"Even if the test result is negative, they should be able to tell us what is wrong with us": a qualitative study of patient expectations of rapid diagnostic tests for malaria.

BACKGROUND: The debate on rapid diagnostic tests (RDTs) for malaria has begun to shift from whether RDTs should be used, to how and under what circumstances their use can be optimized. This has increased the need for a better understanding of the complexities surrounding the role of RDTs in appropriate treatment of fever. Studies have focused on clinician practices, but few have sought to understand patient perspectives, beyond notions of acceptability. METHODS: This qualitative study aimed to explore patient and caregiver perceptions and experiences of RDTs following a trial to assess the introduction of the tests into routine clinical care at four health facilities in one district in Ghana. Six focus group discussions and one in-depth interview were carried out with those who had received an RDT with a negative test result. RESULTS: Patients had high expectations of RDTs. They welcomed the tests as aiding clinical diagnoses and as tools that could communicate their problem better than they could, verbally. However, respondents also believed the tests could identify any cause of illness, beyond malaria. Experiences of patients suggested that RDTs were adopted into an existing system where patients are both physically and intellectually removed from diagnostic processes and where clinicians retain authority that supersedes tests and their results. In this situation, patients did not feel able to articulate a demand for test-driven diagnosis. CONCLUSIONS: Improvements in communication between the health worker and patient, particularly to explain the capabilities of the test and management of RDT negative cases, may both manage patient expectations and promote patient demand for test-driven diagnoses

The Influence of an Agricultural Subsidy Extension Program on Smallholder Maize Farmers in Tanzania

Smallholder farming in Tanzania is a household activity implemented at the subsistence level. The government of Tanzania launched the subsidy program to promote food secure households and shift subsistence farming to business farming. Food insecurity was associated by low rates of fertilizer application and poor seed quality among smallholder farmers due to fertilizer and seed costs which led to an increase in food prices. This study aimed at assessing the impact of the agricultural subsidy program for smallholder maize farmers. Four research objectives focused on agricultural productivity, food security, usage of improved inputs, and farmers’ perceptions of how the program functioned. An ex post facto research design was used with a sample of 120 smallholder farmers. The investigation involved 60 farmers who received subsidies and 60 who did not. The study used an interviewer administered questionnaire. Farmers who received subsidies significantly increased maize production. Comparison of average output before and after subsides shows an increase in number of bags (100 kg) per acre from an average of 5.35 bags to 10.10 bags. Farmers who did not receive subsides produced about the same amount of maize at time one and time two. There was general satisfaction with the functioning of the program, however certain areas need to be improved including that program objectives are followed, ensuring farmers can manage market price of inputs, and enhancing extension services for farmers to produce more surplus

Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007-2013.

SETTING: A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya. OBJECTIVES: Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors. DESIGN: Retrospective cross-sectional study using routine programme data. RESULTS: During the study period, 2635 women delivered at the RMC: 50% were aged 16-24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births. CONCLUSION: This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions

Report on the main activities undertaken and preliminary findings emerging from research on the CGIAR Targeting Agricultural Innovations and Ecosystem Services in the northern Volta basin (TAI) project

The CGIAR Water, Land and Ecosystems research project on Targeting Agricultural Innovations and Ecosystem Services in the northern Volta basin (TAI) is a two year project (2014-2016) led by Bioversity International in collaboration with 11 institutes: CIAT, CIRAD, International Water Management Institute (IWMI), King’s College London (KCL), SNV World Burkina Faso (SNV), Stanford University, Stockholm Resilience Centre (SRC), University of Development Studies Ghana (UDS), University of Minnesota, University of Washington, and the World Agroforestry Institute. We are working with communities across Centre-Est Burkina Faso and Upper-East Ghana to gather empirical data, test research methodologies and co-develop knowledge on solutions to ecosystem service management challenges. Results from the project are still emerging and will continue to do so into 2017 as the team finish analysing the data and writing up their findings. This report presents the main activities accomplished and preliminary headline messages from the first 18 months of the project. Final results from the project will be made available in 2017 on the WLE website

Are Tanzanian patients attending public facilities or private retailers more likely to adhere to artemisinin-based combination therapy?

BACKGROUND: Artemisinin combination therapy (ACT) is first-line treatment for malaria in most endemic countries and is increasingly available in the private sector. Most studies on ACT adherence have been conducted in the public sector, with minimal data from private retailers. METHODS: Parallel studies were conducted in Tanzania, in which patients obtaining artemether-lumefantrine (AL) at 40 randomly selected public health facilities and 37 accredited drug dispensing outlets (ADDOs) were visited at home and questioned about doses taken. The effect of sector on adherence, controlling for potential confounders was assessed using logistic regression with a random effect for outlet. RESULTS: Of 572 health facility patients and 450 ADDO patients, 74.5% (95% CI: 69.8, 78.8) and 69.8% (95% CI: 64.6, 74.5), respectively, completed treatment and 46.0% (95% CI: 40.9, 51.2) and 34.8% (95% CI: 30.1, 39.8) took each dose at the correct time ('timely completion'). ADDO patients were wealthier, more educated, older, sought care later in the day, and were less likely to test positive for malaria than health facility patients. Controlling for patient characteristics, the adjusted odds of completed treatment and of timely completion for ADDO patients were 0.65 (95% CI: 0.43, 1.00) and 0.69 (95% CI: 0.47, 1.01) times that of health facility patients. Higher socio-economic status was associated with both adherence measures. Higher education was associated with completed treatment (adjusted OR = 1.68, 95% CI: 1.20, 2.36); obtaining AL in the evening was associated with timely completion (adjusted OR = 0.35, 95% CI: 0.19, 0.64). Factors associated with adherence in each sector were examined separately. In both sectors, recalling correct instructions was positively associated with both adherence measures. In health facility patients, but not ADDO patients, taking the first dose of AL at the outlet was associated with timely completion (adjusted OR = 2.11, 95% CI: 1.46, 3.04). CONCLUSION: When controlling for patient characteristics, there was some evidence that the adjusted odds of adherence for ADDO patients was lower than that for public health facility patients. Better understanding is needed of which patient care aspects are most important for adherence, including the role of effective provision of advice