Should female health providers be involved in medical male circumcision? Narratives of newly circumcised men in Malawi

Background: The Malawi government has endorsed voluntary medical male circumcision (VMMC) as a biomedical strategy for HIV prevention after a decade of debating its effectiveness in the local setting. The “policy” recommends that male circumcision (MC) should be clinically based, as opposed to the alternative of traditional male circumcision (TMC). Limited finances, acceptability concerns, and the health system’s limited capacity to meet demand are among the challenges threatening the mass rollout of VMMC. In terms of acceptability, the gender of clinicians conducting the operations may particularly influence health facility-based circumcision. This study explored the acceptability, by male clients, of female clinicians taking part in the circumcision procedure.Methods: Six focus group discussions (FGDs) were conducted, with a total of 47 newly circumcised men from non-circumcising ethnic groups in Malawiparticipating in this study. The men had been circumcised at three health facilities in Lilongwe District in 2010. Data were audio recorded and transcribed verbatim. Data were analysed using narrative analysis.Results: Participants in the FGDs indicated that they were not comfortable with women clinicians being part of the circumcising team. While few mentioned that they were not entirely opposed to female health providers’ participation, arguing that their involvement was similar to male clinicians’ involvement in child delivery, most of them opposed to female involvement, arguing that MC was not an illness that necessitates the involvement of clinicians regardless of their gender. Most of the participants said that it was not negotiable for females to be involved, as they could wait until an all-male clinician team could be available. Thematically, the arguments against female clinicians’ involvement include sexual undertones and the influences of traditional male circumcision practices, among others.Conclusion: Men preferred that VMMC should be conducted by male health providers only. Traditionally, male circumcision has been a male-only affair shrouded in secrecy and rituals. Although being medical, this study strongly suggested that it may be difficult for VMMC to immediately move to a public space where female health providers can participate, even for men coming from traditionally non-circumcising background

Capacity Requirements of Traffic Handling Schemes in Multi-Service Networks

Cataloged from PDF version of article.This paper deals with the impact of traffic handling mechanisms on capacity for different network architectures. Three traffic handling models are considered: per-flow, class-based and best-effort (BE). These models can be used to meet service guarantees, the major differences being in their complexity of implementations and in the quantity of network resources that must be provided. In this study, the performance is fixed and the required capacity determined for various combinations of traffic handling architectures for edge-core networks. This study provides a comparison of different QoS architectures. One key result of this work is that on the basis of capacity requirements, there is no significant difference between semi-aggregate traffic handling and per-flow traffic handling. However, best-effort handling requires significantly more capacity as compared to the other methods. (C) 2004 Elsevier B.V. All rights reserve

Assessment of smallholder seed groups performance and market linkages in Southern Malawi. Series Paper Number 12

ICRISAT in partnership with the Rural Livelihoods Support Project was implementing a two year project since 2009 to promote production of groundnuts and pigeon peas in Chiradzulu and Thyolo districts. The project was providing start-up seed of improved pigeon peas and groundnut varieties and technical advice. The variety received for pigeon peas was ICP40 while for groundnuts farmers were given Nsinjilo and CG7. The groups were multiplying the seed and sharing the seed on pass-on scheme. This study was thus conducted to assess the performance of the smallholder seed groups and explore opportunities for linking with the market for seed through the agro-dealer network and other initiatives as marketing outlets for seed. The study methodology involved interviews with selected agro-dealers operating in the project area and focus group discussions with selected farmer groups involved in seed multiplication. In total the study involved nine community seed groups, six in Chiradzulu district and three in Thyolo district and three agro-dealers (2 from Chiradzulu and one from Thyolo). The groups were clear of their objectives to multiply seed to increase access to seed within their communities and engage in small scale seed business. The outcome of these activities would be increased production of pigeon peas and groundnuts and improved livelihoods and incomes. The membership composition for the visited groups shows that most groups were involving more women than men. This means that women were being actively engaged in seed multiplication for the legumes as such they would be primary beneficiaries of the accrued benefits of the project support. Community members joined the groups on voluntary basis based on their willingness to participate in growing the crop. The project provided training to some of the groups in Chiradzulu and in Thyolo. But some groups did not yet receive training. For the groups that received training, the training mainly comprised of crop management aspects. For most groups, the seed support was received once when they started in 2009 and they have been able to multiply it and pass on to others and realized some excess seed for sale. Most of the groups had been able to realize some significant and increasing harvest in the two years so that other farmers have also benefited from the produced seed including sale of excess produce by some groups. For example, Nankuyu group (a group of 20) in Chiradzulu district produced 500kg of pigeon peas in 2009/10 season and increased to 1000kg in 2010/11 season. A number of other farmers also benefited from the produced seed as the groups have been able to share the seed with other farmers thereby expanding access to improve seed of both groundnuts and pigeon peas. This means that the objective of increasing access to seed to other needy farmers was being realized through these groups. The study has highlighted a number of challenges faced by the groups during the two years which affected their production levels. These included lack of training and extension services; late distribution of seed by the project; poor weather; occurrence of pests and diseases; and poor storage condition and storage pests for both pigeon peas and groundnuts. The groups also faced a number of marketing challenges which included: low production limiting the amount for sale; no linkage with reliable and competitive markets; lack of information on profitable market opportunities; high transport costs to markets in the city; and poor road network The seed groups have not yet had any interactions with agro dealers in the area or any other organized seed marketing organizations. However the interviewed agro-dealers are eager to link up with the seed groups to purchase from them the seed and sell in their input retail outlets as long as the seed is of good quality and prices are not exorbitant. The main constraints affecting the seed trading for the agro-dealers include: lack of adequate capital to buy seed stock and run their business; high transport costs; and competition with large seed companies. The groups indicated that the market available is mostly for grain and not seed as the local seed market is not developed and linkages are not yet developed. Apart from selling to vendors and local markets, some groups (e.g. Nankuyu group) have been able to explore and link up with larger buyers with support from ICRISAT. They have been able to sell their grain produce for pigeon peas collectively to Export Trading in Blantyre with assistance from the project and this has helped them to realize better returns. Overall the groups have not been very successful as smallholder seed producing groups. The ICRISAT support may have provided the start-up seed and increased access to good seed for the targeted communities but the groups were not systematically developed and supported to become sustainable seed producing groups. The main reasons include lack of or inadequate training on seed production and government standards and requirements for seed production. Almost all farmer groups interviewed from the two districts indicated that they are not aware of the requirements for seed production as prescribed by either government or seed companies. There is need to link the farmer groups in the project area to organizations which focus on producing and marketing improved seeds in tandem with requirements for seed production as prescribed by either government or seed companies. This can be attained if the farmer groups are linked to organizations such as Association of Smallholder Seed Multiplication Action Group (ASSMAG). The project supported groups can get organized into Seed Multiplication Action Groups (SMAGS) in the districts or join the existing SMAGs and access marketing linkages that has already been developed. ASSMAG works collectively through groups at different levels and ASSMAG coordinates production trainings, seed certification activities, seed processing and seed marketing-related issues of all the member groups. This would be of benefit to the farmer groups in the project area. To achieve maximum benefits and ensure sustainable small scale seed groups the following needs to be taken into consideration: Training of farmers on group dynamics, production technologies and practices; Facilitation of governance issues for sustainability; coordinated effort on marketing; sourcing of foundation seed and distribution to farmers; organizing inspections and seed testing

Mothers’ Social Networks and Socioeconomic Gradients of Isolation

Social connections are fundamental to human wellbeing. This paper examines the social networks of young married women in rural Odisha, India.. This is a group, for whom highly-gendered norms around marriage, mobility, and work are likely to shape opportunities to form and maintain meaningful ties with other women. We track the social networks of 2,170 mothers over four years, and find a high degree of isolation. Wealthier women and women more-advantaged castes have smaller social networks than their less-advantaged peers. These gradients are primarily driven by the fact that more-advantaged women are less likely to know other women within their same socioeconomic group than are less-advantaged women are. There exists strong homophily by socioeconomic status that is symmetric across socioeconomic groups. Mediation analysis shows that SES differences in social isolation are strongly associated to caste, ownership of toilets and distance. Further research should investigate the formation and role of female networks

Effects of milk, pasteurized milk, and milk replacer on health and productivity of dairy calves

Dairy Research, 2014 is known as Dairy Day, 2014Our objectives were to determine the health and blood parameters before, during, and after weaning of 114 Holstein heifers fed either accelerated milk replacer (MR; 28% CP, 18% fat) or non-saleable milk (3.59 ± 0.28% true protein; 4.12 ± 0.37% fat) that was either pasteurized (PM) or raw (RM; refrigerated and fed <24 h after collection). Calves were randomly assigned to feeding treatments at birth. Colostrum (1 L) was fed less than 14 hours after birth (MR and PM = pasteurized colostrum; RM = raw colostrum). All calves were bottle-fed 1.8 ± 0.20 L, 3 times daily; all calves were provided fresh water and grain ad libitum throughout the experiment. Calves began step-down weaning at age 5 weeks and completed weaning at age 6 weeks. Blood samples were collected at ages 3, 5, and 7 weeks and were analyzed for complete blood counts (CBC) using a Procyte Idexx Analyzer (IDEXX Laboratories, Inc., Westbrook, ME). Fecal scores were observed twice daily, on a 1 to 3 scale (FS1 = normal, FS2 = loose, FS3 = scours). Results showed that MR-fed calves had more (P < 0.01) observations (%obs) with FS > 2 than the PM- and RM-fed calves (2.3 vs. 1.6 and 1.7 ± 0.2 %obs, respectively). In addition, there were no differences in body weight or shoulder or hip height between treatments, but a treatment × week interaction (P = 0.05) occurred for grain consumed, with a noticeably higher increase between 6 and 7 weeks of age for MR calves. When CBC was considered, there were no differences in blood cell types, but MR-fed calves had greater mean corpuscular volume (MCV) than the other calves (P < 0.01), leading to higher resistance for iron deficiency anemia. In conclusion, these findings suggest that calf performance and feed intake are not affected by the administration of raw milk, pasteurized milk, or milk replacer. Moreover, CBC health parameters showed no significant changes due to administration of the different types of milk sources

Reduction of Maternal Mortality with Highly Active Antiretroviral Therapy in a Large Cohort of HIV-Infected Pregnant Women in Malawi and Mozambique

Background: HIV infection is a major contributor to maternal mortality in resource-limited settings. The Drug Resource Enhancement Against AIDS and Malnutrition Programme has been promoting HAART use during pregnancy and postpartum for Prevention-of-mother-to-child-HIV transmission (PMTCT) irrespective of maternal CD4 cell counts since 2002. Methods: Records for all HIV+ pregnancies followed in Mozambique and Malawi from 6/2002 to 6/2010 were reviewed. The cohort was comprised by pregnancies where women were referred for PMTCT and started HAART during prenatal care (n = 8172, group 1) and pregnancies where women were referred on established HAART (n = 1978, group 2). Results: 10,150 pregnancies were followed. Median (IQR) baseline values were age 26 years (IQR:23-30), CD4 count 392 cells/mm(3) (IQR:258-563), Viral Load log(10) 3.9 (IQR:3.2-4.4), BMI 23.4 (IQR:21.5-25.7), Hemoglobin 10.0 (IQR:9.0-11.0). 101 maternal deaths (0.99%) occurred during pregnancy to 6 weeks postpartum: 87 (1.1%) in group 1 and 14 (0.7%) in group 2. Mortality was 1.3% in women with <than 350 CD4 cells/mm(3) and 0.7% in women with greater than 350 CD4s cells/mm(3) [OR = 1.9 (CL 1.3-2.9) p = 0.001]. Mortality was higher in patients with shorter antenatal HAART: 22/991 (2.2%) if less than 30 days and 79/9159 (0.9%) if 31 days or greater [OR = 2.6 (CL 1.6-4.2) p<0.001]. By multivariate analysis, shorter antenatal HAART (p, 0.001), baseline values for CD4 cell count (p = 0.012), hemoglobin (p = 0.02), and BMI (p<0.001) were associated with mortality. Four years later, survival was 92% for women with shorter antenatal HAART and 98% for women on established therapy prior to pregnancy, p = 0.001. Conclusions: Antiretrovirals for PMTCT purposes have significant impact on maternal mortality as do CD4 counts and nutritional status. In resource-limited settings, PMTCT programs should provide universal HAART to all HIV+ pregnant women given its impact in prevention of maternal death