Local handpump manufacture : a development option for aid agencies : attitudes expressed by New Zealand NGOs : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Agricultural Engineering/Development Studies at Massey University

A major reason for implementing water supply programmes is their potential contribution to health. The recently concluded United Nations International Drinking Water Supply and Sanitation Decade (1981-1990) attempted to provide access to clean water and sanitation for everyone in the Third World. There are several problems and constraints which preclude success in this area, many of them are sociological factors concerned with the transfer of technology and practices to cultures other than those in which they were conceived. Projects are implemented, often by outsiders, involving handpumps for water supply mounted on wells or boreholes. Such systems have a poor record with regard to their sustainability; often the handpump breaks down after donor withdrawal and is never repaired. Donor assisted projects often use handpumps sourced from the industrialised countries and paid for in hard currency, usually $US. When spare parts are needed they too must be sourced from overseas and paid for in scarce foreign exchange. Local inflation and currency devaluation can make these spares prohibitively expensive. The result has been neglected maintenance and breakdowns. This thesis examined the potential for local handpump manufacture to address operation and maintenance problems and assess the economic contribution local manufacture could make to the local community through employment and income generation. A case study of the Makeni Handpump Workshop in Lusaka. Zambia was used to compare the cost, landed in Lusaka, to an aid agency of handpumps sourced from the U.K. and from a local manufacturing operation. The provision of employment and income to local people arising from patronising the handpump workshop was also assessed as a 'developmental benefit'. This was over and above the acquisition of handpumps alone; aid money would be spent directly in the community by choosing a local source of equipment. Interviews with selected NGOs in New Zealand were conducted to establish their attitudes to water supply projects in general and to local handpump manufacture specifically. It emerged that local handpump manufacture could be profitable at the small-scale level of the case study and a viable form of income generation. New Zealand NGOs agreed that there should be more to water supply projects than a welfare consideration alone, an element of development should be included. They were supportive of local handpump manufacture where it existed but did not invest in it as a means of income generation

Human resources needs for universal access to antiretroviral therapy in South Africa: a time and motion study

<p>Background - Although access to life-saving treatment for patients infected with HIV in South Africa has improved substantially since 2004, treating all eligible patients (universal access) remains elusive. As the prices of antiretroviral drugs have dropped over the past years, availability of human resources may now be the most important barrier to achieving universal access to HIV treatment in Africa. We quantify the number of HIV health workers (HHWs) required to be added to the current HIV workforce to achieve universal access to HIV treatment in South Africa, under different eligibility criteria.</p> <p>Methods - We performed a time and motion study in three HIV clinics in a rural, primary care-based HIV treatment program in KwaZulu-Natal, South Africa, to estimate the average time per patient visit for doctors, nurses, and counselors. We estimated the additional number of HHWs needed to achieve universal access to HIV treatment within one year.</p> <p>Results - For universal access to HIV treatment for all patients with a CD4 cell count of ≤350 cells/μl, an additional 2,200 nurses, 3,800 counselors, and 300 doctors would be required, at additional annual salary cost of 929 million South African rand (ZAR), equivalent to US$141 million. For universal treatment (‘treatment as prevention’), an additional 6,000 nurses, 11,000 counselors, and 800 doctors would be required, at an additional annual salary cost of ZAR 2.6 billion (US$ 400 million).</p> <p>Conclusions - Universal access to HIV treatment for patients with a CD4 cell count of ≤350 cells/μl in South Africa may be affordable, but the number of HHWs available for HIV treatment will need to be substantially increased. Treatment as prevention strategies will require considerable additional financial and human resources commitments.</p&gt

The evolution of harm: effect of sexual conflicts and population size

Conflicts of interest between mates can lead to the evolution of male traits reducing female fitness and to coevolution between the sexes. The rate of adaptation and counter-adaptation is constrained by the intensity of selection and its efficiency, which depends on drift and genetic variability. This leads to the largely untested prediction that coevolutionary adaptations such as those driven by sexual conflict should evolve faster in large populations where the response to selection is stronger and sexual selection is more intense. We test this using the bruchid beetle Callosobruchus maculatus, a species with well documented male harm. Whilst most experimental evolution studies remove sexual conflicts, we reintroduce sexual conflict in populations where it has been experimentally removed. Both population size and standing genetic variability were manipulated in a factorial experimental design. After 90 generations of relaxed conflict (monogamy), the reintroduction of sexual conflicts for 30 generations favoured males that harmed females and females more resistant to the genital damage inflicted by males. Large population size rather than high initial genetic variation allowed males to evolve faster and become more harmful. Sexual selection thus creates conditions where males benefit from harming females and this selection is more effective in larger populations

HIV assessment and testing for hospital inpatients: still a weak link in the cascade

Since 2007, the World Health Organization has recommended that in countries with generalized HIV epidemics, HIV testing and counselling should be offered to all adults and adolescents seen in a health facility (1). This recommendation had been policy in Uganda since 2005 (2). However, evidence suggests that translation of this policy to practice in real-world settings has been patchy and that missed opportunities with HIV testing in the inpatient setting are still contributing to HIV related deaths (3,4)

Sperm precedence in zebra finches does not require special mechanisms of sperm competition

Competition between the spermatozoa of different males to fertilize the eggs of a single female acts as a selection pressure on the behaviour of males and females. However, quantitative predictions about behaviour fan only be made if the paternity consequences of different patterns of copulation are known. Because exhaustive empirical measurement of these consequences may be impractical, interest has centred on determining the mechanisms by which sperm competition occurs, knowledge of which may allow consequences to be calculated. One method of elucidating mechanisms of sperm competition is to use mathematical models to determine which mechanisms are necessary or sufficient to account for empirical observations. We use this approach for zebra finches Taeniopygia guttata and show that empirically measured rates of disappearance of sperm from the reproductive tract, and differences in the number of sperm in the first and subsequent ejaculates of each male, are sufficient to account for observed levels of sperm precedence. Special mechanisms of sperm competition, such as displacement or stratification of sperm, are therefore unnecessary to explain sperm precedence in this species

Time to eligibility for antiretroviral therapy in adults with CD4+ cell count >500 cells/µl in rural KwaZulu-Natal, South Africa

ObjectivesUnderstanding of progression to antiretroviral therapy (ART) eligibility and associated factors remains limited. The objectives of this analysis were to determine the time to ART eligibility and to explore factors associated with disease progression in adults with early HIV infection.MethodsHIV-infected adults (??18 years old) with CD4 cell count >?500 cells/?l were enrolled in the study at three primary health care clinics, and a sociodemographic, behavioural and partnership-level questionnaire was administered. Participants were followed 6-monthly and ART eligibility was determined using a CD4 cell count threshold of 350 cells/?l. Kaplan???Meier and Cox proportional hazard regression modelling were used in the analysis.ResultsA total of 206 adults contributed 381 years of follow-up; 79 (38%) reached the ART eligibility threshold. Median time to ART eligibility was shorter for male patients (12.0 months) than for female patients (33.9 months). Male sex [adjusted hazard ratio (aHR) 3.13; 95% confidence interval (CI) 1.82–5.39], residing in a household with food shortage in the previous year (aHR 1.58; 95% CI 0.99–2.54), and taking nutritional supplements in the first 6 months after enrolment (aHR 2.06; 95% CI 1.11–3.83) were associated with shorter time to ART eligibility. Compared with reference CD4 cell count????559 cells/?l, higher CD4 cell count was associated with longer time to ART eligibility [aHR 0.46 (95% CI 0.25–0.83) for CD4 cell count 560–632 cells/?l; aHR 0.30 (95% CI 0.16–0.57) for CD4 cell count 633–768 cells/?l; and aHR 0.17 (95% CI 0.08–0.38) for CD4 cell count?>?768 cells/?l].ConclusionsOver one in three adults with CD4 cell count?>?500 cells/?l became eligible for ART at a CD4 cell count threshold of 350 cells/?l over a median of 2 years. The shorter time to ART eligibility in male patients suggests a possible need for sex-specific pre-ART care and monitoring strategies

Spatial clustering of drug-resistant tuberculosis in Hlabisa subdistrict, KwaZulu-Natal, 2011-2015.

SETTING: Incidencerates of tuberculosis (TB) in South Africa are among the highest in the world, and drug resistance is a major concern. Understanding geographic variations in disease may guide targeted interventions. OBJECTIVE: To characterise the spatial distribution of drug-resistant TB (DR-TB) in a rural area of KwaZulu-Natal, South Africa, and to test for clustering. DESIGN: This was a cross-sectional analysis of DR-TB patients managed at a rural district hospital from 2011 to 2015. We mapped all patients in hospital data to local areas, and then linked to a population-based demographic surveillance system to map the patients to individual homesteads. We used kernel density estimation to visualise the distribution of disease and tested for clustering using spatial scan statistics. RESULTS: There were 489 patients with DR-TB in the subdistrict; 111 lived in the smaller demographic surveillance area. Spatial clustering analysis identified a high-risk cluster (relative risk of DR-TB inside vs. outside cluster 3.0, P < 0.001) in the south-east, a region characterised by high population density and a high prevalence of human immunodeficiency virus infection. CONCLUSION: We have demonstrated evidence of a geographic high-risk cluster of DR-TB. This suggests that targeting interventions to spatial areas of highest risk, where transmission may be ongoing, could be effective

Short Course for Focused Assessment with Sonography for Human Immunodeficiency Virus/Tuberculosis: Preliminary Results in a Rural Setting in South Africa with High Prevalence of Human Immunodeficiency Virus and Tuberculosis

In Africa, human immunodeficiency virus (HIV)–associated extrapulmonary tuberculosis (TB) is common and poses diagnostic difficulties. Ultrasound is useful to find suggestive signs such as effusions or abdominal lymphadenopathy. Because trained radiologists are scarce in resource-poor settings, even this simple and relatively inexpensive diagnostic tool is frequently unavailable to patients in district hospitals in sub-Saharan Africa. We developed a focused protocol for assessment with sonography for HIV/TB and trained physicians in a rural district hospital in South Africa. In this pilot study, high levels of confidence in identifying specific signs were rapidly achieved and ultrasound was introduced into routine clinical practice