National capacity strengthening within the context of an international vector control partnership: Findings from a qualitative study conducted within the Ugandan ‘Tiny Targets’ programme.

Introduction: The Ugandan Tiny Target programme is an example of an international vector control partnership that held specific capacity-strengthening objectives in support of a disease elimination goal. Drawing on this experience, we sought to derive transferable lessons that may inform capacity strengthening approaches within other partnership-based vector control programmes. Methods: A longitudinal qualitative study encompassing semi-structured interviews conducted with Ugandan partners working on the Tiny Target programme. Data analysis was informed by a general inductive approach. Results: Capacity strengthening priorities evolved over time initially focusing on the immediate capacities needed to perform roles and responsibilities assigned within the partnership then shifting towards more advanced, transferable knowledge and skills. A distinction between operational and systemic priorities was observed: the former necessary to support successful programme implementation whereas the latter reflected fundamental limitations or complexities within the Ugandan context that were bypassed by including an international partner. Systemic priorities were fewer in number than their operational counterparts, although substantially harder to resolve. The largest apparent threat to the long-term sustainability of reported capacity gains was their concentration within a small number of individuals. Conclusion: Our study highlights three key lessons that may inform the design of national capacity strengthening activities conducted within the context of international vector control partnerships, including: 1) Multiple approaches to strengthen capacity are needed and that can adapt to changing capacity strengthening priorities over time; 2) Balancing operational and systemic capacity strengthening priorities, the latter becoming increasingly important within longer-term partnerships; and 3) Partnership members in focal country/ies should be supported to actively facilitate transfer of newly acquired knowledge and skills to relevant colleagues/communities outside of the partnership. The generic nature of these recommendations suggest they are likely to be of benefit to many and diverse international partnerships within the wider global health space. What is already known on this topic • Strengthening vector control capacity is a foundation of the World Health Organization’s global vector control response, 2017-2030. • International vector control partnerships are one means by which vector control capabilities can be strengthened in less well capacitated countries. However, there are few research-derived accounts of how capacity strengthening opportunities can be optimised within the context of such partnerships. What this study adds • We provide pragmatic, research-derived recommendations for designing and implementing capacity strengthening activities within international vector control partnerships. How this study might affect research, practice or policy • International vector control partnerships, as well as bodies that fund such partnerships, can draw on these recommendations to inform more impactful capacity strengthening practice. As the recommendations are relatively generic in nature, they are also likely to be of value to a broad range of partnerships working in the global health space

Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind

Background Several studies in the literature have shown the existence of large disparities in the use of maternal health services by socioeconomic status (SES) in developing countries. The persistence of the socioeconomic disparities is problematic, as the global community is currently advocating for not leaving anyone behind in attaining Sustainable Development Goals (SDGs). However, health care facilities in developing countries continue to report high maternal deaths. Improved accessibility and strengthening of quality in the uptake of maternal health services (skilled birth attendance, antenatal care, and postnatal care) plays an important role in reducing maternal deaths which eventually leads to the attainment of SDG 3, Good Health, and Well-being. Methods This study used the Zimbabwe Demographic Health Survey (ZDHS) of 2015. The ZDHS survey used the principal components analysis in estimating the economic status of households. We computed binary logistic regressions on maternal health services attributes (skilled birth attendance, antenatal care, and postnatal care) against demographic characteristics. Furthermore, concentration indices were then used to measure of socio-economic inequalities in the use of maternal health services, and the Erreygers decomposable concentration index was then used to identify the factors that contributed to the socio-economic inequalities in maternal health utilization in Zimbabwe. Results Overall maternal health utilization was skilled birth attendance (SBA), 93.63%; antenatal-care (ANC) 76.33% and postnatal-care (PNC) 84.27%. SBA and PNC utilization rates were significantly higher than the rates reported in the 2015 Zimbabwe Demographic Health Survey. Residence status was a significant determinant for antenatal care with rural women 2.25 times (CI: 1.55–3.27) more likely to utilize ANC. Richer women were less likely to utilize skilled birth attendance services [OR: 0.20 (CI: 0.08–0.50)] compared to women from the poorest households. While women from middle-income households [OR: 1.40 (CI: 1.03–1.90)] and richest households [OR: 2.36 (CI: 1.39–3.99)] were more likely to utilize antenatal care services compared to women from the poorest households. Maternal service utilization among women in Zimbabwe was pro-rich, meaning that maternal health utilization favoured women from wealthy households [SBA (0.05), ANC (0.09), PNC (0.08)]. Wealthy women were more likely to be assisted by a doctor, while midwives were more likely to assist women from poor households [Doctor (0.22), Midwife (− 0.10)]. Conclusion Decomposition analysis showed household wealth, husband’s education, women’s education, and residence status as important positive contributors of the three maternal health service (skilled birth attendance, antenatal care, and postnatal care) utilization outcomes. Educating women and their spouses on the importance of maternal health services usage is significant to increase maternal health service utilization and consequently reduce maternal mortality

Effect of malaria on productivity in a workplace: the case of a banana plantation in Zimbabwe

Abstract Background Malaria is known to contribute to reduction in productivity through absenteeism as worker-hours are lost thus impacting company productivity and performance. This paper analysed the impact of malaria on productivity in a banana plantation through absenteeism. Methods This study was carried out at Matanuska farm in Burma Valley, Zimbabwe. Raw data on absenteeism was obtained in retrospect from the Farm Manager. Malaria infection was detected using malaria Rapid Diagnostic Test. Measures of absence from work place were determined and included; incidence of absence (number of absentees divided by the total workforce), absence frequency (number of malaria spells), frequency rate (number of spells divided by the number of absentees), estimated duration of spells (number of days lost due to malaria), severity rate (number of days lost divided by number of spells), incapacity rate (number of days lost divided by the number of absentees), number of absent days (number of spells times the severity rate), number of scheduled working days (actual working days in 5 months multiplied by total number of employees), absenteeism rate. Results A total of 143 employees were followed up over a 5-month period. Malaria positivity was 21%, 31.5%, 44.8%, 35.7% and 12.6% for January 2014 to May 2014, respectively. One spell of absence [194 (86.6%)] was common followed by 2 spells of absence [30 (13.4%)] for all employees. Duration of spells of absence due to malaria ranged from 1.5 to 4.1 working-days, with general workers being the most affected. Incidence of absence was 143/155 (93.3%), with total of spells of absence of over a 5-month period totalling 224. The frequency rate of absenteeism was 1.6 with severity rate of absence being 2.4. and incapacity rate was 3.7. Conclusion Malaria contributes significantly to worker absenteeism. Employers, therefore, ought to put measures that protect workers from malaria infections. Protecting workers can be done through malaria educative campaigns, providing mosquito nets, providing insecticide-treated work suits, providing repellents and partnering with different ministries to ensure protection of workers from mosquito bites

Trends in household air pollution contributed by the type of cooking fuel used in Ugandan households from 2000 to 2016 and associated household factors: An analysis of demographic and health surveys

Background The type of cooking fuel used in households can expose the members to polluted air which has been shown to have multiple health effects. We describe the trend in household air pollution (HAP) caused by the type of cooking fuel used in Ugandan households from 2001 to 2016 and explore the household factors associated with it. Methods This was a retrospective analysis of four datasets of Ugandan demographic and health surveys (DHS) conducted from 2000/2001 to 2016 with the household as the unit of analysis. We included variables that described the households, the type of cooking fuel, and where the food was cooked. A household was considered to have exposure to HAP if they used cooking fuels like coal, charcoal, wood, straw/shrubs/grass, crops, or animal dung for cooking. Bivariate and multivariate logistic regression was used to determine the association between household characteristics and exposure to household air pollution (HAP) from the most recent DHS of 2016. Results A total of 45,376 households were included in the study. In all the surveys, the majority of the households were rural (74.33–85.11%), were headed by a male (68.98–72.46%), and with their highest educational attainment as incomplete primary education (37.21–42.44%). In all the surveys, the majority of the households used wood as a cooking fuel (71.69–82.08%). Most of the households were exposed to HAP (96.69–99.80%). From the multivariate logistic regression analysis, households with a household head having attained either complete secondary education [Adjusted Odd ratio: 0.13, 95% Confidence interval (0.03–0.58), p-value = 0.008] or higher education [Adjusted Odd ratio: 0.11, 95% Confidence interval (0.03–0.48), p-value = 0.003] were less likely to be exposed to HAP when compared with households with a household head having no education. Conclusions This study revealed that most households in Uganda have exposure to household air pollution caused by the type of cooking fuel used in the household. This underscores the need for innovations in cooking fuels like clean energy stoves that are cost-effective and cause less exposure to household air pollution

COMMERCIALIZATION OF ALTERNATIVE LIVESTOCK FEEDS COULD SAVE FISH STOCKS IN LAKE VICTORIA.

Fish is an important ingredient of livestock feeds. Therefore the increasing livestock production in East Africa implies increased exploitation of fishes. This is due to the use of some fish species like Silver fish (Rastrineobola argentea) as source of protein in animal diets. This is likely to result into over exploitation of some fish species which has implications for the survival of many other organisms within the food chain/web in the lake. Literature reveals organisms that have a relatively high crude protein content. Insects such as cockroaches (65% crude protein) can be domesticated and used as animal feeds. This has the potential of boosting livestock production such as poultry, fish, and piggery farming. Non-conventional feeds such as cockroaches, houseflies, earthworms, carabid beetles, among others can be domesticated and used in livestock production. This can be achieved through rearing of these alternative sources of proteins and then processing them into a form edible to the livestock. This could partially or completely substitute fishmeal depending on the production. The small acreage of land required to raise these potential sources of protein for livestock production could also reduce on the impact of agricultural practices on watersheds. The biggest problem limiting the use of non-conventional feeds is limited information on breeding insects and community attitudes towards use of these insects as alternative feeds. There is therefore need to optimize conditions for large scale insect breeding and sensitize livestock famers on the integration of non-conventional feeds in the feeding regimes of livestock. Key words: Livestock, Watersheds, Overexploitation, non-conventional feeds.peerReviewe

Infectious vaginitis among women seeking reproductive health services at a sexual and reproductive health facility in Kampala, Uganda

Abstract Background Infectious vaginitis is one of the most prevalent conditions affecting women of reproductive age with significant clinical consequences. Bacterial vaginosis (BV), vulvo-vaginal candidiasis (VVC), and trichomoniasis (TV) are the main etiologies. Unfortunately, there is limited data on the prevalence and associated risk factors, especially in sub-saharan Africa. This study, thus, determined the prevalence and risk factors of infectious vaginitis among women seeking reproductive health services at a Marie-stopes health facility in urban areas of Kampala, Uganda. Methods A cross-sectional study with 361 participants was conducted from July to October 2021. Data on risk factors and infection were collected via a structured questionnaire and laboratory analysis of vaginal swabs, respectively, with data analysis performed using Stata version 14.0 college station, Texas 77,845 US. Results The ages of participants ranged from 18 to 49 years, with a mean age of 29.53 years. Overall, 58.45% were infected, of whom 33.24% had VVC, 24.93% had BV, and 0.28% had TV. Bivariate analysis revealed that women with pruritus (COR: 3.057, 95% CI: 1.940–4.819), pregnancy (COR: 4.914, 95% CI: 1.248–19.36), antibiotic use (COR: 1.592, 95% CI: 1.016–2.494), douching (COR: 1.719, 95% CI: 1.079–2.740), and multiple partners (COR: 1.844, 95% CI: 1.079–2.904) were more likely to have VVC, whereas having higher education status (University; Vocational) (COR: 0.325, 95% CI: 0.134–0.890; COR: 0.345, 95% CI: 0.116–0.905) reduced the risk. On the other hand, women with a smelly discharge (COR: 1.796, 95% CI: 1.036–3.110), IUD use (COR: 1.868, 95% CI: 1.039–3.358), and antibiotic use (COR: 1.731, 95% CI: 1.066–2.811) were more likely to have BV. Multivariable analysis identified pruritus (AOR: 2.861, 95% CI: 1.684–4.863) as the only independent predictor for VVC. Conclusion Results indicate a high prevalence of infection among these women; therefore regular screening and treatment is recommended to curb the high rate of infection. More studies on risk factors of infection are recommended

Commercialisation of Alternative Livestock Feeds Could Save Fish Stocks in Lake Victoria

Increasing livestock production in East Africa requires increased use of fish meal as a source of protein, some of which comes from the Silver Cyprinid (Rastrineobola argentea) in Lake Victoria, which could result in its over-exploitation and affect the survival of other organisms in the lake. The crude protein content of cockroaches (38-76% CP depending on the age) and of other insects is similar to that of fish meal (61.24% CP) and could be a substitute for it, if these insects can be domesticated and used as animal feeds. Non-conventional feeds such as cockroaches, houseflies, termites, earthworms and carabid beetles are used on a small scale by farmers in Uganda who would be willing to use them more if they could be produced on a large scale. There is therefore a need to promote large scale insect breeding so that these alternative protein sources can be integrated into farming systems.Keywords: Alternative protein sources, Fishmeal, Insects, Poultr

Short report on implications of Covid-19 and emerging zoonotic infectious diseases for pastoralists and Africa

Abstract Many emerging and re-emerging zoonotic infectious diseases occur in Africa. These are projected to increase as human–animal host contact increases owing to increasing environmental degradation that shrinks nature habitats for wildlife over the continent. The current outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) responsible for causing coronavirus disease in 2019 (COVID-19) has reinvigorated discourse on the disruptiveness of the zoonotic emerging infectious diseases, owing to their transboundary character. Even as the world focuses on the COVID-19 sweeping pandemic, the Middle East respiratory syndrome coronavirus (MERS)-CoV re-emerged in Saudi Arabia infecting 18 people with five deaths; this has barely received any attention. This outbreak is particularly of concern to the pastoralists in the Horn of Africa, a region that has in recent past seen an increase in camel trade with the Gulf States, especially Yemen and Saudi Arabia. Emerging and re-emerging zoonotic infectious diseases are complex, depend on human–animal–environment interaction and pose a strain on public health systems. There is a need to address these diseases dynamically through a synergistic approach, drawing on expertise from diverse sectors. One Health approach has distinguished itself as an integrative action able to bring together multiple actors on a global, national and local scale to advance the attainment of optimal health outcomes for people, animals and the environment. One Health works by strengthening the preparedness, response, mitigation and monitoring of zoonotic infectious disease risks collaboratively. We opine that as zoonotic emerging and re-emerging infectious diseases continue to rise over pastoral Africa, comprehensive implementation of the One Health approach will be urgently required

Uganda Mountain Community Health System—Perspectives and Capacities towards Emerging Infectious Disease Surveillance

In mountain communities like Sebei, Uganda, which are highly vulnerable to emerging and re-emerging infectious diseases, community-based surveillance plays an important role in the monitoring of public health hazards. In this survey, we explored capacities of village health teams (VHTs) in Sebei communities of Mount Elgon in undertaking surveillance tasks for emerging and re-emerging infectious diseases in the context of a changing climate. We used participatory epidemiology techniques to elucidate VHTs’ perceptions on climate change and public health and assessed their capacities to conduct surveillance for emerging and re-emerging infectious diseases. Overall, VHTs perceived climate change to be occurring with wider impacts on public health. However, they had inadequate capacities in collecting surveillance data. The VHTs lacked transport to navigate through their communities and had insufficient capacities in using mobile phones for sending alerts. They did not engage in reporting other hazards related to the environment, wildlife, and domestic livestock that would accelerate infectious disease outbreaks. Records were not maintained for disease surveillance activities and the abilities of VHTs to analyze data were also limited. However, VHTs had access to platforms that could enable them to disseminate public health information. The VHTs thus need to be retooled to conduct their work effectively and efficiently through equipping them with adequate logistics and knowledge on collecting, storing, analyzing, and relaying data, which will improve infectious disease response and mitigation efforts

Socioeconomic inequalities in food insecurity and malnutrition among underfive children : within and between-group inequalities in Zimbabwe

CITATION: Lukwa, A. T., et al. 2020. Socioeconomic inequalities in food insecurity and malnutrition among under-five children : within and between-group inequalities in Zimbabwe. BMC Public Health, 20:1199, doi:10.1186/s12889-020-09295-z.The original publication is available at http://bmcpublichealth.biomedcentral.comBackground: Food insecurity and malnutrition in children are pervasive public health concerns in Zimbabwe. Previous studies only identified determinants of food insecurity and malnutrition with very little efforts done in assessing related inequalities and decomposing the inequalities across household characteristics in Zimbabwe. This study explored socioeconomic inequalities trend in child health using regression decomposition approach to compare within and between group inequalities. Methods: The study used Demographic Health Survey (DHS) data sets of 2010\11 and 2015. Food insecurity in under-five children was determined based on the WHO dietary diversity score. Minimum dietary diversity was defined by a cut- off point of > 4 therefore, children with at least 3 of the 13 food groups were defined as food insecure. Malnutrition was assessed using weight for age (both acute and chronic under-nutrition) Z-scores. Children whose weight-for-age Z-score below minus two standard deviations (− 2 SD) from the median were considered malnourished. Concentration curves and indices were computed to understand if malnutrition was dominant among the poor or rich. The study used the Theil index and decomposed the index by population subgroups (place of residence and socioeconomic status). Results: Over the study period, malnutrition prevalence increased by 1.03 percentage points, while food insecurity prevalence decreased by 4.35 percentage points. Prevalence of malnutrition and food insecurity increased among poor rural children. Theil indices for nutrition status showed socioeconomic inequality gaps to have widened, while food security status socioeconomic inequality gaps contracted for the period under review. Conclusion: The study concluded that unequal distribution of household wealth and residence status play critical roles in driving socioeconomic inequalities in child food insecurity and malnutrition. Therefore, child food insecurity and malnutrition are greatly influenced by where a child lives (rural/urban) and parental wealth.Publisher's versio