-economic and demographic factors on the fertility decisions taken by a common family in developing countries like Pakistan. Also, this study contravenes the conventional orthodoxy of childbirth decisions of a family by enlarging the canvas and conjectures the fundamental nexus amongst female’s education, fertility and contraceptive use.Design/methodology/approachThe study is based on micro-level data, obtained from the Pakistan Demographic and Health Survey (2012-2013) which is the third survey carried out in Pakistan. Demographic and socio-economic profiles of 13,558 ever-married women, aged 15-49 years, were randomly selected from Gilgit Baltistan and the four provinces of Pakistan. Three dependent variables are used in empirical analysis i.e. current use of contraceptives, total fertility and cumulative fertility. In order to estimate the probability of contraceptive use maximum likelihood, Probit technique is employed with ordinary least squares on reduced form specifications of total fertility and cumulative fertility models.FindingsThe empirical results proved the hypotheses that educated females practice more family planning through modern contraceptives which leads to a decrease in total fertility rates. Some significant links among females’ education, contraceptive use and fertility define the quantity – quality trade-off and opportunity cost of time. Evidently, female education provides maturity and awareness of family size which is necessary to take crucial economic decisions.Research limitations/implicationsThe empirical evidence suggests that maximum efforts should be made toward women’s education. The current standard of education in Pakistan is not enough to overcome the long-standing problem of excessive child birth. This could be done with the help of public – private partnership as the measures taken by the government alone are insufficient. The government should initiate some adequate measures such as education and awareness about contraceptive usage at the secondary school level that could be a vivacious step to support fertility reduction.Practical implicationsThe framework used in this study provides a broader intra-household income–expenditure approach. With a smaller family size, the household’s income would be shared among fewer individuals. It is highly probable that parents would be more attentive if they need to look after a few children. That is the best way to progress their children with limited resources.Social implicationsFrom the socioeconomic perspectives, educated parents plan the ideal family size which allows them to spend more on their children’s upbringing.Originality/valueThis study captures the magnitude of fertility decisions with the relevance of the wife’s education because the present practice in Pakistan does not allow higher education for married women. This is why this study could be used as a benchmark for further study in the same area.

Changing trends in reproductive/lifestyle factors in UK women: descriptive study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

ObjectiveThere has been considerable interest in the impact of reproductive factors on health but there are little data on how these have varied over time. We explore trends in reproductive/lifestyle...

The Anatomy of the Role of Morphological Awareness in Chinese Character Learning: The Mediation of Vocabulary and Semantic Radical Knowledge and the Moderation of Morpheme Family Size

ABSTRACTIn the present study, the mediating roles of syllable awareness, orthographic knowledge, and vocabulary skills and the moderating role of morpheme family size in the association between morphological awareness and Chinese character reading were investigated with 176 second-grade Hong Kong Chinese children. In the path analyses, the results indicated significant partial mediating effects of semantic radical function knowledge and vocabulary skills but not of syllable awareness and pseudocharacter identification. A significant moderating effect of morpheme family size was also observed. Children with relatively poor compounding structure awareness performed much more poorly in reading Chinese characters that had a small family size. The mediating and moderating effects documented in the present study can help us understand the mechanism involved in the relationship between morphological awareness and Chinese character reading and provide evidence as a basis for modifying current instruction strategies for improving Chinese children’s reading performance.

Household food insecurity and associated factors in West Abaya district, Southern Ethiopia, 2015

BackgroundSubsistence farming in West Abaya district is sited in an area prone to drought. Thus, poor food security is a principal concern. But, this has been less documented. Therefore, this study aimed to determine the magnitude of household food insecurity and identify associated factors in West Abaya district, Southern Ethiopia, 2015.MethodsCommunity-based cross-sectional study was done on 779 households from February to March, 2015. Out of 24 kebeles (lowest administrative units) in the district, 9 kebeles were selected randomly. Then from 9 kebeles, 15 ‘gots’ were selected using probability proportionate to size. Gots are villages in a kebele where a kebele may have up to three of them. Data were collected using pretested structured questionnaire by trained data collectors. The study used a ‘Household Food Insecurity Access Scale’ to measure access component of household food insecurity. Data were entered in Epi Info version 3.5.4 and exported to SPSS version 20.0 for cleaning and analysis. Binary and multivariable logistic regression was used to identify factors associated with food insecurity in the study area.ResultsThe overall prevalence of household food insecurity was 38.1% in the study district. Households headed by female were more likely to be food insecure than households headed by males ‘AOR = 2.1 (95% CI 1.15, 3.74).’ Households headed by persons aged >65 years were 6.5 times more likely of being food insecure compared to household headed by persons aged 18–44 years, ‘AOR = 6.51 (95% CI 3.25, 13).’ The odds of households with larger family size to be food insecure was higher than households with smaller family sizes ‘AOR = 2.4 (95% CI 1.7, 3.5).’ Owning smaller farm land increases the risk of being food insecure nearly by 2 times compared to larger land size ‘AOR = 1.7 (95% CI 1.12, 2.7).’ Besides, households headed by uncoupled were likely to be food insecure than married ‘AOR = 2.6 (95% CI 1.53–4.26).’ConclusionsThis study revealed that household food insecurity was considerable in the study area. Hence, proper attention should be given to increase food production and productivity of the farmers by improving access to farm land, strengthening the efforts of family planning and women empowerment.

Impact of a Multi-Strategy Community Intervention to Reduce Maternal and Child Health Inequalities in India: A Qualitative Study in Haryana.

A multi-strategy community intervention, known as National Rural Health Mission (NRHM), was implemented in India from 2005 to 2012. By improving the availability of and access to better-quality healthcare, the aim was to reduce maternal and child health (MCH) inequalities. This study was planned to explore the perceptions and beliefs of stakeholders about extent of implementation and effectiveness of NRHM’s health sector plans in improving MCH status and reducing inequalities. A total of 33 in-depth interviews (n = 33) with program managers, community representatives, mothers and 8 focus group discussions (n = 42) with health service providers were conducted from September to December 2013, in Haryana, post NRHM. Using NVivo software (version 9), an inductive applied thematic analysis was done based upon grounded theory, program theory of change and a framework approach. Almost all the participants reported that there was an improvement in overall health infrastructure through an increased availability of accredited social health activists, free ambulance services, and free treatment facilities in rural areas. This had increased the demand and utilization of MCH services, especially for those related to institutional delivery, even by the poor families. Service providers felt that acute shortage of human resources was a major health system level barrier. District-specific individual, community, and socio-political level barriers were also observed. Overall program managers, service providers and community representatives believed that NRHM had a role in improving MCH outcomes and in reduction of geographical and socioeconomic inequalities, through improvement in accessibility, availability and affordability of the MCH services in the rural areas and for the poor. Any reduction in gender-based inequalities, however, was linked to the adoption of small family sizes and an increase in educational levels.

Crohn’s disease environmental factors in the developing world: A case-control study in a statewide catchment area in Brazil

AIMTo identify environmental risk factors associated with the development of Crohn’s disease (CD) in order to re-assess the hygiene hypothesis.METHODSA hospital-based, case-control study was carried out with CD patients (n = 145) and controls (n = 163) representing a socioeconomically diverse statewide catchment area in Brazil. Controls were recruited from caregivers of patients seen in different outpatient clinics at the same hospital. A multi-item survey with 94 questions regarding family history of CD, perinatal and childhood circumstances, living conditions, tobacco use and familial socioeconomic status was carried out by interviewers.RESULTSOn the univariate analysis, predictive variables for CD included being male, under age of 40, a high education level, urban dweller, smaller family size, exposure to enteric pathogens and user of treated water (P < 0.005). On the multivariate analysis, variables significantly associated with CD were male gender (OR = 2.09), under age 40 (OR = 3.10), white (OR = 2.32), from a small family in childhood (OR = 2.34) and adulthood (OR = 3.02), absence of viral infections in childhood (OR = 2.23), exposure to enteric pathogens (OR = 2.41), having had an appendectomy (OR = 2.47) and prior or current smoker (OR = 2.83/1.12).CONCLUSIONMost variables supporting the “hygiene hypothesis” are associated with the development of CD but are not independent predictors of the diagnosis.

Impact of health insurance on out-of-pocket health expenditure among inpatients in India

Background Introduction of advanced technologies in health sectors have caused high treatment and diagnostic cost to the patients. In developing countries direct out of pocket expenditure is the principle means to cope up with the great burden of health expenditure. Predominant OOP expenditure in health is indicative of a highly regressive health care system as well as poverty.1Objective To estimate the impact of Health insurance plans on OOP health expenditure in India.Methodology The study used 71st round of National Sample Survey NSS data from January to June 2014 on social consumption section 25.0.With multi stage sampling 65932 households and 333104 persons were selected. OOP expenditure was calculated as the difference between total medical expenditure and the amount reimbursed for a person. Univariate and bivariate analysis was used to see the distribution of health insurance coverage. To investigate the variation in coverage at different level of sampling multilevel logistic regression analysis was performed and intra class correlation coefficient was used. Results Male are more covered by any schemes of health insurance than female. People from smaller family size are more likely to have health insurance than people from bigger families. 18 urban people are under coverage while its only 14 for rural people. 4 of the residual variance in the coverage of health insurance is explained due to the change in state while 5 is explained by the change in FSU village. In OLS model the mean OOP health expenditure is 5058.57 Rs for insured person whereas 6063.55 Rs for an un-insured person.Conclusion It shows a reduction of 5136.97 Rs in OOP expenditure for an insured person compared to an uninsured person. We can say that OLS suppress the effect of health insurance on the incidence of OOP health expenditure.

A Study on Empowerment of Rural Women through Backyard Poultry in Anantapur District of Andhra Pradesh

The present study was conducted to analyze the rearing knowledge and socio economic status of rural women in three selected villages in Anantapur district of Andhra Pradesh on the productivity of the backyard poultry, knowledge improvement of women respondents on poultry rearing and their perception of improved empowerment and income generation. Thirty women beneficiaries were personally interviewed using a questionnaire and supplied 45 Vanaraja chicks (ICAR-PDP) for each individual. In spite of their age, education, social status and income levels, they actively participated in poultry rearing activities under natural conditions in villages with normal facilities at home. It was found that there is considerable increase in egg yield, and body weight gain in kg/year (female and male). The findings of the study revealed most of the poultry rearers (53.00%) were middle aged with primary to secondary level education and small size family. Agriculture as primary occupation.Majority (84.17%) of the respondents were marginal to small land holding and getting low level of income. Majority of the respondents had low level of material possession. The productivity performance of backyard poultry knowledge level of beneficiaries on backyard poultry production technology and perception on empowerment have clearly showed that the backyard poultry rearing had a significant impact towards socio-economic development of the rural women folk in generating more income for leading their families happy.

Multiple regression in fertility and family formation

Background: In the present study, attempt has been made to study the determinants of total fertility rate (TFR), by developing the model for TFR so to use TFR determinants for Family Welfare Planning and Programme implementation. Methodology: Principal component analysis was carried out to study the correlates of TFR of Indian states. Further, regression analysis was carried out to estimate TFR, using relevant determinants by studying its correlates and principal components. Results: Two principal components were: (i) “Social Status of Women” explaining 58% of variation comprised “infant mortality rate” with correlation coefficient (−0.95), “Percentage of Literacy of Female” (0.94), “Life Expectancy at Birth” (0.93), “Age at Marriage of Women” (−0.90), and (ii) “Fertility Index” with 20% of variation explained, comprised “Employment Status of Female” (0.762) and “Desire of no more child after Two Living Children” (−0.759). The regression model for TFR with the coefficient of determination (0.466), using desire of no more child after Two Living Children was arrived, with utility to enhance health education and communication to achieve ideal family formation behavior. All Indian states were classified by the regression model (TFR = 3.58–0.019* “Desire of no more child after Two Living Children”) within 68% confidence interval except two states Mizoram and Meghalaya. Conclusions: 'Desire of no more children after two living Children's' has come out the main stay of family formation behavior. Hence, making realize the value of small family size with health education will stabilize the population.

An Omitted Intellectual Tradition: The Chaianov School on Collective Farming

The Chaianov school’s intellectual legacy is usually associated with the study of the peasant economy and its cooperative development. Chaianov’s so-called “neopopulist ideology” of the development of small-sized family farming is accordingly seen in juxtaposition with the Marxist vision of large-scale collective farming. However, this interpretation misses the original and valuable contribution to the study of collective and large-scale farming made by the members of this school. This article provides a new view on the intellectual heritage of Chaianov and his colleagues by analysing how their writings conceptualized collective farming between 1913 and the mid-1960s. It will argue that the Chaianov school made a profound contribution to the study of both peasant and kolkhoz farming. Therefore, it is necessary to re-evaluate the intellectual legacy of this school.

Fertility Transitions in Ghana and Kenya: Trends, Determinants, and Implications for Policy and Programs

As a continent with 54 independent states Africa’s diversity is often highlighted but frequently forgotten when fertility is discussed. Fifty and more years ago to consider that all African countries and societies had a single fertility pattern (large numbers of children) and single trend (unchanging over time) was a valid characterization. Since the 1960s however that uniformity has disappeared replaced by substantial inter- and intra-country differences in fertility patterns and trends that render previous perceptions of continent-wide homogeneity obsolete. In this chapter we consider two African countries—Ghana and Kenya—whose fertility patterns and trends and their determinants have been well documented (Bongaarts 2008; Garenne 2008; Machiyama 2010; Shapiro and Gebreselassie 2008; Sneeringer 2009). Both countries have benefited from regularWorld Fertility Surveys (WFS) and Demographic and Health Surveys (DHS) that record trends in fertility family planning (FP) and other relevant indicators. The recently introduced Performance Monitoring and Accountability 2020 (PMA2020) surveys monitor progress since 2012 for the FP2020 initiative and occasional Situation Analysis and Service Provision Assessment surveys have also detailed the readiness of the health system in both countries to make quality FP services available. Ghana and Kenya share some common history: both have relatively strong health system legacies from the period of British colonialization; both were among the earliest countries to achieve independence; they were the first two African countries that developed policies to address population growth in the 1960s; and both have received substantial and sustained resources over several decades from many external donors and technical assistance organizations explicitly intended to increase the availability and quality of family planning services. However they are composed of cultures that are both diverse within each country and markedly different in many ways between the two countries. The two countries demonstrate remarkably different pathways in fertility and family planning patterns and trends from the 1970s to the present. We highlight some of the key differences and similarities explain why they have occurred and identify insights that could inform a wider understanding of fertility transitions and the role of family planning in other African countries. (excerpt)

Grandchildren as Support and Care Providers to Disabled Older Adults in China

Abstract Increased life expectancy in China implies that adults increasingly survive long enough to see their grandchildren reach adulthood and take on elevated importance—even as smaller family size reduces the number of children and grandchildren available. This article examined the prevalence with which older adults received support and care from grandchildren and the family conditions under which the likelihood of this assistance is enhanced. The data for our analysis derived from the 2014 wave of the Chinese Longitudinal Aging Social Survey, limited to 13.4% of respondents (n = 1,551) who reported requiring personal assistance to perform daily activities. Logistic regression revealed that grandparents were more likely to receive assistance from grandchildren when they had no son available or had daughters who did not provide assistance. Results were consistent across urban and rural regions. These findings support the compensatory or substitution role of grandchildren as sources of support and care for their grandparents within a gendered family system. Implications for policies and services serving older people in China are discussed.

Risk Factors for Behavioral and Emotional Difficulties in Siblings of Children With Autism Spectrum Disorder.

This study examined risk factors for behavioral and emotional problems in 1973 siblings of children with autism spectrum disorders (ASD). Results revealed six correlates of sibling internalizing and externalizing problems: male gender, smaller family size, older age of the child with ASD, lower family income, child with ASD behavior problems, and sibling Broader Autism Phenotype. Siblings with few risk factors were at low risk for behavioral and emotional problems. However, siblings with many risk factors were at increased risk for both internalizing and externalizing problems. These results highlight the need to assess risk for individual siblings to best identify a sub-population of siblings who may be in need of additional support.

Prenatal sex selection and female infant mortality are more common in India after firstborn and second-born daughters

BackgroundThe Indian sex ratio has become highly male-biased in recent decades. This may be attributed to prenatal sex selection (PSS) and excess female infant mortality. However, the question of whether...

Appropriate complementary feeding practices and associated factors among mothers of children age 6-23 months in Southern Ethiopia, 2015.

BackgroundPoor complementary feeding of children aged 6–23 months contributes to the characteristics negative growth trends and deaths observed in developing countries. Evidences have shown that promotion of appropriate complementary feeding practices reduces the incidence of stunting and leads to better health and growth outcome. This study was aimed at assessing practices of complementary feeding and associated factors among mothers of children aged 6–23 months.MethodsA community-based cross sectional study design was conducted among 611 mothers who had children with 6–23 months of age in the ten randomly selected Kebeles (smallest administrative unit). A multistage sampling technique was used to identify study subjects. Data were collected using pre-tested structured questionnaire. Data were entered in to Epi info version 3.5.1. Data cleaning and analysis were done using SPSS version 16. Odds ratios (ORs) with 95 % confidence interval (CI) were computed to measure the strength of association.ResultsThe response rate was 97.6 % (611/626). The practices of timely initiation of complementary feeding, minimum meal frequency and minimum dietary diversity were 72.5, 67.3 and 18.8 % among mothers of 6–23 months aged children, respectively. The practice of appropriate complementary feeding was 9.5 %. Child’s age (12–17 and 18–23 months) [Adjusted OR: 2.75 (95 % CI: 1.07 7.03), 2.64 (95 % CI: 1.06 6.74)], educational level of mother (primary and secondary and above schools) [AOR: 3.24 (1.28 8.20), 3.21 (1.1.07 9.70)], and smaller family size [AOR: 12.10 (95 % CI: 1.10 139.7)] were found to be independent predictors of appropriate complementary feeding practice of 6–23 months old children.ConclusionLow appropriate complementary feeding of children aged 6–23 months was observed. Mothers who are illiterate, children age 6–11 months and families with large size were associated factors for inappropriate feeding practices. Therefore, nutritional counseling on child feeding practices were recommended.

Epidemiology of Childhood Asthma in Fayoum City (District) Egypt

Asthma is a major public health problem worldwide. There was a sharp increase in the global prevalence of asthma over the last two decades. Few studies evaluated asthma prevalence in Egypt. Determination of the prevalence of bronchial asthma among school children aged 6-12 years old in Fayoum city (distrect) and identification of the risk factors associated with asthma. A questionnaire-based study conducted in the period from Feb to April 2013. We used a modified written International Study of Asthma and Allergies in the (ISAAC) questionnaire (phase I) translated into Arabic language. We added questions dealing with risk factors of asthma. We distributed 2872 questionnaires in this study which was conducted on (10) primary schools included both rural and urban areas. The subjects of the study were selected by multistage random sample technique. Out of the 2872 questionnaires, only 1656 questionnaires were returned only 103 children fitted the diagnosis of asthma. The prevalence of asthma in Fayoum city (district) 6.3%. was noted in females, high socioeconomic states and small family size. The main risk factors were: the first and second birth order, overcrowding at homes, high socioeconomic status, and small family size. Respiratory tract infections, exercise, smoking, house dust mites, diet, animal and allergens were the main precipitating factors for asthmatic attacks. The prevalence of bronchial asthma among primary school children aged 6-12 years old in Fayoum district, conducted in the year 2013, was 6.3% and was equally distributed among rural and urban areas.

Factors Influencing the Desired Number of Children Among Married Women in the Reproductive Age and its Implications for Policy Making

Background: Desired number of children is one of the main indexes showing the fertility preferences of couples. This issue is currently more important as Iranian policy makers are revising population policies to improve fertility rate. Objectives: As a result, the main goal of this study was to investigate factors influencing the number of desired children among married women in the reproductive age. A theoretical framework was constructed based on demographic transition theory, demand-supply theory and diffusion theory. Methods: This study was a quantitative research and its research technique was survey. The population of the study included all married women at the reproductive age (15-49), who were living in Shiraz County (Shiraz city and surrounding rural areas). Data was collected by interviews with 626 women, who were selected by multi cluster sampling and purposive sampling during year 2014. Data was analyzed by the SPSS (version 22) software. Results: The findings showed that the desired number of children both in Shiraz city and its surrounding rural areas was exactly below the replacement rate. In addition, findings of this study demonstrated that the desired number of children as a dependent variable is affected by a set of socioeconomic and cultural factors. Results have revealed that the main predictors are couple agreement on the number of children, respondents’ income, son preference, respondents’ authority and ethnicity. Conclusions: Overall, the variables considered in the research model explained only 32.7% of change in the dependent variable. This means that 67.3% of change in the number of desired children is related to factors that are not included in the research model. Moreover, most of the women in Shiraz County desired to have a small family size and this fact can result in further decline of fertility rates in the future because couples respect their desires in fertility. As a result, it is recommender for policy makers to pay more attention to factors influencing the desired number of children.

An Audit on Adequacy of Pap Smears

Conventional Pap smear is a commonly done screening test for cervical cancer. Accurate interpretation depends upon the specimen adequacy which is considered to be the single most important quality indicator of “The Bethesda System (TBS)”. To audit specimen adequacy and compare results based on 2014 TBS. Retrospective audit from 1 April to 31 December 2015. Data was collected from case notes and Pap smear reports. A total of 146 Pap smears were done during the study period. Majority of the women (34 %) were between 41 and 50 years. Fifty-five per cent had a small family size of two children. Seventy-six per cent were premenopausal while 34 % were post-menopausal. Transformation zone/endocervical component (TZ/EC) was seen in 87 % of smears. Blood was seen in 2.7 % and inflammatory cells in 59.6 % of smears. All smears were satisfactory for interpretation by the cytologist. In the final interpretation, atrophic smears were seen in 2/146 (1.4 %), low-grade epithelial abnormality and high-grade abnormality were seen in one smear each (0.7 %). Colposcopy and directed biopsy were normal in both. A total of 43.8 % were normal. A total of 53.4 % were inflammatory. In this audit, 100 % smears were satisfactory for interpretation and above the literature standard of 99.5 %.

A Buddhist application of corporate social responsibility: qualitative evidence from a case study of a small Thai family business

The impact of religion on corporate social responsibility (CSR) engagement has received a great amount of research attention. However, little is known about what and how specific core values of Buddhism influence CSR engagement in the family business setting in Thailand. To explore this gap, we employ a single-case study approach focusing on Chug Yont Engineering Co., Ltd, a small-sized family company in the context of Thailand where Buddhism plays a vital role in people’s personal and organizational practices. Our qualitative findings suggest the following: first, Kamma, as the core value of Buddhism, has a strong impact on how the owner articulates his business philosophy; second, the owner’s business philosophy affected by Kamma in Buddhism has led to several external and internal stakeholder CSR initiatives undertaken by the company; finally, the company’s CSR initiatives have directly and indirectly contributed to improved company reputation, lowered employee turnover, and reduced competitive intensity.

Impacts of community based fisheries management (CBFM) on the livelihood of fishers at Sherudanga beel in Rangpur District, Bangladesh

Community Based Fisheries Management (CBFM) approach appears to be an important factor in managing fisheries successfully. Thus, this study aims to investigate and evaluate the fisheries management practices and its impact on the livelihood of the fisheries community of Sherudanga beel in Rangpur district (Bangladesh) for a period of 12 months, from March 2010 to February 2011. The study was conducted based on Community Based Fisheries Management (CBFM) practices, beel biodiversity, fish production, socio-economic and livelihood condition of the fishermen community. The studied beel is 83 acre seasonal floodplain, which was mainly used by a community consisting of 80 families for their livelihood, where the CBFM approach was introduced by the community. At pre-CBFM, there was no controlled management system from any NGO or even Government for the proper management of the beel. Recently, community fishers leased out this beel from the government in year 2000 for 12 years and started to manage it. The CBFM project works for the development of fishery system, the fishermen community and the general society. &nbsp;&nbsp;The yearly gross fish production was higher than pre-CBFM period, implying that average abundance and fish biodiversity were significantly higher in the CBFM implemented beel. Majority of the fishermen had primary level education (37.5%) compared to 27.5% and 16.5% having secondary level and above secondary level education respectively, while 18.75% of them could sign their name only, indicating the improvement of education level among fishers. About 43.75% of them had small size family, while 40.0% and 16.25% had middle and large size families respectively. The prevalence of unconstructed house was the highest (77.5%) while few of them (22.5%) had semi constructed house. About 68.75% of the fishermen had medium income, while 12.5% and 18.75% had small and large income respectively. More than half (56.25%) of the fishermen received credits from different sources while rest (43.75%) of them did not get any credits. In conclusion, the overall findings showed that community based fisheries management has significantly increased annual fish production, lifted household income levels, improved access to credit from a wide range of sources and enabled livelihood diversification.