Consumer perceptions and demand for biofortified sweet potato-based biscuit: The case of Akarabo golden power biscuit in Rwanda

Certain varieties of sweet potato, especially orange-fleshed, are being promoted as part of the strategy to combat vitamin A deficiency in children and pregnant mothers. However, the consumption of sweet potato is more widespread in rural households where it is mainly boiled or eaten raw. The lack of value addition excludes majority of urban and higher income consumers who consider sweet potato an inferior product. At the same time low income urban households that would be interested in consuming sweet potatoes are not able to receive regular supplies from the rural producing areas due to perishability and bulkiness of the produce. This study examines consumer perceptions and demand for value-added biofortified biscuit derived from the vitamin A-rich orange fleshed sweet potato in Rwanda. Specifically, it assesses consumer perceptions and preference for biofortified biscuit, consumer willingness to pay for biofortified biscuit and consumers’ rating of the biofortified biscuit. It uses data from 1085 consumers stratified by income levels drawn from consumers in several urban markets of Rwanda. The study finds very favorable rating of the taste, color, packaging, looks, and sweetness for the biofortified biscuit. It also finds higher willingness to pay (WTP) for the biofortified biscuit among consumers from low and low/middle income groups. However, the study finds mixed results of WTP for the biofortifed sweet potato among consumers in the high income neigborhoods. Also, contrary to expectations, the study finds no evidence that knowledge of vitamin A increases consumer rating for the biofortified biscuit, suggesting that the promotion campaigns did not change the way consumers perceive the biofortified sweet potato, perhaps due to the way the campaign was designed. The study concludes that the biofortified biscuit is currently more acceptable among the low and low/middle end income categories probably because of greater promotion at these levels. However, it has a high potential for the high amd medium income groups as evident from the high rating it received among these groups. The paper discusses the implications of these findings and suggests a need for more detailed studies and indepth quantitative analysis of consumer perceptions and WTP for orange-fleshed sweet potato.Key words: Consumers, demand, biofortified biscuits, Rwand

Orthopaedic Outreach Program in Uganda: A Strategy to Improve Inequality in Service Delivery between Rural and Urban Communities

Background: Musculoskeletal diseases are on the increase worldwide. Greater than 80% of Ugandans live in rural areas, facing formidable barriers to specialized care. In 1991 the Orthopedics Outreach Program (OOP) was initiated as a plausible solution to the inequity of orthopedic care between the urban and rural disadvantaged populations. This investigation was conducted to evaluate the output, effectiveness, and barriers to access, of the OOP over 13 years.Methods: This was a retrospective analysis to quantify surgical output and effectiveness of the OOP using the outreach record and a cross sectional analysis to assess access and efficacy of the program. Semi-structured and key informant interviews targeted to key actors involved in the OOP were conducted to provide a qualitative assessment of the program.Results: Sixty seven outreach visits were completed, 6,653 patients seen, and 1,071 surgeries performed, at a total cost of US$12,701.00. The cost per patient seen was US$1.91 and US$11.86 per surgery performed. Poverty was uniformly cited as barrier to access, others were, transportation, and lack of awareness. There was unanimous opinion on the worthiness and effectiveness of the OOP, but many operational issues and constraints were cited.Conclusion: The OOP may provide a short and medium term solution to equity and access for orthopedic care in Uganda. There is need to quantify the burden of specific orthopedics conditions. A follow-up analysis assessing operational efficacy and output from 2004 to date, under the African Medical and Research Foundation (AMREF) and Ministry of Health funding is recommended

Farmers’ perceptions of orange-fleshed sweetpotato: Do common beliefs about sweetpotato production and consumption really matter?

Efforts to combat vitamin A deficiency in developing countries have focused on the promotion of growing and consuming orange-fleshed sweetpotato (OFSP), among other crops. Past studies have found increased intake and even incomes among households that have been reached with information about nutritional benefits of OFSP. Consequently, efforts to scale up the production and consumption of OFSP are on-going in several African countries where vitamin A deficiency is a major problem. However, to date, few studies have systematically examined farmers’ perceptions and attitudes towards some of the attributes of OFSP. This paper interrogates some of the beliefs about the production and consumption of sweetpotato in general, and OFSP, in particular. It uses data generated using multi-stage sampling technique and involving 732 households in the Lake zone of Tanzania. The households were stratified into project participants (the intervention group) and non-participants (the control group). Within each household, data were collected from a male or female adult member (usually spouses) through personal interviews. Overall, 455 project participants and 277 non-participants were interviewed. This study uses both descriptive and exploratory factor analysis to assess some common beliefs about sweetpotato production and consumption. Contrary to the common beliefs, the study finds that sweetpotato is an important food crop to producing households, and that the common negative beliefs about sweetpotato production and consumption are not widely held. This study, therefore, recommends the need to upscale and out-scale efforts to sensitize farmers about the nutritional benefits of growing and consuming OFSP to counter the common negative beliefs about sweetpotato. In particular, educating farmers on the health effects of inadequate intake of Vitamin A and the importance of OFSP as its source can greatly influence their perceptions about OFSP. Further, there is need to increase efforts at breeding aimed at supplying the multiple desirable table and postharvest attributes of orange-fleshed sweetpotato, in addition to focusing on agronomic traits. For sub-Saharan Africa, such attributes include taste, storability of the tubers, dry matter content, and sugar content.Keywords: Sweetpotato, attributes, nutritional benefits, common beliefs, farmer perceptions, Tanzani

Bacterial contamination of Kale (Brassica oleracea acephala) along the supply chain in Nairobi and its environment

Objective: To assess the microbiological safety of kale (Brassica oleracea Acephala) produced from farms and those sold at the markets with special focus on coliforms, E.coli and Salmonella.Design: A cross sectional study.Setting: Peri-Urban farms (in Athi River, Ngong and Wangige), wet markets (in Kawangware, Kangemi and Githurai), supermarkets and high-end specialty store both within Nairobi city.Results: Mean coliform count on vegetables from farms were 2.6x105 ±5.0x105 cfu/g while those from the wet markets were 4.6x106 ±9.1x106 cfu/g, supermarkets, 2.6x106 ±2.7x106 and high-end specialty store 4.7x105 ±8.9x105. Coliform numbers obtained on kales from the wet markets and supermarkets were significantly higher (p<0.05) compared to those from farms, while kale samples purchased from high- end specialtystore had similar levels of coliform loads as those from the farms. E. coli prevalence in the wet markets, supermarkets and high-end specialty store were: 40, 20 and 20%, respectively. Salmonella was detected on 4.5 and 6.3% of samples collected from the farms in Wangige and wet market in Kawangware, respectively. Fecal coliforms in water used on farms (for irrigation) and in the markets (for washing the vegetables) exceeded levels recommended by World Health Organization (WHO) of 103 organisms per 100 milliliter while Salmonella was detected in 12.5% of washing water samples collected from Kangemi market.Conclusion: Poor cultivation practices and poor handling of vegetables along the supply chain could increase the risk of pathogen contamination thus puting the health of the public at risk, therefore good agricultural and handling practices should be observed

Stakeholder narratives on trypanosomiasis, their effect on policy and the scope for One Health

Background This paper explores the framings of trypanosomiasis, a widespread and potentially fatal zoonotic disease transmitted by tsetse flies (Glossina species) affecting both humans and livestock. This is a country case study focusing on the political economy of knowledge in Zambia. It is a pertinent time to examine this issue as human population growth and other factors have led to migration into tsetse-inhabited areas with little historical influence from livestock. Disease transmission in new human-wildlife interfaces such as these is a greater risk, and opinions on the best way to manage this are deeply divided. Methods A qualitative case study method was used to examine the narratives on trypanosomiasis in the Zambian policy context through a series of key informant interviews. Interviewees included key actors from international organisations, research organisations and local activists from a variety of perspectives acknowledging the need to explore the relationships between the human, animal and environmental sectors. Principal Findings Diverse framings are held by key actors looking from, variously, the perspectives of wildlife and environmental protection, agricultural development, poverty alleviation, and veterinary and public health. From these viewpoints, four narratives about trypanosomiasis policy were identified, focused around four different beliefs: that trypanosomiasis is protecting the environment, is causing poverty, is not a major problem, and finally, that it is a Zambian rather than international issue to contend with. Within these narratives there are also conflicting views on the best control methods to use and different reasoning behind the pathways of response. These are based on apparently incompatible priorities of people, land, animals, the economy and the environment. The extent to which a One Health approach has been embraced and the potential usefulness of this as a way of reconciling the aims of these framings and narratives is considered throughout the paper. Conclusions/Significance While there has historically been a lack of One Health working in this context, the complex, interacting factors that impact the disease show the need for cross-sector, interdisciplinary decision making to stop rival narratives leading to competing actions. Additional recommendations include implementing: surveillance to assess under-reporting of disease and consequential under-estimation of disease risk; evidence-based decision making; increased and structurally managed funding across countries; and focus on interactions between disease drivers, disease incidence at the community level, and poverty and equity impacts

Relationship between Plasmodium falciparum malaria prevalence, genetic diversity and endemic Burkitt lymphoma in Malawi

Endemic Burkitt lymphoma (eBL) has been linked to Plasmodium falciparum (Pf) malaria infection, but the contribution of infection with multiple Pf genotypes is uncertain. We studied 303 eBL (cases) and 274 non eBL-related cancers (controls) in Malawi using a sensitive and specific molecular-barcode array of 24 independently segregating Pf single nucleotide polymorphisms. Cases had a higher Pf malaria prevalence than controls (64.7% versus 45.3%; odds ratio [OR] 2.1, 95% confidence interval (CI): 1.5 to 3.1). Cases and controls were similar in terms of Pf density (4.9 versus 4.5 log copies, p = 0.28) and having ≥3 non-clonal calls (OR 2.7, 95% CI: 0.7-9.9, P = 0.14). However, cases were more likely to have a higher Pf genetic diversity score (153.9 versus 133.1, p = 0.036), which measures a combination of clonal and non-clonal calls, than controls. Further work is needed to evaluate the possible role of Pf genetic diversity in the pathogenesis of endemic BL

Household consumption of orange-fleshed sweet potato and its associated factors in Chipata District, Eastern Province Zambia

BACKGROUND: The Integrating Orange Project promotes production and consumption of orange-fleshed sweet potato (OFSP) to address vitamin A deficiency among rural populations of Zambia since 2011. OBJECTIVE: This study assessed household production and consumption of OFSP and identified factors associated with consumption thereof in Integrating Orange Project areas in Chipata district, Zambia. METHODS: Respondents of 295 randomly selected households were interviewed using a structured questionnaire during the sweet potato harvest season. Associations between OFSP consumption and household factors were assessed using w2 tests. RESULTS: Frequency of OFSP consumption was categorized as 4 days during the last 7 days (30.2%), 1 to 3 days during the last 7 days (49.5%), eats OFSP but not during the last 7 days (7.1%), and never (13.2%). In total, 60.3% of households planted OFSP, and 40.0% bought OFSP, mostly from farmers within the community. Orange-fleshed sweet potato consumption was associated with the presence of children aged less than 5 years in the household (P ¼ .018), production of OFSP (P < .001), purchasing of OFSP (P < .001), and respondent having knowledge on health benefits of OFSP (P ¼ .014). Age and sex of the household head and household size had no association with OFSP consumption (P > .05). CONCLUSION: A high percentage of households consumed OFSP during the harvesting season in Integrating Orange Project areas. Programs promoting OFSP consumption should thus focus on OFSP production and sensitizing households on nutritional benefits of OFSP and target households with children aged less than 5 years as entry point.IS

Efficacy, Safety, and Tolerability of Three Regimens for Prevention of Malaria: A Randomized, Placebo-Controlled Trial in Ugandan Schoolchildren

BACKGROUND: Intermittent preventive treatment (IPT) is a promising malaria control strategy; however, the optimal regimen remains unclear. We conducted a randomized, single-blinded, placebo-controlled trial to evaluate the efficacy, safety, and tolerability of a single course of sulfadoxine-pyrimethamine (SP), amodiaquine + SP (AQ+SP) or dihydroartemisinin-piperaquine (DP) among schoolchildren to inform IPT. METHODS: Asymptomatic girls aged 8 to 12 years and boys aged 8 to 14 years enrolled in two primary schools in Tororo, Uganda were randomized to receive one of the study regimens or placebo, regardless of presence of parasitemia at enrollment, and followed for 42 days. The primary outcome was risk of parasitemia at 42 days. Survival analysis was used to assess differences between regimens. RESULTS: Of 780 enrolled participants, 769 (98.6%) completed follow-up and were assigned a treatment outcome. The risk of parasitemia at 42 days varied significantly between DP (11.7% [95% confidence interval (CI): 7.9, 17.1]), AQ+SP (44.3% [37.6, 51.5]), and SP (79.7% [95% CI: 73.6, 85.2], p<0.001). The risk of parasitemia in SP-treated children was no different than in those receiving placebo (84.6% [95% CI: 79.1, 89.3], p = 0.22). No serious adverse events occurred, but AQ+SP was associated with increased risk of vomiting compared to placebo (13.0% [95% CI: 9.1, 18.5] vs. 4.7% [95% CI: 2.5, 8.8], respectively, p = 0.003). CONCLUSIONS: DP was the most efficacious and well-tolerated regimen tested, although AQ+SP appears to be a suitable alternative for IPT in schoolchildren. Use of SP for IPT may not be appropriate in areas with high-level SP resistance in Africa. TRIAL REGISTRATION: ClinicalTrials.gov NCT00852371

Intensive Case Finding and Isoniazid Preventative Therapy in HIV Infected Individuals in Africa: Economic Model and Value of Information Analysis

Background: Tuberculosis (TB) accounts of much of the morbidity and mortality associated with HIV. We evaluate the costeffectiveness of different strategies to actively screen for TB disease in HIV positive individuals, where isoniazid preventative therapy (IPT) is given to those screening negative, and use value of information analysis (VOI) to identify future research priorities. Methodology / Principal Findings: We built an individual sampling model to investigate the costs (2010 US Dollars) and consequences of screening for TB, and providing TB treatment or IPT in adults testing HIV positive in Sub-Saharan Africa. A systematic review and meta-analysis was conducted to assess performance of the nine different TB screening strategies evaluated. Probabilistic sensitivity analysis was conducted to incorporate decision uncertainty, and expected value of perfect information for the entire model and for groups of parameters was calculated. Screening all HIV infected individuals with sputum microscopy was the least costly strategy, with other strategies not cost-effective at WHO recommended thresholds. Screening those with TB symptoms with sputum microscopy and CXR would be cost-effective at a threshold ICER of $7,800 per quality-adjusted life year (QALY), but associated with significant uncertainty. VOI analysis suggests further information would be of value. Conclusions / Significance: Resource-constrained countries in sub-Saharan Africa wishing to scale up TB preventativ