Using art and story to explore how primary school students in rural Tanzania understand planetary health: a qualitative analysis

Background The global planetary health community increasingly recognises the need to prepare students to investigate and address connections between environmental change and human health. As we strive to support education on planetary health themes for students of all ages, understanding students’ concepts of linkages between the health of people and animals, and their shared environments might advance educational approaches. Children living in villages bordering Ruaha National Park in Iringa Region, Tanzania, have direct experience of these connections as they share a water-stressed but biodiverse environment with domestic animals and wildlife. Livelihoods in these villages depend predominantly on crop and livestock production, including extensive pastoralist livestock keeping. Through qualitative research, we aim to explore and describe Tanzanian primary school students’ understanding of connections between human health and the environment

Using art and story to explore how primary school students in rural Tanzania understand planetary health: a qualitative analysis

Background The global planetary health community increasingly recognises the need to prepare students to investigate and address connections between environmental change and human health. As we strive to support education on planetary health themes for students of all ages, understanding students’ concepts of linkages between the health of people and animals, and their shared environments might advance educational approaches. Children living in villages bordering Ruaha National Park in Iringa Region, Tanzania, have direct experience of these connections as they share a water-stressed but biodiverse environment with domestic animals and wildlife. Livelihoods in these villages depend predominantly on crop and livestock production, including extensive pastoralist livestock keeping. Through qualitative research, we aim to explore and describe Tanzanian primary school students’ understanding of connections between human health and the environment

Using art and story to explore how primary school students in rural Tanzania understand planetary health: a qualitative analysis

Background The global planetary health community increasingly recognises the need to prepare students to investigate and address connections between environmental change and human health. As we strive to support education on planetary health themes for students of all ages, understanding students’ concepts of linkages between the health of people and animals, and their shared environments might advance educational approaches. Children living in villages bordering Ruaha National Park in Iringa Region, Tanzania, have direct experience of these connections as they share a water-stressed but biodiverse environment with domestic animals and wildlife. Livelihoods in these villages depend predominantly on crop and livestock production, including extensive pastoralist livestock keeping. Through qualitative research, we aim to explore and describe Tanzanian primary school students’ understanding of connections between human health and the environment

Using art and story to explore how primary school students in rural Tanzania understand planetary health: a qualitative analysis

Background: The global planetary health community increasingly recognises the need to prepare students to investigate and address connections between environmental change and human health. As we strive to support education on planetary health themes for students of all ages, understanding students' concepts of linkages between the health of people and animals, and their shared environments might advance educational approaches. Children living in villages bordering Ruaha National Park in Iringa Region, Tanzania, have direct experience of these connections as they share a water-stressed but biodiverse environment with domestic animals and wildlife. Livelihoods in these villages depend predominantly on crop and livestock production, including extensive pastoralist livestock keeping. Through qualitative research, we aim to explore and describe Tanzanian primary school students' understanding of connections between human health and the environment. Methods: Working with 26 village primary schools in Iringa Rural District, Tanzania, we adapted an art and story outreach activity to explore student perceptions of planetary health concepts. Following a standardised training session, a lead teacher at each primary school helped students aged 12–15 years form small teams to independently develop and illustrate a story centred on themes of how human health depends on water sources, wildlife, livestock, climate, and forest or grassland resources. Students were encouraged to discuss these themes with their teachers, peers, and families while developing their stories to gain broader as well as historical perspectives. The students generated stories that incorporated solutions to challenges within these themes. Written materials and illustrations were collected from each school along with data on sex and tribe of the group members. We translated all stories from Swahili to English for analysis. The primary outcomes of interest in analysing the students' writing and illustrations were the relationships students identified between human health and wildlife, livestock, water sources, and forest resources. Findings: A total of 1043 students in 168 groups participated in the art and story activity between October and November 2017, with groups containing a mean of six students (SD 1·5, range four to 11). In our preliminary review that we present here, students identified diverse beneficial and adverse connections between human health and environmental change through direct and indirect pathways, which included both ecological or biological and socioeconomic linkages. Preliminary themes noted in student work were clean air and water provision by forests, altered food, fuel, and medicinal resources, contact with animals and their waste, livelihood impacts, and cultural values. We are in the process of coding and analysing the student submissions to explore and describe their understanding of planetary health and to identify potential differences among student groups related to village, gender, and tribe. Interpretation: Through their art and writing, rural primary school students showed evidence of systems thinking in describing connections among human health and their surrounding environments. Focusing on links to wildlife, livestock, water sources, or forest resources, the students described both direct (eg, meat from wildlife or livestock to support human nutrition) and indirect (eg, funding for local human health clinics from wildlife tourism revenue) relationships between the environment and human health. Many student groups also interpreted relationships among people and components of their surrounding environment as beneficial or adverse, proposing specific solutions to enhance or mitigate these effects. Because responses varied widely among the included primary schools, future research on these gaps has the potential to improve planetary health educational approaches and student understanding. Funding: This study was supported with funding from the Agricultural Research Division of the University of Nebraska, Lincoln

Effect of age, cerebral infarcts, vasculopathy and haemoglobin on cognitive function, in Tanzanian children with sickle cell anaemia

BACKGROUND: Developmental difficulties in many cognitive domains are common in children with sickle cell anaemia (SCA). Children with stroke are most affected but delayed or atypical cognitive function has been reported in children with SCA and silent infarcts (SCI), vasculopathy, and normal brain MRI. However, very few studies of cognition have been conducted in Africa, a continent with 75% of the SCA burden. We therefore investigated cognitive profiles in Tanzanian children with SCA and examined the impact of age, SCI, vasculopathy, and haemoglobin concentration (Hb). METHODS: Children aged 6-16 years with and without SCA were eligible for this cross-sectional study. Cognitive assessment was performed using Raven's Matrices, assessing fluid, non-verbal intelligence and subtests from the Wechsler Intelligence Scales for Children (WISC-IV), assessing processing speed (PS), perceptual reasoning (PR), and working memory (WM) as these tests are less culture-bound. Magnetic resonance imaging (MRI) and angiography (MRA) were also completed to assess the presence of SCI and vasculopathy. Hb was collected in both SCA children and their non-SCA siblings. RESULTS: Seventy-three children with SCA and 71 healthy siblings (Meanages 11.9, SD = 2.8 and 11.1, SD = 2.9 years respectively) were recruited. Compared with healthy siblings, children with SCA had lower PS (Meandiff 7.35 points; p = .002). Older children had higher performance scores on all tests in relation to their ages. Lowest cognitive scores were observed on the PS subtest, where patients with SCI (SCI+) had lowest mean values as compared to children with no SCI (SCI-) and healthy siblings (i.e., SCI+ < SCI- < healthy siblings, p = .028). On post-hoc analysis the difference was between SCI+ and healthy siblings SCI+ < non-SCA siblings (p = .015); there was no difference between SCI+ and SCI- patient groups. PS was significantly lower in SCA patients with no vasculopathy as compared to healthy siblings. The mean difference from healthy siblings was -8.352 and -0.752 points for VASC- and VASC + respectively (p = .004). There was a significant positive effect of Hb on PSI (p = .001) in both patients and controls and a trend level significant positive effect of Hb on PR (p = .050) and WM (p = .051). CONCLUSION: In this Tanzanian study, cognitive performance was reduced in children with SCA with or without SCI on MRI or vasculopathy. Cognitive performance improved with increasing age. Lower Hb was associated with lower cognitive performance in both patients with SCA and their non-SCA siblings. SCI and vasculopathy do not appear to have an impact on cognitive function

Effect of age, cerebral infarcts, vasculopathy and haemoglobin on cognitive function, in Tanzanian children with sickle cell anaemia

Background: Developmental difficulties in many cognitive domains are common in children with sickle cell anaemia (SCA). Children with stroke are most affected but delayed or atypical cognitive function has been reported in children with SCA and silent infarcts (SCI), vasculopathy, and normal brain MRI. However, very few studies of cognition have been conducted in Africa, a continent with 75% of the SCA burden. We therefore investigated cognitive profiles in Tanzanian children with SCA and examined the impact of age, SCI, vasculopathy, and haemoglobin concentration (Hb). Methods: Children aged 6–16 years with and without SCA were eligible for this cross-sectional study. Cognitive assessment was performed using Raven's Matrices, assessing fluid, non-verbal intelligence and subtests from the Wechsler Intelligence Scales for Children (WISC-IV), assessing processing speed (PS), perceptual reasoning (PR), and working memory (WM) as these tests are less culture-bound. Magnetic resonance imaging (MRI) and angiography (MRA) were also completed to assess the presence of SCI and vasculopathy. Hb was collected in both SCA children and their non-SCA siblings. Results: Seventy-three children with SCA and 71 healthy siblings (Mean ages 11.9, SD = 2.8 and 11.1, SD = 2.9 years respectively) were recruited. Compared with healthy siblings, children with SCA had lower PS (Mean diff 7.35 points; p = .002). Older children had higher performance scores on all tests in relation to their ages. Lowest cognitive scores were observed on the PS subtest, where patients with SCI (SCI+) had lowest mean values as compared to children with no SCI (SCI-) and healthy siblings (i.e., SCI+ &lt; SCI- &lt; healthy siblings, p = .028). On post-hoc analysis the difference was between SCI+ and healthy siblings SCI+ &lt; non-SCA siblings (p = .015); there was no difference between SCI+ and SCI- patient groups. PS was significantly lower in SCA patients with no vasculopathy as compared to healthy siblings. The mean difference from healthy siblings was -8.352 and -0.752 points for VASC- and VASC + respectively (p = .004). There was a significant positive effect of Hb on PSI (p = .001) in both patients and controls and a trend level significant positive effect of Hb on PR (p = .050) and WM (p = .051). Conclusion: In this Tanzanian study, cognitive performance was reduced in children with SCA with or without SCI on MRI or vasculopathy. Cognitive performance improved with increasing age. Lower Hb was associated with lower cognitive performance in both patients with SCA and their non-SCA siblings. SCI and vasculopathy do not appear to have an impact on cognitive function. </p