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This paper provides an extensive case study of the Turkish automotive and the consumer electronics industries. Despite a macroeconomic environment that inhibits investment and growth, both industries have achieved remarkable output and productivity growth since the early 1990s. Although there are similarities between the performances of the two industries, there are significant differences between their structures, links with domestic suppliers, technological orientation, and modes of integration with the global economy. The automobile industry is dominated by multinational companies, has a strong domestic supplier base, and has seized the opportunities opened up by the Customs Union by investing in new product and process technology and learning. The consumer electronics industry is dominated by a few, large, domestic firms, and has become competitive in the European market thanks to its geographical proximity, productive domestic labor, and focus on a protected and technologically mature segment of the market, which also helps explain the recent decline in industry's fortunes. These industries could have performed even better had more responsive macroeconomic policies been adopted. It is certain that governments could be more responsive only if far-reaching political/institutional reforms are undertaken by changing the constitution and current political party and election laws in order to establish public control over the political elites.

This paper tracks the process through which FIAS, the investment climate advisory service of the World Bank Group advised the government of Latvia from 1998 to 2004 on ways to improve the business environment, achieve higher rates of economic growth, and thereby alleviate poverty. This case study shows that it is reasonable to describe how assistance by FIAS led to an improved business environment. The role that FIAS advice played may be discerned at the level of benefits accruing to the target population (i.e., the amount of resources freed up by lower costs associated with administrative procedures). Whether these benefits accruing to the business community translated into higher rates of investment and productivity, and thus to higher economic growth and reduced poverty, is a function of the entire political, social, and economic structure in Latvia. It is evident that there are many links in the chain of causation, and that the direct attribution FIAS can claim diminishes at every step downstream from its activities. Credit for success must be shared with the Government of Latvia and its immediate stakeholders (i.e., the businesses and their associations), the European Union accession process, the input of many other complementary projects, market forces, and fortuitous timing.

The paper is based on a scenario workshop held on January 20, 2009, where leading financial and private sector development experts from IFC, the International Monetary Fund, and the World Bank discussed the unfolding crisis. This paper is a product of the staff of the Financial and Private Sector Development Vice Presidency of the World Bank Group. The scenarios described in this paper do not necessarily reflect the views of the World Bank Group, its Executive Directors, or the governments they represent. The scenarios described serve as the basis of a planning exercise and are not to be interpreted as forecasts or projections on the part of the World Bank Group or the authors of this paper. The purpose of this paper is to sketch scenarios taking into account the information currently at hand. In this way, scenarios can provide decision makers with alternative views of the future. Decision makers can test their strategies against the different ways in which the future might play out. Scenarios provide a framework for debate, leading to better policy making and strategies. They are especially useful in situations where major global changes are under way but there is huge uncertainty over what may happen. Staffs of the World Bank Group are providing these scenarios to help governments and organizations prepare for an uncertain future. Being well prepared and open to thinking about different outcomes is much better than continually being behind the curve and having to chase events.

The year's report projects an increase in the growth rate of global output, with notable contributions from Sub-Saharan Africa, the developing countries of Europe and Central Asian, and East Asian countries. This report places special emphasis on the role of the "Big 5" developing and transition economies – China, India, Indonesia, Brazil, and Russia – in the future of the global economy. In addition to assessing the current state of the world economy, this report discusses the expansion of global production and the costs of making the transition to a more open economy

Indonesia's economic performance through mid-2011 has been positive. Solid growth has been accompanied by further portfolio capital and foreign direct investment inflows. Public and financial sector balance sheets remain strong. However, events over the past quarter serve as a reminder of a number of Indonesia's ongoing policy challenges. At the same time, the launch of the government's master plan 2011-2025 has focused attention on the investments and policy reforms which can help Indonesia reach its future growth potential. Finally, heightened international risk aversion originating from the Greek debt crisis, and the potential market implications of any haircut, were it to occur, are a reminder of the external shocks which could prompt reversals of short-term capital flows to Indonesia. However, events over the past quarter are a reminder of the current challenges which are faced and the need to put in place, and implement, the policies and investments necessary for Indonesia to reach its potential as a leading global growth driver of the next few decades.

Rapid growth since 1980 has transformed India from the world's 50th ranked economy in nominal U.S. dollars to the 10th largest in 2005. The growth of per capita income has helped reduce poverty. At the same time, evidence suggests that income inequality is rising and that the gap in average per capita income between the rich and poor states is growing. This paper reviews India's long term growth experience with a view to understanding the determinants of growth and the underlying political economy. The paper looks specifically at the political economy of India's growth transformation from a low-growth environment (pre-1980s) to a rapid-growth environment (post 1980s) and asks how sustainable is this transformation in view of concerns about regional disparity and income inequality. The paper concludes that the pledge that India's post-independence leadership had undertaken to abolish mass poverty remains only partially redeemed. Half the battle still lies ahead. Many more would like the fruits of the economic boom to come to them. The greatest challenge for India's policy makers today is to balance the growth momentum with inclusionary policies.

In 1928, Utah Construction Company completed its first project outside of the United States with the 110 mile railroad for Southern Pacific of Mexico. Over the next 30 years, UCC continued to work on projects in Mexico including dams, roads, mining, and canals. The collection contains several booklets and correspondence along with approximately 500 photographs. ; 8.5 x 11 in. paper ; 96) Return to Harry McNev Mexico- Copper & Exploration ABSTRACT CONDITIONS THAT AFFECT MINING EXPLORATION AND MINING PRODUCTION IN MEXICO Private mining industry is experiencing difficult times in many countries that are or have been large mineral producers. Would Mexico offer opportunities for exploration and production? Mexico is a mineral rich country. For the exploration en-gineer this is the most vital point. If the exploration groups are professionally adept, they will find mineralization. A broad review of metallogenetic provinces and of past and present production in Mexico can be used as a guide to explora-tion. Although Mexico is well endowed with minerals, there are many factors that must be considered before a determination can be made that the mineral discovered is ore; (a) restrictive factors in-cluca governmental policy such as taxes, Mexicanization, commodity prices and certain laws; (b) favorable factors include a stable government, strong and freely-convertible peso, and relatively low direct-production costs. -The Mexican mining industry offers an opportunity to those willing to study the problems, accept the law, and invest in the social -as well as financial- future of Mexico. CONDITIONS THAT AffECT MINING EXPLORATION AND MINING PRODUCTION IN MEXICO I. INTRODUCTION. The potential foreign investor in Mexico's Mining In-dustry must carefully consider many facets of the industry and of the country. On the positive side, a stable govern-ment, a healthy monetary position and. above all, a mineral-iy rich country can be found. However, no investments should be made until the potential investor has investigated the min-ing law with its Mexicanization requirements, the mining taxes, the technical manpower regulations and the power of the ex-ecutive branch to set commodity prices. The official mining policy during the period 1930 to 1954, did not encourage investments in the mining industry. However, the future looks much brighter, for now Mexicanization has been accomplished for over 90% of the industry and the gov-ernment realizes that mine products provide a base for Mexico's currency and bring in foreign exchange, that mining provides an important source of government revenue and is an important con-sumer of power, supplies, and transportation services. Also, and of great future importance, Mexico's expanding industry will be in need of more raw materials to supply its demand and its increasing export of manufactured goods. II. HISTORY. The Spanish conquistadores were obsessed by the riches found in Mexico - particularly gold and silver. Thus began the systematic plundering of the new colony and the beginning of mining as the basis of Mexico's economy, Mexico became known as the ""mine and mint of Spain"". Major mining districts such as Taxco, Zacatecas, Santa Brbara and Guanajuato were discovered and brought into pro-duction between 1520 and 1550. It is interesting to note that these selected districts are ail still in production. From 1810, which saw the start, of independence from Spain to 1910 when the Mexican Revolution broke out, mining continued to play a leading role in the national economy. It probably would be fair to say that it sustained the economy. From 1875 to 1900, for example, mining accounted for 70% of the value of Mexico's exports. During the period of the 1910-1917 Revolution mineral pro-duction sharply declined. Silver, lead, and zinc, however, hit their peaks in the late 1920's nut then the general depression followed by governmental restrictions and high taxes reduced exploration which then was followed by reduced production and to date the peaks of production of the late 1920's have not been reached. Under the progressive regime of President Diaz Ordaz, which started in 1964, governmental stimulation to the mining industry has led to greater exploration which is now showing up in increased production. Today Mexico ranks as the leading producer of silver and is the fourth largest producer of lead, fifth of zinc and fourteenth of copper. Mexico also produces major amounts of mercury, bismuth, sulphur, antimony and is the leading producer of fluorite. The entire mineral industry accounts for over 20 percent of the country's foreign exchange earnings although this amounts to less than 2% of the Gross National Product. III. CONDITIONS IN THE MINING INDUSTRY OF MEXICO THAT AFFECT IN-VESTMENT. A. Mexicanization. The term Mexicanization has often been misinterpreted as nationalization. Mexicanization only implies the control of a company in Mexican hands. The transfer of control from foreign to Mexican hands proceeds on a private level by negotiations between local and foreign businessman. Although foreign capital is welcomed, the investor should not expect more favorable treatment than that accorded domestic investors. In Mexicanization it is implicit that as a country progres-ses and matures it must create a body of national capital. For if the profit earned leaves the country (although it created jobs, paid taxes, etc.) the servicing of loans and repatriation of capital would likely endanger the balance of payments leading to an unsound economy. Instead, by retaining within the country at least 51% of the profit, a national capital can be created which is so necessary for further economic expansion and industrialization. - 3 - In 1961 a mining law was passed providing that new mining concessions can be granted only to Mexican nationals, and companies in which a minimum of 51 percent of their capital stock (or 66 per-cent in some instances) is owned by Mexican nationals. This same law, however, granted tax privileges to Mexicanized companies. B. Immigration Restrictions. To protect their skilled and unskilled labor, the Mexican Government has regulated the immigration of foreign technicians in-to Mexico. However, if for the good of the country it is felt that a foreign expert is vitally needed, he can be permitted to enter generally with the stipulation that he train his replacement. Mexican universities are training mining engineers, metal lurgists and geologists but their training is principally academic and an industrial training period is necessary to make these en-gineers capable of filling normal production positions, C. The mining law of Mexico was completely redrafted in 1961, This is an extensive law and only a few of the points will be discussed, 1. Only Mexicans or Mexicanized companies have the right to obtain concessions. 2. A concession shall have a maximum surface area of 500 hectares l hr = 10,000 sq. meters). The sides of the con-cession are limited by vertical planes, 3. The total maximum concession area for a company or an individual is limited depending on the substance. However, three times this maximum can be held for a five-year exploration period. As an example for gold, silver, copper, lead and zinc, a maximum of 9000 hectares can be held for the first five years. After this five year period, a maximum of only 3000 hectares can be held. 4. Mining concessions are issued for 25 years but may be extended on proof of effective exploitation. 5. Assessment work is required. D. Taxes. Taxes paid by mining companies include: 4 1. Income Tax. This tax is modarate and has a maximum of 42%. 2. Production and Export Tax. These taxes are based on price set monthly by the Treasury Department. This official value is arbitrary and can change but generally reflects world prices. These taxes are levied whether the Company is making an operating profit or not. 3. Surface Tax. This tax is a rental on mineral concession of $1.20 dollars per hectare per year. 4. Capital Gains. Capital gains are included in gross income but at a reduced percentage depending on the length of time that assets have been held. 5. Depletion. There is no deduction allowed for depletion. 6. Amortization and Depreciation. It can be stated that deductions allowed are those that the tax authorities regard as normal and necessary for conduct of business. 7. Reduction in Taxes for New Mines. A directive calls for a five year reduction of up to 40% income tax and up to 100% of the federal portion of the production and export taxes, and accelerated depreciation and amortization for certain investment in new operations. 8. Other Taxes. Other taxes such as social security payments and distribution of a portion of annual profits to employees are required. E. Metal Prices. Metal prices for sale in Mexico are set by a govern- - 5 - merit agency. These prices are lower than world prices and act to subsidize Mexico's metal-using industries at the expense of the mining industry. F. Favorable Conditions. 1. Stable Government. The Mexican Government is stable and this stability will be entrenched each passing year with the development of a larger middle class and the strong emphasis on education. 2. Financial Stability. Exchange restrictions have never been imposed and funds are freely convertible and transferable to and from Mexico. The exchange rate has remained at 12.50 pesos per U.S. dollar since 1954. An exchange stabilisation agreement exists between Mexico and the International Monetary Fund which permits Mexico to draw on foreign currencies to maintain the parity of the peso. However, Mexico has maintained a favorable balance of payments for numerous years. 3. Low cost labor. Although there is a notable lack of qualified mining and exploration personnel of the highly technical and supervisory calibre, there is plentiful mining labor in the mining regions. In general, the mining labor is efficient and the costs are reason-able. Recent wage raises have been higher than increased productivity and management must work for higher productivity. In recent years strikes of over 15 days duration have been exceptional and peaceful labor relations are the rule. 4. High mineral potential. We can start with the premise that Mexico is a country extremely well endowed with minerals and many ore bodies await to be discovered. The fact that there has not been more than possibly three major metallic mineral discoveries in the last two decades is not that the bodies do not exist but that fiscal conditions have been such that no search has been made - 6 - for them. Now methods and philosophies of exploration have not been tried until very recently but in them lies the great ex-ploration potential of Mexico. There are three general geologic zones in Mexico. The nor-thern zone is separated from the southern zone by the volcanic-rift belt which runs east-west through Mexico City and Guadalaja-ra and has as its most obvious surface feature a belt of Cenozoic volcanics. Most of the mining in Mexico has taken place in the northern zone in which the more acidic intrusive rocks are found. The southern zone contains more basic rocks, and although there are numerous mineral occurrences, the mines are small in size and number. The scarcity of mines in this zone is undoubt-edly due, in great part, to the lack of exploration which is made difficult due to lack of roads and facilities and to the heavy vegetation covering the outcrops. The volcanic-rift belt exhibits difficult exploration con-ditions; the principal ones being the great amount of volcanic cover and the intense faulting. As in the southern zone this area has not received intensive exploration; however, the famous silver deposits of Pachuca, Taxco, El Oro and Guanajuato lie within this region or at its edge. In the northern zone a long, large northwest trending belt of middle Cenozoic volcanics is found, which constitutes the Sierra Madre Occidental. Pew large mines are known within this belt of very thick volcanics; but where the rocks below the volcanics have been exposed, they are abnormally well mineralized. Therefore, here again the scarcity of mines is due to lack of out-crops. In order to investigate the exploration possibilities in greater detail, let us evaluate the situation of various metals. a. Silver. Mexico is and has been for many years (except 1968) the world's leading producer of silver. In the past a majority of the silver came from such bonanza camps as Pachuca, Guanajuato and Tax co where the silver was found in very high-grade deposits with very minor amounts of other metals. Today. most of Mexico's silver is produced as an accessory mineral in the lead and zinc deposits. This means that with lower lead and zinc prices there has been a reduction in the production of silver although silver prices have advanced. Although the bonanza camps have been reported as ""worked out"", there are definite signs that this may not be the case. Recant high-grade discoveries in Guanajuato and Taxco indicate that if modern techniques and vigorous exploration are carried out, it is quite possible that bonanza deposits will be discovered. Silver is well distributed in many parts of Mexico and it would be difficult to pin-point exact locations favorable for exploration. Slide No.2 shows in general the major distribution of silver. Since the environments vary widely, so also would the exploration techniques. In parts of Mexico numerous silver deposits have been known but left unexploited due to lack of roads and facilities. Large, low-grade deposits probably exist but as yet company philosophies have not been such that they would explore for this type of deposit. b. Copper. Copper, like silver, appears to have a future at favor-able prices. Added to this is the great increase in demand for copper by Mexico to satisfy its rapidly expanding industry. Until this year (1970), there has been only one copper mine in Mexico that could be considered major; the Cananea mine which produces approximately 70% of Mexico's copper. The Santa Rosalia mine in Baja California could be considered a medium sized mine and the rest of the present copper production comes from very small mines or as a minor mineral from other base metal mines. Because of this limited production, Mexico is presently producing just enough copper to supply its internal demand. This picture, however, is changing rapidly. In early 1971, Asarco Mexicana, S.A. will bring into production their Inguarn mine, in the State of Michoacn, which will have a mill capacity of 2000 metric tons per day of 1.8% copper which will more than take care of Mexico's immediate industrial demands for copper. Then in the future lies the immense deposit, La Ca-ridad, of Mexicana de Cobre, which has reserves in excess of 600 million metric tons of 0.75% copper with values in molybdenum. The exact size of this deposit is as yet unknown. Work is now underway to bring this deposit into production in 1974. -8- The reason for not producing more copper in Mexico has been the lack of exploration incentive by the mining companies. The small prospector is not equipped to explore for bulk, low-grade copper deposits and only in the last year or so have major companies made an exerted effort in this field. A very favorable copper mineral province exists in the State of Sonora, Perhaps the most important structural characteristic of this area is its location (Slide #3) along the north-trending Wasatch-Jerome crustal lineament at or near its intersection with the northwest-trending Texas lineament. Correlation between these lineaments and the distribution of the bulk low-grade deposits has been remarkable. Mexico's largest copper producer at Cananea and the previously mentioned La Caridad deposit lie along the Wasatch-Jerome near the intersection with the Texas lineament. Although northern Sonora is a most favorable area in which to explore for copper, this area should not be considered as the only target area since favorable areas exist in other parts of Mexico. Molybdenum can often be expected as an accessory metal with the copper mineralization. If unfavorable conditions for mining investment in Zambia, Peru and Chile -all major copper producing countries- continue or worsen, Mexico will become a major exporter of copper within the next ten years. Even if conditions become better in those countries, Mexico will still play a major role as a copper producing country. c. Lead and Zinc. Although the long term picture for lead and zinc, with silver as an accessory metal, may not be as bright as for copper, established smelter capacity and both local and foreign markets exist and, therefore, exploration for lead and zinc can be con-sidered by both large and small companies. For many years there has been little exploration for new lead and zinc deposits and there has been no exploration with the use of modern tools for locating unexposed bodies. The greatest exploration provinces for lead and zinc are shown on Slide #5. In these areas substantial silver values associated with the lead and zinc could be expected. - 9 d. Other Metals and Minerals. Mexico is a major producer of fluorite, barite, mercury, tungsten and antimony. Exploration will continue for these ma-terials depending primarily on world prices. i IV. SUMMARY OF CONDITIONS. Prom the foregoing, we can quickly summarize the conditions that exist in Mexico that directly affect investment in the mining industry. A. Regulatory. 1. Mexicanization. The requirement of majority investment by Mexican nationals by itself is certainly not unfavorable; however, risk capital is difficult to find. 2. Immigration Restrictions. It is often difficult to obtain highly technical personnel and companies are limited to the number of foreign personnel they can hire. 3. Mining Law. The mining law has been updated and is meant to broaden the mining industry base in Mexico. However restrictions and control are an essential part of the law. 4. Taxes. Income Taxes are moderate but production and ex-port, taxes are a severance tax not based on profit. There is no reduction in taxes for depletion. 5. Metal Prices. Mexico's industry is subsidised at the expense of the mining industry through official prices set slightly lower than world prices -10- B. Favorable. l. Mexico is a mineral-rich country. 2. Mexico has a stable government. 3. Mexico has a strong-convertible currency. 4. Direct production costs for medium to large operations are low. 5. The proximity to the United States assures a large market in addition to the growing market in Mexico. Future. The most striking feature about Mexico today is the tremendous social gains. Education receives, by far, the largest share of the national budget; health facilities are readily available and are ex-panding; electricity and roads are coming to the small villages and wages are being raised in an attempt to make even the poor farmer a consumer. Mexico is expanding industrially to keep in step with the local demands and manufacturing more and more of its necessities in or-der to reduce the need to import, which makes its trade balance more favorable. Mexico yearly increases the export of manufactured goods where previously the country had only been an exporter of raw material and crafts. Politically Mexicans are, and should be, proud of their ancient past and their recant history. They are, therefore, ready and anxious to work with foreign companies if this partership will assist in the development of Mexico as a country and to the advantage of the Mexican people. The exploitation of Mexico to the advantage of other peoples is a thing of the past. Mexico is a developed country and expects to be treated as such. The Mexican mining industry offers an opportunity to those willing to study the problems accept the laws and invest in the social -as well as financial- future of Mexico. D.F. Coolbaugh Mexico, D.F. Mexico, May 1970. DFC/mfb. - 11 -

The Indonesia economic quarterly reports on and synthesizes the past three months' key developments in Indonesia's economy. It places them in a longer-term and global context, and assesses the implications of these developments and other changes in policy for the outlook for Indonesia's economic and social welfare. Its coverage ranges from the macro economy to financial markets to indicators of human welfare and development. It is intended for a wide audience, including policy makers, business leaders, financial market participants, and the community of analysts and professionals engaged in Indonesia's evolving economy. Economic developments over the past quarter bear some strong similarities with the situation seen in the first half of 2008. Most notably, rises in domestic and international commodity prices have again brought with them a variety of risks, both positive and negative, at the macroeconomic and household level. While oil prices increased sharply with political developments in the Middle East and North Africa, strong price rises have been seen across global commodities. Non-energy commodities, including food, were up 30 percent in the six months to February 2011, similar to the increases seen in the first half of 2008. The experiences of other countries through the 2008 food price crisis suggest a range of potential policies which can provide well-targeted protection for vulnerable households and maintain and create incentives for producers to help limit future price volatility.

Life insurance has become an increasingly important part of the financial sector over the past 40 years, providing a range of financial services for consumers and becoming a major source of investment in the capital market. But what drives the large variation in life insurance consumption across countries remains unclear. Using a panel with data aggregated at different frequencies for 68 economies in 1961-2000, this article finds that economic indicators such as inflation, income per capita, and banking sector development and religious and institutional indicators are the most robust predictors of the use of life insurance. Education, life expectancy, the young dependency ratio, and the size of the social security system appear to have no robust association with life insurance consumption. The results highlight the importance of price stability and banking sector development in fully realizing the savings and investment functions of life insurance in an economy.

This article takes an integrated approach to evaluating the interaction of initial conditions, political change, reforms and economic performance in a unified framework covering 28 transition economies in East Asia, Central and Eastern Europe, and the Former Soviet Union (FSU). Initial conditions and economic policy jointly determine the large differences in economic performance among transition economies. Initial conditions dominate in explaining inflation, but economic liberalization is the most important factor determining differences in growth. Political reform emerges as the most important determinant of the speed and comprehensiveness of economic liberalization, raising the important question of what determines political liberalization. Results suggest the importance of the level of development in determining the decision to expand political freedoms.

China's remarkable economic performance over the last 30 years resulted from reforms that met the specific conditions of China at any point in time. Starting with a heavily distorted and extremely poor economy, China gradually reformed by improving incentives in agriculture, phasing out the planned economy and allowing non-state enterprise entry, opening up to the outside world, reforming state enterprises and the financial sector, and ultimately by starting to establish the modern tools of macroeconomic management. The way China went about its reforms was marked by gradualism, experimentation, and decentralization, which allowed the most appropriate institutions to emerge that delivered high growth that by and large benefited all. Strong incentives for local governments to deliver growth, competition among jurisdictions, and strong control of corruption limited rent seeking in the semi reformed system, whereas investment in human capital and the organizations that were to design reforms continued to provide impetus for the reform process. Learning from other countries' experience was important, but more important was China's adaptation of that experience to its own particular circumstances and needs.

Reforms in recent decades have sharply reduced the distortions affecting agriculture in developing countries, particularly by cuts to agricultural export taxes and by some reductions in government assistance to agriculture in high-income countries, but international trade in farm products continues to be far more distorted than trade in nonfarm goods. This paper summarizes a series of empirical studies that focus on the effects of the remaining distortions to world merchandise trade for poverty and inequality, especially in developing countries. To obtain different insights into the various impacts, two global studies are undertaken using the World Bank's Linkage model, one multi-country study uses the Global Trade Analysis Project (GTAP) model, and ten country case studies are also included, each using a national economy-wide model. The Linkage model results suggest that liberalization will reduce international inequality, largely by boosting farm incomes and raising real wages for unskilled workers in developing countries, and will reduce the number of poor people worldwide by 3 percent. The analysis based on the GTAP model for a sample of 15 countries, and the ten stand-alone national case studies, all point to larger reductions in poverty, especially if only the non-poor are subjected to increased income taxation to compensate for the loss of trade tax revenue.

One of the most contentious issues of globalization is the effect of global economic integration on inequality and poverty. This article documents five trends in the modern era of globalization, starting around 1980. The first trend is that growth rates in poor economies have accelerated and are higher than growth rates in rich countries for the first time in modern history. Developing countries per capita incomes grew more than 3.5 percent a year in the 1990s. Second, the number of extremely poor people in the world has declined significantly. The share of people in developing economies living on less than dollar 1 a day has been cut in half since 1981, though the decline in the share living on less than dollar 2 per day was much less dramatic. Third, global inequality has declined modestly, reversing a 200-year trend toward higher inequality. Fourth, within-country inequality in general is not growing, though it has risen in several populous countries (China, India, and the United States). Fifth, wage inequality is rising worldwide. This may seem to contradict the fourth trend, but it does not because there is no simple link between wage inequality and household income inequality. Furthermore, the trends toward faster growth and poverty reduction are strongest in developing economies that have integrated with the global economy most rapidly, which supports the view that integration has been a positive force for improving the lives of people in developing areas

Open Peer Review reports Background Perinatal mental health problems affect up to one in five women worldwide [1, 2]. Stress, anxiety and depression in pregnancy affect not only the mother but can also have long-term adverse effects on her child via biological mechanisms in utero [3]. Along with the impact on the mother and her developing infant, antenatal depression and anxiety are the most common predictors of postnatal depression [4, 5]. Postnatal depression can reduce her ability to provide sensitive and responsive caregiving that can potentially impair child development [6]. Mental health problems in the perinatal period are a particular challenge in low- and middle-income countries (LMICs) where they can be at least twice as frequent as in higher-income countries [1]. Our geographical context for this work will be The Gambia, in West Africa, where mental health services are minimal, services for perinatal mental health are non-existent and high levels of stigma associated with mental health issues, as well as specific local attitudes and beliefs, impede recognition and prevent help-seeking behaviour. It is thus of high priority to develop new low-cost, low-resource, non-stigmatising and culturally appropriate approaches to reduce symptoms of anxiety and depression perinatally, for the benefit of both the mother and child. The current project will test the hypothesis that the creative arts—in particular group-singing—will show special promise in alleviating perinatal mental distress in The Gambia. In high-income countries, such as the UK and the USA, singing in groups has been shown to be a powerful modulator of mood and emotion, evoking positive effects on mental health, well-being and social affiliation [7] via mechanisms involving synchrony and entrainment [8], the saliency of relational communicative features in musical interaction [9] and significant effects on the endocrine system [10]. In addition, the mother's voice is a key channel through which meaningful, sensitive and contingent interactions between the caregiver and infant can take place [11]. Recent studies have found that music and its use specifically during the perinatal period can reduce women's stress levels and depressive symptoms and increase women's attachment to their infant [12,13,14,15]. Music-centred approaches may be particularly fruitful in The Gambia as there are already a range of musical practices that specifically engage pregnant women and new mothers [16]. For instance, infant naming ceremonies occur 7 days after birth and are musical celebrations to recognise the new mother and her family [16]. Performances by Kanyeleng groups are closely associated with pregnancy and motherhood and are important in health communication [17]. These pre-existing cultural and creative practices provide an excellent context from which to explore, co-design and ultimately evaluate culturally situated, music-centred interventions that aim to reduce symptoms of anxiety and depression perinatally and facilitate mother-infant caregiving. Study aims This is a feasibility study which aims to inform the design of a larger trial to investigate a Community Health Intervention through Musical Engagement (CHIME) to help reduce symptoms of anxiety and depression in pregnant women compared to standard care. This article describes the trial protocol (version 1.0, 11/11/18). The protocol was prepared in accordance with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidance. The trial SPIRIT checklist can be viewed in Additional file 1. Objectives Our primary objective is to test (a) the feasibility of delivering a group-singing intervention to a sample of pregnant women in The Gambia using a stepped wedge design and (b) the feasibility of using standardised tools to measure the impact of this intervention on anxiety and depression symptoms, before and after the intervention. This objective can be broken down into five specific feasibility objectives: 1) To obtain demographic information on the eligible population 2) To determine if our measurement tools, the Edinburgh Postnatal Depression Scale (EPDS) and the Self-Reporting Questionnaire (SRQ-20), are useable 3) To determine if the intervention is deliverable 4) To determine if the stepped wedge trial design is deliverable and obtain information that will inform the definitive study. Specifically to: a. Assess recruitment and acceptability of randomising clinics b. Assess the recruitment rate of women to control and intervention groups c. Assess participants' adherence to the intervention group and follow-up in both arms d. Test the feasibility of data collection 5) To determine if this type of intervention is culturally appropriate and well received by the community and health workers. Methods/design We will be testing the feasibility of a stepped wedge cluster design, which differs from a parallel arm cluster design in that all clinics involved in the study receive the intervention [18]. Advantages over a parallel arm cluster trial include the requirement of a smaller sample size due to the availability of a within group comparison and prevention of potential disappointment for health clinics who are not randomised into the intervention. Study setting This multi-site study will recruit from four antenatal clinics in western Gambia. Study population All participants will be Mandinka or Wolof Gambian women who are pregnant. Inclusion criteria Pregnant (14–24 weeks gestation) Speak Wolof or Mandinka fluently Exclusion criteria At least one previous late term miscarriage Current psychosis or history of psychosis Withdrawal criteria If the participant develops any serious medical condition or the participant's mental health significantly declines (as assessed by the care team), and the care team deem it necessary, then she may be withdrawn from the study. Intervention The intervention will be delivered on the community level, meaning that it will include women with a range of anxiety and depression symptoms. Our primary aim is to reduce symptoms in those experiencing them (whether these are at a high level or a medium or low level). We anticipate this may also help to reduce their symptoms into the postnatal period. By including those with low and high levels of symptoms, rather than screening and including only those with high levels of symptoms, we will aim to avoid stigma and increase acceptability. The intervention has been developed following focus groups with various stakeholders including health professionals (midwives and community birth companions), pregnant women and musicians (griots and Kanyeleng groups). Four groups of 20 women between 14 and 24 weeks gestation will attend six 60-min group-singing sessions at their local antenatal clinic. This will take place in the morning as this is the time deemed to best suit the majority of women and clinics. Local Kanyeleng groups who specialise in musical practices to support women's health will lead the sessions. The content of the six sessions will be co-designed with the Kanyeleng groups via two extended workshops with the research team. All sessions will begin with a welcome song and end with a closing song. Some of the songs used during the main body of the session will cover topics including the (a) importance of the singing group in supporting each other, (b) importance of other positive relationships in their lives, (c) resilience to challenges and empowerment and (d) importance of being open, removing stigma to discuss challenges. One lullaby will be introduced at each session. Kanyeleng leaders will also be encouraged to ensure that all the women feel comfortable and are participating when they can. The nature of the intervention will necessarily vary somewhat across the four settings, especially as Wolof speaking groups and Mandinka groups have different and distinct cultural beliefs, practices and language. By using the Kanyeleng groups local to each of the four clinics involved, the sessions will be contextually appropriate, while the workshop with all four Kanyeleng groups before the intervention begins will ensure that the overarching goals, content and approach to session delivery are broadly standardised. Over the course of the 6-week intervention period, a research assistant will observe and video and audio record two singing sessions (the first and the fourth sessions) from each of the four clinics to ascertain, using a checklist, the extent to which the sessions conform to our articulated goals. A community health nurse at each clinic will be engaged to take attendance data and report any issues of concern to the research team. The control group will consist of four groups of 20 women between 14 and 24 weeks gestation from the same four clinics. These women will receive only standard care without any additional intervention. Randomisation and blinding As we will be testing the feasibility of delivering a stepped wedge cluster design, the four different antenatal clinics will be randomised with two sites starting first (creating the first sequence) and two starting 6 weeks later (the second sequence). Randomisation will be performed by the study statistician who will generate a randomisation list using software and apply it to the pre-concealed list of clinics. The researchers and participants will not be blinded to whether they are in the intervention or the control cohort. Outcome measurements Two local research assistants (RAs) will collect all measures orally as there is a high rate of illiteracy among the target population. All scales have been translated into Mandinka and Wolof. The translation method used was based on suggestions by the World Health Organisation, Hanlon et al. [19] and Cox, Holden and Henshaw [20]. First, the scales were translated into Mandinka and Wolof. An expert panel discussion then refined the translation before back translating it into English. The expert panel came together once more to resolve any remaining issues before finalising the translation. Two questionnaires will measure antenatal anxiety and depression symptoms. The Edinburgh Postnatal Depression Scale (EPDS) [21] is a ten-item scale that was developed to screen for postnatal depression. It has subsequently been validated to be used during pregnancy [22]. This measurement tool has been used and validated in other African contexts; however, there is no avaliable validated version of the EPDS in Mandinka or Wolof even though it has been used in The Gambia before [23]. The Self-report Questionnaire (SRQ-20) [24] is a 20-item scale developed by the World Health Organization to measure anxiety and depression symptoms in a variety of cultural contexts. It has been used in many different African contexts such as Ethiopia [19], South Africa [25] and Rwanda [26] and as a way to measure perinatal mental health [23]. However, the SRQ-20 has never been used in the Gambian context nor has it been translated into Wolof or Mandinka. Demographic outcomes We will collect demographic information about all participants. The data we will collect is as follows: date of birth, gestational age, time taken to get to the health centre, parity, gravida, place of birth, current place of residence, ethnic group, history of serious illness, occupation, husband's occupation, marital status, educational background and amount of regular musical engagement. Feasibility outcomes The feasibility outcomes are as follows: Recruitment rate Retention and attrition rates of participants Clinics' adherence to stepped wedge schedule Completeness of data by site and over time Video and audio recording of sessions to determine fidelity of the intervention at each site, i.e. whether key content emphasised in training workshops was being delivered at each site. Qualitative interviews with participants after the intervention to capture enjoyment and perceived benefit. Recruitment Four antenatal clinics will be chosen to take part in the study based on three criteria: (1) availability of a local Kanyeleng group to deliver the intervention, (2) the language group predominantly spoken in the area (with at least one clinic being in a predominantly Wolof speaking area) and (3) the type of community the clinic serves (with at least one within an urban area). The health professionals working at the health centre will first approach participants for the study. If they meet the criteria, they will be given information about the study and asked if they would like to be referred to the RAs. They will then be put in contact with one of the RAs who will meet them privately face to face. The information sheet will be read out in their native language verbatim to ensure participants' ability to give informed consent. Consent will be taken orally by the RAs and recorded by signature or thumbprint. If participants do not choose to take part we will record their reason, if it is given, to help understand why women might not want or be able to participate. Incentive and participant retention Participants in both groups will be offered a total of 600 Dalasi (about 12 USD) for their time, 200 Dalasi for each of the three data collection time points (baseline, post, follow-up). All participants will be reminded of the data collection and the group-singing sessions by phone call. Calls will be made by the RAs 3 days and 1 day before as well as on the day of these appointments. Where possible, a record will be kept of the reasons women give for failing to join the intervention or data collection session. Sample size As this is a feasibility study, it is not designed to assess the efficacy of the intervention, although pilot data on this will be collected. We will evaluate the feasibility of study design, data collection and whether the intervention is deliverable and acceptable to the participants. In the study, we will gather information to be used in the design of the future definitive study including an estimate of the standard deviation of potential primary outcomes to inform the sample size. We aim to collect data from a total of 120 pregnant women, 60 in the control condition and 60 in the intervention condition [27]. This number will be sufficient to provide estimates of binary feasibility outcomes with precision of at least ± 9 percentage points for the 95% confidence interval. Trial schedule This trial design involves a sequential crossover of clusters whereby each cluster (antenatal clinic) receives the control condition followed by the intervention condition. The four chosen clinics will be randomised to two sequences of a 12-week phase. A separate cohort of participants will be recruited to the control group and the intervention (singing) group. Each cohort will be recruited around 4–6 months into their pregnancy. The 12-week phase for both the control and intervention cohort will include data collection at week 1 ("baseline") and week 7 ("post") after either group-singing (intervention) or standard care (control) as well as at week 11 ("follow-up"), 4 weeks after the intervention finished. Contamination will be avoided by having data for the control group collected before the intervention groups start at each clinic. See Fig. 1 for a schematic for the study. Fig. 1 figure1 Schematic of the study Full size image Assessment and management of risk There are no high risks within our study compared to standard care. We have identified three areas of ethical concern and have outlined how each of these issues will be managed. 1. Mothers may experience an adverse effect such as a miscarriage, difficult birth, still birth, a sudden drastic change in physical or mental health, infant health problems or even a serious adverse effect such as death during the intervention. It is possible that a participant experiencing such an adverse event may attribute a causal link between the adverse event and their involvement in the study. We will mitigate this association being made, firstly, by clearly explaining the nature of the intervention and any possible risks to the women when they are recruited into the study. If, despite this, an association of this nature was still made, we would enlist the help of the Ministry of Health & Social Welfare (our partner on the project) to disseminate information to the women and the community concerning the incidence of such events occurring in the general population in an attempt to reassure those concerned that such adverse events should not be attributed to involvement in the study. 2. It is possible that some of the themes involved in questionnaires could lead to the women revealing episodes of self-harm. If this is the case, the woman will receive in the moment front-line counselling to talk through these issues with the RAs who are trained psychiatric nurses. Then, if needed, she will be referred on to the community mental health team (CMHT) for further management. If the CMHT deems it appropriate, they may then refer her on to the psychiatric team. 3. It is possible that some of the themes involved in questionnaires may also lead the women to reveal domestic abuse. If this is the case, the woman will receive in the moment front-line counselling to talk through these issues with the RAs. For emergencies and cases that require immediate intervention, the RAs will connect with the Gender-Based Violence focal person. For other cases, the RAs will refer the woman to the One Stop Center at Serekunda General Hospital or Edward Francis Small Teaching Hospital. 4. Women throughout the study will be monitored by the RAs, both trained psychiatric nurses. If the RAs feel that at any point a woman's score indicates a high level of symptoms and/or the women reveal that they are particularly struggling, the RAs will refer the woman on to the Community Mental Health Team (CMHT) for further management. If the CMHT deems it appropriate, they may then refer her on to the psychiatric team. Data management All consent forms will be stored in a master file, which will be kept in a locked drawer where only members of the research team have access. All case report forms will not be linked to names, just a participant number, and kept in a separate locked cabinet where only the research team has access. All data, including video and audio recordings, will be held on an encrypted hard drive only members of the research team can access. Data will be stored for 5 years after the study and will then be deleted or destroyed. Analysis All data will be entered into a database by an RA and verified by the second RA using double data entry to ensure data quality. As this is a feasibility study, we will examine missing data as an outcome. Descriptive statistics will be summarised to understand the demographic variables relating to the recruited population. Descriptive statistics and plots will be used to assess the distribution of the measurement tools, repeated at baseline and follow-up and by each arm. We will also examine the distributions of scores in the different language groups to see to what extent item scores and overall distributions differ or are similar. Correlations between our two measurement tools will be calculated. To determine if the intervention is deliverable, we will record the number of sessions that the Kanyeleng groups delivered, aiming to deliver two thirds of the sessions, and the duration of each session, aiming to last between 45 and 75 min. We will also perform a qualitative evaluation, using the video and audio recordings, to determine intervention fidelity at the four sites. Both RAs will watch the video and audio recordings of the first and fourth group-singing sessions at each clinic and complete a checklist to determine if all the necessary elements—as outlined in the training workshops—were included in the intervention. Reliability of the fidelity measure will be ascertained by measuring inter-rater consistency. We will also calculate the proportion of clinics approached that consented, aiming to reach over 50% recruitment rate, and record any scheduling problems in keeping with the stepped wedge timeline. Recruitment, adherence and completeness of data will be calculated for both groups. We aim to achieve a 60% recruitment rate and no more than 30% attrition in both arms. To determine if the intervention was culturally appropriate and well received by the community and health workers, we will collect qualitative data from post-intervention interviews and perform a thematic analysis. Discussion The absence of mental health services in The Gambia, coupled with the stigma associated with mental illness in general, results in high levels of unmet need for pregnant women dealing with mental distress in The Gambia. The development of a low-cost, low-resource intervention, which is rooted in local health and cultural practices, is of high priority, and the feasibility study we intend to carry out will inform a full-scale trial to investigate efficacy of such an approach. By employing local research assistants and creating a partnership with governmental agencies, such as The Ministry of Health & Social Welfare and The National Centre for Arts and Culture, this study brings the understanding of existing health services and access to a network of primary healthcare workers throughout the country as well as the diversity of local musical practices and the meanings attached to them. This valuable knowledge will help us cope with the practical and operational issues that may arise. We hope to disseminate our findings within various scientific publications, during field days in various areas in The Gambia, and during a meeting in London which will bring together the researchers as well community members, academic colleagues and health professionals interested in hearing about this work. Trial status This article describes the protocol for a Community Health Intervention through Musical Engagement (CHIME) for perinatal mental health in The Gambia (version 1.0, 11/11/18). The sponsor for this trial is Goldsmiths, University of London. The project is funded by the MRC and the AHRC. Ethical approval was obtained from the Goldsmiths University Ethics Committee, the Research and Publication Committee (RePubliC) from the University of The Gambia and the Australian National University ethics committee. 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Funding The funders (MRC and AHRC) and sponsor (Goldsmiths) have no roles or responsibilities in the design, conduct, data analysis and interpretation, manuscript writing and dissemination of results. Author information Author notes Katie Rose M. Sanfilippo and Bonnie McConnell are joint first authors. Affiliations Goldsmiths, University of London, London, UK Katie Rose M. Sanfilippo & Lauren Stewart The Australian National University, Canberra, Australia Bonnie McConnell Imperial College London, London, UK Victoria Cornelius & Vivette Glover The Ministry of Health and Social Welfare, Banjul, The Gambia Buba Darboe, Hajara B. Huma & Malick Gaye The National Centre for Arts and Culture, Banjul, The Gambia Hajara B. Huma, Malick Gaye & Hassoum Ceesay University of Cambridge, Cambridge, UK Paul Ramchandani & Ian Cross Contributions LS is the principal investigator and obtained grant funding and conceived of the study. KRMS wrote the first draft of this publication manuscript, helped with the ethics and grant application, the intervention design, and the data monitoring and data collection plan. BM helped with the ethics and grant applications, translations of questionnaires, administration of focus groups and design of the intervention. VC obtained study funding, designed the study and statistical analysis plan, contributed to writing the manuscript. BD helped with the grant and ethics application, translations of questionnaires, administration of focus groups and design of the intervention. HBH and MG helped with the translation of the questionnaires, administration of the focus groups and design of the intervention. HC helped with planning the logistics for running the study as well as with the translation of the questionnaires. IC, VG and PR all helped with the grant application and advised on research and intervention design. All authors reviewed and had input into the final submission. All authors read and approved the final manuscript. Corresponding author Correspondence to Katie Rose M. Sanfilippo. Ethics declarations Ethics approval and consent to participate Ethical approval was obtained from the Goldsmiths University Ethics Committee, the Research and Publication Committee (RePubliC) from the University of The Gambia and the Australian National University ethics committee. Members of the research team will carry out the consenting and conduct of this study orally. It will be emphasised that any participant is able to withdraw from the study at any point without any consequences. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information Additional file 1. SPIRIT Checklist. Rights and permissions Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions About this article Verify currency and authenticity via CrossMark Cite this article Sanfilippo, K.R.M., McConnell, B., Cornelius, V. et al. A study protocol for testing the feasibility of a randomised stepped wedge cluster design to investigate a Community Health Intervention through Musical Engagement (CHIME) for perinatal mental health in The Gambia. Pilot Feasibility Stud 5, 124 (2019) doi:10.1186/s40814-019-0515-5 Download citation Received 22 February 2019 Accepted 15 October 2019 Published 07 November 2019 DOI https://doi.org/10.1186/s40814-019-0515-5 Share this article Anyone you share the following link with will be able to read this content: Get shareable link Keywords Perinatal mental health Feasibility trial The Gambia Music Singing group Kanyeleng Comments By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Please note that comments may be removed without notice if they are flagged by another user or do not comply with our community guidelines.