End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

<p>Abstract</p> <p>Background</p> <p>End of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL care is ethical and culturally appropriate. This article aims to synthesize qualitative research on EoL care in sub-Saharan Africa to inform policy, practice and further research. It seeks to identify areas of existing research; describe findings specifically relevant to the African context; and, identify areas lacking evidence.</p> <p>Methods</p> <p>Relevant literature was identified through eight electronic databases: AMED, British Nursing Index & Archive, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, and the Social Sciences Citation Index; and hand searches. Inclusion criteria were: published qualitative or mixed-method studies in sub-Saharan Africa, about EoL care. Study quality was assessed using a standard grading scale. Relevant data including findings and practice recommendations were extracted and compared in tabular format.</p> <p>Results</p> <p>Of the 407 articles initially identified, 51 were included in the qualitative synthesis. Nineteen came from South Africa and the majority (38) focused on HIV/AIDS. Nine dealt with multiple or unspecified conditions and four were about cancer. Study respondents included health professionals, informal carers, patients, community members and bereaved relatives. Informal carers were typically women, the elderly and children, providing total care in the home, and lacking support from professionals or the extended family. Twenty studies focused on home-based care, describing how programmes function in practice and what is needed to make them effective. Patients and carers were reported to prefer institutional care but this needs to be understood in context. Studies focusing on culture discussed good and bad death, culture-specific approaches to symptoms and illness, and the bereavement process.</p> <p>Conclusions</p> <p>The data support or complement the findings from quantitative research. The review prompts a reconsideration of the assumption that in Africa the extended family care for the sick, and that people prefer home-based care. The review identifies areas relevant for a research agenda on socio-cultural issues at the EoL in sub-Saharan Africa.</p

Conservation Agriculture, Gendered Impacts on Households Livelihood Outcomes in Zambia

In light of climate change, new technologies resilient to climatic variability have been promoted along the years among smallholder farmers. Conservation Agriculture (CA) is one such technology, which has been promoted since the 1990 s in Sub-Saharan Africa. However, as with any new technology, various factors affect adoption and ultimately the impact of the technology of which gender is one such factor. Both female and male smallholder farmers are faced with numerous constraints to access productive resources, more so for female farmers, resulting in limited adoption capability, which in turn reduces the impact that these technologies have on their livelihood. Using nationally representative data the study examines the gendered impacts of CA on livelihood outcomes - household income, crop income, crop diversification, and dietary diversity. Results show that CA adoption improves a household s level of dietary diversity and crop diversification. However, the impact of CA on these livelihood outcomes reduces if the household is female headed or the farmer (male or female) is in a female headed household. Therefore, promotion of CA should take into account the gender differences at household level and within the household, as well as female farmer s access to productive resources. Keywords: Conservation Agriculture, Gender, Impact, Zambia Acknowledgement : The Indaba Agricultural Policy Research Institute (IAPRI) is a non-profit company limited by guarantee that collaboratively works with public and private stakeholders. IAPRI exists to carry out agricultural policy research and outreach, serving the agricultural sector in Zambia so as to contribute to sustainable, pro-poor agricultural development. We wish to acknowledge the Financial and Substantive support of the Swedish International Development Agency (SIDA), the United States Agency for International Development (USAID) and the European Union 11th EDF programming in Lusaka

DETERMINANTS OF PROFITABILITY AND WILLINGNESS TO PAY FOR METROPOLITAN WASTE-USE IN URBAN AGRICULTURE OF THE FEDERAL CAPITAL TERRITORY, ABUJA, NIGERIA

ABSTRACT The study attempts to analyse the profitability of urban agriculture using metropolitan organic waste in Abuja, the Federal Capital Territory of Nigeria. The results show that the enterprise is profitable, and that output price is the most important determinant of maximum variable profit. Other price factors, specifically planting materials, labour, and metropolitan waste (organic manure) were not significant. Further analysis shows that level of education, age of farmers, per capita farm income, and household size are important determinants of choice of urban agriculture for food security and improvement of environmental quality. The chances of farmers willing to pay for urban agriculture will increase when their level of education and per capita income increase, while the chances of not willing to pay for such venture will increase when their ages and household size increase. The creation of more market outlets for urban produced foods is recommended, among others

Semantic Fields and Collocational Restriction: Insights from Igbo

This work has considered the field theory in semantics which has to do with semantic fields and collocation. It is an established fact that there exists an inter-related network of words or what we call semantic field. Words of a language belong to different groups, words of each groups are related in one way or the other and are said to belong to the same semantic field. Based on their relationship there is always a collocational restriction in their usage. These networks and collocation are built on sense relations in a language (Syal and Jindal 155). Based on this fact, some sense relations were considered in this work in other to bring the term ‘semantic field’ home. Some collocates obtainable in Igbo were identified. Furthermore, the three kinds of collocational restrictions identified by (Palmer 79) were analyzed and illustrated using Igbo examples. However, it was also noted that just as some other languages, collocational restrictions are not applicable to all lexical items in Igbo. In other words, some words have no specific collocational restrictions

Dis-incentivizing sustainable intensification? The case of Zambia s fertilizer subsidy program

Poor and declining soil fertility remains a major constraint on increased cereal production in sub-Saharan Africa. Input subsidy programs (ISPs) for inorganic fertilizer are a popular and expensive tool used by African governments to increase cereal yields; however, far fewer resources are devoted to promoting other soil fertility management (SFM) practices that can improve soil quality, increase cereal yield response to inorganic fertilizer, and support sustainable agricultural intensification. This article uses nationally-representative household panel survey data from Zambia to estimate the effects of the country s ISP on smallholder farm households adoption of several SFM practices: fallowing, intercropping, crop rotation, and the use of animal manure. The results suggest that Zambia s ISP induces reductions in fallowing and intercropping of maize with other crops. We also find some evidence that the program incentivizes an increase in continuous maize cultivation on the same plot in consecutive seasons but little evidence of effects on animal manure use. The changes in SFM practices induced by the ISP are likely to be detrimental to soil fertility, maize yield response to fertilizer, and returns to government expenditures on the ISP over the medium- to long-term. Overall, Zambia s ISP may have dis-incentivized sustainable intensification rather than promoted it. Acknowledgement : This research was funded by the United States Agency for International Development (USAID) through funding to the Feed the Future Innovation Lab for Food Security Policy and the USAID Mission to Zambia, and by the United States Department of Agriculture National Institute of Food and Agriculture and Michigan AgBioResearch (project number MICL02501)

Contamination of Laboratory Bench-tops, Incubators and the Effects of a Spray-Disinfectant - A Quarterly Ammonium Compound

We surveyed the prevalence of contaminants associated with bench-tops and incubators during a routine working day in our clinical microbiology laboratories in Benin City. A total of 93 swabs, 50 from bench-tops and 43 from inside incubators were randomly collected. One ml of sterile phosphate buffered saline was added into the swab and incubated aerobically at 37oC for 48 hours. Isolated organisms were characterized biochemically. Spray disinfectant, was applied on the bench top and cultured accordingly. Swabs were collected from the incubators every day for 10 consecutive days. Results indicate, that both bench-tops and incubators are contaminated with organisms of clinical importance. Thirty-six (72%) of the swabs yielded growth, with Bacillus subtilis (24%) being the predominant organism, followed by coagulase negative Staphylococcus (CNS) (12%), Staphylococcus aureus (10%), Proteus spp. and Escherichia coli (8%) each, Pseudomonas aeruginosa (4%), moulds (2%) and Candida albicans (2%). Eighteen (41%) swabs from incubators yielded growth, with B. subtilis (13.8%) dominating, followed by Proteus spp. (9.3%), Staphylococcus aureus (6.9%), CNS (4.5%) and moulds (2.2%). Three hours after the spray disinfection, only 5 (10%) of the bench-top swabs yielded growth of B. subtilis, while the swabs from incubators, even after 10 days yielded no growth. This study recommends that spray disinfectant, mostly quaternary ammonium compounds, free of aldehydes can minimize contamination of bench-tops and microbiology incubators during routine working hours. Keywords: Laboratory, contaminants, incubators, bench-tops, spray-disinfectants. Journal of Medical Laboratory Science Vol. 13 (2) 2004: pp. 33-3