Adaptive geostatistical design and analysis for prevalence surveys

Non-adaptive geostatistical designs (NAGDs) offer standard ways of collecting and analysing geostatistical data in which sampling locations are fixed in advance of any data collection. In contrast, adaptive geostatistical designs (AGDs) allow collection of geostatistical data over time to depend on information obtained from previous information to optimise data collection towards the analysis objective. AGDs are becoming more important in spatial mapping, particularly in poor resource settings where uniformly precise mapping may be unrealistically costly and the priority is often to identify critical areas where interventions can have the most health impact. Two constructions are: singleton and batch adaptive sampling. In singleton sampling, locations xi are chosen sequentially and at each stage, xk+1 depends on data obtained at locations x1,…,xk. In batch sampling, locations are chosen in batches of size b>1, allowing each new batch, {x(k+1),…,x(k+b)}, to depend on data obtained at locations x1,…,xkb. In most settings, batch sampling is more realistic than singleton sampling. We propose specific batch AGDs and assess their efficiency relative to their singleton adaptive and non-adaptive counterparts using simulations. We then show how we are applying these findings to inform an AGD of a rolling Malaria Indicator Survey, part of a large-scale, five-year malaria transmission reduction project in Malawi

Inhibitory geostatistical designs for spatial prediction taking account of uncertain covariance structure

The problem of choosing spatial sampling designs for investigating an unobserved spatial phenomenon S arises in many contexts, for example in identifying households to select for a prevalence survey to study disease burden and heterogeneity in a study region D. We studied randomised inhibitory spatial sampling designs to address the problem of spatial prediction whilst taking account of the need to estimate covariance structure. Two specific classes of design are inhibitory designs and inhibitory designs plus close pairs. In an inhibitory design, any pair of sample locations must be separated by at least an inhibition distance δ. In an inhibitory plus close pairs design, n − k sample locations in an inhibitory design with inhibition distance δ are augmented by k locations each positioned close to one of the randomly selected n − k locations in the inhibitory design, uniformly distributed within a disc of radius ζ. We present simulation results for the Mat´ern class of covariance structures. When the nugget variance is non-negligible, inhibitory plus close pairs designs demonstrate improved predictive efficiency over designs without close pairs. We illustrate how these findings can be applied to the design of a rolling Malaria Indicator Survey that forms part of an ongoing large-scale, five-year malaria transmission reduction project in Malawi

High Prevalence of DHFR and DHPS Molecular Markers in Plasmodium Falciparum in Pregnant Women of Nchelenge District, Northern Zambia

Background: Sulphadoxine-pyrimethamine (SP) is the recommended drug for intermittent preventive treatment in pregnancy (IPTp) in most African countries, including Zambia. However, malaria is still one of the leading causes of morbidity and mortality in pregnant women despite reports of greater than 50% of women taking at least two doses of SP in IPTp. Studies have shown that resistance to SP is associated with mutations in the dhfr and dhps gene of Plasmodium falciparum. This study examined the prevalence of dhfr and dhps polymorphisms in P. falciparum found in pregnant women of Nchelenge district. Method: This cross-sectional study was conducted in 2013 in Nchelenge, a holoendemic area with malaria prevalence estimated at 50% throughout the year. Three rural health centres were randomly selected and a census survey carried out at each health centre. A questionnaire was administered and malaria testing done using RDT and microscopy, with collection of a dried blood spot. A chelex extraction was done to extract parasite DNA from dried blood spots followed by nested PCR and enzyme restriction digestion. Results: Of the enrolled participants (n∈=∈375), the median age of the women was 23. The prevalence of malaria by PCR was 22%. The PCR positive samples examined (n∈=∈72) showed a high prevalence of dhfr triple (Asn-108∈+∈Arg-59∈+∈Ile-59) mutant (68%) and dhps double (Gly -437∈+∈Glu-540) mutant (21%). The quintuple haplotype was found in 17% with 2 samples with an additional Gly-581mutation. In addition 6% mutations at Val-16 were found and none found at Thr-108 respectively, these both confer resistance to cycloguanil. Multivariate analysis showed that there was an association between malaria and women aged 30-34 years old p∈\u3c∈0.05(AOR: 0.36) at 95% CI. Conclusion: This study showed a high number of mutations in the dhfr and dhps genes. The high malaria endemicity in the general population of this area may have contributed to the high prevalence of resistant parasites in pregnant women, suggesting a need to examine the efficacy of SP given that it is the only approved drug for IPTp in Zambia. © 2015 Siame et al.; licensee BioMed Central

Common framework on market-oriented agricultural advisory services

Produced with the Neuchâtel Group, an informal group of representatives of development agencies and professional institutions involved in agricultural development in sub-Saharan Africa, this booklet summarises the findings of more than 30 case-studies collected in 2006 on agricultural advisory services. It provides guidance on how to promote market orientation

What makes staff consider leaving the health service in Malawi?

Malawi faces a severe shortage of health workers, a factor that has contributed greatly to high maternal mortality in the country. Most clinical care is performed by mid-level providers (MLPs). While utilization of these cadres in providing health care is a solution to the current shortages, demotivating factors within the Malawian health system are pushing them into private, non-governmental, and other non-health related positions. This study aims to highlight these demotivating factors by exploring the critical aspects that influence MLPs' intention to leave their jobs

Note de cadrage sur les services de conseil agricole répondant aux besoins du marché

Préparé par le Groupe de Neuchâtel, un groupe informel constitué de représentants d'agences de développement et d'organisations professionnelles participant au développement agricole en Afrique subsaharienne, ce livret résume les résultats d'une trentaine d'études de cas compilées en 2006 sur les services d'encadrement agricole. L'ouvrage abonde de conseils sur les moyens de promouvoir une démarche orientée vers le marché

Farmer experience of pluralistic agricultural extension, Malawi

Purpose: Malawi’s current extension policy supports pluralism and advocates responsiveness to farmer demand. We investigate whether smallholder farmers’ experience supports the assumption that access to multiple service providers leads to extension and advisory services that respond to the needs of farmers. Design/methodology/approach: Within a case study approach, two villages were purposively selected for in-depth qualitative analysis of available services and farmers’ experiences. Focus group discussions were held separately with male and female farmers in each village, followed by semi-structured interviews with 12 key informants selected through snowball sampling. Transcripts were analysed by themes and summaries of themes were made from cross case analysis. Findings: Farmers appreciate having access to a variety of sources of technical advice and enterprise specific technology. However, most service providers continue to dominate and dictate what they will offer. Market access remains a challenge, as providers still emphasize pushing a particular technology to increase farm productivity rather than addressing farmers’ expressed needs. Although farmers work in groups, providers do not seek to strengthen these to enable active interaction and to link them to input and produce markets. This limits farmers’ capacity to continue with innovations after service providers pull out. Poor coordination between providers limits exploitation of potential synergies amongst actors. Practical implications: Services providers can adapt their approach to engage farmers in discussion of their needs and work collaboratively to address them. At a system level, institutions that have a coordination function can play a more dynamic role in brokering interaction between providers and farmers to ensure coverage and responsiveness. Originality/value: The study provides a new farmer perspective on the implementation of extension reforms

Differences among rice cultivars in their adaptation to low ionic strength solution with toxic level of aluminum that mimics tropical acid soil conditions

BACKGROUND: Spatio-temporal variations in malaria burden are currently complex and costly to measure, but are important for decision-making. We measured the spatio-temporal variation of clinical malaria incidence at a fine scale in a cohort of children under five in an endemic area in rural Chikhwawa, Malawi, determined associated factors, and monitored adult mosquito abundance. METHODS: We followed-up 285 children aged 6-48 months with recorded geolocations, who were sampled in a rolling malaria indicator survey, for one year (2015-2016). Guardians were requested to take the children to a nearby health facility whenever ill, where health facility personnel were trained to record malaria test results and temperature on the child's sick-visit card; artemisinin-based combination therapy was provided if indicated. The cards were collected and replaced 2-monthly. Adult mosquitoes were collected from 2-monthly household surveys using a Suna trap. The head/thorax of adult Anopheles females were tested for presence of Plasmodium DNA. Binomial logistic regression and geospatial modelling were performed to determine predictors of and to spatially predict clinical malaria incidence, respectively. RESULTS: Two hundred eighty two children, with complete results, and 267.8 child-years follow-up time were included in the analysis. The incidence rate of clinical malaria was 1.2 cases per child-year at risk; 57.1% of the children had at least one clinical malaria case during follow-up. Geographical groups of households where children experienced repeated malaria infections overlapped with high mosquito densities and high entomological inoculation rate locations. CONCLUSIONS: Repeated malaria infections within household groups account for the majority of cases and signify uneven distribution of malaria risk within a small geographical area

Inhibitory geostatistical designs for spatial prediction taking account of uncertain covariance structure

The problem of choosing spatial sampling designs for investigating an unobserved spatial phenomenon S arises in many contexts, for example, in identifying households to select for a prevalence survey to study disease burden and heterogeneity in a study region D. We studied randomized inhibitory spatial sampling designs to address the problem of spatial prediction while taking account of the need to estimate covariance structure. Two specific classes of design are inhibitory designs and inhibitory designs plus close pairs. In an inhibitory design, any pair of sample locations must be separated by at least an inhibition distance δ. In an inhibitory plus close pairs design, n − k sample locations in an inhibitory design with inhibition distance δ are augmented by k locations each positioned close to one of the randomly selected n − k locations in the inhibitory design, uniformly distributed within a disk of radius ζ. We present simulation results for the Matérn class of covariance structures. When the nugget variance is non-negligible, inhibitory plus close pairs designs demonstrate improved predictive efficiency over designs without close pairs. We illustrate how these findings can be applied to the design of a rolling Malaria Indicator Survey that forms part of an ongoing large-scale, 5-year malaria transmission reduction project in Malawi