Community knowledge on HIV/AIDS and its relationship with sexual practices in Tabora and Igunga Districts, western Tanzania.

No Abstract

Impact of intermittent screening and treatment for malaria among school children in Kenya: a cluster randomised trial.

BACKGROUND: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence of the benefits of alternative school-based malaria interventions or how the impacts of interventions vary according to intensity of malaria transmission. We investigated the effect of intermittent screening and treatment (IST) for malaria on the health and education of school children in an area of low to moderate malaria transmission. METHODS AND FINDINGS: A cluster randomised trial was implemented with 5,233 children in 101 government primary schools on the south coast of Kenya in 2010-2012. The intervention was delivered to children randomly selected from classes 1 and 5 who were followed up for 24 months. Once a school term, children were screened by public health workers using malaria rapid diagnostic tests (RDTs), and children (with or without malaria symptoms) found to be RDT-positive were treated with a six dose regimen of artemether-lumefantrine (AL). Given the nature of the intervention, the trial was not blinded. The primary outcomes were anaemia and sustained attention. Secondary outcomes were malaria parasitaemia and educational achievement. Data were analysed on an intention-to-treat basis. During the intervention period, an average of 88.3% children in intervention schools were screened at each round, of whom 17.5% were RDT-positive. 80.3% of children in the control and 80.2% in the intervention group were followed-up at 24 months. No impact of the malaria IST intervention was observed for prevalence of anaemia at either 12 or 24 months (adjusted risk ratio [Adj.RR]: 1.03, 95% CI 0.93-1.13, p = 0.621 and Adj.RR: 1.00, 95% CI 0.90-1.11, p = 0.953) respectively, or on prevalence of P. falciparum infection or scores of classroom attention. No effect of IST was observed on educational achievement in the older class, but an apparent negative effect was seen on spelling scores in the younger class at 9 and 24 months and on arithmetic scores at 24 months. CONCLUSION: In this setting in Kenya, IST as implemented in this study is not effective in improving the health or education of school children. Possible reasons for the absence of an impact are the marked geographical heterogeneity in transmission, the rapid rate of reinfection following AL treatment, the variable reliability of RDTs, and the relative contribution of malaria to the aetiology of anaemia in this setting. TRIAL REGISTRATION: www.ClinicalTrials.gov NCT00878007

Amplifying local voices to reduce failure in the water, sanitation and hygiene sector

This is a poster briefWASH endeavours regularly fail. Sometimes this means that entire programmes do not achieve their stated aims, sometimes these failures are setbacks which can be rectified with sufficient reflection and action. This research aimed to develop an evidence base of how and why field-based WASH professionals in four sub-Saharan African countries believe failures occur, their experiences when sharing and discussing them within their organisations, and how they believe a culture conducive to publicly sharing and learning from failures could be nurtured

Interrupting transmission of soil-transmitted helminths : a study protocol for cluster randomised trials evaluating alternative treatment strategies and delivery systems in Kenya

Introduction: In recent years, an unprecedented emphasis has been given to the control of neglected tropical diseases, including soil-transmitted helminths (STHs). The mainstay of STH control is school-based deworming (SBD), but mathematical modelling has shown that in all but very low transmission settings, SBD is unlikely to interrupt transmission, and that new treatment strategies are required. This study seeks to answer the question: is it possible to interrupt the transmission of STH, and, if so, what is the most costeffective treatment strategy and delivery system to achieve this goal? Methods and analysis: Two cluster randomised trials are being implemented in contrasting settings in Kenya. The interventions are annual mass anthelmintic treatment delivered to preschool- and school-aged children, as part of a national SBD programme, or to entire communities, delivered by community health workers. Allocation to study group is by cluster, using predefined units used in public health provision—termed community units (CUs). CUs are randomised to one of three groups: receiving either (1) annual SBD; (2) annual community-based deworming (CBD); or (3) biannual CBD. The primary outcome measure is the prevalence of hookworm infection, assessed by four cross-sectional surveys. Secondary outcomes are prevalence of Ascaris lumbricoides and Trichuris trichiura, intensity of species infections and treatment coverage. Costs and cost-effectiveness will be evaluated. Among a random subsample of participants, worm burden and proportion of unfertilised eggs will be assessed longitudinally. A nested process evaluation, using semistructured interviews, focus group discussions and a stakeholder analysis, will investigate the community acceptability, feasibility and scale-up of each delivery system. Ethics and dissemination: Study protocols have been reviewed and approved by the ethics committees of the Kenya Medical Research Institute and National Ethics Review Committee, and London School of Hygiene and Tropical Medicine. The study has a dedicated web site. Trial registration number: NCT0239777

Analysis of the Yellow Bean Corridor in Tanzania

The yellow bean value chain in Tanzania was necessary to understand value chain. The objective of the survey was to characterize and explore trade of yellow bean grain and potential seed. The survey collected data and grain samples from 298 grain traders (including wholesalers, exporters, aggregators, and retailers) and 64 potential seed traders (large and retail traders) from 12 regions across four administrative zones in Tanzania. The grain samples collected were for DNA analyses. Results show existence of an established yellow bean corridor across Tanzania and the region at large (Burundi, DRC, Kenya, Rwanda, Uganda, Zambia) and demonstrated a huge market pull in the Eastern and Southern Africa regions. There are also strong perceptions on the organoleptic quality of various yellow bean grains and varieties that are traced to their sources

Community-level epidemiology of soil-transmitted helminths in the context of school-based deworming: Baseline results of a cluster randomised trial on the coast of Kenya.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02397772

Community knowledge on HIV/AIDS and its relationship with sexual practices in Tabora and Igunga Districts, western Tanzania

HIV/AIDS represents one of the critical challenges to human development in sub Saharan Africa. This study was carried out to assess the knowledge of HIV/AIDS and its relationship with sexual practices among communities in Tabora and Igunga Districts in western Tanzania. The study employed both qualitative and quantitative methods, which included interviews and group discussions. A total of 568 participants (female=49%; males= 51%) were involved in the study. Two hundred and eighty-four of the respondents were adults (>25 years) and 284 were youths of 12 – 25 years. The results showed although the knowledge of the disease and its prevention was high (90%) among the community, some gaps regarding the knowledge on modes of transmission were observed. About 17.2% of the respondents reported to have multiple sexual partners and only about half of the respondents reported the use of condoms. The level of education correlated significantly with the individual knowledge on HIV/AIDS (P=0.003). There was no significant difference between urban and rural communities on their knowledge on HIV/AIDS (P>0.05). Health education on HIV/AIDS prevention needs to be strengthened and improved to include cognitive behavioural interventions that emphasize attitude changes, negotiation skills and decisionmaking skills that could be effective in changing and maintaining safe sexual behaviour

Challenges for consent and community engagement in the conduct of cluster randomized trial among school children in low income settings: experiences from Kenya.

BACKGROUND: There are a number of practical and ethical issues raised in school-based health research, particularly those related to obtaining consent from parents and assent from children. One approach to developing, strengthening, and supporting appropriate consent and assent processes is through community engagement. To date, much of the literature on community engagement in biomedical research has concentrated on community- or hospital-based research, with little documentation, if any, of community engagement in school-based health research. In this paper we discuss our experiences of consent, assent and community engagement in implementing a large school-based cluster randomized trial in rural Kenya. METHODS: Data collected as part of a qualitative study investigating the acceptability of the main trial, focus group discussions with field staff, observations of practice and authors' experiences are used to: 1) highlight the challenges faced in obtaining assent/consent; and 2) strategies taken to try to both protect participant rights (including to refuse and to withdraw) and ensure the success of the trial. RESULTS: Early meetings with national, district and local level stakeholders were important in establishing their co-operation and support for the project. Despite this support, both practical and ethical challenges were encountered during consenting and assenting procedures. Our strategy for addressing these challenges focused on improving communication and understanding of the trial, and maintaining dialogue with all the relevant stakeholders throughout the study period. CONCLUSIONS: A range of stakeholders within and beyond schools play a key role in school based health trials. Community entry and information dissemination strategies need careful planning from the outset, and with on-going consultation and feedback mechanisms established in order to identify and address concerns as they arise. We believe our experiences, and the ethical and practical issues and dilemmas encountered, will be of interest for others planning to conduct school-based research in Africa. TRIAL REGISTRATION: National Institute of Health NCT00878007

Participatory on-farm selection of sweetpotato varieties in western Kenya

Sweet potato production in western Kenya is constrained by widespread use of low yielding and late maturing traditional varieties. Studies conducted at several sites in Kenya between 1994 and 1996 identified some potential varieties for production in different sweet potato growing agro-ecologies in western Kenya. The objective of this study was to assess the performance of the selected varieties under farmer management conditions. Four sweet potato varieties Mugande, SPK013, SPK004 and Kemb 10 were evaluated by farmers at four clusters of trial sites between 1997 and 1999. Information on yield, taste and farmer acceptance was obtained at each trial site. Varieties Mugande, SPK013 and Kemb 10 performed better than the local check 'Mar Ooko' at all sites. Mugande and Kemb 10 had a wide adaptation while SPK013 yielded well in the Upper Midland high potential areas of western Kenya. Key Words: Adaptability, farmer acceptance, Ipomea batatas, western Kenya (African Crop Science Journal 2001 9(1): 41-49