40 research outputs found

    Cost-Benefit Analysis and Growth Effects of Pelleted and Unpelleted On-Farm Feed on African Catfish (Claries Gariepinus Burchell 1822) in Earthen Ponds

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    Fish feed constitutes 40-60% of the total operational costs of a fish farm. Commercial feeds are often too expensive for rural fish farmers. Consequently, farmers use non-conventional and locally available fish feed ingredients including agro-industrial by-products. These feeds have not led to increased pond productivity due to poor processing, higher fibre content, and anti-nutritional factors that limit nutrient bio-availability. Farmers have not embraced processing of fish feeds because the cost-effectiveness of processing has not been clearly demonstrated. The African catfish (Clarias gariepinus) is an important farmed fish in sub-Saharan Africa hence the need for research on its nutrition and growth performance. The growth performance and cost-benefit of using pelleted diets formulated from locally available feed ingredients on C. gariepinus were evaluated in a rural African setting. The experiment included diets that differed in the ingredients and form used (pelleted and un-pelleted). Four isocaloric and isonitrogenous diets were formulated from freshwater shrimp (Caridina nilotica), rice bran (Oryza sativa) and wheat bran (Triticum aestivum). The diets were C. nilotica and wheat bran pelleted (CWBp), C. nilotica and wheat bran un-pelleted (CWBup), C. nilotica and rice bran pelleted (CRBp), and C. nilotica and rice bran un-pelleted (CRBup). The diets were fed to C. gariepinus fingerlings (mean initial weight 1.75±0.03g), in triplicates for 5 months. The pelleted diets showed significantly better performance (P<0.05) compared to the un-pelleted diets. Fish grew to a weight of 266.77±6.21g on CWBp, 224.9±3.91g on CRBp, 211.38±4.46g on CWBup and 190.87±4.47g on CRBup. Cost benefit analysis of the pelleted and un-pelleted diets indicated positive net returns of US180.1forCWBp,US 180.1 for CWBp, US142.5 for CRBp, US126.8forCWBupandUS 126.8 for CWBup and US 115.5 for CRBup. The CWBp had significantly higher net returns than the other diets. This paper demonstrates that although on-farm pelleting of diets adds extra cost of labour, pelleted diets are cost-effective and should be incorporated as an essential part of on-farm feed production.Key words: Catfish, feed, pelleting, cost-effectiveness, pon

    NUTRITIVE VALUE AND AVAILABILITY OF COMMONLY USED FEED INGREDIENTS FOR FARMED NILE TILAPIA (OREOCHROMIS NILOTICUS L.) AND AFRICAN CATFISH (CLARIAS GARIEPINUS, BURCHELL) IN KENYA, RWANDA AND TANZANIA

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    ABSTRACT Commonly utilized feed ingredients for culture of Nile tilapia (Oreochromis niloticus) and African catfish (Clarias gariepinus) from Kenya, Tanzania and Rwanda were collected over a period of six months (January -June 2010) and evaluated for their nutritive composition through proximate analysis. Most of the fish feed ingredients were found in all the three countries except a few that were unique to one or two countries as detailed in the results. Feed ingredients of animal origin exhibited significantly (P<0.05) higher crude protein levels (407 -635 g/kg DM) compared to the feed ingredients of plant based origin. Freshwater shrimps (Caridina nilotica) contained the highest crude protein levels of 635 g/kg DM. Feed ingredients of animal origin had low ether extracts (EE) with an exception of Omena fish (Rastrineobola argentea). Crude fibre (CF) was generally higher on feed ingredients of plant origin and ranged between 55-368 g/kg DM while Nitrogen Free Extracts (NfE) and ash content were higher in the feedstuffs of plant origin with an exception of maize bran which had the lowest value. Omena fish and freshwater shrimp had higher ash content of 182 and 228g/kg DM compared to other feed ingredients of animal origin, which may indicate contamination with soil particles during drying process. Based on the feed ingredient availability, potential competition with other human uses, content of crude protein and crude fibre and the feasibility of removal of anti-nutritional factors, C. nilotica, blood meal, meat and bone meal, were identified as most promising sources of animal based protein. Cotton (Gossypium spp) and sunflower (Helianthus annuus) seed cakes provided the best option as source of processed plant based protein. Leaves of gallant soldier (Galisonga parviflora), sweet potato (Ipomoea batatus), cassava (Manihot esculenta) and papaya (Papaya carica) were identified as high potential feedstuffs of plant origin either processed or in raw form for small-scale fish farming. We recommend that in well fertilized semiintensive ponds, maize (Zea mays), wheat (Triticum aestivum) and rice (Oryza sativa) bran may be utilized where available to supplement natural pond food

    What happened to anti-malarial markets after the Affordable Medicines Facility-malaria pilot? Trends in ACT availability, price and market share from five African countries under continuation of the private sector co-payment mechanism

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    BACKGROUND: The private sector supplies anti-malarial treatment for large proportions of patients in sub-Saharan Africa. Following the large-scale piloting of the Affordable Medicines Facility-malaria (AMFm) from 2010 to 2011, a private sector co-payment mechanism (CPM) provided continuation of private sector subsidies for quality-assured artemisinin combination therapies (QAACT). This article analyses for the first time the extent to which improvements in private sector QAACT supply and distribution observed during the AMFm were maintained or intensified during continuation of the CPM through 2015 in Kenya, Madagascar, Nigeria, Tanzania and Uganda using repeat cross-sectional outlet survey data. RESULTS: QAACT market share in all five countries increased during the AMFm period (p < 0.001). According to the data from the last ACTwatch survey round, in all study countries except Madagascar, AMFm levels of private sector QAACT availability were maintained or improved. In 2014/15, private sector QAACT availability was greater than 70% in Nigeria (84.3%), Kenya (70.5%), Tanzania (83.0%) and Uganda (77.1%), but only 11.2% in Madagascar. QAACT market share was maintained or improved post-AMFm in Nigeria, Tanzania and Uganda, but statistically significant declines were observed in Kenya and Madagascar. In 2014/5, QAACT market share was highest in Kenya and Uganda (48.2 and 47.5%, respectively) followed by Tanzania (39.2%), Nigeria (35.0%), and Madagascar (7.0%). Four of the five countries experienced significant decreases in median QAACT price during the AMFm period. Private sector QAACT prices were maintained or further reduced in Tanzania, Nigeria and Uganda, but prices increased significantly in Kenya and Madagascar. SP prices were consistently lower than those of QAACT in the AMFm period, with the exception of Kenya and Tanzania in 2011, where they were equal. In 2014/5 QAACT remained two to three times more expensive than the most popular non-artemisinin therapy in all countries except Tanzania. CONCLUSIONS: Results suggest that a private sector co-payment mechanism for QAACT implemented at national scale for 5 years was associated with positive and sustained improvements in QAACT availability, price and market share in Nigeria, Tanzania and Uganda, with more mixed results in Kenya, and few improvements in Madagascar. The subsidy mechanism as implemented over time across countries was not sufficient on its own to achieve optimal QAACT uptake. Supporting interventions to address continued availability and distribution of non-artemisinin therapies, and to create demand for QAACT among providers and consumers need to be effectively implemented to realize the full potential of this subsidy mechanism. Furthermore, there is need for comprehensive market assessments to identify contemporary market barriers to high coverage with both confirmatory testing and appropriate treatment

    Experience developing national evidence-based clinical guidelines for childhood pneumonia in a low-income setting - making the GRADE?

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    BACKGROUND: The development of evidence-based clinical practice guidelines has gained wide acceptance in high-income countries and reputable international organizations. Whereas this approach may be a desirable standard, challenges remain in low-income settings with limited capacity and resources for evidence synthesis and guideline development. We present our experience using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for the recent revision of the Kenyan pediatric clinical guidelines focusing on antibiotic treatment of pneumonia. METHODS: A team of health professionals, many with minimal prior experience conducting systematic reviews, carried out evidence synthesis for structured clinical questions. Summaries were compiled and distributed to a panel of clinicians, academicians and policy-makers to generate recommendations based on best available research evidence and locally-relevant contextual factors. RESULTS: We reviewed six eligible articles on non-severe and 13 on severe/very severe pneumonia. Moderate quality evidence suggesting similar clinical outcomes comparing amoxicillin and cotrimoxazole for non-severe pneumonia received a strong recommendation against adopting amoxicillin. The panel voted strongly against amoxicillin for severe pneumonia over benzyl penicillin despite moderate quality evidence suggesting clinical equivalence between the two and additional factors favoring amoxicillin. Very low quality evidence suggesting ceftriaxone was as effective as the standard benzyl penicillin plus gentamicin for very severe pneumonia received a strong recommendation supporting the standard treatment. CONCLUSIONS: Although this exercise may have fallen short of the rigorous requirements recommended by the developers of GRADE, it was arguably an improvement on previous attempts at guideline development in low-income countries and offers valuable lessons for future similar exercises where resources and locally-generated evidence are scarce

    Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya

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    BACKGROUND: There are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial. METHODS: Repeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention. RESULTS: 9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7%) were diagnosed with diarrhoea, with 130 of these being bloody (dysentery) therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7%) of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02). CONCLUSION: We found some evidence that the multi-faceted, sustained intervention described in this paper led to a reduction in the inappropriate use of antibiotics in treating children with non-bloody diarrhoea. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register ISRCTN42996612

    Optimising the use of caesarean section: a generic formative research protocol for implementation preparation

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    BACKGROUND: Caesarean section rates are rising across all geographical regions. Very high rates for some groups of women co-occur with very low rates for others. Both extremes are associated with short and longer term harms. This is a major public health concern. Making the most effective use of caesarean section is a critical component of good quality, sustainable maternity care. In 2018, the World Health Organization published evidence-based recommendations on non-clinical interventions to reduce unnecessary caesarean section. The guideline identified critical research gaps and called for formative research to be conducted ahead of any interventional research to define locally relevant determinants of caesarean birth and factors that may affect implementation of multifaceted optimisation strategies. This generic formative research protocol is designed as a guide for contextual assessment and understanding for anyone planning to take action to optimise the use of caesarean section. METHODS: This formative protocol has three main components: (1) document review; (2) readiness assessment; and (3) primary qualitative research with women, healthcare providers and administrators. The document review and readiness assessment include tools for local mapping of policies, protocols, practices and organisation of care to describe and assess the service context ahead of implementation. The qualitative research is organized according to twelve identified interventions that may optimise use of caesarean section. Each intervention is designed as a "module" and includes a description of the intervention, supporting evidence, theory of change, and in-depth interview/focus group discussion guides. All study instruments are included in this protocol. DISCUSSION: This generic protocol is designed to underpin the formative stage of implementation research relating to optimal use of caesarean section. We encourage researchers, policy-makers and ministries of health to adapt and adopt this design to their context, and share their findings as a catalyst for rapid uptake of what works

    Nanotechnology advances towards development of targeted-treatment for obesity

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    Obesity through its association with type 2 diabetes (T2D), cancer and cardiovascular diseases (CVDs), poses a serious health threat, as these diseases contribute to high mortality rates. Pharmacotherapy alone or in combination with either lifestyle modifcation or surgery, is reliable in maintaining a healthy body weight, and preventing progression to obesity-induced diseases. However, the anti-obesity drugs are limited by non-specifcity and unsustainable weight loss efects. As such, novel and improved approaches for treatment of obesity are urgently needed. Nanotechnology-based therapies are investigated as an alternative strategy that can treat obesity and be able to overcome the drawbacks associated with conventional therapies. The review presents three nanotechnology-based anti-obesity strategies that target the white adipose tissues (WATs) and its vasculature for the reversal of obesity. These include inhibition of angiogenesis in the WATs, transformation of WATs to brown adipose tissues (BATs), and photothermal lipolysis of WATs. Compared to conventional therapy, the targeted-nanosystems have high tolerability, reduced side efects, and enhanced efcacy. These efects are reproducible using various nanocarriers (liposomes, polymeric and gold nanoparticles), thus providing a proof of concept that targeted nanotherapy can be a feasible strategy that can combat obesity and prevent its comorbiditie

    Cost-Benefit Analysis And Growth Effects Of Pelleted And Unpelleted On-Farm Feed On African Catfish ( Clarias Gariepinus Burchell 1822) In Earthen Ponds

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    Fish feed constitutes 40-60% of the total operational costs of a fish farm. Commercial feeds are often too expensive for rural fish farmers. Consequently, farmers use non-conventional and locally available fish feed ingredients including agro-industrial by-products. These feeds have not led to increased pond productivity due to poor processing, higher fibre content, and anti-nutritional factors that limit nutrient bio-availability. Farmers have not embraced processing of fish feeds because the cost-effectiveness of processing has not been clearly demonstrated. The African catfish ( Clarias gariepinus ) is an important farmed fish in sub-Saharan Africa hence the need for research on its nutrition and growth performance. The growth performance and cost-benefit of using pelleted diets formulated from locally available feed ingredients on C. gariepinus were evaluated in a rural African setting. The experiment included diets that differed in the ingredients and form used (pelleted and un-pelleted). Four isocaloric and isonitrogenous diets were formulated from freshwater shrimp ( Caridina nilotica ), rice bran ( Oryza sativa ) and wheat bran ( Triticum aestivum ). The diets were C. nilotica and wheat bran pelleted (CWBp), C. nilotica and wheat bran un-pelleted (CWBup), C. nilotica and rice bran pelleted (CRBp), and C. nilotica and rice bran un-pelleted (CRBup). The diets were fed to C. gariepinus fingerlings (mean initial weight 1.75±0.03g), in triplicates for 5 months. The pelleted diets showed significantly better performance (P<0.05) compared to the un-pelleted diets. Fish grew to a weight of 266.77±6.21g on CWBp, 224.9±3.91g on CRBp, 211.38±4.46g on CWBup and 190.87±4.47g on CRBup. Cost benefit analysis of the pelleted and un-pelleted diets indicated positive net returns of US180.1forCWBp,US 180.1 for CWBp, US142.5 for CRBp, US126.8forCWBupandUS 126.8 for CWBup and US 115.5 for CRBup. The CWBp had significantly higher net returns than the other diets. This paper demonstrates that although on-farm pelleting of diets adds extra cost of labour, pelleted diets are cost-effective and should be incorporated as an essential part of on-farm feed production
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