Consumer Demand for Value-added Products of African Indigenous Vegetables in Coastal Kenya: The Case of Sun-dried and Frozen Cowpea Leaves

Some recent efforts to improve the food and nutrition security of rural households have focused on the promotion of African indigenous vegetables (AIVs). This has been due to the challenges smallholder farmers face in participating in high-value global food systems. AIVs contain vitamins and micronutrients not found in most exotic vegetables, and therefore their consumption could contribute to resolving malnutrition among poor rural households. Higher consumption could also lead to improved rural incomes through sales into urban niche markets, resulting in enhanced community development. Despite the role AIVs can play in promoting food security and community development, the AIV supply is highly seasonal, characterized by large gluts and acute shortages. Much study of AIVs has focused on production rather than consumption. In this study we use descriptive analysis to describe AIV consumers and assess demand for basic value-addition practices by AIV retailers. We then use regression analysis to examine the factors conditioning consumers' willingness to pay (WTP) for more advanced value-addition processes that can smooth out the supply of AIVs. It focuses on cowpea (Vigna unguiculata), one of the most widely consumed AIVs in western, eastern, and coastal Kenya. We find that several socio-economic factors and varietal attributes condition the WTP for value addition. Specifically, WTP is affected by age, gender, education, awareness of the selected value-addition techniques, and the self-reported likelihood of purchasing value-added vegetables. Additionally, color, tenderness of leaves, and the washing off of soil affect WTP for value addition. The paper discusses the implications of these findings for traditional fresh produce food systems, community development, and policy

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated