Integration of medical service provision and nature conservation worldwide 1980–2022: collaborative evidence mapping of 43 projects across 22 countries

Background Biodiversity protection is fundamental to human wellbeing, and, in turn, serving human health in medically underserved areas can sometimes strengthen conservation. We aimed to collaboratively map the evidence on projects worldwide that are, or have been, providing health services with the intention of producing conservation outcomes in addition to health improvements. Methods Scoping indicated many NGO projects are never published in the academic literature. To avoid missing such interventions we asked conservation staff worldwide to contribute data online or through zoom calls. Advertising to join the collaboration was through formal networks (International Union for Conservation of Nature, Planetary Health Alliance, etc.), professional contacts, funders, and a call in The Lancet Planetary Health. Additionally, data and literature were synthesised from libraries and datasets of collaborators at Population Reference Bureau, Sussex Sustainability Research Programme, and Ecological Levers for Health. Findings Forty-three projects from 22 countries fitted inclusion criteria. Around half had not been published in the collected literature, with data only available through direct submission. Tropical wet forest was by far the most common habitat, followed by tropical dry forest, coral reefs, and tropical grasslands. The most represented region was Sub-Saharan Africa with 27 projects, followed by South-East Asia (five), South Asia (five), Oceania (two), South America (two), Central America (one), Europe (one). Projects ranged from basic health interventions bolted on to pre-existing conservation programmes to generate goodwill (e.g., vaccination rounds bordering national parks) to complex schemes jointly acting on health and biodiversity driven (and funded) by concerns for human welfare as much as conservation. Interpretation Synergistic action on biodiversity conservation and health service provision is very often effective and the approach is more widespread than literature would indicate. However, funding was usually provided on a siloed basis for either health or conservation, and this remains a barrier to wider adoption

A review of the indigenous coffee resources of Uganda and their potential for coffee sector sustainability and development.

Uganda is a major global coffee exporter and home to key indigenous (wild) coffee resources. A comprehensive survey of Uganda’s wild coffee species was undertaken more than 80 years ago (in 1938) and thus a contemporary evaluation is required, which is provided here. We enumerate four indigenous coffee species for Uganda: , , (var. ) and . Based on ground point data from various sources, survey of natural forests, and literature reviews we summarise taxonomy, geographical distribution, ecology, conservation, and basic climate characteristics, for each species. Using literature review and farm survey we also provide information on the prior and exiting uses of Uganda’s wild coffee resources for coffee production. Three of the indigenous species (excluding ) represent useful genetic resources for coffee crop development (e.g. breeding, or selection), including: adaptation to a changing climate, pest and disease resistance, improved agronomic performance, and market differentiation. Indigenous has already been pivotal in the establishment and sustainability of the robusta coffee sector in Uganda and worldwide, and has further potential for the development of this crop species. var. (excelsa coffee) is emerging as a commercially viable coffee crop plant in its own right, and may offer substantial potential for lowland coffee farmers, i.e. in robusta coffee growing areas. It may also provide useful stock material for the grafting of robusta and Arabica coffee, and possibly other species. Preliminary conservation assessments indicate that var. and are at risk of extinction at the country-level (Uganda). Adequate protection of Uganda’s humid forests, and thus its coffee natural capital, is identified as a conservation priority for Uganda and the coffee sector in general

Flora of Sango Bay and Minziro, two important plant areas on the Uganda/Tanzania

The flora of Sango Bay (Uganda) and Minziro (Tanzania) is discussed: these areas comprise the floodplain of a river, with a mixed vegetation influenced by a flat relief and relatively high moisture through regular flooding. Protection is only partial, which is of concern as the sites form an area of high biodiversity with high conservation value, and several rare and/or (near-)endemic plant species. Both areas are proposed as Important Plant Areas, and a checklist of plant species is provided

Wild edible plants used by communities in and around selected forest reserves of Teso-Karamoja region, Uganda

Abstract Background The consumption of wild plants is an ancient tradition which serves multiple purposes. Cognizant that Teso-Karamoja region is frequently affected by food scarcity and is not adequately surveyed for its flora, this study sought to establish an inventory and use of wild edible plants by the communities living in and around the forest reserves. Methods Data was collected using semi-structured questionnaires administered to 240 respondents living in and around eight forest reserves between November 2017 and May 2018. One focus group discussion (8–12 members) per forest reserve and field excursions to collect the plant voucher specimens were also conducted. The data was analyzed using descriptive statistics, relative frequency of citation (RFC), and the factor of informants’ consensus (FIC). Results A total of 100 plant species in 47 families were reported as edible. Carissa spinarum, Strychnos innocua, Balanites aegyptiaca, Tamarindus indica, and Ximenia americana presented the highest RFC, while the families Rubiaceae, Fabaceae, Anacardiaceae, Amaranthaceae, and Moraceae had more than five species each. Grasses (Poaceae) comprised only 1% of the edible species and trees 35%, while shrubs were the most important source of wild food (RFC = 0.47). The fruits contributed 63% while leaves (29%), seeds (9%), tubers (5%), and gum (1%). The fruits were considered as the most important use category (RFC = 0.78). Respondent homogeneity was none for gum but very high for seeds (FIC - 0.93). Only 36% of species are cooked, while 64% are eaten in raw. Harvesting is done rudimentarily by digging (5%), collecting from the ground (fruits that fall down) (13%), and plucking from mother plants (82%). Only 9% of the species were collected throughout the year, 27% in the dry season, and 64% in the rainy season. The consumption of these plants is attributed to food scarcity, spicing staple food, nutri-medicinal value, cultural practice, and delicacy. Conclusion A high diversity of wild edible plant species exists in the forest reserves of Teso-Karamoja region. The shrubs and fruits are the most locally important life forms and use category, respectively. These edible plant species are important throughout the year because their consumption serves multiple purposes

Community health and human-animal contacts on the edges of Bwindi Impenetrable National Park, Uganda.

Cross-species transmission of pathogens is intimately linked to human and environmental health. With limited healthcare and challenging living conditions, people living in poverty may be particularly susceptible to endemic and emerging diseases. Similarly, wildlife is impacted by human influences, including pathogen sharing, especially for species in close contact with people and domesticated animals. Here we investigate human and animal contacts and human health in a community living around the Bwindi Impenetrable National Park (BINP), Uganda. We used contact and health survey data to identify opportunities for cross-species pathogen transmission, focusing mostly on people and the endangered mountain gorilla. We conducted a survey with background questions and self-reported diaries to investigate 100 participants health, such as symptoms and behaviours, and contact patterns, including direct contacts and sightings over a week. Contacts were revealed through networks, including humans, domestic, peri-domestic, and wild animal groups for 1) contacts seen in the week of background questionnaire completion, and 2) contacts seen during the diary week. Participants frequently felt unwell during the study, reporting from one to 10 disease symptoms at different intensity levels, with severe symptoms comprising 6.4% of the diary records and tiredness and headaches the most common symptoms. After human-human contacts, direct contact with livestock and peri-domestic animals were the most common. The contact networks were moderately connected and revealed a preference in contacts within the same taxon and within their taxa groups. Sightings of wildlife were much more common than touching. However, despite contact with wildlife being the rarest of all contact types, one direct contact with a gorilla with a timeline including concerning participant health symptoms was reported. When considering all interaction types, gorillas mostly exhibited intra-species contact, but were found to interact with five other species, including people and domestic animals. Our findings reveal a local human population with recurrent symptoms of illness in a location with intense exposure to factors that can increase pathogen transmission, such as direct contact with domestic and wild animals and proximity among animal species. Despite significant biases and study limitations, the information generated here can guide future studies, such as models for disease spread and One Health interventions

Effect of a 72 Hour Stroke Care Bundle on Early Outcomes after Acute Stroke: A Non Randomised Controlled Study

<div><p>Background</p><p>Integrated care pathways (ICP) in stroke management are increasingly being implemented to improve outcomes of acute stroke patients. We evaluated the effect of implementing a 72 hour stroke care bundle on early outcomes among patients admitted within seven days post stroke to the national referral hospital in Uganda.</p><p>Methods</p><p>In a one year non-randomised controlled study, 127 stroke patients who had ‘usual care’ (control group) were compared to 127 stroke patients who received selected elements from an ICP (intervention group). Patients were consecutively enrolled (controls first, intervention group second) into each group over 5 month periods and followed to 30-days post stroke. Incidence outcomes (mortality and functional ability) were compared using chi square test and adjusted for potential confounders. Kaplan Meier survival estimates and log rank test for comparison were used for time to death analysis for all strokes and by stroke severity categories. Secondary outcomes were in-hospital mortality, median survival time and median length of hospital stay.</p><p>Results</p><p>Mortality within 7 days was higher in the intervention group compared to controls (RR 13.1, 95% CI 3.3–52.9). There was no difference in 30-day mortality between the two groups (RR 1.2, 95% CI 0.5–2.6). There was better 30-day survival in patients with severe stroke in the intervention group compared to controls (P = 0.018). The median survival time was 30 days (IQR 29–30 days) in the control group and 30 days (IQR 7–30 days) in the intervention group. In the intervention group, 41patients (32.3%) died in hospital compared to 23 (18.1%) in controls (P < 0.001). The median length of hospital stay was 8 days (IQR 5–12 days) in the controls and 4 days (IQR 2–7 days) in the intervention group. There was no difference in functional outcomes between the groups (RR 0.9, 95% CI 0.4–2.2).</p><p>Conclusions</p><p>While implementing elements of a stroke-focused ICP in a Ugandan national referral hospital appeared to have little overall benefit in mortality and functioning, patients with severe stroke may benefit on selected outcomes. More research is needed to better understand how and when stroke protocols should be implemented in sub-Saharan African settings.</p><p>Trial Registration</p><p>Pan African Clinical Trials Registry <a href="http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=1272" target="_blank">PACTR201510001272347</a></p></div

Elements of the stroke care bundle versus ‘usual care’ for patients presenting to the Accident and Emergency unit with acute stroke.

<p>Elements of the stroke care bundle versus ‘usual care’ for patients presenting to the Accident and Emergency unit with acute stroke.</p

Kaplan Meier survival curves by stroke severity category comparing survival of patients in the control group and the intervention group.

<p>(A) shows Kaplan Meier curves comparing survival of participants with mild stroke in the control and intervention groups. (B) shows Kaplan Meier curves comparing survival of participants with moderate stroke in the control and intervention groups. (C) shows Kaplan Meier curves comparing survival of participants with severe stroke in the control and intervention groups. (D) shows Kaplan Meier curves comparing survival of participants with very severe stroke in the control and intervention groups. The p values were obtained from the log rank tests.</p