Evidence of pollen transport by the Sanaga River on the Cameroon shelf

Thirty-eight samples were taken from the banks of the Sanaga River and its main tributaries draining different plant ecosystems, but also from rivers in the coastal basins of Cameroon. This study aims to characterize the origins of pollen and the dominant mode of transport of pollen inputs to the continental shelf. The classical method of pollen spectra analysis and multivariate statistical analysis revealed three groups of samples corresponding to the three main ecosystems in which the samples were taken. Pollens typical of the northern savannas are found in the spectra of samples taken further downstream from the Sanaga River in forest areas and not in samples from rivers draining mainly the forested coastal basins. The level of similarity between groups and the spatial evolution of spectra from upstream to downstream are related to the fluvial transport of pollen

Evidence of pollen transport by the Sanaga River on the Cameroon shelf

Thirty-eight samples were taken from the banks of the Sanaga River and its main tributaries draining different plant ecosystems, but also from rivers in the coastal basins of Cameroon. This study aims to characterize the origins of pollen and the dominant mode of transport of pollen inputs to the continental shelf. The classical method of pollen spectra analysis and multivariate statistical analysis revealed three groups of samples corresponding to the three main ecosystems in which the samples were taken. Pollens typical of the northern savannas are found in the spectra of samples taken further downstream from the Sanaga River in forest areas and not in samples from rivers draining mainly the forested coastal basins. The level of similarity between groups and the spatial evolution of spectra from upstream to downstream are related to the fluvial transport of pollen

Can selenium deficiency in Malawi be alleviated through consumption of agro-biofortified maize flour? Study protocol for a randomised, double-blind, controlled trial

Micronutrient deficiencies including selenium (Se) are widespread in Malawi and potentially underlie a substantial disease burden, particularly among poorer and marginalised populations. Concentrations of Se in staple cereal crops can be increased through application of Se fertilisers – a process known as agronomic biofortification (agro-biofortification) – and this may contribute to alleviating deficiencies. The Addressing Hidden Hunger with Agronomy (AHHA) trial aims to establish the efficacy of this approach for improving Se status in rural Malawi

Preparing for a community-based agriculture-to-nutrition trial in rural Malawi: formative research to assess feasibility and inform design and implementation decisions.

BACKGROUND: This study reports findings from formative research conducted to assess the feasibility and inform the design and implementation of the Addressing Hidden Hunger with Agronomy (AHHA) trial. The AHHA trial was a randomised, controlled trial conducted in rural Malawi, in which participants were given maize flour biofortified with selenium or control flour not biofortified with selenium for a period of 10 weeks, after which blood samples were taken to measure selenium status. METHODS: Formative research was conducted in villages near to the AHHA trial study site 1 year before the planned intervention. A short questionnaire with adult women (n = 50), focus group discussions with male (n groups = 3) and female (n groups = 3) community members, and in-depth key informant interviews (n = 7) were conducted to understand community practices and perceptions. FINDINGS: Meals were typically cooked and eaten at home in this community, while participants reported that maize flour would be less readily sold than maize grain - important considerations for the design of the trial. Regarding intervention delivery, we identified potential concerns around effects on fertility, links between blood sampling and witchcraft, and the potential for social stigma if community members considered participants lazy for receiving free flour. Participants reported that involvement of the Malawi government partners including health extension workers would increase trust. INTERPRETATION: Following the formative research, the AHHA trial appeared feasible. However, community sensitisation would be essential to address potential fears and concerns; effective sensitisation would support recruitment and treatment adherence, and would protect the safety and wellbeing of participants and researchers. People in positions of authority and trust including village headmen, religious leaders, health and agriculture extension workers, and community care groups should be involved in community sensitisation

Preuve du transport de pollen par la rivière Sanaga sur le plateau camerounais

TraductionTrente-huit échantillons ont été prélevés sur les berges de la rivière Sanaga et de ses principaux affluents drainant différents écosystèmes végétaux, mais aussi dans les rivières des bassins côtiers du Cameroun. Cette étude vise à caractériser les origines du pollen et le mode dominant de transport des apports polliniques vers le plateau continental. La méthode classique d'analyse des spectres polliniques et d'analyse statistique multivariée a révélé trois groupes d'échantillons correspondant aux trois principaux écosystèmes dans lesquels les échantillons ont été prélevés. Les pollens typiques des savanes septentrionales se retrouvent dans les spectres d'échantillons prélevés plus en aval du fleuve Sanaga dans les zones forestières et non dans les échantillons de rivières drainant principalement les bassins côtiers boisés

Factors associated with medical consumable availability in level 1 facilities in Malawi : a secondary analysis of a facility census

BACKGROUND: Medical consumable stock-outs negatively affect health outcomes not only by impeding or delaying the effective delivery of services but also by discouraging patients from seeking care. Consequently, supply chain strengthening is being adopted as a key component of national health strategies. However, evidence on the factors associated with increased consumable availability is limited. METHODS: In this study, we used the 2018-19 Harmonised Health Facility Assessment data from Malawi to identify the factors associated with the availability of consumables in level 1 facilities, ie, rural hospitals or health centres with a small number of beds and a sparsely equipped operating room for minor procedures. We estimate a multilevel logistic regression model with a binary outcome variable representing consumable availability (of 130 consumables across 940 facilities) and explanatory variables chosen based on current evidence. Further subgroup analyses are carried out to assess the presence of effect modification by level of care, facility ownership, and a categorisation of consumables by public health or disease programme, Malawi's Essential Medicine List classification, whether the consumable is a drug or not, and level of average national availability. FINDINGS: Our results suggest that the following characteristics had a positive association with consumable availability-level 1b facilities or community hospitals had 64% (odds ratio [OR] 1·64, 95% CI 1·37-1·97) higher odds of consumable availability than level 1a facilities or health centres, Christian Health Association of Malawi and private-for-profit ownership had 63% (1·63, 1·40-1·89) and 49% (1·49, 1·24-1·80) higher odds respectively than government-owned facilities, the availability of a computer had 46% (1·46, 1·32-1·62) higher odds than in its absence, pharmacists managing drug orders had 85% (1·85, 1·40-2·44) higher odds than a drug store clerk, proximity to the corresponding regional administrative office (facilities greater than 75 km away had 21% lower odds [0·79, 0·63-0·98] than facilities within 10 km of the district health office), and having three drug order fulfilments in the 3 months before the survey had 14% (1·14, 1·02-1·27) higher odds than one fulfilment in 3 months. Further, consumables categorised as vital in Malawi's Essential Medicine List performed considerably better with 235% (OR 3·35, 95% CI 1·60-7·05) higher odds than other essential or non-essential consumables and drugs performed worse with 79% (0·21, 0·08-0·51) lower odds than other medical consumables in terms of availability across facilities. INTERPRETATION: Our results provide evidence on the areas of intervention with potential to improve consumable availability. Further exploration of the health and resource consequences of the strategies discussed will be useful in guiding investments into supply chain strengthening. FUNDING: UK Research and Innovation as part of the Global Challenges Research Fund (Thanzi La Onse; reference MR/P028004/1), the Wellcome Trust (Thanzi La Mawa; reference 223120/Z/21/Z), the UK Medical Research Council, the UK Department for International Development, and the EU (reference MR/R015600/1)