A ‘Mystery Client’ Evaluation of Adolescent Sexual and Reproductive Health services in Health Facilities from Two Regions in Tanzania

Unwelcoming behaviours and judgemental attitudes have long been recognised as a barrier to young people’s access to reproductive health services. Over the last decade youth friendly reproductive health services have been promoted and implemented world-wide. However, long term evidence of the impact of these programmes is lacking. We report the results of a large mystery client evaluation of adolescent sexual and reproductive health services in Tanzania, a country that has had a long established youth friendly policy. Forty-eight visits made to thirty-three health facilities were conducted by twelve young people (six in each region) trained to perform three different scripted scenarios (i.e., condom request, information on sexually transmitted infections and family planning). The study revealed barriers in relation to poor signage and reception for services. In addition health workers demonstrated paternalistic attitudes as well as lack of knowledge about adolescent sexual and reproductive health services. In some cases, health workers discouraged young people from using services such as condoms and family planning methods. Lack of confidentiality and privacy were also noted to be common challenges for the young people involved. Intervention strategies that focus on changing health workers’ mind-set in relation to adolescent sexual and reproductive health are crucial for ensuring quality provision of sexual and reproductive health services to young people. The study identified the importance of reception or signs at the health units, as this can facilitate young people’s efforts in seeking sexual and reproductive health services. Likewise, improvement of health workers knowledge of existing policy and practice on sexual and reproductive health services and youth friendly services is much needed

Preventing neonatal sepsis in rural Uganda: a cross-over study comparing the tolerance and acceptability of three alcohol-based hand rub formulations

BACKGROUND Neonatal sepsis causes 0.5 million deaths annually, mostly in low resource settings. Babies born in African rural homes without running water or toilet facilities are especially vulnerable. Alcohol-based hand rub (ABHR) may be used by mothers and carers as an alternative to hand washing with soap to prevent neonatal infection. However, no definite study has established the preferred formulation of hand rub for the mothers. This study aimed to assess the effects of addition of bitterants and perfume towards the acceptability of the alcohol-based hand rubs by the mothers in their homes after childbirth. METHODS This was a 3-way blinded cross-over study design. Mothers with children aged ≤3 months were recruited from immunisation clinics at 3 local health facilities in rural eastern Uganda and received 3-different ABHR formulations (in the order plain, bitterant and perfumed) packed in 100 ml bottles. Each ABHR was used for 5 consecutive days followed by a 2-day 'washout' period (evaluation period). Overall satisfaction with each hand rub was evaluated at the end of each week using a 7-point Likert scale. RESULTS A total of 43 women were recruited, whose ages ranged from 16 to 45 years (mean 26.2 years old). None of the participants normally used a hand protective lotion/cream. The three formulations were used for a mean of 5 (range 3-7) days. A significantly greater volume of the "bitterant" and "perfumed" formulations (mean 91 and 83 ml respectively) were used in comparison to the "plain" formulation (mean 64 ml). Overall satisfaction was high with all the hand rubs, but the perfumed formulation had a significantly higher overall satisfaction score [mean 6.7, range 4-7] compared with the plain [6.4, 3-7] and bitterant [6.2, 2-7] formulations. CONCLUSIONS All the 3 ABHR formulations were well accepted with little to choose between them. The ABHR with added perfume scored highest on overall satisfaction and was used significantly more often than plain ABHR. ABHR with bitterant additive did, however, score highly and may be a preferable choice to those with concern over alcohol misuse. TRIAL REGISTRATION ISRCTN67852437 , prospectively registered on 18/03/2018

Optimising informed consent for participants in a randomised controlled trial in rural Uganda: a comparative prospective cohort mixed-methods study

Background Poor participant understanding of research information can be a problem in community interventional studies with rural African women, whose levels of illiteracy are high. This study aimed to improve the informed consent process for women living in rural eastern Uganda. We assessed the impact of alternative consent models on participants’ understanding of clinical trial information and their contribution to the informed consent process in rural Uganda. Methods The study applied a parallel mixed-methods design for a prospective comparative cohort, nested within a pilot study on the community distribution of an alcohol-based hand rub to prevent neonatal sepsis (BabyGel pilot trial). Women of at least 34 weeks’ pregnancy, suitable for inclusion in the BabyGel pilot trial, were recruited into this study from their homes in 13 villages in Mbale District. As part of the informed consent process, information about the trial was presented using one of three consent methods: standard researcher-read information, a slide show using illustrated text on a flip chart or a video showing the patient information being read as if by a newsreader in either English or the local language. In addition, all women received the patient information sheet in their preferred language. Each information-giving method was used in recruitment for 1 week. Two days after recruitment, women’s understanding of the clinical trial was evaluated using the modified Quality of Informed Consent (QuIC) tool. They were also shown the other two methods and their preference assessed using a 5-point Likert scale. Semi-structured interviews were administered to each participant. The interviews were audio-recorded, transcribed and translated verbatim, and thematically analysed. Results A total of 30 pregnant women in their homes participated in this study. Their recall of the trial information within the planned 48 h was assessed for the majority (90%, 27/30). For all three consent models, women demonstrated a high understanding of the study. There was no statistically significant difference between the slide-show message (mean 4.7; standard deviation, SD 0.47; range 4–5), video message (mean 4.9; SD 0.33; range 4–5) and standard method (mean 4.5; SD 0.53; range 4–5; all one-way ANOVA, p = 0.190). The slide-show message resulted in the most objective understanding of question items with the highest average QuIC score of 100 points. For women who had been recruited using any of the three models, the slide show was the most popular method, with a mean score for all items of not less than 4.2 (mean 4.8; SD 0.6; range 4–5). Most women (63%, 19/30) preferred the slide-show message, compared with 17% (5/30) and 20% (6/30) for the standard and video messages, respectively. The reasons given included the benefits of having pictures to aid understanding and the logical progression of the information. Conclusion Our results from this small study suggest that slide-show messages may be an effective and popular alternative way of presenting trial information to women in rural Uganda, many of whom have little or no literacy

Are health systems interventions gender blind? examining health system reconstruction in conflict affected states

Background Global health policy prioritizes improving the health of women and girls, as evident in the Sustainable Development Goals (SDGs), multiple women’s health initiatives, and the billions of dollars spent by international donors and national governments to improve health service delivery in low-income countries. Countries recovering from fragility and conflict often engage in wide-ranging institutional reforms, including within the health system, to address inequities. Research and policy do not sufficiently explore how health system interventions contribute to the broader goal of gender equity. Methods This paper utilizes a framework synthesis approach to examine if and how rebuilding health systems affected gender equity in the post-conflict contexts of Mozambique, Timor Leste, Sierra Leone, and Northern Uganda. To undertake this analysis, we utilized the WHO health systems building blocks to establish benchmarks of gender equity. We then identified and evaluated a broad range of available evidence on these building blocks within these four contexts. We reviewed the evidence to assess if and how health interventions during the post-conflict reconstruction period met these gender equity benchmarks. Findings Our analysis shows that the four countries did not meet gender equitable benchmarks in their health systems. Across all four contexts, health interventions did not adequately reflect on how gender norms are replicated by the health system, and conversely, how the health system can transform these gender norms and promote gender equity. Gender inequity undermined the ability of health systems to effectively improve health outcomes for women and girls. From our findings, we suggest the key attributes of gender equitable health systems to guide further research and policy. Conclusion The use of gender equitable benchmarks provides important insights into how health system interventions in the post-conflict period neglected the role of the health system in addressing or perpetuating gender inequities. Given the frequent contact made by individuals with health services, and the important role of the health system within societies, this gender blind nature of health system engagement missed an important opportunity to contribute to more equitable and peaceful societies

"There are bugs in condoms": Tanzanian close-to-community providers' ability to offer effective adolescent reproductive health services

Objectives Young people in Tanzania are known to access reproductive health services from a range of close-to-community providers outside formal health settings such as drug stores, village AIDS committees, traditional healers and traditional birth attendants (TBAs). However, questions remain about the quality of services such agents provide. This study investigated their capacity to provide adolescent reproductive health (ARH) services and explored their readiness and ability to integrate with the mainstream health sector through community referral interventions. Methods Thirty-five focus group discussions exploring close-to-community provider experiences and attitudes to ARH service provision were carried out in two districts in Northern Tanzania. Discussions were conducted in Kiswahili, digitally recorded, verbatim-transcribed, translated and back-translated from Swahili to English. A thematic analysis was conducted using NVivo 9. Results The major close-to-community cadres providing reproductive health services were drug stores, traditional healers, TBAs and village health workers. They reported being the first port of call for adolescents seeking reproductive health services, but their knowledge of ARH needs was poor. They had negative attitudes to, and lacked the necessary resources for, the provision of such services for adolescents. Some were particularly unwilling to provide condom services and were prejudiced against adolescents using them. There was poor integration between the close-to-community providers and the formal health sector, further limiting their ability to provide adequate services. Conclusions Although close-to-community providers are considered a key resource in the community, most have limited capacity to provide ARH services. Without capacity-building investments such as training and cooperation with the mainstream health sector, their contribution to positive reproductive health outcomes is limited, or could indeed lead to adverse outcomes

Ponds' Water Quality Analysis and Impact of Heavy Metals on Fishes' Body

The anthropogenic activities have caused increase in the aquatic heavy metals pollution. The higher concentration of heavy metals in fish's body also affects the consumers as it reaches to human body through the food chain. This study was conducted to analyze the ponds' water quality based on physicochemical parameters and nutrients in relation to the dissolved heavy metals accumulated in the fishes' body by using R programing. In this study, the heavy metals bio-accumulated from barrage pond and diversions ponds was analysed. Kigembe, Nyamagana, Rwasave fertilized and Rwasave non-fertilized ponds were purposively chosen for the study. The water sample was analysed using HACH DR5000 UV-Vis Spectrophotometer to measure Ammonium-Nitrogen, Nitrate-Nitrogen, Phosphates and Total Phosphorus at Chemistry Department's Laboratory of University of Rwanda. While after filtration of water samples using Whatman filter papers, heavy metals including Fe, Cu, Mn, Zn, Ni, Co, Cd, Cr and Pb were determined using ICP-MS 7900. The analysis of physicochemical parameters showed that the temperature, pH, Conductivity, Turbidity and TDS were within the permissible limit of ponds' water (20-300C, 6.5-9, less than 1000 µs/cm, 30-60 NTU and less than 2000 mg/L respectively) quality for all the sites except Rwasave fishponds, where lower pH was observed. The nutrients level in these ponds were low comparing to the standard limit. The assessed heavy metals were Fe, Cu, Mn, Zn, Cd, Cr and Pb whose concentrations analyzed in water were within permissible limit of 0.3ppm, 1ppm, 0.1ppm, 3ppm, 0.003ppm, 0.5ppm and 0.01ppm respectively while heavy metals bio-accumulated were within the permissible limit of 0.1ppm, 1ppm, 0.05ppm, 5ppm, 0.05ppm, 0.05ppm and 0.05ppm respectively for all the sites except for both dissolved and bio-accumulated Fe and Mn concentration which were high for all sites. The highest level of heavy metals concentration was obtained in particular Fe and Mn. This shows that there is urgent need of continuous water quality analysis within the ponds for maintaining the favorite conditions for fish. The water quality monitoring will help the farmers to create the safe aquatic environment for fishes and improve their production output

Boiling water treatment: a simple, rapid and effective technique for nematode and banana weevil management in banana and plantain (Musa spp.) planting material

Published online: 30 Aug 2010.We studied the effect of treating banana and plantain (Musa spp.) suckers using boiling water for the generation of healthy planting material. Small, medium and large-sized suckers of two East African highland bananas (cvs. Mbwazirume, Kibuzi, AAA-EA) and one of plantain (cv. Agbagba, AAB) were dipped in boiling water for 10, 20 or 30 s after root removal and corm (sucker) paring. Treatments were compared with a conventional farmer method (control), which was not pared or treated with boiling water, and also with pared only. At three months after treatment, germination, plant height and girth of plants were similar within sucker size and between treatments for each cultivar. Root health was improved by boiling water treatment for all cultivars compared to untreated controls. Boiling water treatment of suckers reduced combined nematode densities of Helicotylenchus multicinctus, Radopholus similis and Meloidogyne spp. to 0.7% of farmer controls. Boiling water-treated suckers had less banana weevil damage than controls. Treatment of pared suckers for at least 20 s and up to 30 s was highly efficient for disinfesting banana and plantain planting material. This modification of the hot water treatment is a practical adaptation, suitable for smallholder growers to improve the quality of banana and plantain planting material in smallholder farms

Analysis of the pathogenic variability and genetic diversity of the plantparasitic nematode Radopholus similis on bananas

Radopholus similis is responsible for huge production losses of banana in Uganda, where a large proportion of the population are reliant on cooking banana as their main staple crop. Assessment of the pathogenic and genetic variability of seven populations of R. similis originating from banana plantations in Uganda demonstrated that their virulence on Musa cultivars differed, displaying pathotype-like variation. Using RAPD and AFLP techniques the populations could be grouped into two putative genomic groups, which corresponded with R. similis relative pathogenicity. Most, but not all, populations were able to reproduce and damage roots on the two widely confirmed sources of resistance, Yangambi km5 and Pisang Jari Buaya. Studies using RAPD techniques furthermore revealed putative markers for nematode virulence. Variation in virulence of R. similis populations was also demonstrated at the regional (Africa) level. Phylogenetic analysis most closely associated the Uganda populations with populations from Sri Lanka, indicating their likely source of origin. However, genetic variability between Uganda populations also indicate that R. similis was probably introduced into Uganda on separate occasions from different sources, which may help to explain the causes of variability in banana decline in Uganda. The results of this study have clear implications for the development and deployment of sustainable nematode management practices based on the use of resistance, which could help underpin ongoing management initiatives

New sources of resistance to Radopholus similis in Musa germplasm from Asia

The burrowing nematode, Radopholus similis, is a serious threat to sustainable banana production worldwide. A promising method for nematode control is the development and deployment of nematode-resistant banana cultivars. This requires the identification of sources of resistance, which can then be included in breeding programs to improve the local banana cultivars. In this regard, 23 accessions, including wild bananas and landraces, were evaluated for resistance to R. similis using the individual root inoculation method. The accessions Marau, Pora Pora, Kokopo, Pisang Mas, Saba, Gia Hiu, M. acuminata ssp. burmannica, M. acuminata ssp. malaccensis and Vudu papua were resistant to R. similis. Four other accessions, Pitu, Yalim, M. balbisiana and Yanun yefan, showed partial resistance to R. similis