THE BLENDING OF PARTICIPATORY RESEARCH AND QUANTITATIVE METHODS: WEALTH STATUS, GENDER AND THE ADOPTION OF IMPROVED FALLOWS IN ZAMBIA

Although there is increasing emphasis on targeting of improved technology towards poor and female farmers, few adoption studies assess the uptake of new practices by these groups in a comprehensive manner. In this study, community members used the wealth ranking method to identify the different wealth groups in their communities, to determine each household's wealth status, and to assess the association of wealth and different types of households with the planting of improved tree fallows, a practice for improving crop yields. There were no significant differences between the proportions of women and men planting improved fallows nor were there differences between single women and female heads of households who were married. There was some evidence of association between planting improved fallows and wealth. That 22% of the 'poor' group and 16% of the 'very poor' group were planting them suggests that there are no barriers preventing low-income households from doing so. Moreover, the proportion of females, poor, and very poor people planting improved fallows varied considerably among villages, suggesting that opportunities exist for increasing their use of technology. Whereas the use of mineral fertilizer is strongly associated with high-income, male farmers, improved fallows appear to be a gender-neutral and wealth-neutral technology. Poor farmers appreciate improved fallows because they permit them to substitute small amounts of land and labour for cash, their most scarce resource. Finally, the high degree of consistency among different key informants in classifying households among wealth groups confirmed the effectiveness and accuracy of the wealth ranking exercise.Adoption, agroforestry, Participatory research, Sesbania sesban, Research and Development/Tech Change/Emerging Technologies,

Rotavirus Genotypes in Hospitalized Children With Acute Gastroenteritis Before and After Rotavirus Vaccine Introduction in Blantyre, Malawi, 1997-2019

BACKGROUND: Rotavirus vaccine (Rotarix [RV1]) has reduced diarrhea-associated hospitalizations and deaths in Malawi. We examined the trends in circulating rotavirus genotypes in Malawi over a 22-year period to assess the impact of RV1 introduction on strain distribution. METHODS: Data on rotavirus-positive stool specimens among children aged <5 years hospitalized with diarrhea in Blantyre, Malawi before (July 1997-October 2012, n = 1765) and after (November 2012-October 2019, n = 934) RV1 introduction were analyzed. Rotavirus G and P genotypes were assigned using reverse-transcription polymerase chain reaction. RESULTS: A rich rotavirus strain diversity circulated throughout the 22-year period; Shannon (H') and Simpson diversity (D') indices did not differ between the pre- and postvaccine periods (H' P < .149; D' P < .287). Overall, G1 (n = 268/924 [28.7%]), G2 (n = 308/924 [33.0%]), G3 (n = 72/924 [7.7%]), and G12 (n = 109/924 [11.8%]) were the most prevalent genotypes identified following RV1 introduction. The prevalence of G1P[8] and G2P[4] genotypes declined each successive year following RV1 introduction, and were not detected after 2018. Genotype G3 reemerged and became the predominant genotype from 2017 onward. No evidence of genotype selection was observed 7 years post-RV1 introduction. CONCLUSIONS: Rotavirus strain diversity and genotype variation in Malawi are likely driven by natural mechanisms rather than vaccine pressure

THE BLENDING OF PARTICIPATORY RESEARCH AND QUANTITATIVE METHODS: WEALTH STATUS, GENDER AND THE ADOPTION OF IMPROVED FALLOWS IN ZAMBIA

Although there is increasing emphasis on targeting of improved technology towards poor and female farmers, few adoption studies assess the uptake of new practices by these groups in a comprehensive manner. In this study, community members used the wealth ranking method to identify the different wealth groups in their communities, to determine each household's wealth status, and to assess the association of wealth and different types of households with the planting of improved tree fallows, a practice for improving crop yields. There were no significant differences between the proportions of women and men planting improved fallows nor were there differences between single women and female heads of households who were married. There was some evidence of association between planting improved fallows and wealth. That 22% of the 'poor' group and 16% of the 'very poor' group were planting them suggests that there are no barriers preventing low-income households from doing so. Moreover, the proportion of females, poor, and very poor people planting improved fallows varied considerably among villages, suggesting that opportunities exist for increasing their use of technology. Whereas the use of mineral fertilizer is strongly associated with high-income, male farmers, improved fallows appear to be a gender-neutral and wealth-neutral technology. Poor farmers appreciate improved fallows because they permit them to substitute small amounts of land and labour for cash, their most scarce resource. Finally, the high degree of consistency among different key informants in classifying households among wealth groups confirmed the effectiveness and accuracy of the wealth ranking exercise

Reduction in Severity of All-Cause Gastroenteritis Requiring Hospitalisation in Children Vaccinated against Rotavirus in Malawi

Rotavirus is the major cause of severe gastroenteritis in children aged <5 years. Introduction of the G1P[8] Rotarix® rotavirus vaccine in Malawi in 2012 has reduced rotavirus-associated hospitalisations and diarrhoeal mortality. However, the impact of rotavirus vaccine on the severity of gastroenteritis presented in children requiring hospitalisation remains unknown. We conducted a hospital-based surveillance study to assess the impact of Rotarix® vaccination on the severity of gastroenteritis presented by Malawian children. Stool samples were collected from children aged <5 years who required hospitalisation with acute gastroenteritis from December 2011 to October 2019. Gastroenteritis severity was determined using Ruuska and Vesikari scores. Rotavirus was detected using enzyme immunoassay. Rotavirus genotypes were determined using nested RT-PCR. Associations between Rotarix® vaccination and gastroenteritis severity were investigated using adjusted linear regression. In total, 3159 children were enrolled. After adjusting for mid-upper arm circumference (MUAC), age, gender and receipt of other vaccines, all-cause gastroenteritis severity scores were 2.21 units lower (p < 0.001) among Rotarix®-vaccinated (n = 2224) compared to Rotarix®-unvaccinated children (n = 935). The reduction in severity score was observed against every rotavirus genotype, although the magnitude was smaller among those infected with G12P[6] compared to the remaining genotypes (p = 0.011). Each one-year increment in age was associated with a decrease of 0.43 severity score (p < 0.001). Our findings provide additional evidence on the impact of Rotarix® in Malawi, lending further support to Malawi’s Rotarix® programme

Leveraging Beneficial Off-Target Effects of Live-Attenuated Rotavirus Vaccines

Following the introduction of live-attenuated rotavirus vaccines in many countries, a notable reduction in deaths and hospitalisations associated with diarrhoea in children &lt;5 years of age has been reported. There is growing evidence to suggest that live-attenuated vaccines also provide protection against other infections beyond the vaccine-targeted pathogens. These so called off-target effects of vaccination have been associated with the tuberculosis vaccine Bacille Calmette Guérin (BCG), measles, oral polio and recently salmonella vaccines, and are thought to be mediated by modified innate and possibly adaptive immunity. Indeed, rotavirus vaccines have been reported to provide greater than expected reductions in acute gastroenteritis caused by other enteropathogens, that have mostly been attributed to herd protection and prior underestimation of rotavirus disease. Whether rotavirus vaccines also alter the immune system to reduce non targeted gastrointestinal infections has not been studied directly. Here we review the current understanding of the mechanisms underlying off-target effects of vaccines and propose a mechanism by which the live-attenuated neonatal rotavirus vaccine, RV3-BB, could promote protection beyond the targeted pathogen. Finally, we consider how vaccine developers may leverage these properties to improve health outcomes in children, particularly those in low-income countries where disease burden and mortality is disproportionately high relative to developed countries.</jats:p