Why latrines are not used : communities' perceptions and practices regarding latrines in a Taenia solium endemic rural area in Eastern Zambia

Taenia solium cysticercosis is a neglected parasitic zoonosis occurring in many developing countries. Socio-cultural determinants related to its control remain unclear. Studies in Africa have shown that the underuse of sanitary facilities and the widespread occurrence of free-roaming pigs are the major risk factors for porcine cysticercosis. The study objective was to assess the communities' perceptions, practices and knowledge regarding latrines in a T. solium endemic rural area in Eastern Zambia inhabited by the Nsenga ethno-linguistic group, and to identify possible barriers to their construction and use. A total of 21 focus group discussions on latrine use were organized separately with men, women and children, in seven villages of the Petauke district. The themes covered were related to perceived latrine availability (absence-presence, building obstacles) and perceived latrine use (defecation practices, latrine management, socio-cultural constraints). The findings reveal that latrines were not constructed in every household because of the convenient use of existing latrines in the neighborhood. Latrines were perceived to contribute to good hygiene mainly because they prevent pigs from eating human feces. Men expressed reluctance to abandon the open-air defecation practice mainly because of toilet-associated taboos with in-laws and grown-up children of the opposite gender. When reviewing conceptual frameworks of people's approach to sanitation, we found that seeking privacy and taboos hindering latrine use and construction were mainly explained in our study area by the fact that the Nsenga observe a traditionally matrilineal descent. These findings indicate that in this local context latrine promotion messages should not only focus on health benefits in general. Since only men were responsible for building latrines and mostly men preferred open defecation, sanitation programs should also be directed to men and address related sanitary taboos in order to be effective

Perceptions and acceptability of piloted Taenia solium control and elimination interventions in two endemic communities in eastern Zambia

Infections with Taenia solium cause significant public health and economic losses worldwide. Despite effective control tools, long‐term sustained control/elimination of the parasite has not been demonstrated to date. Success of intervention programs is dependent on their acceptability to local communities. Focus group discussions (FGDs) and questionnaires (QS) were conducted in two study communities in eastern Zambia to assess local perceptions and acceptance of two piloted intervention strategies: one targeting pigs only (‘control’ study arm), and one integrated human‐ and pig‐based (‘elimination’) strategy. QS (n = 227) captured data regarding participation in project activities, knowledge and perceptions of T. solium and of the interventional drugs used in the study. FGDs (n = 18) discussed perceived advantages and disadvantages of the interventions and of the project's delivery and value. QS data revealed 67% of respondents participated in at least one educational activity, and 80% correctly identified at least one disease targeted by the education. All elimination study arm respondents (n = 113) had taken the human treatment, and 98% intended to do so next time. Most (70%) indicated willingness to pay for future treatments (median 0.20 USD per dose). Of pig‐owning respondents, 11/12 (92%) had allowed their pigs to be treated/vaccinated and all intended to do so again next time. Four pig owners indicated willingness to pay 0.10–0.50 USD per dose of treatment or vaccine. FGD feedback revealed positive perceptions of interventions; people reported improved health in themselves and their pigs, and fewer cysticerci in pork. Latrine use, hand washing, meat inspection and proper cooking of pork had reportedly increased since the program's inception. Preliminary assessment indicates that the piloted intervention methods are generally acceptable to the communities. The reported willingness of many respondents to pay for the medications would contribute to the feasibility of long‐term, government‐led T. solium intervention programs in future

Iron for Africa-Report of an Expert Workshop.

Scientific experts from nine countries gathered to share their views and experience around iron interventions in Africa. Inappropriate eating habits, infections and parasitism are responsible for significant prevalence of iron deficiency, but reliable and country-comparable prevalence estimates are lacking: improvements in biomarkers and cut-offs values adapted to context of use are needed. Benefits of iron interventions on growth and development are indisputable and outweigh risks, which exist in populations with a high infectious burden. Indeed, pathogen growth may increase with enhanced available iron, calling for caution and preventive measures where malaria or other infections are prevalent. Most African countries programmatically fortify flour and supplement pregnant women, while iron deficiency in young children is rather addressed at individual level. Coverage and efficacy could improve through increased access for target populations, raised awareness and lower cost. More bioavailable iron forms, helping to decrease iron dose, or prebiotics, which both may lower risk of infections are attractive opportunities for Africa. Fortifying specific food products could be a relevant route, adapted to local context and needs of population groups while providing education and training. More globally, partnerships involving various stakeholders are encouraged, that could tackle all aspects of the issue

Healthcare designers’ use of prescriptive and performance-based approaches

In the UK, healthcare built environment design is guided by a series of long-established design standards and guidance issued by the Department of Health. More recently, healthcare design focus has broadened to encompass new approaches, supported by large bodies of credible research evidence. It is therefore timely to rethink how healthcare design standards and guidance should be best expressed to suit ‘designerly ways’ of using evidence, to improve their use and effectiveness in practice. This research explored how designers use performance and prescriptive approaches during the healthcare design process. Three in-depth healthcare built environment case studies were used to explore how designers employed such approaches during the design of selected exemplar design elements. Results show that design elements in the pre and conceptual design phases significantly employed performance-based approaches, and due to project-unique circumstances, prescriptive solutions were often significantly modified based on performance criteria. For design elements in the detailed and technical design phases, there was a significant use of solutions based on prescriptive approaches, whilst performance-based criteria were used to evaluate design solutions. This research proposes a performance-based, specification-driven healthcare design with supplementary prescriptive specifications provided for optimum healthcare environment design

A comparative study of the efficacy of piperazine and Carica papaya for the control of helminth parasites in village chickens in Zambia

Journal articleVillage chickens play vital roles in the livelihoods of those people keeping them. Backyard poultry provide a critical source of food and income for people in developing countries (Lans et al. 2007) and so is the case in Zambia. However, their productivity has been hampered by many constraints resulting in low flock sizes (Kusina and Kusina 1999). Among the constraints is the problem of external and internal parasites (Abebe et al. 1997). In Africa, the control of these parasites is limited by the high cost of anthelmintics, their uncertain availability and the increasing frequency of drug resistance (Naidoo et al. 2008). Therefore, possible alternatives such as the use of plant products that function by mechanisms other than those of chemotherapeutics, with the additional advantage of a natural origin have been recommended (Naidoo et al. 2008). Besides, the cost of treatment with alternative traditional methods (herbs) is negligible when compared with the cost of conventional medicines. In addition to being very inexpensive, herbal preparations have good medicinal value (Mbaria et al. 1998). Therefore, in a quest for provision of safe animal products, a number of studies on use of herbal therapy especially in poultry, have been conducted many of which have reported a number of herbal products that are of potential use as therapeutic or prophylactic agents against bacteria (Arshad et al. 2008), protozoa (Nweze and Obiwulu 2009; Naidoo et al. 2008; Arshad et al. 2008) and viruses (Kong et al. 2006). However, only a few herbal products (Lans et al. 2007; Purwati and He 1991) have been reported to be potential antihelmintic agents in poultry. The objective of the current study was to compare the efficacy of Carica papaya latex with that of piperazine in the control of nematode parasites in village chickens as well as assess the effect of treatment on productivity (weight gain)

Prevalence of Taenia solium porcine cysticercosis in the Eastern, Southern and Western provinces of Zambia

Journal articleTongue examination and detection of circulating antigen (Ag-ELISA) were used to establish the prevalence of Taenia solium porcine cysticercosis in free-range pigs in selected districts of Eastern, Southern and Western provinces of Zambia, and to determine if prevalence of porcine cysticercosis was associated with age, breed and sex. Households with pigs were identified using the snowballing technique. A total of 1691 pigs were examined out of which 183 (10.8%) were positive on tongue examination. Ag-ELISA gave a sero-prevalence of 23.3%. When considering the factors in a logistic regression analysis, only breed type was significantly associated with porcine cysticercosis (OR = 0.72; 95%CI = 0.63–0.81). The crossbred pigs were 72% more likely to have had cysticercosis than the Nsenga (dwarf local) breed as determined by Ag-ELISA. The result that crossbred pigs had a higher prevalence of T. solium cysticercosis suggests that pig breeds may display different susceptibility to cysticercosis. The limited use of latrines in these areas implies that people use the nearby bush for defecation, resulting in pigs having access to human faeces. Therefore, investigation of taeniosis and cysticercosis in humans is warranted to better comprehend the local epidemiology and transmission risks. This should then be followed by extension programs to communities so that the control plans that could be instituted are more sustainable

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

A comparative study of the efficacy of piperazine and Carica papaya for the control of helminth parasites in village chickens in Zambia

Journal articleVillage chickens play vital roles in the livelihoods of those people keeping them. Backyard poultry provide a critical source of food and income for people in developing countries (Lans et al. 2007) and so is the case in Zambia. However, their productivity has been hampered by many constraints resulting in low flock sizes (Kusina and Kusina 1999). Among the constraints is the problem of external and internal parasites (Abebe et al. 1997). In Africa, the control of these parasites is limited by the high cost of anthelmintics, their uncertain availability and the increasing frequency of drug resistance (Naidoo et al. 2008). Therefore, possible alternatives such as the use of plant products that function by mechanisms other than those of chemotherapeutics, with the additional advantage of a natural origin have been recommended (Naidoo et al. 2008). Besides, the cost of treatment with alternative traditional methods (herbs) is negligible when compared with the cost of conventional medicines. In addition to being very inexpensive, herbal preparations have good medicinal value (Mbaria et al. 1998). Therefore, in a quest for provision of safe animal products, a number of studies on use of herbal therapy especially in poultry, have been conducted many of which have reported a number of herbal products that are of potential use as therapeutic or prophylactic agents against bacteria (Arshad et al. 2008), protozoa (Nweze and Obiwulu 2009; Naidoo et al. 2008; Arshad et al. 2008) and viruses (Kong et al. 2006). However, only a few herbal products (Lans et al. 2007; Purwati and He 1991) have been reported to be potential antihelmintic agents in poultry. The objective of the current study was to compare the efficacy of Carica papaya latex with that of piperazine in the control of nematode parasites in village chickens as well as assess the effect of treatment on productivity (weight gain)

Evidence and perceptions of rainfall change in Malawi: Do maize cultivar choices enhance climate change adaptation in sub-Saharan Africa?

Getting farmers to adopt new cultivars with greater tolerance for coping with climatic extremes and variability is considered as one way of adapting agricultural production to climate change. However, for successful adaptation to occur, an accurate recognition and understanding of the climate signal by key stakeholders (farmers, seed suppliers and agricultural extension services) is an essential precursor. This paper presents evidence based on fieldwork with smallholder maize producers and national seed network stakeholders in Malawi from 2010 to 2011, assessing understandings of rainfall changes and decision-making about maize cultivar choices. Our findings show that preferences for short-season maize cultivars are increasing based on perceptions that season lengths are growing shorter due to climate change and the assumption that growing shorter-season crops represents a good strategy for adapting to drought. However, meteorological records for the two study areas present no evidence for shortening seasons (or any significant change to rainfall characteristics), suggesting that short-season cultivars may not be the most suitable adaptation option for these areas. This demonstrates the dangers of oversimplified climate information in guiding changes in farmer decision-making about cultivar choice

Increasing understanding of the relationship between geographic access and gendered decision-making power for treatment-seeking for febrile children in the Chikwawa district of Malawi

Background: This study used qualitative methods to investigate the relationship between geographic access and gendered intra-household hierarchies and how these influence treatment-seeking decision-making for childhood fever within the Chikwawa district of Malawi. Previous cross-sectional survey findings in the district indicated that distance from facility and associated costs are important determinants of health facility attendance in the district. This paper uses qualitative data to add depth of understanding to these findings by exploring the relationship between distance from services, anticipated costs and cultural norms of intra-household decision-making, and to identify potential intervention opportunities to reduce challenges experienced by those in remote locations. Qualitative data collection included 12 focus group discussions and 22 critical incident interviews conducted in the local language, with primary caregivers of children who had recently experienced a febrile episode. Results: Low geographic accessibility to facilities inhibited care-seeking, sometimes by extending the ‘assessment period’ for a child’s illness episode, and led to delays in seeking formal treatment, particularly when the illness occurred at night. Although carers attempted to avoid incurring costs, cash was often needed for transport and food. Whilst in all communities fathers were normatively responsible for treatment costs, mothers generally had greater access to and control over resources and autonomy in decision-making in the matrilineal and matrilocal communities in the central part of the district, which were also closer to formal facilities. Conclusions: This study illustrates the complex interplay between geographic access and gender dynamics in shaping decisions on whether and when formal treatment is sought for febrile children in Chikwawa District. Geographic marginality and cultural norms intersect in remote areas both to increase the logistical and anticipated financial barriers to utilising services and to reduce caretakers’ autonomy to act quickly once they recognize the need for formal care. Health education campaigns should be based within communities, engaging all involved in treatment-seeking decision-making, including men and grandmothers, and should aim to promote the ability of junior women to influence the treatment-seeking process. Both mothers’ financial autonomy and fathers financial contributions are important to enable timely access to effective healthcare for children with malaria