The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries

Community health workers (CHWs) have been proposed as a means for bridging gaps in healthcare delivery in rural communities. Recent CHW programmes have been shown to improve child and neonatal health outcomes, and it is increasingly being suggested that paid CHWs become an integral part of health systems. Remuneration of CHWs can potentially effect their motivation and focus. Broadly, programmes follow a social, monetary or mixed market approach to remuneration. Conscious understanding of the differences, and of what each has to offer, is important in selecting the most appropriate approach according to the context

Editorial: health financing and spending in low- and middle-income countries

The World Bank has introduced the Atlas method to determine in an econometrically valid way borderline thresholds for classifications of all national economies into low, middle, and high-income categories in an objective and predictable manner. Although this approach may be challenged to some extent, it has long served well in observation and predictions of long-term trends in GDP growth and national health expenditures (1–3). The contribution of low- and middle-income countries (LMICs) share in total health expenditures as observed through the (4) Global Health Expenditure criteria has almost doubled in terms of purchase power parity (PPP) basis from only 20% of the global share in 1995 up to almost 40% in 2013 (5, 6). These fiscal flows have been well-documented via WHO’s National Health Accounts database. This lengthy and rocky road forward for the LMICs contains many difficulties. A few core challenges include socioeconomic inequalities in medical care access and affordability, large out-of-pocket expenses, and vulnerabilities against catastrophic household expenditures. These challenges remain matters of grave concern in many LMICs (7). Broad trends give far greater grounds for optimism, however, since networks of rural and suburban health care facilities are growing and strengthening. Preventive lifestyle interventions, provision of essential medicines, and spreading of cost-effective basic medical technologies, designated in WHO policy as “best buys” interventions, all contributed to exceptionally improved early childhood survival and extended life expectancy. Current circumstances in most LMICs are characterized by aging populations, rapid urbanization, and increased citizen expectations in terms of health insurance coverage. Prescription drugs consumption is still dominated by generic medicines, with brand name originals gradually taking root. Hospital sectors are state or publicly owned in most former and modern day centrally-planned socialist economies. By contrast, in some regions like the Middle East and North African (MENA) Arabic nations, Latin America, and free-market Far East Asian economies, hospital property structure is predominantly privately owned (1).The authors would like to hereby express gratitude to Grant No.175014 of the Ministry of Education, Science and Technological Development of the Republic of Serbia, out of which some underlying studies were partially financed. Publication of results was not contingent on Ministry’s censorship or approval.info:eu-repo/semantics/publishedVersio

The Cost of Acute Respiratory Infections With Cough Among Urban Aboriginal and Torres Strait Islander Children

Introduction: Acute respiratory infections with cough (ARIwC) contribute considerably to childhood morbidity, yet few studies have examined the cost of these illnesses among Australian children. Moreover, of the few studies that have, none are inclusive of Aboriginal and/or Torres Strait Islander children, despite this population experiencing a greater burden of respiratory illnesses. This study aimed to determine the costs of ARIwC among urban Aboriginal and/or Torres Strait Islander children from the perspective of caretakers, the public healthcare system, and employers.Methods: This cost of illness study used data collected from Aboriginal and/or Torres Strait Islander children aged <5 years enrolled in a 12 month prospective cohort study conducted through an urban primary healthcare clinic in Queensland, Australia. Illness-related resource use was collected for each episode of ARIwC reported, and costed at market rates. Linear regression was used to (a) examine cost per episode by season of illness onset and cough duration and (b) examine cost per month of observation by baseline child and family characteristics.Results: During the study period, a total of 264 episodes of ARIwC were reported among 138 children. The total mean cost was estimated to be $AU252 per non-hospitalized episode (95$991 (95%CI 514–1468). Winter episodes and episodes resulting in chronic cough were associated with significantly higher costs per episode. A prior history of wheezing, connections to traditional lands and parent/guardian belief that antibiotics should be given until symptoms resolved were associated with significantly higher cost per child month of observation.Conclusion: The cost of ARIwC in this predominantly disadvantaged population is substantial, particularly for caretakers and this needs to be considered in both clinical management and public health initiatives. The importance of cultural factors on health and burden of illness should not be overlooked. Further research into the prevention of chronic cough may play an important role in reducing the economic burden of pediatric respiratory infections

Scaling up antiretroviral therapy: experience of the Joint Clinical Research Centre (JCRC) access programme

Despite Uganda’s success in lowering the rate of HIV infection, numbers of people already infected and progressing to AIDS continue to rise. The JCRC pioneered the use of antiretroviral drugs in Africa since 1992, and developed a successful model that incorporates drugs logistics, adherence and sustainability strategies, as well as regional referral centres of excellence and laboratories. JCRC rapidly established 35 satellite centres in the various districts, currently providing antiretroviral drugs to over 35 000 out of 70 000 patients on therapy. Increased access to treatment proceeds   contemporaneously with improving infrastructure, while addressing critical human resource needs by ongoing training. This model provides data that inform a way forward for a robust, high-quality and sustainable ART programme, and aims to integrate into an improved national continuum of health care delivery

Evaluation of early-generation tropical maize testcrosses for grain-yield potential and weevil (Sitophilus zeamais Motschulsky) resistance

Smallholder maize farmers in Africa experience pre- and post-harvest production stresses either individually or in combination at different stages of the crop cycle. The maize weevil is among the major post-harvest storage pests. A strategy to address this problem is to develop and promote high yielding maize germplasm with resistance to multiple stresses. A study was conducted to: 1) assess yield and agronomic performance of testcross hybrids developed from early generation lines; and 2) assess the response of the testcross hybrids to infestation with Sitophilus zeamais. Fifty-eight drought-tolerant testcross hybrids were evaluated for agronomic performance and weevil resistance at four environments in Uganda in 2016. Hybrid G39 (L2/T2) had the best grain yield performance; it significantly out-performed the best check by 11.4% in all environments. Hybrid grain from field trials was subjected to Sitophilus zeamais infestation in a choice and no choice test under laboratory conditions. Hybrids G56 (L49/T2) and G58 (L51/T2) had the least weevil damage and were rated as resistant to Sitophilus zeamais. The numbers of damaged kernels, number of exit holes and ear aspect were positively correlated with the grain weight loss. The results suggest possibilities for simultaneous selection for high grain yield and storage insect pest resistance among drought-tolerant genotypes. Use of high-yielding and resistant maize hybrids to storage insect pest should be promoted for increased maize production and managing post-harvest losses due to the maize weevil in smallholder farming communities in Africa

Managing a Transboundary Pest: The Fall Armyworm on Maize in Africa

The fall armyworm (Spodoptera frugiperda J.E Smith) (Lepidoptera: Noctuidae) invaded Africa in 2016, and has since spread to all countries in sub-Saharan Africa, causing devastating effects on mainly maize and sorghum. The rapid spread of this pest is aided by its high reproductive rate, high migration ability, wide host range and adaptability to different environments, among others. Since its introduction, many governments purchased and distributed pesticides for emergency control, with minimal regard to their efficacy. In this chapter, we review efforts towards managing this pest, highlight key challenges, and provide our thoughts on considerations for sustainable management of the pest

Population genetic structure of the bean leaf beetle Ootheca mutabilis (Coleoptera: Chrysomelidae) in Uganda

Bean leaf beetle (BLB) (Ootheca mutabilis) has emerged as an important bean pest in Uganda, leading to devastating crop losses. There is limited information on the population genetic structure of BLB despite its importance. In this study, novel microsatellite DNA markers and the partial mitochondrial cytochrome oxidase subunit I (mtCOI) gene sequences were used to analyze the spatial population genetic structure, genetic differentiation and haplotype diversity of 86 O. mutabilis samples from 16 (districts) populations. We identified 19,356 simple sequence repeats (SSRs) (mono, di-, tri-, tetra-, penta-, and hexa-nucleotides) of which 81 di, tri and tetra-nucleotides were selected for primer synthesis. Five highly polymorphic SSR markers (4–21 alleles, heterozygosity 0.59–0.84, polymorphic information content (PIC) 50.13–83.14%) were used for this study. Analyses of the 16 O. mutabilis populations with these five novel SSRs found nearly all the genetic variation occurring within populations and there was no evidence of genetic differentiation detected for both types of markers. Also, there was no evidence of isolation by distance between geographical and genetic distances for SSR data and mtCOI data except in one agro-ecological zone for mtCOI data. Bayesian clustering identified a signature of admixture that suggests genetic contributions from two hypothetical ancestral genetic lineages for both types of markers, and the minimum-spanning haplotype network showed low differentiation in minor haplotypes from the most common haplotype with the most common haplotype occurring in all the 16 districts. A lack of genetic differentiation indicates unrestricted migrations between populations. This information will contribute to the design of BLB control strategie

Genetic basis of maize resistance to multiple insect pests: integrated genome-wide comparative mapping and candidate gene prioritization

Several species of herbivores feed on maize in field and storage setups, making the development of multiple insect resistance a critical breeding target. In this study, an association mapping panel of 341 tropical maize lines was evaluated in three field environments for resistance to fall armyworm (FAW), whilst bulked grains were subjected to a maize weevil (MW) bioassay and genotyped with Diversity Array Technology’s single nucleotide polymorphisms (SNPs) markers. A multi-locus genome-wide association study (GWAS) revealed 62 quantitative trait nucleotides (QTNs) associated with FAW and MW resistance traits on all 10 maize chromosomes, of which, 47 and 31 were discovered at stringent Bonferroni genome-wide significance levels of 0.05 and 0.01, respectively, and located within or close to multiple insect resistance genomic regions (MIRGRs) concerning FAW, SB, and MW. Sixteen QTNs influenced multiple traits, of which, six were associated with resistance to both FAWandMW, suggesting a pleiotropic genetic control. Functional prioritization of candidate genes (CGs) located within 10–30 kb of the QTNs revealed 64 putative GWAS-based CGs (GbCGs) showing evidence of involvement in plant defense mechanisms. Only one GbCG was associated with each of the five of the six combined resistance QTNs, thus reinforcing the pleiotropy hypothesis. In addition, through in silico co-functional network inferences, an additional 107 network-based CGs (NbCGs), biologically connected to the 64 GbCGs, and di erentially expressed under biotic or abiotic stress, were revealed within MIRGRs. The provided multiple insect resistance physical map should contribute to the development of combined insect resistance in maize

Factors influencing genomic prediction accuracies of tropical maize resistance to fall armyworm and weevils

Genomic selection (GS) can accelerate variety improvement when training set (TS) size and its relationship with the breeding set (BS) are optimized for prediction accuracies (PAs) of genomic prediction (GP) models. Sixteen GP algorithms were run on phenotypic best linear unbiased predictors (BLUPs) and estimators (BLUEs) of resistance to both fall armyworm (FAW) and maize weevil (MW) in a tropical maize panel. For MW resistance, 37% of the panel was the TS, and the BS was the remainder, whilst for FAW, random-based training sets (RBTS) and pedigree-based training sets (PBTSs) were designed. PAs achieved with BLUPs varied from 0.66 to 0.82 for MW-resistance traits, and for FAW resistance, 0.694 to 0.714 for RBTS of 37%, and 0.843 to 0.844 for RBTS of 85%, and these were at least two-fold those from BLUEs. For PBTS, FAW resistance PAs were generally higher than those for RBTS, except for one dataset. GP models generally showed similar PAs across individual traits whilst the TS designation was determinant, since a positive correlation (R = 0.92***) between TS size and PAs was observed for RBTS, and for the PBTS, it was negative (R = 0.44**). This study pioneered the use of GS for maize resistance to insect pests in sub-Saharan Africa

Performance of Bt maize event MON810 in controlling maize stem borers Chilo partellus and Busseola fusca in Uganda

Stem borers are major insect pests of maize in Uganda. A study was conducted in 2014–2016 to assess the performance of Bt hybrids expressing Cry1Ab (event MON810) against the two major stem borer species in Uganda – the African stem borer (Busseola fusca) and the spotted stem borer (Chilo partellus) – under artificial infestation. The study comprised 14 non-commercialized hybrids, including seven pairs of Bt and non-Bt hybrids (isolines), three non-Bt commercial hybrids and a conventional stem borer resistant check. All stem borer damage parameters (leaf damage, number of internodes tunneled and tunnel length) were generally significantly lower in Bt hybrids than in their isolines, the conventionally resistant hybrid, and local commercial hybrids. Mean yields were significantly higher by 29.4–80.5% in the Bt hybrids than in the other three categories of non-Bt hybrids. This study demonstrated that Bt maize expressing Cry1Ab protects against leaf damage and can limit entry of stem borers into the stems of maize plants, resulting in higher yield than in the non-transgenic hybrids. Thus, Bt maize has potential to contribute to the overall management package of stem borers in Uganda