CCAFS East Africa Regional Science Workshop Report

The East Africa regional program of the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS) hosted a three-day workshop to engage with partners from agricultural research, agricultural extension, climate services and products, food security, and early warning systems in East Africa. The overall objective of the workshop was to plan and develop thematic research to support climate risk management, adaptation and mitigation options in East Africa, resulting in four to five project concepts that can be supported as seed participatory action research (PAR) activities. From these seed activities, CCAFS intends to build longer term projects from those with the greatest potential to deliver bigger outcomes and impact. The workshop built on the regional needs for research and priorities identified from previous national and regional workshops in 2011

Spinal cystic echinococcosis - a systematic analysis and review of the literature : part 1. Epidemiology and anatomy

Bone involvement in human cystic echinococcosis (CE) is rare, but affects the spine in approximately 50% of cases. Despite significant advances in diagnostic imaging techniques as well as surgical and medical treatment of spinal CE, our basic understanding of the parasite's predilection for the spine remains incomplete. To fill this gap, we systematically reviewed the published literature of the last five decades to summarize and analyze the currently existing data on epidemiological and anatomical aspects of spinal CE

Urban and peri-urban family-based pig-keeping in Cambodia : Characteristics, management and perceived benefits and constraints

Keeping pigs in urban and peri-urban areas may not only provide many benefits for the urban households, but may also be challenging and a potential health hazard. The aim of this cross-sectional study was to describe household characteristics and to evaluate perceived benefits and constraints among pig-keepers in the urban and peri-urban areas of Phnom Penh, Cambodia. The study included 204 households and a structured questionnaire was used to interview the household member responsible for taking care of the pigs. Descriptive analyses showed that most households kept between 5 and 15 pigs and that all households kept their pigs in confinement. About 97% of the households owned the pigs themselves and the pigs were generally managed by female household members (43%). Pigs were mainly kept for commercial purposes and more than 60% of the households stated that income from pig-keeping was the main or one of the main sources of revenue for the household. More than 82% reported that they had experienced disease outbreaks among their pigs during the past three years and disease outbreaks were more commonly reported in households with lower socio-economic position (P = 0.025). Disease outbreaks were considered one of the main constraints, along with expensive feed and low payment prices for the slaughter pigs, but few households considered sanitary or other public health issues problematic. Thus, pig-keeping makes an important contribution to the livelihoods of urban and peri-urban households, but many households face external constraints on their production, such as diseases and low revenues, which may have a negative impact on their livelihoods

Integrated management of HIV, diabetes and hypertension in sub Saharan Africa: a pragmatic multi-country cluster-randomised trial

Introduction: In Africa, health care provision for chronic conditions is fragmented. We evaluated integrated management of HIV, diabetes and hypertension in Dar es Salaam, Tanzania and Kampala, Uganda. Methods: We conducted a pragmatic, cluster-randomised trial. Primary health care facilities were randomised to provide either integrated or standard care. In integrated care, participants with HIV, diabetes or hypertension were managed by the same healthcare workers, used the same pharmacy, had similarly designed medical records, shared the same registration and waiting area and had an integrated laboratory service. In standard care , these services were delivered vertically for each condition. Analyses used Generalised Estimating Equations. Recruitment was between 30th June 2020 and 1st April 2021 and follow-up was for 12 months. This trial is registered: ISCRTN 43896688. Findings: 32 health facilities were randomised. Just 3% of patients declined to join. Among participants with diabetes, hypertension or both, mean age (standard deviation) was 60.1 (12.7) years in the integrated care arm and 57.7 (12.2) in the standard care arm; among participants with HIV, these figures were 42.6 (11.2) and 42.7 (10.8) respectively. Among participants with diabetes, hypertension or both, the proportion alive and retained in care at study end was 1254/1409 (89.0%) in integrated care and 1457/1623 (89.8%) in standard care. The differences (95% CI were -0.65% (-5.76, 4.46; p=0.80) unadjusted and - 0.60% (-5.46, 4.26; p=0.81) adjusted. Among participants with HIV, the proportion who had plasma viral load <1,000 copies per ml was 1412/1456 (97.0%) in integrated care and 1451/1491 (97.3%) in standard care. The differences were -0.37% (One-sided 95% CI -1.99, 1.26; p-value for non-inferiority <0.0001 unadjusted) and -0.36% (-1.99, 1.28; p-value for non-inferiority <0.0001 adjusted). Conclusion: In sub-Saharan Africa, integrated chronic care services could improve outcomes for people with diabetes or hypertension without adversely affect outcomes for people with HIV

The efficacy of long-lasting nets with declining physical integrity may be compromised in areas with high levels of pyrethroid resistance

BACKGROUND: Long-lasting insecticide-treated mosquito nets (LLINs) are a primary malaria prevention strategy in sub-Saharan Africa. However, emergence of insecticide resistance threatens the effectiveness of LLINs. METHODS: Cross-sectional surveys of LLINs were conducted in houses of seven and four villages in Gem and Bungoma Districts in western Kenya, respectively. Condition (number and area of holes in the nets), number and species of mosquitoes resting inside them, and insecticidal activity of nets were quantified. Mosquitoes collected inside nets were allowed to lay eggs and progeny tested for susceptibility to deltamethrin and permethrin, pyrethoids commonly deployed in LLINs in western Kenya. RESULTS: In Gem, 83.3% of nets were less than three years old and 32.4% had at least one hole of any size; while in Bungoma, 92% were less than three years old and 48% had at least one hole. No anopheline and five Culex spp. mosquitoes were found resting inside nets in Gem regardless of the number and size of holes, while 552 Anopheles gambiae s.l., five Anopheles funestus s.l. and 137 Culex spp. were in nets in Bungoma. The number of mosquitoes resting inside nets increased with hole areas >50 cm in Bungoma. In WHO resistance assays, f1 offspring of samples collected in nets in Bungoma were 94 and 65% resistant to deltamethrin and permethrin, respectively. Nets from Bungoma retained strong activity against a susceptible laboratory strain, but not against f1 offspring of field-collected An. gambiae s.s. All An. gambiae s.s. samples collected in nets were homozygous for the kdr genotype L1014S. CONCLUSIONS: In areas with pyrethroid resistant vectors, LLINs with modest hole areas permit mosquito entry and feeding, providing little protection against the vectors. LLIN formulations develop large holes within three years of use, diminishing their presupposed lifetime effectiveness