4 research outputs found

    Unpacking ‘sustainable’ cocoa: do sustainability standards, development projects and policies address producer concerns in Indonesia, Cameroon and Peru?

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    ‘Sustainable cocoa’ has attracted considerable attention. However, stakeholders in cocoa development may differ in their understanding of sustainable cocoa, their interests and actions taken in advancing sustainable cocoa. This article analyses cocoa sustainability at nested scales and analyses to what extent sustainability standards, policies and development projects address sustainability concerns and contribute to ecosystem services. The analysis is based on literature reviews and key informant interviews in Sulawesi (Indonesia), Ucayali (Peru) and Centre Region (Cameroon). Producers in all three countries shared concerns of price volatility, weak farmer organizations and dependence on few buyers. Producers in Sulawesi and Centre Region compensated low returns to cocoa production by diversification of cocoa systems. Public and private development actors were concerned with low production volumes. Research has so far focused on biodiversity loss, which differed depending on the cocoa sector’s age in a country. Policies and development programs in all countries have focused on cocoa sector expansion and productivity increases, irrespective of smallholder needs for economically viable farming systems and existing market structures resulting in little bargaining power to farmers. Sustainability standards have spread unevenly and have converged in compliance criteria over time, although initially differing in focus. Recently added business and development criteria of sustainability standards can potentially address farmers’ concerns. Competing interests and interdependencies between different actors’ responses to concerns have so far not been openly acknowledged by public and private sector actors.EDITED BY Beria Leimon

    Improving COVID-19 contact tracing and testing of exposed individuals in Cameroon using digital health technology: a cluster randomised trialResearch in context

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    Summary: Background: Contact tracing was described as a key strategy to contribute to controlling the spread of severe acute respiratory syndrome of Coronavirus 2 (SARS-CoV-2) but implementing it can be a challenge. Digitalisation of contact tracing is among the proposed solutions being explored in sub-Saharan African settings. We assessed the effectiveness of a digital tool to expand SARS-CoV-2 testing in exposed individuals in Cameroon. Methods: We conducted a cluster-randomised (1:1) trial in eight health districts, including 22 facilities and SARS-CoV-2 testing units, randomly assigned to a digital (intervention) or standard (control) contact tracing approach. The intervention consisted of a contact tracing module added to the digital platform “Mamal PRO” used for monitoring and coordination of Coronavirus Disease 2019 pandemic response in Cameroon. The primary outcome was the proportion of contacts declared by SAR-CoV-2 index patients who were successfully traced and tested for SARS-CoV-2 evaluated with a Poisson regression model with cluster adjustment. This study is registered with ClinicalTrials.gov (NCT05684887). Findings: Between October 18, 2022, and March 31, 2023, we enrolled 164 index patients in the intervention arm and 149 in the control arm, who identified 854 and 849 contacts, respectively. In the intervention arm, 93.8% (801/854) of identified contacts were successfully reached by the tracing unit versus 54.5% (463/849) in the control arm. The intervention significantly increased the likelihood of successfully tracing contacts (adjusted relative risks (RR) 1.72 [95% CI: 1.00–2.95], p = 0.049). The median (interquartile range, IQR) time to successfully tracing contacts was 0 days [IQR: 0, 1] in the intervention and 1 day [IQR: 0, 2] in the control arm. In the intervention arm, 21.3% (182/854) of identified contacts received SARS-CoV-2 testing compared to 14.5% (123/849) in the control arm (adjusted RR 1.47 [95% CI: 0.44–4.90], p = 0.530). Interpretation: Digitalising the contact tracing process improved exposure notification and facilitated the tracing of a greater number of contacts of individuals infected with SARS-CoV-2 in resource-limited settings. Funding: The study was funded by FIND, United Kingdom (FCDO 40105983), Switzerland (81066910), Netherlands (SDD 4000004160), Canada (DFATD 7429348), The Kingdom of Saudi Arabia (FIND—ACT-A DX PARTNERSHIP 20.08.2020), The Rockefeller Foundation (2020 HTH 059), Germany (BMZ Covid-19 Diagnostic and Surveillance Response 27.07.2021), Australia (DFAT 76442), Kuwait (M239/2020), The Government of Portugal and Partners (ANF, BCP, CGF, APIFARMA) and The BlackRock Foundation (Grant Agreement as of April 20, 2022)
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