Towards a Replicable Innovative Tool for Adaptive Climate Monitoring and Weather Forecasting Using Traditional Indigenous and Local Indicators to Strengthen AgroWeather Resilience at Scale

This paper presents lessons of a replicable innovative decision support tool to systematize traditional indigenous knowledge base for local climate monitoring and weather forecasting. The methodological tool, herein called the traditional indigenous and local knowledge tool (TILKIT), was conceptualized under two training-of-trainers initiatives on Climate-Smart Agriculture (CSA) in East Africa from March 2016 to December 2021. The aim was to build local momentum for consensus-based ethnographic weather monitoring, local weather forecasting and agroweather advisory development for adoption by local stakeholders to improve agro-climatic extension service delivery. The objective was to strengthen local capacity of smallholder farmer leaders, agribusiness value chain partners, and field extension agents on the practical applications of indigenous climatology. Most of this indigenous traditional knowledge or local technical knowledge (ITK or LTK) is now getting lost due to climate change and loss of institutional memory but little effort is being made to identify and systematize the use of emerging ITK or LTK. It is against this background that these initiatives conceptualised and developed an innovative approach to bridge the gaps in order to address the challenges of salience, access, legitimacy, equity and integration of climate information to meet users’ felt needs. The study adopted a transdisciplinary, participatory learning and action research (PLAR) model to identify and confirm emerging local weather indicators and what they mean for local rainfall forecasting, and to drive self-organization processes to bring indigenous climate knowledge into practical use in each community. The tool emphasizes a consensus-based co-production of local weather forecasts and agro-weather advisories to improve climate information services and extension service delivery. Testing and validation were conducted with 1,127 participants among various communities across Kenya, Tanzania and Uganda. Results comprise identified ethnographic weather prediction indicators per locality, and their implications for local weather forecasting, which for the first time is presented in probabilistic terms in a way local communities can associate with, and which can compare and contrast empirically with conventional weather forecast language. The tool also provides actionable agro-climate/ agro-weather advisories with appropriate lead times for local response and a basis for strategic seasonal planning and operational risk management decision-making. Evidence from this work can be packaged for sensitization to influence policy reforms and decision-making at various levels among relevant stakeholders in the region

A model of COVID-19 pandemic evolution in African countries

We studied the COVID-19 pandemic evolution in selected African countries. For each country considered, we modeled simultaneously the data of the active, recovered and death cases. In this study, we used a year of data since the first cases were reported. We estimated the time-dependent basic reproduction numbers, $R_0$, and the fractions of infected but unaffected populations, to offer insights into containment and vaccine strategies in African countries. We found that $R_0\leq 4$ at the start of the pandemic but has since fallen to $R_0 \sim 1$. The unaffected fractions of the populations studied vary between $1-10$\% of the recovered cases.Comment: 27 pages, 9 figures and 1 tabl

Malaria in HIV-Infected Children Receiving HIV Protease-Inhibitor- Compared with Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy, IMPAACT P1068s, Substudy to P1060

HIV and malaria geographically overlap. HIV protease inhibitors kill malaria parasites in vitro and in vivo, but further evaluation in clinical studies is needed

Arsenic in Peruvian rice cultivated in the major rice growing region of Tumbes river basin

Arsenic (As) exposure from surface and groundwater in Peru is being recognised as a 16 potential threat but there are limited studies on As in the food-chain and none on As in 17 Peruvian rice. In this study, we have determined the As content in rice cultivated in the 18 Tumbes river basin located in the northern province of Peru, an area known for extensive rice 19 cultivation. We collected rice and soil samples from agricultural fields, soil was collected 20 using grid sampling technique while rice was collected from the heaps of harvested crop 21 placed across the fields. The average total As concentration in rice was 167.94 ± 71 μg kg-1 22 (n=29; range 68.39-345.31 μg kg-1). While the rice As levels were not highly elevated, the As 23 content of few samples (n=7) greater than 200 μg kg-1 could contribute negatively to human health upon chronic exposure. Average concentration of As in soil was 8.63 ± 7.8 mg kg-1 25 (n=30) and soil to grain transfer factor was 0.025 ± 0.018 for 12 matched samples. Compared 26 to our previous pilot study in 2006 (samples collected from the same agricultural fields but 27 not from exact locations) there was a 41% decrease in As soil concentration in this study. 28 Rice samples collected in 2006 (n=5) had a mean concentration of 420 ± 109 μg kg-1. Our 29 data provides a baseline of rice grain As concentrations in Peruvian province of Tumbes and 30 warrants further studies on factors affecting uptake of As by the rice varieties cultivated in 31 Peru and any potential human health risks

Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis.

BACKGROUND: Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission. METHODS/FINDINGS: We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive. CONCLUSIONS: Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

PURPOSE: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS: Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

Factors that influence the use of insecticide treated bed nets in a rural community in Mangochi District, Malawi

Includes bibliographical references (leaves 44-45).The aim of the current study was to investigate factors that influence the use of insecticide treated bed nets in a rural community in Mangochi district in Malawi