Sustainable electricity for sustainable health? A case study in North-western Zambia

This study explores the under-researched link between clean energy and public health outcomes, and offers new insights into the link between wider access to clean energy and progress towards health outcomes, in particular the prevention and treatment of non-communicable diseases such as diabetes. This is the first study to consider the impact of a run-of-river hydropower plant (RORHP) in a remote rural community in Zambia in relation to health outcomes. Exploring this relationship establishes how the health benefits which renewable energy can bring can be capitalised upon to meet the health-related objectives of the United Nations sustainable development goals. Workshops and semi-structured interviews were conducted with a range of stakeholders including community members, health workers, business owners, and key people involved with the plant, to establish health and social impacts of the introduction of electricity in the community of Ikelenge. Findings are used to establish both synergies and trade-offs of the RORHP on the health of the community, and recommendations are made for the continued improvement of health following the introduction of the RORHP, to achieve further progress towards meeting SDG targets

Adapting and implementing training, guidelines and treatment cards to improve primary care-based hypertension and diabetes management in a fragile context: results of a feasibility study in Sierra Leone

Background Sierra Leone, a fragile country, is facing an increasingly significant burden of non-communicable diseases (NCDs). Facilitated by an international partnership, a project was developed to adapt and pilot desktop guidelines and other clinical support tools to strengthen primary care-based hypertension and diabetes diagnosis and management in Bombali district, Sierra Leone between 2018 and 2019. This study assesses the feasibility of the project through analysis of the processes of intervention adaptation and development, delivery of training and implementation of a care improvement package and preliminary outcomes of the intervention. Methods A mixed-method approach was used for the assessment, including 51 semi-structured interviews, review of routine treatment cards (retrieved for newly registered hypertensive and diabetic patients from June 2018 to March 2019 followed up for three months) and mentoring data, and observation of training. Thematic analysis was used for qualitative data and descriptive trend analysis and t-test was used for quantitative data, wherever appropriate. Results A Technical Working Group, established at district and national level, helped to adapt and develop the context-specific desktop guidelines for clinical management and lifestyle interventions and associated training curriculum and modules for community health officers (CHOs). Following a four-day training of CHOs, focusing on communication skills, diagnosis and management of hypertension and diabetes, and thanks to a CHO-based mentorship strategy, there was observed improvement of NCD knowledge and care processes regarding diagnosis, treatment, lifestyle education and follow up. The intervention significantly improved the average diastolic blood pressure of hypertensive patients (n = 50) three months into treatment (98 mmHg at baseline vs. 86 mmHg in Month 3, P = 0.001). However, health systems barriers typical of fragile settings, such as cost of transport and medication for patients and lack of supply of medications and treatment equipment in facilities, hindered the optimal delivery of care for hypertensive and diabetic patients. Conclusion Our study suggests the potential feasibility of this approach to strengthening primary care delivery of NCDs in fragile contexts. However, the approach needs to be built into routine supervision and pre-service training to be sustained. Key barriers in the health system and at community level also need to be addressed

Developing a socio-ecological model of dietary behaviour for people living with diabetes or high blood glucose levels in urban Nepal: A qualitative investigation

Instances of non-communicable diseases such as diabetes are on the rise globally leading to greater morbidity and mortality, with the greatest burden in low and middle income countries [LMIC]. A major contributing factor to diabetes is unhealthy dietary behaviour. We conducted 38 semi structured interviews with patients, health professionals, policy-makers and researchers in Kathmandu, Nepal, to better understand the determinants of dietary behaviour amongst patients with diabetes and high blood glucose levels. We created a social ecological model which is specific to socio-cultural context with our findings with the aim of informing culturally appropriate dietary behaviour interventions for improving dietary behaviour. Our findings show that the most influential determinants of dietary behaviour include cultural practices (gender roles relating to cooking), social support (from family and friends), the political and physical environment (political will, healthy food availability) and individuals’ motivations and capabilities. Using these most influential determinants, we suggest potentially effective dietary interventions that could be implemented by policy makers. Our findings emphasise the importance of considering socio-cultural context in developing interventions and challenges one-size-fits-all approaches which are often encouraged by global guidelines. We demonstrate how multifaceted and multi layered models of behavioural influence can be used to develop policy and practice with the aim of reducing mortality and morbidity from diabetes

Ammonium regeneration: Its contribution to phytoplankton nitrogen requirements in a eutrophic environment

Ammonium regeneration, nutrient uptake, bacterial activity and primary production were measured from March to August 1980 in Bedford Basin, Nova Scotia, Canada, a eutrophic environment. Rates of regeneration and nutrient uptake were determined using 15N isotope dilution and tracer methodology. Although primary production, nutrient uptake and ammonium regeneration were significantly intercorrelated, no relationship was detected between these parameters and heterotrophic activity. The average contribution of ammonium to total nitrogen (ammonium+nitrate) uptake was similar in the spring and in the summer (approximately 60%). On a seasonal average basis, 36% of the phytoplankton ammonium uptake could be supplied by rapid remineralization processes. In spite of the high average contribution of NH4 regeneration to phytoplankton ammonia uptake, there is indirect evidence suggesting that other NH4 sources may occasionally be important