South Sudan Research Articles

Cost effectiveness and return on investment analysis for surgical care in a conflict-affected region of Sudan.

The delivery of healthcare in conflict-affected regions places tremendous strains to health systems, and the economic value of surgical care in conflict settings remains poorly understood. Our aims were to evaluate the cost-effectiveness, societal economic benefits, and return on investment (ROI) for surgical care in a conflict-affected region in Sudan. We conducted a retrospective study of surgical care from January to December 2022 at the Mother of Mercy-Gidel Hospital (MMH) in the Nuba Mountains of Sudan, a semi-autonomous region characterized by chronic and cyclical conflict. We collected data on all patients undergoing surgical procedures (n = 3016), including age, condition, and procedure. We used the MMH budget and financial statements to measure direct medical and non-medical expenditures (costs) for care. We estimated the proportion of expenditures for surgical care through a survey of surgical vs non-surgical beds. The benefits of care were calculated as averted disability-adjusted life-years (DALYa) based on predicted outcomes for the most common 81% of procedures, and then extrapolated to the overall cohort. We calculated the average cost-effectiveness ratio (CER) of care. The societal economic benefits of surgical care were modeled using a human capital approach, and we performed a ROI analysis. Uncertainty was estimated using sensitivity analysis. We found that the CER for all surgical care was $72.54/DALYa. This CER is far less than the gross domestic product per capita in the comparator economy of South Sudan ($585), qualifying it as very cost-effective by World Health Organization standards. The total societal economic impact of surgical care was $9,124,686, yielding a greater than 14:1 ROI ratio. Sensitivity analysis confirmed confidence in all output models. Surgical care in this conflict-affected region of Sudan is very cost-effective, provides substantial societal economic benefits, and a high return on investment.

The indispensable function of agricultural cooperatives in South Sudan

AbstractMost of South Sudan's rural population ekes out a living from farming in a fragile context characterized by compounding and interrelated shocks. The productivity of maize, a key staple, has remained comparatively low. South Sudan is currently transforming its agricultural sector to be at the centre of its economic activity. Programming has zoomed in on seed‐related interventions. Cooperatives, which are longstanding and widespread in the country, are leveraged to distribute seed and, by mitigating production risk, could contribute to resilient development. To shed light on the key functions of cooperatives and how their role can be enhanced, we analysed recent data from 1247 maize‐producing households and 126 agricultural cooperatives from South Sudan. We find that through their services cooperatives contribute to both increasing maize yields and reducing their variability. Yield increases associated with seed production and/or distribution services are substantial but exclusive to members. Managerial capital in the form of a hired manager instead also generates spillover effects to the broader community. Our findings point to the relevance of cooperatives as indispensable stakeholders for the resilient development of the country and the need for investments to strengthen their managerial capital and enhance the provision of services related to seed production and/or distribution.

Returning to fund refugeehood: dispersal and survival between Uganda and South Sudan

ABSTRACT Return movements of refugees, even when gradual or temporary, are typically understood as part of a process of full repatriation or as a ‘strategy’ for leveraging socio-economic opportunities across borders. However, for some refugees, return is neither a step towards repatriation nor an empowering strategy. Drawing on qualitative and quantitative data from Uganda and South Sudan, this article shows how, due to gradual reductions in aid and the lack of livelihood opportunities in Uganda, South Sudanese refugees travel back to their homeland in order to financially support their relatives who remain in exile. These return movements and the phenomenon of split households among South Sudanese are responses to severe hardship and, paradoxically, are deployed to sustain their life in Uganda. While cross-border migration enables refugees to access subsistence opportunities, this article argues that it underscores how refugees must now find their own means to ‘fund’ their refugeehood, given ongoing reductions in international assistance for protracted displacement.

Safety of hepatitis E vaccine in pregnancy: an emulated target trial following a mass reactive vaccination campaign in Bentiu internally displaced persons camp, South Sudan

Epidemic forms of hepatitis E cause high mortality among pregnant people, with case fatality risks over 30% and adverse fetal outcomes. In 2022, the first mass reactive vaccination campaign against hepatitis E was conducted in South Sudan with the HEV239 vaccine. We aimed to assess whether vaccination against hepatitis E in pregnancy increases the risk of fetal loss in a cohort of vaccinated and unvaccinated pregnant people. In this emulated target trial, an exhaustive pregnancy census was conducted in Bentiu internally displaced persons camp after the second of three vaccination rounds. Women and girls aged 14-45 years with no current jaundice or acute illness were eligible for participation. Individuals who consented were revisited 28 days after their delivery date to document the pregnancy outcome. We used an emulated target trial framework to address biases inherent in observational studies. We matched vaccinated to unvaccinated participants on age, gestational age, and vaccination propensity score and estimated cumulative incidence functions for fetal loss in vaccinated compared to unvaccinated women in a competing risks framework using the Aalen-Johansen estimator. Between May 16 and June 30, 2022, 3421 participants were enrolled and followed up for inclusion in analysis. Among 2741 women who had a pregnancy outcome after the start of the vaccination campaign, 67 (2·4%) were vaccinated before conception, 2036 (74·3%) were vaccinated during pregnancy, and 638 (23·2%) were not vaccinated. Among the 2407 women retained in the matched analyses, the cumulative risk of fetal loss among individuals vaccinated during pregnancy was 7·2% (95% CI 5·6-8·7) compared with 6·1% (3·7-9·2) among unvaccinated individuals, implying a risk ratio of 1·2 (95% CI 0·7-1·9). No evidence of increased risk of fetal loss was found among individuals vaccinated during pregnancy. Médecins Sans Frontières.

Pre- and post-harvest aflatoxin contamination and management strategies of Aspergillus spoilage in East African Community maize: review of etiology and climatic susceptibility.

Globally, maize (Zea mays L.) is deemed an important cereal that serves as a staple food and feed for humans and animals, respectively. Across the East African Community, maize is the staple food responsible for providing over one-third of calories in diets. Ideally, stored maize functions as man-made grain ecosystems, with nutritive quality changes influenced predominantly by chemical, biological, and physical factors. Food spoilage and fungal contamination are convergent reasons that contribute to the exacerbation of mycotoxins prevalence, particularly when storage conditions have deteriorated. In Kenya, aflatoxins are known to be endemic with the 2004 acute aflatoxicosis outbreak being described as one of the most ravaging epidemics in the history of human mycotoxin poisoning. In Tanzania, the worst aflatoxin outbreak occurred in 2016 with case fatalities reaching 50%. Similar cases of aflatoxicoses have also been reported in Uganda, scenarios that depict the severity of mycotoxin contamination across this region. Rwanda, Burundi, and South Sudan seemingly have minimal occurrences and fatalities of aflatoxicoses and aflatoxin contamination. Low diet diversity tends to aggravate human exposure to aflatoxins since maize, as a dietetic staple, is highly aflatoxin-prone. In light of this, it becomes imperative to formulate and develop workable control frameworks that can be embraced in minimizing aflatoxin contamination throughout the food chain. This review evaluates the scope and magnitude of aflatoxin contamination in post-harvest maize and climate susceptibility within an East African Community context. The paper also treats the potential green control strategies against Aspergillus spoilage including biocontrol-prophylactic handling for better and durable maize production.

E-Tendering and Performance of Humanitarian United Nations Agencies and Non-Governmental Organizations in South Sudan

Purpose: Manual procurement processes are expensive in terms of human resource cost, purchasing cost, wastage due to errors of commission or omissions, cause of delays in delivery of goods, services, and works which accounts for 40% of losses due to inefficiencies, and attracts corruption in the system amongst others. The study aimed to assess the effect of e-tendering on performance of humanitarian United Nations agencies and non-governmental organizations in South Sudan. Methodology: The study methodology adopted an explanatory research design of cross-sectional type for the population under study. There were over 235 National Non-governmental organizations, 150 International organizations in addition to over 15 United Nations agencies, bringing the total target population to 400 organizations. This study targeted 400 humanitarian organizations operating in South Sudan. Therefore, the sample size of 200 humanitarian organizations operating in South Sudan was selected using a stratified random sampling technique. Data was collected using structured questionnaires and analyzed using descriptive and inferential statistics. Results: Reliability findings indicated that e-tendering had a Cronbach Alpha Coefficient of 0.873, and performance had 0.859. The study established that e-tendering had a positive and significant relationship with performance significant (β=0.282, P=0.000). Conclusion: The study concluded that e-tendering has a positive and significant effect on performance of humanitarian United Nations agencies and non-governmental organizations. This study hence suggested that all NGOs and humanitarian agencies should ensure they adopt the use of e-tendering in their solicitation and sourcing processes in conducting procurement activities. The study cited advantages such saving time, wide coverage of markets and reaching more potential suppliers and finally save environment from printing more paper works attaining sustainable procurement practice.

Checklist and prioritization of crop wild relatives in Sudan and South Sudan

Crop wild relatives (CWR) encompass wild plant species or subspecies closely related to domesticated crops. This study presents the first comprehensive checklist and prioritized inventory of CWR for Sudan and South Sudan. Building on the regional CWR list for Northeast Africa, we identified 499 CWR taxa belonging to 44 families, with 90% of these being native species. The most prominently represented families were Poaceae (148), Fabaceace (72) and Convolvulaceae (43), while Panicum (32), Eragrostis (27), Ficus (24) and Pennisetum (20) were the most frequent genera. A prioritized inventory of 85 CWR taxa was developed based on three criteria: economic value, utilization potential and threat status. The prioritized CWR are predominately native (78%) and encompass 12 families dominated by Poaceae (38), followed by Solanaceae (9), Fabaceae (6) and Cucurbitaceae (6). Priority genera included 27, with Digitaria (17), Solanum (9) and Cucumis (5) emerging as key genera for conservation attention. This comprehensive national CWR inventory provides a crucial foundation for developing targeted conservation strategies in Sudan and South Sudan.

Reading Comprehension Activities in the Ugandan English as a Foreign Language Classroom

The study examines the reading comprehension activities in the Ugandan English as a Foreign Language (EFL) classroom. It particularly analyses the activities that the learners of EFL participate in as part of their reading comprehension lessons. The study focusses on EFL learners from countries such as Congo, Eritrea, South Sudan, and Ethiopia, among others studying in Ugandan adult language schools. The specific objectives of the study were to identify the reading comprehension activities in the Ugandan EFL classroom and to establish the learners’ response to the reading comprehension activities used in the EFL class. Drawing on the transactional theory, the study analyses the reading comprehension activities and the learners’ response to them. The findings indicate that the most profound activities in the classes were pre-reading activities. In their order of frequency, pre-reading activities were the most profound in the classes observed, followed by while-reading and the post-reading activities, which were the least used. In the classes where reading activities were used, they excited the majority of the EFL learners and they paid attention to the lesson. The learners’ response to the activities was diverse with the majority expressing interest in the activities as others chose not to participate at all. The study recommends the use of more reading comprehension activities especially at the while- and post-reading comprehension stages of the lessons which were lacking in most of the classes observed. It further recommends involving the learners and putting into consideration their views during the identification and selection of reading comprehension activities to ensure their maximum participation in the reading comprehension activities

Luo Cultural Shrines: The Hembko of Got Ramogi, Kenya

Got Ramogi in Kenya is a hill shrouded with many mysteries and awe-inspiring cultural beliefs and practices. He hill has attracted the interests of archeologists, geologists, historians, ethnographers, foresters, herbalists, worshippers, politicians and tourists in equal measure. Ramogi Ajwang’, the founder father of the Luo nation, is believed to have settled on the strategichill when his people arrived in Kenya through Uganda from the southern Sudan. The objective ofthe study was to establish the number of cultural sites and shrines (hembko) at the hill, the cultural beliefs and practices associated with them, and the spiritual significance of each shrine on the spirituality and he future of the Luo community in Kenya and the diaspora. The information discussed in his paper was obtained through internet library research using the Google search engine. Google is considered to be the most popular and the best search engine due to its advanced algorithms and vast database. The search was able to identify nine (9) cultural shrines or hembko in Dholuo. Each of these shrines had unique name and function in the cultural and spiritual heritage of the people. The Luo offered spotless animal rituals to their God Nyasaye to propitiate or placate the supernatural world for continued prosperity and posterity. Further research should be conducted on Ramogi Hill to discover even more unearthed shrines.

Renewable energy: A way out for South Sudan’s electricity crisis

South Sudan is one of the least electrified countries in the world, despite having abundant renewable energy resources that could be exploited to generate electricity. The country relies on imported diesel for electricity generation, besides having limited focus on renewable energy development. This policy brief sheds light on the potential of renewable energy as a solution to South Sudan’s ongoing electricity crisis. It examines the key factors hindering the development of renewable energy resources for electricity generation in the country. The brief also provides recommendations to the Government of South Sudan, policymakers, experts, and funding institutions on how to improve electricity access in the country. It is stressing on the importance of prioritising the development of diverse renewable energy resources, such as solar, wind, and small hydropower, as an immediate solution to the electricity access challenges in the country.

Breaking from the past? Environmental narratives, logics of power, and the (re)production of food insecurity in South Sudan.

Skyrocketing commodity prices and conflict-induced mass hunger in recent years have resuscitated discussions about why famines frequently reoccur in specific spaces of vulnerability. Intervention efforts still too often isolate food (in)security from its interwovenness in the political economy of water and energy and from the role of ideas in forging these interconnections across long time periods. Using (South) Sudanese history to rethink the causes of recurrent food insecurity, we underscore the need to analyse how political elites imagine the role of the water-energy-food nexus and associated environmental narratives in consolidating power. South Sudan's 2011 secession (from Sudan) marked the culmination of a struggle against a state that insurgents regarded as having starved its citizens. However, since independence, its leaders have replicated the nostrum they once combatted: Sudanese resources must 'feed the world'. A fixation with inserting water, energy, and food resources into global markets infuses their strategy, even if such an approach will not engender food abundance.

Politics of International Oil Companies (IOCs): Understanding PETRONAS Carigali Nile Ltd Exit From South Sudanese Oilfields

The study has examined the politics of the International Oil Companies (IOCs), the case study of PETRONAS Carigali Nile Ltd. It does this by appraising the legal violations of PETRONAS Carigali Nile Ltd exit and farming out from South Sudanese oilfields. The study explains the politics of IOCs and particularly, PETRONAS Carigali Nile Ltd as dependent variable and independent variables such as legal violations of Petronas Carigali Nile Ltd, types of residual liabilities and responsibility of these liabilities.The study was subjected to stringent empirical literature review and the gaps in the literature were filled through fieldwork. During fieldwork, the methodology of research tools and instruments such as questionnaires and interview guides/schedules were deployed with target of 52 respondents. Persuasive and cluster type of sampling amongst the senior staff of Ministry of Petroleum (MOP), Nile Petroleum Corporation (NILEPET), Dar Petroleum Operating Company (DPOC), Sudd Petroleum Operating Company (SPOC) and Greater Pioneer Operating Company (GPOC) were applied. The study findings indicate that PETRONAS Carigali Nile Ltd has politicized and violated sections 12, 22, 23, 24, 41 & 42 of the Petroleum Act 2012. Various types of liabilities such as cost recovery audits, environmental audit, petroleum taxes, surface rentals, and cash calls should be taken care off by Petronas Carigali Nile Ltd or by a company that farms into its shares. While the study concludes that PETRONAS Carigali Nile Ltd exit and farming out has been politicized and violated the laws of the Republic of South Sudan, the study recommends that the Ministry of Petroleum should be held responsible for all the legal violations Petronas Carigali Nile Ltd have committed in South Sudan without any action. Whether Savannah Energy Ltd farms into Petronas Carigali Nile Ltd shares or not after the PETRONAS has exited, consequences should be rolled out for such violations so that no any other IOC can do it again in the near future in this volatile oil and gas industry.

Environmental changes in South Sudan are changing the fabric of people’s lives and steering humanitarian operations

Environmental changes in South Sudan are changing the fabric of people’s lives and steering humanitarian operations

Music and the politics of famine: everyday discourses and shame for suffering.

Understanding the politics of famine is crucial to understanding why famines still occur. A key part of this is how famine is remembered, understood, and discussed. This paper focuses on songs popular among communities that have recently experienced deadly famine. Contemporary famines almost always manifest in armed conflict contexts, where there is limited political freedom. Here, songs and music can be an important way to debate sensitive political issues. This paper focuses on the way that songs and music shape 'regimes of truth' around famine, and who is shamed and held accountable for associated suffering. It is based on long-term ethnographic research, the recordings of famine-related songs, and collaborative analysis in Jonglei and Warrap States (South Sudan) in 2021-24. The paper shows how songs can mock soldiers for their seizing of assets during times of hunger and how they can create familial shame for famine suffering, shifting responsibility away from the real causes to family members.

Influence of Leadership Styles on Performance of Local Government Agencies: Case of Central Equatoria State Local Government in South Sudan

An organization's success depends on successful leadership and good organizational culture. This study investigates the influence of various leadership styles on the performance of local government agencies in Central Equatoria State, Juba, South Sudan. It explores how transformational, transactional, and laissez-faire leadership styles influence the performance of the central Equatoria state local government. The general objective of the study was to examine the influence of various leadership styles under the long-range leadership model on the performance of the central Equatoria state local government. The specific objectives of the study include the following: To assess the influence of transformational leadership style on performance of the central Equatoria state Local Government, to establish the influence of transactional leadership style on performance of the Central Equatoria state Local Government and to examine influence of laisses-faire leadership style on performance of the Central Equatoria state Local Government. The research employed a descriptive design, targeting 791 individuals, including local government officers and leaders from public institutions. A sample of 138 respondents was selected through stratified random sampling, and data was collected via questionnaires, interviews, and document analysis. To ensure validity of the finding, the researcher performed a pilot study on the data collection and analysis instruments in Juba County. This was done to guarantee the instrument's content coverage and authenticity by enhancing problems, the format, and the measuring scales. the researcher ensured protection of the research process to ensure reduction of anomalies, inaccuracy and scoring in the measurements to guarantee reliability of the data obtained. This research was focused on both primary and secondary data. Questionnaires was used as the main tool of data collection supported by both physical and telephone interview. Analysis of reports published on newspapers and internet was as well done. The study utilized the full range leadership model by James MacGregor Burns (1985) and Bernard M. Bass (1985), which encompasses transformational, transactional, and laissez-faire leadership styles. The findings revealed that both transformational and transactional leadership styles are not widely practiced by the CESLG Leaders and had limited impact on performance of the central Equatoria state local government while laissez-faire leadership being the most practiced style, significantly influenced poor performance outcomes of the central Equatoria state local government and it’s one of the reasons for the poor performance of the CESLG institutions. As such the researcher recommend among others, the following to both the CESLG leaders and other stake holders for implementation; The CESLG leaders need to consider recruiting young and well-educated local government officer as the study revealed that majority 48.8% of the local government officials are aged between 51 to 60 years whose performance are average , the local government leaders need to consider initiating executive training and development Programme for local government officers, The CESLG leadership is advised to conduct regular performance review for its institutions and staff. the CESLG leaders and other stakeholders/institutions are encouraged to adopt modern leadership styles such as transformational and transactional in their management styles.

Forced Displacement, Gender, and Livelihoods: Refugees in Ethiopia

This study uses the Ethiopia Skills Profile Survey (2017) to examine the gender differences in livelihood opportunities and activities between refugees and host communities. The results show a significant gender gap in participation in the labour market where refugee and host women are less likely to have employment, and that household characteristics influence women’s economic opportunities. While having a female household head, access to agricultural land, and additional female adults increase both refugee and host female’s participation in economic activities, higher numbers of children in the household significantly reduce refugee women’s opportunities. In addition, higher educational attainment boosts both male and female refugees’ participation in wage employment. Among refugees, both female and male Somali refugees have relatively better access to employment opportunities compared to other refugee groups, especially refugees from South Sudan and Sudan.

Beyond Hunger: Assessing Influence of School Feeding Programmes on Primary Education Enrolment Rate in Twic East County, South Sudan.

School feeding programmes attract learners in developing countries, improves enrolment rates, academic performance, nutrition and participation. However, challenges like persistent hunger and food scarcity greatly impede their ability to learn and grow. Therefore, in this paper we investigate the influence of school feeding programme on learners' enrolment rates in primary education in Twic East County, Jonglei State, South Sudan. The paper employed descriptive survey design, the sample size was 371 respondents who included; County Education Director (CED,1), Headteacher (10), Teachers (30), Leaners (300), and Parents (PTA, 30). The paper primarily collected data through questionnaires and interviews. The study established that 90% of head teachers, 97% of teachers, 87% of learners, 96% of parents, and one CED acknowledged the presence of the School Feeding Programme (SFP) and meals in primary schools. The paper established that School feeding programmes (SFP) during education in emergencies (EiE) had a positive effect on enrolment rate in primary education in Twic East County, Jonglei State, South Sudan. The paper recommends the upscaling of school feeding programmes to other schools to enhance learners’ participation and academic performance in South Sudan.

Institutional Logic of Fragile States: Afghanistan and South Sudan in Comparative Perspective

ABSTRACT In the violence trap framework, ruling elites use rents to control contending elites who pose a violent threat. Political development results in transitions from a fragile state, wherein rents are tentative and personalized, to a basic natural state, and then a mature natural state, through standardization of elite privileges, consolidated state control of the political-military apparatus, and the enactment of a credible contracts regime. Accordingly, the institutional logic of fragile states is rooted in the incentives that undergird elite bounded rationality, transacting under highly personalized, tentative patronage networks. The paper addresses the question of why fragile states fail to develop into basic natural states. In doing so, it applies the violence trap analytical framework to illustrate the logic of the fragile state through a most different systems (MDS) comparison of Afghanistan and South Sudan. The main finding is that the institutional logic of the fragile state in the two cases is rooted in a lack of three necessary conditions: institutional incentives for broadening elite consensus, credible patronage agreements among different elite groups, and a consolidated state with specialized political and military functions.

Usability of a digital tool to support long-lasting insecticide net distribution in Northern Bahr el Ghazal State, South Sudan.

Long-lasting insecticidal nets (LLINs) have been a widely used malaria prevention method for decades. In South Sudan, LLINs are typically distributed by volunteers who use paper-based systems to collect distribution data. Paper-based systems are simple to use but have a higher occurrence of data inaccuracies and can hinder the timely use of data for decision-making. In 2022, a digital tool was introduced to collect data during the LLIN campaign in Northern Bahr el Ghazal (NBeG). The tool aimed to improve the accuracy of data entry and enable data to be used in real-time for decision making during the campaign. The digital tool was developed with offline functionality and interoperability with DHIS2 tracker version 2.8 in DHIS2 version 2.38. This study assessed the usability of the tool according to user perspectives. A questionnaire containing open- and closed-ended questions was conducted with users of the digital tool, supervisors and other key stakeholders in five counties of NBeG. The questionnaire was administered using Malaria Consortium's Projects Results System Android mobile application. Usability was determined through a modified and validated System Usability Scale (SUS) approach. A total of 93 participants responded to the usability questionnaire. The mean (± standard deviation) usability score across 10 SUS-scoring items was60.91 (12.87), indicating a modest level of usability. The majority of users agreed the tool was useful for managing the LLIN distribution workflow, was easy to use, reduced workload, and supported stock management and real-time campaign monitoring. There was no significant difference in the usability scores across genders, roles, and counties. Respondents with experience of both paper-based and the digital tool tended to express a preference for the digital tool over paper-based systems. The majority of respondents also reported they would recommend the digital tool to colleagues. Digital tools are perceived to improve data collection during LLIN campaigns, even in remote areas where network coverage is challenging. Additional improvements can be implemented to overcome operational challenges and improve usability of the tool. Further study is needed to assess the impact of the digital tool on data quality and real-time data use.

Combat readiness, alcohol abuse, and posttraumatic stress disorder among Uganda peoples’ defence forces soldiers

BackgroundThis cross-sectional study assessed combat readiness, alcohol abuse and post-traumatic stress disorder (PTSD) among Uganda Peoples’ Defense Forces (UPDF) soldiers returning from Operation Lightning Thunder (OLT) in South Sudan and Central African Republic.MethodsOne hundred fifty participants recruited from UPDF soldiers who had recently withdrawn from OLT, and were based in Singo Peace Support Operation School were screened for combat readiness, alcohol abuse and PTSD. The Perceived Combat Readiness Questionnaire, Alcohol Use Disorder Identification Test, and PTSD checklist military version were used to measure the variables. Inferential analyses were performed to determine the association between combat readiness, alcohol abuse, and PTSD, while controlling for sociodemographic factors.ResultsWe found that 16% of UPDF soldiers met positive screening results for PTSD, and 21% met the positive screening results for moderate substance use disorder. UPDF soldiers who benefited from combat readiness were less likely to develop PTSD or alcohol abuse. Our results showed a mediating effect of alcohol abuse on combat readiness and PTSD among soldiers with UPDF.ConclusionOur results highlight the high rates of PTSD and alcohol abuse among UPDF soldiers returning from military deployment. These findings provide insight into the role of combat readiness in reducing the risk of alcohol abuse and vulnerability to PTSD in the aftermath of military deployment.