Iterative Adaptation of a Mobile Health Intervention Across Countries Using Human-Centered Design: Qualitative Study

Background: Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. Objective: The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. Methods: Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. Results: We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video’s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. Conclusions: Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions

"Because at school, you can become somebody" - the perceived health and economic returns on secondary schooling in rural Burkina Faso

Background The perceived returns on schooling are critical in schooling decision-making but are not well understood. This study examines the perceived returns on secondary schooling in Burkina Faso, where secondary school completion is among the lowest globally (<10%). Methods We conducted a two-staged qualitative study using semi-structured interviews (N = 49). In the first stage, we sampled students, dropouts, parents and teachers from a random sample of five schools (n = 39). In the second stage, we interviewed key informants knowledgeable of the school context using snowball sampling (n = 10). Systematic analysis was based on a grounded theory approach with a reading of transcripts, followed by coding of the narratives in NVivo 12. Results Respondents nearly universally perceived health benefits to schooling. In particular, key health benefits included improved sexual and reproductive health outcomes, hygiene knowledge and practices, as well as better interactions with the formal health system. Common economic returns on schooling included improved employment opportunities and the provision of support to family members, in addition to generally attaining success and recognition. Indirect and long-term health returns, however, were infrequently mentioned by respondents. Conclusions While respondents reported nearly universally short-term health benefits to schooling, responses with regard to economic as well as indirect and long-term health benefits were more ambiguous. Future intervention studies on the perceived returns on formal education are needed to inform policy and reach education and health targets in the region

A Two-Center Randomized Trial of an Additional Early Dose of Measles Vaccine: Effects on Mortality and Measles Antibody Levels.

Background: In addition to protecting against measles, measles vaccine (MV) may have beneficial nonspecific effects. We tested the effect of an additional early MV on mortality and measles antibody levels. Methods: Children aged 4-7 months at rural health and demographic surveillance sites in Burkina Faso and Guinea-Bissau were randomized 1:1 to an extra early standard dose of MV (Edmonston-Zagreb strain) or no extra MV 4 weeks after the third diphtheria-tetanus-pertussis-hepatitis B-Haemophilus influenzae type b vaccine. All children received routine MV at 9 months. We assessed mortality through home visits and compared mortality from enrollment to age 3 years using Cox proportional hazards models, censoring for subsequent nontrial MV. Subgroups of participants had blood sampled to assess measles antibody levels. Results: Among 8309 children enrolled from 18 July 2012 to 3 December 2015, we registered 145 deaths (mortality rate: 16/1000 person-years). The mortality was lower than anticipated and did not differ by randomization group (hazard ratio, 1.05; 95% confidence interval, 0.75-1.46). At enrollment, 4% (16/447) of children in Burkina Faso and 21% (90/422) in Guinea-Bissau had protective measles antibody levels. By age 9 months, no measles-unvaccinated/-unexposed child had protective levels, while 92% (306/333) of early MV recipients had protective levels. At final follow-up, 98% (186/189) in the early MV group and 97% (196/202) in the control group had protective levels. Conclusions: Early MV did not reduce all-cause mortality. Most children were susceptible to measles infection at age 4-7 months and responded with high antibody levels to early MV. Clinical Trials Registration: NCT01644721

Design and methods for a quasi-experimental pilot study to evaluate the impact of dual active ingredient insecticide-treated nets on malaria burden in five regions in sub-Saharan Africa

Background Vector control tools have contributed significantly to a reduction in malaria burden since 2000, primarily through insecticidal-treated bed nets (ITNs) and indoor residual spraying. In the face of increasing insecticide resistance in key malaria vector species, global progress in malaria control has stalled. Innovative tools, such as dual active ingredient (dual-AI) ITNs that are effective at killing insecticide-resistant mosquitoes have recently been introduced. However, large-scale uptake has been slow for several reasons, including higher costs and limited evidence on their incremental effectiveness and cost-effectiveness. The present report describes the design of several observational studies aimed to determine the effectiveness and cost-effectiveness of dual-AI ITNs, compared to standard pyrethroid-only ITNs, at reducing malaria transmission across a variety of transmission settings. Methods Observational pilot studies are ongoing in Burkina Faso, Mozambique, Nigeria, and Rwanda, leveraging dual-AI ITN rollouts nested within the 2019 and 2020 mass distribution campaigns in each country. Enhanced surveillance occurring in select study districts include annual cross-sectional surveys during peak transmission seasons, monthly entomological surveillance, passive case detection using routine health facility surveillance systems, and studies on human behaviour and ITN use patterns. Data will compare changes in malaria transmission and disease burden in districts receiving dual-AI ITNs to similar districts receiving standard pyrethroid-only ITNs over three years. The costs of net distribution will be calculated using the provider perspective including financial and economic costs, and a cost-effectiveness analysis will assess incremental cost-effectiveness ratios for Interceptor® G2, Royal Guard®, and piperonyl butoxide ITNs in comparison to standard pyrethroid-only ITNs, based on incidence rate ratios calculated from routine data. Conclusions Evidence of the effectiveness and cost-effectiveness of the dual-AI ITNs from these pilot studies will complement evidence from two contemporary cluster randomized control trials, one in Benin and one in Tanzania, to provide key information to malaria control programmes, policymakers, and donors to help guide decision-making and planning for local malaria control and elimination strategies. Understanding the breadth of contexts where these dual-AI ITNs are most effective and collecting robust information on factors influencing comparative effectiveness could improve uptake and availability and help maximize their impact

Design and methods for a quasi-experimental pilot study to evaluate the impact of dual active ingredient insecticide-treated nets on malaria burden in five regions in sub-Saharan Africa

Background:Vector control tools have contributed significantly to a reduction in malaria burden since 2000, primar‑ily through insecticidal‑treated bed nets (ITNs) and indoor residual spraying. In the face of increasing insecticide resist‑ance in key malaria vector species, global progress in malaria control has stalled. Innovative tools, such as dual active ingredient (dual‑AI) ITNs that are effective at killing insecticide‑resistant mosquitoes have recently been introduced. However, large‑scale uptake has been slow for several reasons, including higher costs and limited evidence on their incremental effectiveness and cost‑effectiveness. The present report describes the design of several observational studies aimed to determine the effectiveness and cost‑effectiveness of dual‑AI ITNs, compared to standard pyre‑throid‑only ITNs, at reducing malaria transmission across a variety of transmission settings.Methods:Observational pilot studies are ongoing in Burkina Faso, Mozambique, Nigeria, and Rwanda, leveraging dual‑AI ITN rollouts nested within the 2019 and 2020 mass distribution campaigns in each country. Enhanced surveil‑lance occurring in select study districts include annual cross‑sectional surveys during peak transmission seasons, monthly entomological surveillance, passive case detection using routine health facility surveillance systems, and studies on human behaviour and ITN use patterns. Data will compare changes in malaria transmission and disease burden in districts receiving dual‑AI ITNs to similar districts receiving standard pyrethroid‑only ITNs over three years. The costs of net distribution will be calculated using the provider perspective including financial and economic costs, and a cost‑effectiveness analysis will assess incremental cost‑effectiveness ratios for Interceptor® G2, Royal Guard®, and piperonyl butoxide ITNs in comparison to standard pyrethroid‑only ITNs, based on incidence rate ratios calcu‑lated from routine data.Conclusions:Evidence of the effectiveness and cost‑effectiveness of the dual‑AI ITNs from these pilot studies will complement evidence from two contemporary cluster randomized control trials, one in Benin and one in Tanzania, to provide key information to malaria control programmes, policymakers, and donors to help guide decision‑making and planning for local malaria control and elimination strategies. Understanding the breadth of contexts where these dual‑AI ITNs are most effective and collecting robust information on factors influencing comparative effectiveness could improve uptake and availability and help maximize their impact

Operational global actual evapotranspiration: development, evaluation, and dissemination

Satellite-based actual evapotranspiration (ETa) is becoming increasingly reliable and available for various water management and agricultural applications from water budget studies to crop performance monitoring. The Operational Simplified Surface Energy Balance (SSEBop) model is currently used by the US Geological Survey (USGS) Famine Early Warning System Network (FEWS NET) to routinely produce and post multitemporal ETa and ETa anomalies online for drought monitoring and early warning purposes. Implementation of the global SSEBop using the Aqua satellite’s Moderate Resolution Imaging Spectroradiometer (MODIS) land surface temperature and global gridded weather datasets is presented. Evaluation of the SSEBop ETa data using 12 eddy covariance (EC) flux tower sites over six continents indicated reasonable performance in capturing seasonality with a correlation coefficient up to 0.87. However, the modeled ETa seemed to show regional biases whose natures and magnitudes require a comprehensive investigation using complete water budgets and more quality-controlled EC station datasets. While the absolute magnitude of SSEBop ETa would require a one-time bias correction for use in water budget studies to address local or regional conditions, the ETa anomalies can be used without further modifications for drought monitoring. All ETa products are freely available for download from the USGS FEWS NET website

Pastoralisme et aires protegees en Afrique de l'Ouest: du conflit a la gestion concertee de la transhumance transfrontaliere dans la region du parc regional W (Benin, Burkina Faso, Niger)Pastoralism and protected area in West Africa: from conflict to concerted management of transboundary transhumance in the region of the “W” national park (Benin, Burkina Faso, Niger)

L'étude a pour objectif de faire l'état des lieux en vue de mieux gérer la transhumance dans la région du parc W. Elle a montré que les mouvements partent des terroirs d'attache situés en zone sahélo-soudanienne ou des villages riverains, soit pour aboutir dans le parc W, soit pour le traverser en direction du Sud-Borgou (Bénin) et du Togo. L'occupation des espaces pastoraux dans les zones périphériques par les champs et les zones de chasse, le souci d'éviter les dégâts de champs, l'abondance des ressources alimentaires et " l'accès libre " ont fait du parc W la principale zone d'accueil des troupeaux transhumants. Cette exploitation illégale du parc par le bétail est jugée incompatible avec les objectifs de conservation de la biodiversité en ce qu'elle occasionne la dégradation de l'habitat, une compétition alimentaire et un risque sanitaire à l'interface entre le bétail et la faune sauvage. Afin de réduire les conflits récurrents qui opposent les transhumants aux forestiers et aux agriculteurs, un processus de concertation entre tous les acteurs a abouti à l'élaboration d'une stratégie régionale de gestion de la transhumance dans la région du parc W.Mots-clés: Parc W, transhumance, conflit, Afrique de l'Ouest Bulletin of Animal Health and Production in Africa Vol. 54(1) 2006: 43-5

Improvements and Evaluation of the Agro-Hydrologic VegET Model for Large-Area Water Budget Analysis and Drought Monitoring

We enhanced the agro-hydrologic VegET model to include snow accumulation and melt processes and the separation of runoff into surface runoff and deep drainage. Driven by global weather datasets and parameterized by land surface phenology (LSP), the enhanced VegET model was implemented in the cloud to simulate daily soil moisture (SM), actual evapotranspiration (ETa), and runoff (R) for the conterminous United States (CONUS) and the Greater Horn of Africa (GHA). Evaluation of the VegET model with independent data showed satisfactory performance, capturing the temporal variability of SM (Pearson correlation r: 0.22–0.97), snowpack (r: 0.86–0.88), ETa (r: 0.41–0.97), and spatial variability of R (r: 0.81–0.90). Absolute magnitudes showed some biases, indicating the need of calibrating the model for water budget analysis. The seasonal Landscape Water Requirement Satisfaction Index (L-WRSI) for CONUS and GHA showed realistic depictions of drought hazard extent and severity, indicating the usefulness of the L-WRSI for the convergence of an evidence toolkit used by the Famine Early Warning System Network to monitor potential food insecurity conditions in different parts of the world. Using projected weather datasets and landcover-based LSP, the VegET model can be used not only for global monitoring of drought conditions, but also for evaluating scenarios on the effect of a changing climate and land cover on agriculture and water resources