View Point: Economic growth and child health in Sub Saharan Africa

After independence most African countries witnessed growth in their economies and decreases in child mortality. However both economic growth and the gains in under 5 mortality slowed dramatically in the 1980s and 1990s

Technical guidelines for economic valuation of inland small-scale fisheries in developing countries

These ôTechnical Guidelines for Economic Valuation of Inland Small-scale Fisheries in Developing Countriesö are one of the outputs of the project on ôFood security and poverty alleviation through improved valuation and governance of river fisheries in Africaö. The guidelines draw upon research results and experience gained during the course of the project. The project was coordinated and implemented by the WorldFish Center and was carried out in cooperation with the National Agricultural Research Institutes (NARs) from the participating countries: the Nigeria Institute for Freshwater Fisheries Research, the Departments of Fishery of Niger, Malawi and Zambia, and the Cameroonian MinistΦre de lÆElevage, des PΩches et de lÆIndustrie Animale; and three advanced research institutes (ARIs): the Leibniz University of Hannover in Germany, the Institute for Sustainable Development and Aquatic Resources in UK, and the University of Cape Town in South Africa.Rural development, Sustainable development, Livelihoods, Economic analysis, Research, Artisanal fishing

The structure and margins of the Lake Chilwa fisheries in Malawi: a value chain analysis

Small freshwater pelagic fisheries in closed lakes are very important to millions of people in sub-Saharan Africa providing livelihoods and nutritional security. However, returns from these fisheries have been shown to �uctuate in response to climatic variability. In order to understand the impact of these fluctuations on the livelihoods of people dependant on these fisheries, there is a need for information on how the fish value chain is organized and how it functions in response to variation in supplies. The results will feed into strategies that build resilience in fishing households against the uncertainties arising from unstable ecosystems. The Lake Chilwa fishery value chain is composed of fishers, processors, traders, fish transporters, boat owners, owners of fish processing shades, fisheries associations, gear owners, gear makers, firewood sellers, and traders of fishing gear and equipment. The value chain employs many people and local authorities can consider using this information in the design of rural development strategies for employment generation in small-scale fishing communities. The findings from this study have a number of implications for the improvement of the livelihood of fishers and enhancing their capacity to mitigate against the effects of climate change

Strategic breeding investments for legume expansion: Lessons learned from the comparison of Groundnut and Pigeonpea, Socioeconomics Discussion Paper Series NUmber 1

Sustained, well-targeted, and effectively used investments in agricultural R&D improved productivity worldwide and thereby contributed to food security. In this context, research spillover effects refer to situations in which a technology that is developed for a specific target region or product is also applicable to other locations or products that are not targeted during the research process. (Deb/Bantilan 2001) The focus of this paper is the comparative analysis of spillover effects and the distribution of benefits across countries in Asia and Africa that arise from research in groundnut and pigeonpea. Efforts to quantify these effects have shown that the contribution of spillover effects to the overall impact can be substantial at times. After illustrating the basis for the transferability measurement, the application of the concept is outlined and results for the two crops are compared. To maximize impact from international agricultural research, the thorough understanding of varietal movement and benefit levels across countries and regions is crucial for future success

Population level usage of health services, and HIV testing and care, prior to decentralization of antiretroviral therapy in Agago District in rural Northern Uganda: Additional Files

A study protocol developed to investigate health service usage, particularly HIV testing and care, in 2/6 parishes of the Lapono sub-county of northern Uganda, prior to introduction of AntiRetroviral Therapy (ART) services in Lira Kato Health Centre (a local lower-level health centre III). The protocol consists of household and individual questionnaires which were administered to members of each household. These captured individual demographic and health-related information on adults (aged 15–59 years) and socioeconomic data on children living in each household. The protocol was approved by the Joint Clinical Research Centre/Research Ethical Committee (JCRC/REC), Uganda National Council for Science and Technology (UNCST) and Office of the President of the Republic of Uganda

Patient level benefits associated with decentralisation of antiretroviral therapy services to primary health facilities in Malawi and Uganda

BACKGROUND: The Lablite project captured information on access to antiretroviral therapy (ART) at larger health facilities (‘hubs’) and lower-level health facilities (‘spokes’) in Phalombe district, Malawi and in Kalungu district, Uganda. METHODS: We conducted a cross-sectional survey among patients who had transferred to a spoke after treatment initiation (Malawi, n=54; Uganda, n=33), patients who initiated treatment at a spoke (Malawi, n=50; Uganda, n=44) and patients receiving treatment at a hub (Malawi, n=44; Uganda, n=46). RESULTS: In Malawi, 47% of patients mapped to the two lowest wealth quintiles (Q1–Q2); patients at spokes were poorer than at a hub (57% vs 23% in Q1–Q2; p<0.001). In Uganda, 7% of patients mapped to Q1–Q2; patients at the rural spoke were poorer than at the two peri-urban facilities (15% vs 4% in Q1–Q2; p<0.001). The median travel time one way to a current ART facility was 60 min (IQR 30–120) in Malawi and 30 min (IQR 20–60) in Uganda. Patients who had transferred to the spokes reported a median reduction in travel time of 90 min in Malawi and 30 min in Uganda, with reductions in distance and food costs. CONCLUSIONS: Decentralizing ART improves access to treatment. Community-level access to treatment should be considered to further minimize costs and time

The Lablite project: A cross-sectional mapping survey of decentralized HIV service provision in Malawi, Uganda and Zimbabwe

Background In sub-Saharan Africa antiretroviral therapy (ART) is being decentralized from tertiary/secondary care facilities to primary care. The Lablite project supports effective decentralization in 3 countries. It began with a cross-sectional survey to describe HIV and ART services. Methods 81 purposively sampled health facilities in Malawi, Uganda and Zimbabwe were surveyed. Results The lowest level primary health centres comprised 16/20, 21/39 and 16/22 facilities included in Malawi, Uganda and Zimbabwe respectively. In Malawi and Uganda most primary health facilities had at least 1 medical assistant/clinical officer, with average 2.5 and 4 nurses/midwives for median catchment populations of 29,275 and 9,000 respectively. Primary health facilities in Zimbabwe were run by nurses/midwives, with average 6 for a median catchment population of 8,616. All primary health facilities provided HIV testing and counselling, 50/53 (94%) cotrimoxazole preventive therapy (CPT), 52/53 (98%) prevention of mother-to-child transmission of HIV (PMTCT) and 30/53 (57%) ART management (1/30 post ART-initiation follow-up only). All secondary and tertiary-level facilities provided HIV and ART services. In total, 58/81 had ART provision. Stock-outs during the 3 months prior to survey occurred across facility levels for HIV test-kits in 55%, 26% and 9% facilities in Malawi, Uganda and Zimbabwe respectively; for CPT in 58%, 32% and 9% and for PMTCT drugs in 26%, 10% and 0% of facilities (excluding facilities where patients were referred out for either drug). Across all countries, in facilities with ART stored on-site, adult ART stock-outs were reported in 3/44 (7%) facilities compared with 10/43 (23%) facility stock-outs of paediatric ART. Laboratory services at primary health facilities were limited: CD4 was used for ART initiation in 4/9, 5/6 and 13/14 in Malawi, Uganda and Zimbabwe respectively, but frequently only in selected patients. Routine viral load monitoring was not used; 6/58 (10%) facilities with ART provision accessed centralised viral loads for selected patients. Conclusions Although coverage of HIV testing, PMTCT and cotrimoxazole prophylaxis was high in all countries, decentralization of ART services was variable and incomplete. Challenges of staffing and stock management were evident. Laboratory testing for toxicity and treatment effectiveness monitoring was not available in most primary level facilities

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century