A Systematic Literature Review of the Contribution of Past Climate Information Services Pilot Projects in Climate Risk Management

Many pilot-based initiatives have been developed to promote awareness and use of climate information services among vulnerable smallholder farmers in Africa through million-dollar investments. However, despite their experimental nature, these pilot projects have been successful in raising participating farmers’ awareness and use of climate information services and they can inform transferrable good practices. Through a systematic literature review approach, this review sought to understand ways in which these past pilot projects have contributed to climate risk management in the context of smallholder farming and the factors that led to their success. Results showed that climate information services main contribution to climate risk management has been through facilitating farm level decision making. Factors that led to success of the pilots include: use of downscaled information; building institutional partnerships to add value to climate information; involving farmers through the co-designing and co-developing process; face-to-face way of communication; embedding pre-seasonal workshops in the activities of local institutions for sustainability; using diversity of communication channels to enhance reach among others. These factors can be borrowed as good practices to inform future efforts focused on increasing adoption of climate information services among a wider population beyond pilot project reach

Enhancing Maize Grain Yield in Acid Soils of Western Kenya Using Aluminium Tolerant Germplasm

Abstract: Maize (Zea mays L.) is one of the world’s most important cereals and is a staple food for many people in developing countries. However, in acid soils (pH < 5.5), its productivity is limited by aluminium (Al) toxicity, besides other factors. The objectives of this study were to: develop Al tolerant maize inbred lines for a maize breeding program in Kenya, develop single cross hybrids (SCHs) from some of the tolerant inbred lines and determine Al tolerance levels of the SCHs. One hundred and seventy five inbreds and 49 SCHs were developed and screened in nutrient culture containing 0 or 222 μM using Relative Net Root Growth (RNRG), hematoxylin staining (HS) and under Al saturated field conditions (44%-45.6%) at Sega and Chepkoilel. Seedling root growth was inhibited in 95% of the inbreds. F1 hybrids obtained from inbreds varying in Al tolerance, exhibited tolerance equal to or greater than that of the more tolerant parent indicating a positive transgressive inheritance to Al toxicity. Fifty eight percent of the F1 SCHs were heterotic for tolerance to Al toxicity. Al tolerance estimated by RNRG was well correlated to that of HS (r2 = 0.88, P < 0.005) but minimally correlated with the field estimates (r2 = 0.24-0.35), implying that RNRG can predict field selection under Al toxic soils by between 24% and 35%. Plant breeders should therefore employ both approaches in selecting cultivars under Al stress. This study has developed and identified Al tolerant inbreds and SCHs for use in the acid soils of Kenya and similar regions

Development of maize single cross hybrids for tolerance to low phosphorus

Low available phosphorus (P) is one of the major hindrances to maize (Zea mays L.) productivity in acid soils. The objectives of this study were to: (1) develop P-efficient maize inbred lines, (2) develop single cross hybrids from the P-efficient inbred lines, and (3) determine their response to P application in the P-deficient acid soils of western Kenya. Ninety-eight inbred lines and 49 single crosses were developed and screened at P-deficient (2.0 to 2.2 mg P/kg soil) soils of Sega and Bumala. Mean grain yield (GY) for the hybrids was 75.3% higher with P-fertilizer than without P for the same hybrids. Thirty-three percent (33%) of these hybrids were inefficient but responsive to P application, 27% were efficient and none responsive, only 13% were efficient and responsive, while the rest were inefficient and non-responsive. GY was positively correlated (r = 0.57**) with plant height (PH) and ear height (EH) (r = 0.60**) and PH was correlated with EH (r = 0.86***). This study has developed and identified P-efficient maize germplasm that can be utilized directly or in developing other hybrids for use in acid soils of western Kenya and in other acid soils where P is limiting

Phylogenetic relationship among Kenyan sorghum germplasms based on aluminium tolerance

Eighty nine (89) sorghum lines sourced from various parts of Kenya were used to determine phylogenetic relationships based on 10 DNA fragments at AltSB loci with SbMATE, ORF9 and MITE primers. Nine lines of varying aluminium tolerance levels were selected to compare their SbMATE gene expression via the real-time PCR quantification of SbMATE gene expression. The sorghum line MSCR O2 expressed a thousandfold more SbMATEgene activity than the sensitive lines (MSCRM49, MSCRN84 and MSCRN61) under Al treatment. Analysis was done by agarose gel electrophoresis stained with ethidium bromide. The objective of this study was to assess the level of phylogenetic relationships among the Kenyan sorghum germplasms at a known Al tolerance locus. Hierarchical cluster analysis joined at 70% simple matching coefficient using average linkage similarity level produced nine groups in which 67 lines fell in three major clusters of 39, 15 and 13 lines each. The three Al tolerant lines MSCRO2, MSCRC1 and MSCRN60 were clustered together. Lines MSCRO2, MSCRC1 and MSCRN60, screened to be Al tolerant were genetically related at 70% average linkage similarity level and therefore recommend their further development as a food security measure in Kenya.Keywords: Aluminium (Al) toxicity, Sorghum bicolor, Sorghum bicolor multi-drug, toxic extrusion compound (SbMATE) gene expressionAfrican Journal of Biotechnology Vol. 12(22), pp. 3528-353

Organizational Customers’ Retention Strategies on Customer Satisfaction: Case of Equity Bank Thika Branch, Kenya

The study set to examine evaluate customers’ retention strategies on customer satisfaction in the banking sector in Kenya case of Equity bank Thika branch, Kenya. Despite their central role in the economy, banks are faced with intense competition as a result of many similar products offered in the market, fast changing technological advancements and demanding customers. These challenges have rendered most traditional forms of competitive advantage like cost management, technology, product features and robust marketing strategies ineffective. Due to this, most banks have resorted to customers’ retention. Specifically the study investigated how customers’ demographic factors (age, gender, income and level of formal education), service quality and corporate image affect customers’ retention in the banking industry in Kenya. Data for this study was collected from 100 customers of Equity bank, Thika branch who were selected through multistage sampling technique using a questionnaire. The quantitative data was analyzed using SPSS. Data was analyzed using both the descriptive and analytical techniques. The study result found that the quality of services offered by the bank has a great effect on customers’ retention. However, customers’ demographic factors like age, gender, level of formal education and marital status had no influence on customers’ retention. Further, the study found that the bank stability, reliability and involvement in community work will influence customers’ retention. This study therefore recommended that banks should strive to ensure good quality service so that they ensure high customer retention. This can be achieved by improving their opening hours and closing hours, speed of service, and degree of responsiveness to enquires, time taken to get service and good communication with the bank staff. Further, banks should market themselves but in their marketing they should emphasize their uniqueness especially on their services and products offered. Key words: Customer retention, Quality Service and Corporate imag

High-quality health systems in the Sustainable Development Goals era: time for a revolution.

Executive summary: Although health outcomes have improved in low-income and middle-income countries (LMICs) in the past several decades, a new reality is at hand. Changing health needs, growing public expectations, and ambitious new health goals are raising the bar for health systems to produce better health outcomes and greater social value. But staying on current trajectory will not suffice to meet these demands. What is needed are high-quality health systems that optimise health care in each given context by consistently delivering care that improves or maintains health, by being valued and trusted by all people, and by responding to changing population needs. Quality should not be the purview of the elite or an aspiration for some distant future; it should be the DNA of all health systems. Furthermore, the human right to health is meaningless without good quality care because health systems cannot improve health without it. We propose that health systems be judged primarily on their impacts, including better health and its equitable distribution; on the confidence of people in their health system; and on their economic benefit, and processes of care, consisting of competent care and positive user experience. The foundations of high-quality health systems include the population and their health needs and expectations, governance of the health sector and partnerships across sectors, platforms for care delivery, workforce numbers and skills, and tools and resources, from medicines to data. In addition to strong foundations, health systems need to develop the capacity to measure and use data to learn. High-quality health systems should be informed by four values: they are for people, and they are equitable, resilient, and efficient. For this Commission, we examined the literature, analysed surveys, and did qualitative and quantitative research to evaluate the quality of care available to people in LMICs across a range of health needs included in the Sustainable Development Goals (SDGs). We explored the ethical dimensions of high-quality care in resource-constrained settings and reviewed available measures and improvement approaches. We reached five conclusions: The care that people receive is often inadequate, and poor-quality care is common across conditions and countries, with the most vulnerable populations faring the worst Data from a range of countries and conditions show systematic deficits in quality of care. In LMICs, mothers and children receive less than half of recommended clinical actions in a typical preventive or curative visit, less than half of suspected cases of tuberculosis are correctly managed, and fewer than one in ten people diagnosed with major depressive disorder receive minimally adequate treatment. Diagnoses are frequently incorrect for serious conditions, such as pneumonia, myocardial infarction, and newborn asphyxia. Care can be too slow for conditions that require timely action, reducing chances of survival. At the system level, we found major gaps in safety, prevention, integration, and continuity, reflected by poor patient retention and insufficient coordination across platforms of care. One in three people across LMICs cited negative experiences with their health system in the areas of attention, respect, communication, and length of visit (visits of 5 min are common); on the extreme end of these experiences were disrespectful treatment and abuse. Quality of care is worst for vulnerable groups, including the poor, the less educated, adolescents, those with stigmatised conditions, and those at the edges of health systems, such as people in prisons. Universal health coverage (UHC) can be a starting point for improving the quality of health systems. Improving quality should be a core component of UHC initiatives, alongside expanding coverage and financial protection. Governments should start by establishing a national quality guarantee for health services, specifying the level of competence and user experience that people can expect. To ensure that all people will benefit from improved services, expansion should prioritise the poor and their health needs from the start. Progress on UHC should be measured through effective (quality-corrected) coverage. High-quality health systems could save over 8 million lives each year in LMICs More than 8 million people per year in LMICs die from conditions that should be treatable by the health system. In 2015 alone, these deaths resulted in US$6 trillion in economic losses. Poor-quality care is now a bigger barrier to reducing mortality than insufficient access. 60% of deaths from conditions amenable to health care are due to poor-quality care, whereas the remaining deaths result from non-utilisation of the health system. High-quality health systems could prevent 2·5 million deaths from cardiovascular disease, 1 million newborn deaths, 900 000 deaths from tuberculosis, and half of all maternal deaths each year. Quality of care will become an even larger driver of population health as utilisation of health systems increases and as the burden of disease shifts to more complex conditions. The high mortality rates in LMICs for treatable causes, such as injuries and surgical conditions, maternal and newborn complications, cardiovascular disease, and vaccine preventable diseases, illustrate the breadth and depth of the health-care quality challenge. Poor-quality care can lead to other adverse outcomes, including unnecessary health-related suffering, persistent symptoms, loss of function, and a lack of trust and confidence in health systems. Waste of resources and catastrophic expenditures are economic side effects of poor-quality health systems. As a result of this, only one-quarter of people in LMICs believe that their health systems work well. Health systems should measure and report what matters most to people, such as competent care, user experience, health outcomes, and confidence in the system Measurement is key to accountability and improvement, but available measures do not capture many of the processes and outcomes that matter most to people. At the same time, data systems generate many metrics that produce inadequate insight at a substantial cost in funds and health workers' time. For example, although inputs such as medicines and equipment are commonly counted in surveys, these are weakly related to the quality of care that people receive. Indicators such as proportion of births with skilled attendants do not reflect quality of childbirth care and might lead to false complacency about progress in maternal and newborn health. This Commission calls for fewer, but better, measures of health system quality to be generated and used at national and subnational levels. Countries should report health system performance to the public annually by use of a dashboard of key metrics (eg, health outcomes, people's confidence in the system, system competence, and user experience) along with measures of financial protection and equity. Robust vital registries and trustworthy routine health information systems are prerequisites for good performance assessment. Countries need agile new surveys and real-time measures of health facilities and populations that reflect the health systems of today and not those of the past. To generate and interpret data, countries need to invest in national institutions and professionals with strong quantitative and analytical skills. Global development partners can support the generation and testing of public goods for health system measurement (civil and vital registries, routine data systems, and routine health system surveys) and promote national and regional institutions and the training and mentoring of scientists. New research is crucial for the transformation of low-quality health systems to high-quality ones Data on care quality in LMICs do not reflect the current disease burden. In many of these countries, we know little about quality of care for respiratory diseases, cancer, mental health, injuries, and surgery, as well as the care of adolescents and elderly people. There are vast blind spots in areas such as user experience, system competence, confidence in the system, and the wellbeing of people, including patient-reported outcomes. Measuring the quality of the health system as a whole and across the care continuum is essential, but not done. Filling in these gaps will require not only better routine health information systems for monitoring, but also new research, as proposed in the research agenda of this Commission. For example, research will be needed to rigorously evaluate the effects and costs of recommended improvement approaches on health, patient experience, and financial protection. Implementation science studies can help discern the contextual factors that promote or hinder reform. New data collection and research should be explicitly designed to build national and regional research capacity. Improving quality of care will require system-wide action To address the scale and range of quality deficits we documented in this Commission, reforming the foundations of the health system is required. Because health systems are complex adaptive systems that function at multiple interconnected levels, fixes at the micro-level (ie, health-care provider or clinic) alone are unlikely to alter the underlying performance of the whole system. However, we found that interventions aimed at changing provider behaviour dominate the improvement field, even though many of these interventions have a modest effect on provider performance and are difficult to scale and sustain over time. Achieving high-quality health systems requires expanding the space for improvement to structural reforms that act on the foundations of the system. This Commission endorses four universal actions to raise quality across the health system. First, health system leaders need to govern for quality by adopting a shared vision of quality care, a clear quality strategy, strong regulation, and continuous learning. Ministries of health cannot accomplish this alone and need to partner with the private sector, civil society, and sectors outside of health care, such as education, infrastructure, communication, and transport. Second, countries should redesign service delivery to maximise health outcomes rather than geographical access to services alone. Primary care could tackle a greater range of low-acuity conditions, whereas hospitals or specialised health centres should provide care for conditions, such as births, that need advanced clinical expertise or have the risk of unexpected complications. Third, countries should transform the health workforce by adopting competency-based clinical education, introducing training in ethics and respectful care, and better supporting and respecting all workers to deliver the best care possible. Fourth, governments and civil society should ignite demand for quality in the population to empower people to hold systems accountable and actively seek high-quality care. Additional targeted actions in areas such as health financing, management, district-level learning, and others can complement these efforts. What works in one setting might not work elsewhere, and improvement efforts should be adapted for local context and monitored. Funders should align their support with system-wide strategies rather than contribute to the proliferation of micro-level efforts. In this Commission, we assert that providing health services without guaranteeing a minimum level of quality is ineffective, wasteful, and unethical. Moving to a high-quality health system—one that improves health and generates confidence and economic benefits—is primarily a political, not technical, decision. National governments need to invest in high-quality health systems for their own people and make such systems accountable to people through legislation, education about rights, regulation, transparency, and greater public participation. Countries will know that they are on the way towards a high-quality, accountable health system when health workers and policymakers choose to receive health care in their own public institutions.Fil: Kruk, Margaret E.. Harvard University. Harvard School of Public Health; Estados UnidosFil: Gage, Anna D.. Harvard University. Harvard School of Public Health; Estados UnidosFil: Arsenault, Catherine. Harvard University. Harvard School of Public Health; Estados UnidosFil: Jordan, Keely. New York College of Global Public Health; Estados UnidosFil: Leslie, Hannah H.. Harvard University. Harvard School of Public Health; Estados UnidosFil: Roder DeWan, Sanam. Harvard University. Harvard School of Public Health; Estados UnidosFil: Adeyi, Olusoji. Banco Mundial; Estados UnidosFil: Barker, Pierre. Institute For Healthcare Improvement; Estados UnidosFil: Daelmans, Bernadette. Organizacion Mundial de la Salud; SuizaFil: Doubova, Svetlana V.. Instituto Mexicano del Seguro Social; MéxicoFil: English, Mike. KEMRI - Wellcome Trust; KeniaFil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Guanais, Frederico. Banco Interamericano de Desarrollo; Estados UnidosFil: Gureje, Oye. University Of Ibadan; NigeriaFil: Hirschhorn, Lisa R.. Northwestern University; Estados UnidosFil: Jiang, Lixin. National Center For Cardiovascular Diseases; ChinaFil: Kelley, Edward. Organizacion Mundial de la Salud; SuizaFil: Lemango, Ephrem Tekle. Federal Ministry of Health; EtiopíaFil: Liljestrand, Jerker. Bill and Melinda Gates Foundation; Estados UnidosFil: Malata, Address. Malawi University Of Science And Technology; MalauiFil: Marchant, Tanya. London School of Hygiene & Tropical Medicine; Reino UnidoFil: Matsoso, Malebona Precious. National Department of Health of the Republic of South Africa; SudáfricaFil: Meara, John G.. Harvard Medical School; Estados UnidosFil: Mohanan, Manoj. University of Duke; Estados UnidosFil: Ndiaye, Youssoupha. Ministry of Health and Social Action of the Republic of Senegal; SenegalFil: Norheim, Ole F.. University of Bergen; NoruegaFil: Reddy, K. Srinath. Public Health Foundation of India; IndiaFil: Rowe, Alexander K.. Centers for Disease Control and Prevention; Estados UnidosFil: Salomon, Joshua A.. Stanford University School Of Medicine; Estados UnidosFil: Thapa, Gagan. Legislature Parliament Of Nepal; NepalFil: Twum Danso, Nana A. Y.. Maza; GhanaFil: Pate, Muhammad. Big Win Philanthropy; Reino Unid

Incidence and predictors of hospital readmission in children presenting with severe anaemia in Uganda and Malawi: a secondary analysis of TRACT trial data

Background: Severe anaemia (haemoglobin < 6 g/dL) is a leading cause of recurrent hospitalisation in African children. We investigated predictors of readmission in children hospitalised with severe anaemia in the TRACT trial (ISRCTN84086586) in order to identify potential future interventions. Methods: Secondary analyses of the trial examined 3894 children from Uganda and Malawi surviving a hospital episode of severe anaemia. Predictors of all-cause readmission within 180 days of discharge were identified using multivariable regression with death as a competing risk. Groups of children with similar characteristics were identified using hierarchical clustering. Results: Of the 3894 survivors 682 (18%) were readmitted; 403 (10%) had ≥2 re-admissions over 180 days. Three main causes of readmission were identified: severe anaemia (n = 456), malaria (n = 252) and haemoglobinuria/dark urine syndrome (n = 165). Overall, factors increasing risk of readmission included HIV-infection (hazard ratio 2.48 (95% CI 1.63–3.78), p < 0.001); ≥2 hospital admissions in the preceding 12 months (1.44(1.19–1.74), p < 0.001); history of transfusion (1.48(1.13–1.93), p = 0.005); and missing ≥1 trial medication dose (proxy for care quality) (1.43 (1.21–1.69), p < 0.001). Children with uncomplicated severe anaemia (Hb 4-6 g/dL and no severity features), who never received a transfusion (per trial protocol) during the initial admission had a substantially lower risk of readmission (0.67(0.47–0.96), p = 0.04). Malaria (among children with no prior history of transfusion) (0.60(0.47–0.76), p < 0.001); younger-age (1.07 (1.03–1.10) per 1 year younger, p < 0.001) and known sickle cell disease (0.62(0.46–0.82), p = 0.001) also decreased risk of readmission. For anaemia re-admissions, gross splenomegaly and enlarged spleen increased risk by 1.73(1.23–2.44) and 1.46(1.18–1.82) respectively compared to no splenomegaly. Clustering identified four groups of children with readmission rates from 14 to 20%. The cluster with the highest readmission rate was characterised by very low haemoglobin (mean 3.6 g/dL). Sickle Cell Disease (SCD) predominated in two clusters associated with chronic repeated admissions or severe, acute presentations in largely undiagnosed SCD. The final cluster had high rates of malaria (78%), severity signs and very low platelet count, consistent with acute severe malaria. Conclusions: Younger age, HIV infection and history of previous hospital admissions predicted increased risk of readmission. However, no obvious clinical factors for intervention were identified. As missing medication doses was highly predictive, attention to care related factors may be important. Trial registration: ISRCTN ISRCTN84086586. Keywords: Severe anaemia, Readmissio

Enhancing adoption of climate services through an innovation systems approach

Recent years have marked the emergence of the innovation systems approach as a shift from the conventional linear models of technology transfer. Linear technology diffusion models hinder participatory approaches of local actors such as smallholder farmers and regards them as spectators in the development process, which impedes wide adoption of technology by the intended beneficiary. This article sought to understand the potential of the innovations systems approach as an incentive to enhance the adoption of climate services by smallholder farmers through regarding them and other relevant stakeholders as part of the process, fostering knowledge sharing and interactive learning. The methodology included stakeholder/actor identification, mapping of stakeholder linkages, capacity building and active involvement of stakeholders through the climate services process. The results showed that unlike the conventional linear knowledge delivery process, the innovation systems approach takes into consideration the complex processes that are highlighted by non-linear processes, feedback loops, and other complex interactions that occur among heterogeneous actors. As such in place of the linear knowledge delivery approach, a more systems approach is necessary to help mobilize science and technology such as climate services to deliver benefits, which has the potential to enhance access, salience, credibility and legitimacy of the scientific information

Co-designed Practical Use of Probabilistic Climate Advisories among Smallholder Farmers: A Balance between Confidence and Caution

Especially for smallholder farmers with limited land and financial resources, farming in arid and semi-arid lands (ASALs), where season-to-season rainfall fluctuation dictates production, is a risky business. Through participatory approaches, this study compares deterministic and probabilistic interpretations of climate forecasts and their use by smallholder farmers through a crop-growing season. The study revealed that deterministic advisories are good for smallholder farmers only when formulated from forecasts with higher accuracy than the historical climatological distribution. Otherwise, they cause farm loss in terms of labor and inputs. On the other hand, probabilistic advisories help farmers spread the risk to cater to all the uncertainty and in so doing bring out a balance between confidence and caution. However, farmers must be supported with enough sensitization to comprehend forecast probability, translate it into probabilistic advisories and use that to plan and manage farm activities. The findings support the hypothesis providing packaged climate products in transparent probabilistic terms in place of deterministic form can overcome inherent credibility challenges. The study’s conclusion highlights important takeaways and new understandings of the advantage of using probabilistic advisories among resource-poor smallholder farmers

Communicating African Spirituality through Ecology: Challenges and Prospects for the 21st Century

This review was set in the context of African spirituality and ecology. Specifically, the review addressed issues of African spirituality and the environment from a Kenyan context. Through analyses on existing literature, we examined African worldviews, determined how African spirituality was communicated through the environment, evaluated African ways of regulating the use of the environment, and explored challenges facing African spirituality and ecology today. Results show that African spirituality has been enhanced through the environment where humanity worshipped and venerated everything under the earth, on earth, between the earth and heavens and in the heavens above. Consequently, various methods to restrict the utilization of certain natural resources are employed as a way of conserving the environment. Additional findings demonstrate that African spirituality and ecology are currently facing a number of challenges, hence a major challenge of sustainability of African spirituality in regard to environment. From a spiritual point of view, it is therefore recommended that environmental diversity should be conserved through sustainable development where every person from grassroots level is involved in protecting and maintaining God’s creation. We conclude that African knowledge and belief systems on environmental sustainability could be revitalized and used in environmental conservation