On-farm evaluation of effectiveness of improved postharvest handling of maize in reducing grain losses, mold infection and aflatoxin contamination in rural Uganda

Postharvest losses remain a challenge among smallholder farmers in sub-Saharan Africa. The uses of hermetic storage containers  (hermetic bags and metallic silos), tarpaulin sheet (plastic sheet) and raised racks reduce postharvest deterioration of grain. This study evaluated the effectiveness of selected improved drying and storage postharvest technologies and practices in reducing maize grain postharvest losses among smallholder farmers in Kamuli and Apac districts, Uganda. The assessed improved storage technologies were hermetic bags and metallic silos against woven polypropylene bags (common farmer practice). For drying, use of tarpaulins and raised racks were assessed against drying on bare ground (common farmer practice). Grain quality and quantity were determined at harvest as well as during drying and six months of storage using Longe 10H variety. Mean quantitative losses, mold infection and aflatoxin level of maize at harvest were 13.72 ± 5.44%, 59.01 ± 17.97% and 1.21 ± 0.7 ppb, respectively for traditional practice. Improved drying and storage technologies resulted in significantly lower (p≤0.05) losses, mold infection and aflatoxin level than the common  farmer practices. Drying on bare ground (3.04 ± 1.50%) resulted in 1.94 times and 7.07 times higher quantitative losses than drying on  tarpaulins (1.56 ± 1.09%) and raised racks (0.43 ± 0.58%). By the sixth month of storage, polypropylene bag storage resulted in 3.7 times and 84 times higher quantitative losses (23.7 ± 5.11%) than hermetic bags (6.33 ± 5.41%) and metallic silos (0.28 ± 0.22%), respectively. Polypropylene bag storage also resulted in 4.4 times and 6 times higher aflatoxin levels (45.82 ± 20.88 ppb) than hermetic bags and metallic silos, respectively. The interaction effects of type of drying technology and storage technology used on aflatoxin levels at the end of the storage period was significant. The highest mold infection and aflatoxin levels were observed when drying was done on bare ground and storage was in polypropylene bags and by the sixth month of storage, mold infection was 90.54 ± 5.48% and average aflatoxin content was 53.47 ± 22.79 ppb. Storage in metallic silos was the most effective in controlling mold infection and aflatoxin contamination, regardless of drying practice, while storage in polypropylene bags was the least effective. From the results, improved drying and storage technologies and practices were found to reduce postharvest maize losses, mold infection and aflatoxin level by over 50%. Use of raised drying racks and storage in metallic silos was found to be the most effective combination in maintaining maizequality and reducing postharvest losses. Key words: Aflatoxins, maize quality, mold infection, grain storage, postharvest losse

A Multifaceted Intervention to Improve the Quality of Care of Children in District Hospitals in Kenya: A Cost-Effectiveness Analysis

A cost-effective analysis conducted by Edwine Barasa and colleagues estimates that a complex intervention aimed at improving quality of pediatric care would be affordable and cost-effective in Kenya

Economic evaluation of pneumococcal conjugate vaccination in The Gambia

<p>Abstract</p> <p>Background</p> <p>Gambia is the second GAVI support-eligible country to introduce the 7-valent pneumococcal conjugate vaccine (PCV7), but a country-specific cost-effectiveness analysis of the vaccine is not available. Our objective was to assess the potential impact of PCVs of different valences in The Gambia.</p> <p>Methods</p> <p>We synthesized the best available epidemiological and cost data using a state-transition model to simulate the natural histories of various pneumococcal diseases. For the base-case, we estimated incremental cost (in 2005 US dollars) per disability-adjusted life year (DALY) averted under routine vaccination using PCV9 compared to no vaccination. We extended the base-case results for PCV9 to estimate the cost-effectiveness of PCV7, PCV10, and PCV13, each compared to no vaccination. To explore parameter uncertainty, we performed both deterministic and probabilistic sensitivity analyses. We also explored the impact of vaccine efficacy waning, herd immunity, and serotype replacement, as a part of the uncertainty analyses, by assuming alternative scenarios and extrapolating empirical results from different settings.</p> <p>Results</p> <p>Assuming 90% coverage, a program using a 9-valent PCV (PCV9) would prevent approximately 630 hospitalizations, 40 deaths, and 1000 DALYs, over the first 5 years of life of a birth cohort. Under base-case assumptions ($3.5 per vaccine), compared to no intervention, a PCV9 vaccination program would cost$670 per DALY averted in The Gambia. The corresponding values for PCV7, PCV10, and PCV13 were $910,$670, and $570 per DALY averted, respectively. Sensitivity analyses that explored the implications of the uncertain key parameters showed that model outcomes were most sensitive to vaccine price per dose, discount rate, case-fatality rate of primary endpoint pneumonia, and vaccine efficacy against primary endpoint pneumonia.</p> <p>Conclusions</p> <p>Based on the information available now, infant PCV vaccination would be expected to reduce pneumococcal diseases caused by <it>S. pneumoniae </it>in The Gambia. Assuming a cost-effectiveness threshold of three times GDP per capita, all PCVs examined would be cost-effective at the tentative Advance Market Commitment (AMC) price of$3.5 per dose. Because the cost-effectiveness of a PCV program could be affected by potential serotype replacement or herd immunity effects that may not be known until after a large scale introduction, type-specific surveillance and iterative evaluation will be critical.</p

DIETARY PATTERNS IN UGANDA AND THEIR INFLUENCING FACTORS: A CRITICAL REVIEW

Improving the understanding of dietary patterns and underlying factors remains crucial in designing nutritional interventions and policy making. This review sought to provide a holistic picture of the studies covering dietary patterns in Uganda and the associated factors so as to identify gaps in existing literature and provide a basis for nutrition-sensitive interventions. A literature search for publications dating from March 2010 to 2021 was done using the terms dietary diversity, nutrient intake, food consumption and food choices in Uganda. Studies covering populations above 6 months of age, male and female, with exception of diseased populations, were screened. Because of the variability in the methodologies for assessment of dietary intake and dietary diversity, meta-analysis was not conducted. A total of 17,728 articles were found and 25 studies met the inclusion criteria. Nine of the 25 studies reported on dietary diversity indicators and their associated factors. The literature shows that diets in Uganda are mainly composed of starchy staples, especially cereals, roots, tubers and bananas, with legumes constituting the main protein source. The diets are characterized by low consumption of fruits and vegetables as well as animal protein sources. The share of food expenditure allocated to the different food groups corresponded to information on consumption for the different groups. Studies revealed that household food expenditure was higher among urban households, an observation attributable to their high reliance on food purchases to meet food requirements. The share of household expenditure on cereals and staples was reported to decrease with increasing wealth quantile and was lower among urban households. An opposite trend was reported for animal protein sources. Across the different studies, the mean dietary diversity score was above three (3). Nonetheless, intake of micronutrients and the mean dietary energy consumption (DEC) were reported to be lower than the daily recommended values. Given the lack of uniformity in the indicators across the different studies and differences in methodologies especially for dietary diversity scores, the existing research is inadequate for establishing quantitative evidence on the trends in dietary patterns and diversity, gender and age group differences in relation to dietary patterns. There is a need for highquality, nation-wide research using validated tools and methodologies to measure dietary patterns and trends and explore the relation to gender and age groups

DIETARY PATTERNS IN UGANDA AND THEIR INFLUENCING FACTORS: A CRITICAL REVIEW

Improving the understanding of dietary patterns and underlying factors remains crucial in designing nutritional interventions and policy making. This review sought to provide a holistic picture of the studies covering dietary patterns in Uganda and the associated factors so as to identify gaps in existing literature and provide a basis for nutrition-sensitive interventions. A literature search for publications dating from March 2010 to 2021 was done using the terms dietary diversity, nutrient intake, food consumption and food choices in Uganda. Studies covering populations above 6 months of age, male and female, with exception of diseased populations, were screened. Because of the variability in the methodologies for assessment of dietary intake and dietary diversity, meta-analysis was not conducted. A total of 17,728 articles were found and 25 studies met the inclusion criteria. Nine of the 25 studies reported on dietary diversity indicators and their associated factors. The literature shows that diets in Uganda are mainly composed of starchy staples, especially cereals, roots, tubers and bananas, with legumes constituting the main protein source. The diets are characterized by low consumption of fruits and vegetables as well as animal protein sources. The share of food expenditure allocated to the different food groups corresponded to information on consumption for the different groups. Studies revealed that household food expenditure was higher among urban households, an observation attributable to their high reliance on food purchases to meet food requirements. The share of household expenditure on cereals and staples was reported to decrease with increasing wealth quantile and was lower among urban households. An opposite trend was reported for animal protein sources. Across the different studies, the mean dietary diversity score was above three (3). Nonetheless, intake of micronutrients and the mean dietary energy consumption (DEC) were reported to be lower than the daily recommended values. Given the lack of uniformity in the indicators across the different studies and differences in methodologies especially for dietary diversity scores, the existing research is inadequate for establishing quantitative evidence on the trends in dietary patterns and diversity, gender and age group differences in relation to dietary patterns. There is a need for highquality, nation-wide research using validated tools and methodologies to measure dietary patterns and trends and explore the relation to gender and age groups

Power Transformer Fault Severity Estimation Based on Dissolved Gas Analysis and Energy of Fault Formation Technique

Decision making on transformer insulation condition based on the evaluated incipient faults and aging stresses has been the norm for many asset managers. Despite being the extensively applied methodology in power transformer incipient fault detection, solely dissolved gas analysis (DGA) techniques cannot quantify the detected fault severity. Fault severity is the core property in transformer maintenance rankings. This paper presents a fuzzy logic methodology in determining transformer faults and severity through use of energy of fault formation of the evolved gasses during transformer faulting event. Additionally, the energy of fault formation is a temperature-dependent factor for all the associated evolved gases. Instead of using the energy-weighted DGA, the calculated total energy of related incipient fault is used for severity determination. Severity of faults detected by fuzzy logic-based key gas method is evaluated through the use of collected data from several in-service and faulty transformers. DGA results of oil samples drawn from transformers of different specifications and age are used to validate the model. Model results show that correctly detecting fault type and its severity determination based on total energy released during faults can enhance decision-making in prioritizing maintenance of faulty transformers

Economic evaluation of delivering Haemophilus influenzae type b vaccine in routine immunization services in Kenya

OBJECTIVE: Haemophilus influenzae type b (Hib) vaccine was introduced into routine immunization services in Kenya in 2001. We aimed to estimate the cost-effectiveness of Hib vaccine delivery. METHODS: A model was developed to follow the Kenyan 2004 birth cohort until death, with and without Hib vaccine. Incidence of invasive Hib disease was estimated at Kilifi District Hospital and in the surrounding demographic surveillance system in coastal Kenya. National Hib disease incidence was estimated by adjusting incidence observed by passive hospital surveillance using assumptions about access to care. Case fatality rates were also assumed dependent on access to care. A price of US$3.65 per dose of pentavalent diphtheria-tetanus-pertussis-hep B-Hib vaccine was used. Multivariate Monte Carlo simulations were performed in order to assess the impact on the cost-effectiveness ratios of uncertainty in parameter values. FINDINGS: The introduction of Hib vaccine reduced the estimated incidence of Hib meningitis per 100,000 children aged < 5 years from 71 to 8; of Hib non-meningitic invasive disease from 61 to 7; and of non-bacteraemic Hib pneumonia from 296 to 34. The costs per discounted disability adjusted life year (DALY) and per discounted death averted were US$ 38 (95% confidence interval, CI: 26-63) and US$1197 (95$ 1.82 per dose. CONCLUSION: Hib vaccine is a highly cost-effective intervention in Kenya. It would be cost-saving if the vaccine price was below half of its present level