The role of Monitoring and Evaluation in improving Sustainability of water projects: A case study of Water Projects in Bagamoyo district, Pwani Region

This dissertation is about explaining the role of Monitoring and Evaluation in improving the sustainability in water projects. The study was conducted in Bagamoyo District in Pwani region, whereas five (5) wards and six (6) villages were studied, those wards includes Zinga, Kiromo, Fukayosi, Dunda and Kiwangwa. The study had the following specific objectives, firstly to determine the current M&E practices applied in water projects, to determine challenges faced by water projects in implementing M&E practices and to find out the proposed best approaches to be used in improving M&E practices applied in water projects. A total of 100 respondents were drawn from different levels which included the officials in District water department, who are the project implementers, Village government members including water committees members and local communities who are the water users and the project beneficiaries. Both Quantitative data obtained through prepared questionnaires and Qualitative data from Interviews done with villagers, district officials and village government members were used, together with documentary evidences. Findings of this study showed that, the most applied M&E practices in water projects is Field visit and meeting. Other practices are APR, LFA and PRA, which are not effectively applied. It also revealed that, most of established water projects lacks sustainability, and the major reason among others is ineffective M&E systems. The findings showed that, water projects faces challenges in implementing M&E practices including Low budgetary allocation in M&E activities, Lack of technical M&E staffs, Low central government support, poor project reports and information systems, poor community participation. It also revealed the absence of an independent M&E unit in the District water department and the use of Unqualified and untrained M&E staffs. Lastly, the findings proposed on the use of best approaches to improve M&E systems including Capacity building and Training programmes, the change of National policies and plans from Infrastructure to service oriented or approach, to establish an Independent M&E unit in Bagamoyo district water department and adopting Participatory approach. Keywords: Monitoring, Evaluation, Sustainability and Water projects

Stimulating resilience for recovery: building adaptive resilience in emergency WASH response in Haiti, the Philippines and Lebanon

Recovery deficits are often witnessed within disaster-affected societies following post-disaster interventions. Humanitarian operations have struggled to find coherence between relief and recovery activities, which has resulted in a perceived operational ‘gap’ between relief, recovery and development. Building individual/household resilience within the humanitarian sphere has been theoretically posed to be fundamental for recovery; a programmatic consideration that could ensure former weak resilience would not hinder post-disaster recovery. Therefore, could a resilience building approach offer much needed solutions to the challenge of recovery within post-disaster contexts? This paper will present findings from recent doctoral research undertaken in the 2010 Haiti earthquake response, as well as presenting case study evidence from the 2013 post-disaster responses in the Philippines and the Syrian response in Lebanon. The paper will look specifically at the common barriers to recovery experienced by individuals/ households in a crisis event, understanding how emergency response operations within the WASH sector affects recovery, individual/ household resilience within the post-disaster environment will be detailed, gauging its relevance for stimulating recovery; giving case study examples of how in practice resilience at the individual/ household level can be operationalised in emergency response programming

A predictive algorithm for identifying children with sickle cell anemia among children admitted to hospital with severe anemia in Africa

Sickle cell anemia (SCA) is common in sub-Saharan Africa where approximately 1% of births are affected. Severe anemia is a common cause for hospital admission within the region yet few studies have investigated the contribution made by SCA. The Transfusion and Treatment of severe anemia in African Children Trial (ISRCTN84086586) investigated various treatment strategies in 3983 children admitted with severe anemia (hemoglobin < 6.0 g/dl) based on two severity strata to four hospitals in Africa (three Uganda and one Malawi). Children with known-SCA were excluded from the uncomplicated stratum and capped at 25% in the complicated stratum. All participants were genotyped for SCA at trial completion. SCA was rare in Malawi (six patients overall), so here we focus on the participants recruited in Uganda. We present baseline characteristics by SCA status and propose an algorithm for identifying children with unknown-SCA. Overall, 430 (12%) and 608 (17%) of the 3483 Ugandan participants had known- or unknown-SCA, respectively. Children with SCA were less likely to be malaria-positive and more likely to have an affected sibling, have gross splenomegaly, or to have received a previous blood transfusion. Most outcomes, including mortality and readmission, were better in children with either known or unknown-SCA than non-SCA children. A simple algorithm based on seven admission criteria detected 73% of all children with unknown-SCA with a number needed to test to identify one new SCA case of only two. Our proposed algorithm offers an efficient and cost-effective approach to identifying children with unknown-SCA among all children admitted with severe anemia to African hospitals where screening is not widely available

Monitoring and moderating extreme indoor temperatures in low-income urban communities

Climate change presents significant threats to human health, especially for low-income urban communities in the Global South. Despite numerous studies of heat stress, surprisingly little is known about the temperatures actually encountered by people in their homes, or the benefits of affordable adaptations. This paper examines indoor air temperature measurements gathered from 47 living rooms within eight low-income communities of Accra and Tamale, Ghana. Using multiple temperature indices and a tiered analysis, we evaluate indoor temperature variations linked to roof type, ceiling insulation, presence of fans, and tree shade, for different housing types and locations. Our data reveal indoor temperatures in the range 22.4 ◦C to 45.9 ◦C for Accra, and 22.2 ◦C to 43.0 ◦C in Tamale. Using dummy regression analysis, we find that tree shade reduces the number of very hot days (>40 ◦C) and nights (>30 ◦C) by about 12 and 15 d per year, respectively. Building materials also strongly moderate indoor temperatures but in opposing ways: rooms with traditional mud walls and thatch roofs are on average 4.5 ◦C cooler than rooms in concrete block houses with uninsulated metal roofs during the day but are 1.5 ◦C warmer at night; rooms with ceiling insulation are on average 6.9 ◦C cooler in the day but 1.4 ◦C warmer at night. We conclude that sub-daily data are necessary for reporting extreme indoor temperatures, and that trade-offs between minimum and maximum temperatures require interventions to be assessed carefully before attempting to counter extreme heat inside homes

Transfusion Volume for Children with Severe Anemia in Africa

Background Severe anemia (hemoglobin level, 37.5°C) at screening (P=0.001 after Sidak correction). Among the 1943 children (60.8%) without fever, mortality was lower with a transfusion volume of 30 ml per kilogram than with a volume of 20 ml per kilogram (hazard ratio, 0.43; 95% CI, 0.27 to 0.69). Among the 1253 children (39.2%) with fever, mortality was higher with 30 ml per kilogram than with 20 ml per kilogram (hazard ratio, 1.91; 95% CI, 1.04 to 3.49). There was no evidence of differences between the randomized groups in readmissions, serious adverse events, or hemoglobin recovery at 180 days. Conclusions Overall mortality did not differ between the two transfusion strategies. (Funded by the Medical Research Council and Department for International Development, United Kingdom; TRACT Current Controlled Trials number, ISRCTN84086586. opens in new tab.

Incidence and predictors of hospital readmission in children presenting with severe anaemia in Uganda and Malawi: a secondary analysis of TRACT trial data

Background: Severe anaemia (haemoglobin < 6 g/dL) is a leading cause of recurrent hospitalisation in African children. We investigated predictors of readmission in children hospitalised with severe anaemia in the TRACT trial (ISRCTN84086586) in order to identify potential future interventions. Methods: Secondary analyses of the trial examined 3894 children from Uganda and Malawi surviving a hospital episode of severe anaemia. Predictors of all-cause readmission within 180 days of discharge were identified using multivariable regression with death as a competing risk. Groups of children with similar characteristics were identified using hierarchical clustering. Results: Of the 3894 survivors 682 (18%) were readmitted; 403 (10%) had ≥2 re-admissions over 180 days. Three main causes of readmission were identified: severe anaemia (n = 456), malaria (n = 252) and haemoglobinuria/dark urine syndrome (n = 165). Overall, factors increasing risk of readmission included HIV-infection (hazard ratio 2.48 (95% CI 1.63–3.78), p < 0.001); ≥2 hospital admissions in the preceding 12 months (1.44(1.19–1.74), p < 0.001); history of transfusion (1.48(1.13–1.93), p = 0.005); and missing ≥1 trial medication dose (proxy for care quality) (1.43 (1.21–1.69), p < 0.001). Children with uncomplicated severe anaemia (Hb 4-6 g/dL and no severity features), who never received a transfusion (per trial protocol) during the initial admission had a substantially lower risk of readmission (0.67(0.47–0.96), p = 0.04). Malaria (among children with no prior history of transfusion) (0.60(0.47–0.76), p < 0.001); younger-age (1.07 (1.03–1.10) per 1 year younger, p < 0.001) and known sickle cell disease (0.62(0.46–0.82), p = 0.001) also decreased risk of readmission. For anaemia re-admissions, gross splenomegaly and enlarged spleen increased risk by 1.73(1.23–2.44) and 1.46(1.18–1.82) respectively compared to no splenomegaly. Clustering identified four groups of children with readmission rates from 14 to 20%. The cluster with the highest readmission rate was characterised by very low haemoglobin (mean 3.6 g/dL). Sickle Cell Disease (SCD) predominated in two clusters associated with chronic repeated admissions or severe, acute presentations in largely undiagnosed SCD. The final cluster had high rates of malaria (78%), severity signs and very low platelet count, consistent with acute severe malaria. Conclusions: Younger age, HIV infection and history of previous hospital admissions predicted increased risk of readmission. However, no obvious clinical factors for intervention were identified. As missing medication doses was highly predictive, attention to care related factors may be important. Trial registration: ISRCTN ISRCTN84086586. Keywords: Severe anaemia, Readmissio