Factors associated with under-5 mortality in three disadvantaged East African districts

BACKGROUND: The high rate of avoidable child mortality in disadvantaged communities in Africa is an important health problem. This article examines factors associated with mortality in children 6 h away from the nearest health centre (6-23 h: AOR 1.66 [95% CI 1.4-2.0] and ?24 h: AOR 1.43 [95% CI 1.26-1.72]) reported higher mortality rates in children 6 h away from health centres and mothers who received inadequate ANC visits during pregnancy

Governments' policy response to drought in Eswatini and Lesotho : a systematic review of the characteristics, comprehensiveness, and quality of existing policies to improve community resilience to drought hazards

The southern African kingdoms of Eswatini and Lesotho experience recurrent drought-induced disasters. Policies have been enacted, but no attempt has been made to synthesise the effects on disaster resilience. This review analyses the characteristics, quality, and comprehensiveness of drought-resilience policies in Eswatini and Lesotho. We have systematically reviewed public policies that shape responses to disaster resilience published between 1 January 1980 and 30 June 2019. A combination of keywords was used to search electronic bibliographic databases, multidisciplinary databases, key organisational websites, and the first 20 pages of Google for policies that addressed disaster and/or drought resilience. Identified documents were downloaded into an EndNote database and screened for eligibility using predetermined criteria. The logic of events framework was used for quality assessment, and a metaethnographic approach was applied for data synthesis. Three broad categories of characteristics, thematic outcomes and quality, and comprehensiveness of policy documents emerged and are presented. Policy responses contributing to disaster resilience were found in n = 32 out of 13,700 documents. Three (n = 3/32) policies were statutory, and the rest were nonstatutory. Eleven (n = 11/32) were assessed to be of high quality. Policy responses relating to drought resilience focused on reducing vulnerability to recurrent disasters; promoting drought and climate change adaptation; improving agriculture and food security; safeguarding cultural heritage; and preventing gender inequality and gender-based violence as well as improving disaster governance. However, the construct of drought resilience was not strongly articulated as a major policy goal across policy documents. There is an urgent need to promote better understanding of drought resilience in order to motivate policymakers to steer away from reactive interventions and position resilience as a major national policy goal in both countries to expedite inclusive growth and safeguard development gains and the health and wellbeing of the majority of their populations who are rural-based populations

The impact of the livelihoods and income fortification and socio-civic transformation project on the quality of life, wellbeing, self-esteem, and quality of neighbourhood social environment among the youth in slum areas of in Kampala, Uganda

Background: Various interventions to improve the quality of life (QoL) among slum dwellers across sub Saharan Africa have been implemented. However, the interventions impacts remain less understood. We assessed the impact of the Urban Program on Livelihoods and Income Fortification and Socio-civic Transformation (UPLIFT) project on QoL, psychological wellbeing, self-esteem, and the quality of neighbourhood social environment of young people aged 13–25 years in slum areas of Makindye and Nakawa Divisions in Kampala, Uganda. Methods: The study was designed as a mixed method evaluation using repeated cross-sectional survey and grounded theory in both the intervention and comparison communities. The intervention effect was estimated using the difference-in-differences Kernel propensity-score matching technique, with bootstrapping. The “rcs” option was used given that data were from repeated cross-sectional surveys. A thematic analysis was adopted for the qualitative data to triangulate and complement the quantitative data. Results: The UPLIFT project led to an improvement in QoL, psychological wellbeing, and self-esteem of young people. In terms of QoL, the project led to a six-percentage point increase in quality of living conditions scores (where higher scores reflect better living conditions; lower ones, worse living conditions). However, a negative effect was observed for personal independence whilst the project did not have any impact on social relations. In terms of self-esteem and psychological wellbeing, the project led to a 4.6-point increase in self-esteem scores, a 5.4-point increase in self-acceptance scores, a 5.3- point increase in purpose in life scores, a 5.7 - point increase in personal growth, and a 10.7-point increase in autonomy scores. However, the project had a negative effect on personal independence; and had no impact on environmental mastery and the quality of neighbourhood social environment. Conclusion: Functional community-owned assets accumulation and capacity building initiatives for young people in slum areas improved their psychological wellbeing and quality of life. However, such initiatives do not appear to address social relationships and personal independence of young people in slum areas

Building Resilience in Southern Africa: A Case Study of World Vision in Swaziland and Lesotho

The main purpose of this study was to establish the state of resilience in World Vision assisted communities across two countries (Swaziland and Lesotho). At the National level, the study was conducted in World Vision operational and control non-intervention areas to establish the level of resilience in the target Area Development Program (ADP) communities, to assess the rational fit between clearly defined activities addressing drivers of community vulnerability and community resilience strategies, and to identify factors that may have facilitated or hindered the effectiveness of community resilience in improving the overall wellbeing. This study was carried out at the height of the impact of the 2015-16 El Nino climatic event in Southern Africa, which has caused the worst drought in 35 years. The drought has had catastrophic effect on the food and water security of millions of people across the region. In the absence of baseline that captures key tenets of resilience and adequate monitoring data, the study used a non-equivalent control groups post-test only quasi experimental design, incorporating mixed methods. The design allowed comparison of three groups: the control non-intervention areas vs two groups from World Vision operational areas- an ADP (which usually incorporates development programs only) and an ADP that incorporates emergency programs into its development and operational plans. The study areas were: Nkilongo (the control area), Maphalaleni ADP (without emergency programs) and Mpolonjeni ADP (with emergency programs) in Swaziland; and Kubake (control area), Mpharane ADP (without emergency programs) and Malumeng ADP (with emergency programs) in Lesotho. The adopted design was the best approach to answer the postulated research questions. It is important to note that a major problem with this design is that the control non-intervention areas and World Vision operational areas might not have necessarily been comparable before World Vision instigated its programs and at the time of this study. Hence, this illustrates the importance of obtaining good and comprehensive baseline data and having robust monitoring systems. Nevertheless, any difference in demographic and socio-economic factors between the three groups observed at the time of the study and its impact on observed effects was addressed by controlling for these variables in regression models. The study incorporated 16 focus group discussions, with a total sample size of 197 (93 in Swaziland and 104 in Lesotho); and a household survey that included 1,789 households in Swaziland and 1,535 households in Lesotho

Biofuel production and its impact on food security in low and middle income countries : implications for the post-2015 sustainable development goals

The post-2015 sustainable development goals (SDGs) aim to strengthen the achievements of the Millennium Development Goals (MDGs). There are 17 SDGs, the first two tackle ending poverty and hunger as well as food insecurity, under nutrition and sustainable agriculture. To address these goals requires eradicating chronic hunger. This paper examines challenges associated with biofuel production and how they relate to SDGs and their targets. We mainly focus on challenges associated with biofuel production not adequately addressed in the SDGs. It draws from a range of peer reviewed and grey literature to advance the understanding of how biofuel production will impact the post-2015 development agenda. The findings suggest that increasing use of food crops to produce biofuels in the United States, European Union, Japan and Brazil has been one important element in explaining the steady rise in staple food prices since 2000. While this is a potential threat to food and nutrition security in low and middle-income countries, biofuel production also offers significant opportunities in low income countries. There are several challenges to the development and harnessing of biofuels, these include 1) the interaction between biofuel production and climate change; 2) biofuel production and foreignisation of land; 3) food wastage; 4) poor governance and limited production capacity; 5) biofuel production within a weak and fragmented policy framework; 6) biofuel production, land tenure, and socio-economic impacts; 7) biofuel production and conflicts; and 8) biofuel production and deforestation. For the post-2015 sustainable development agenda to have an impact, strong actions are required to protect rural communities as well as nurture the biofuels industry. This should be matched by commensurate investments in food and nutrition security, and transparent public–private partnerships. This calls for strong and pro-poor policies on feedstock farming, processing and trading. Such policies must address the rhetoric of stakeholder participation in land use management

Understanding disaster resilience in communities affected by recurrent drought in Lesotho and Swaziland : a qualitative study

Background: Lesotho and Swaziland experience intense, recurring drought resulting in disaster situations. Despite the recurrence of drought, both its influence on rural subsistence communities’ support systems and the actions that enable structures of resilience remain poorly understood. Each incidence of drought stimulates a disaster resilience discussion that stalls without achievement of positive results until the next disaster. This study has examined the influence of recurring drought on communities’ inherent resilience and proposes an evidence-based framework to enhance community resilience. Methods: Data were collected from 16 focus group discussions (N = 197) in the Highveld, Midveld and Lowveld agro-ecological regions of Swaziland and Lesotho. Themes and subthemes have been identified, defined, categorised and narrated using structuration theory as a guide. Results: Resilience activities were found to be characterised by knowledgeability and changes in behaviour in adapting and applying appropriate actions, all of which were enhanced by institutional support. The effectiveness of institutional support hinged on harnessing communities’ knowledge, social groups, value systems, connectedness, participation, decision-making and collectivism. Conclusion: Large-scale interventions to build and strengthen resilience are urgently needed in order to maintain cohesiveness and development gains, especially because rural subsistence farmers make up the majority of these two countries’ populations. Policies that integrate resilience with national development planning must be urgently developed and executed

Combating recurrent hazards : evidence from rural Lesotho and Eswatini : a qualitative study

This study explored community disaster preparedness among rural subsistence communities affected by recurrent drought-induced disasters in Eswatini and Lesotho. Sixteen focus group discussions comprising 197 participants from different backgrounds were conducted. Recorded interviews were transcribed, coded and categorised. Themes and subthemes were developed and formed the basis of analysis and interpretation guided by structuration theory. Emerging themes related to community disaster preparedness included: (1) knowledgeability and systems of meaning; (2) structural responses to disaster preparedness; and (3) the dispensation of power and control. However, power and control were also impediments to effective disaster preparedness through the curtailing of collaboration, access to resources and information, and collective participation. Addressing these impediments can improve learning and contribute to developing robust disaster preparedness. There is an urgent need to streamline and integrate traditional knowledge and systems to be used in tandem with existing scientific knowledge

The epidemiological burden of and overall distribution of chronic comorbidities in coronavirus disease-2019 among 202,005 infected patients : evidence from a systematic review and meta-analysis

Purpose The main purpose of this study was to examine the overall distribution of chronic comorbidities in coronavirus disease-19 (COVID-19) infected populations and the risk of the underlying burden of disease in terms of the case fatality ratio (CFR). Methods We carried out a systematic review and meta-analysis of studies on COVID-19 patients published before 10th April 2020. Twenty-three studies containing data for 202,005 COVID-19 patients were identified and included in our study. Pooled effects of chronic comorbid conditions and CFR with 95% confidence intervals were calculated using random-effects models. Results A median age of COVID-19 patients was 56.4 years and 55% of the patients were male. The most prevalent chronic comorbid conditions were: any type of chronic comorbidity (37%; 95% CI 32–41%), hypertension (22%; 95% CI 17–27%), diabetes (14%; 95% CI 12–17%), respiratory diseases (5%; 95% CI 3–6%), cardiovascular diseases (13%; 95% CI 10–16%) and other chronic diseases (e.g., cancer) (8%; 95% CI 6–10%). Furthermore, 37% of COVID-19 patients had at least one chronic comorbid condition, 28% of patients had two conditions, and 19% of patients had three or more chronic conditions. The overall pooled CFR was 7% (95% CI 6–7%). The crude CFRs increased significantly with increasing number of chronic comorbid conditions, ranging from 6% for at least one chronic comorbid condition to 13% for 2 or 3 chronic comorbid conditions, 12% for 4 chronic comorbid conditions, 14% for 5 chronic comorbid conditions, and 21% for 6 or more chronic comorbid conditions. Furthermore, the overall CFRs also significantly increased with higher levels of reported clinical symptoms, ranging from 14% for at least four symptoms, to 15% for 5 or 6 symptoms, and 21% for 7 or more symptoms. Conclusions The chronic comorbid conditions were identified as dominating risk factors, which should be considered in an emergency disease management and treatment choices. There is urgent need to further enhance systematic and real-time sharing of epidemiologic data, clinical results, and experience to inform the global response to COVID-19

Understanding the challenges of improving sanitation and hygiene outcomes in a community based intervention : a cross-sectional study in rural Tanzania

Good sanitation and clean water are basic human rights yet they remain elusive to many rural communities in Sub-Saharan Africa (SSA). We carried out a cross sectional study to examine the impact of a four-year intervention aimed at improving access to water and sanitation and reducing waterborne disease, especially diarrhea in children under five years old. The study was carried out in April and May 2015 in Busangi, Chela and Ntobo wards of Kahama District of Tanzania. The interventions included education campaigns and improved water supply, and sanitation. The percentage of households (HHs) with access to water within 30 min increased from 19.2 to 48.9 and 17.6 to 27.3 in the wet and dry seasons, respectively. The percentage of HHs with hand washing facilities at the latrine increased from 0% to 13.2%. However, the incidence of diarrhea among children under five years increased over the intervention period, RR 2.91 95% CI 2.71–3.11, p < 0.0001. Availability of water alone may not influence the incidence of waterborne diseases. Factors such as water storage and usage, safe excreta disposal and other hygiene practices are critical for interventions negating the spread of water borne diseases. A model that articulates the extent to which these factors are helpful for such interventions should be explored

Resilience to climate-induced disasters and its overall impact on well-being in Southern Africa : a mixed-methods systematic review protocol

Background: Southern Africa has long been vulnerable to climate-induced disasters, especially droughts and floods. The severity and frequency of disasters increased in the early 1980s, continuously eroding livelihoods, which in turn invoked humanitarian intervention. A systematic review of the relationship between resilience to drought and well-being will be undertaken. Methods: Studies will be included if they were conducted between January 1980 and December 2017; used quantitative and/or qualitative methods; were peer reviewed or comprise grey literature; covered Southern Africa; and measured resilience and its relationship to well-being. Data extraction will be informed by the Cochrane Public Health Group and the Joanna Briggs Institute manuals. The quality of evidence of the studies included will be assessed for risk bias, psychometric properties of tools used, and their suitability. The findings will be summarised into themes and narrated. Discussion: This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. The protocol gives insight of the scope and parameters for the systematic review to be carried out. The systematic review will establish how resilience to climate-induced disasters affects well-being. It will also provide recommendations to improve humanitarian coordination in Southern Africa. Systematic review registration: The protocol was registered by the PROSPERO international prospective register of systematic reviews, reference CRD42017064396