Cassava brown streak disease and the sustainability of a clean seed system

One method of reducing disease in crops is the dissemination of disease-free planting material from a multiplication site to growers. This study assesses the validity and sustainability of this method for cassava brown streak disease, a threat to cassava crops across East Africa. Using mathematical modelling, the effects of different environmental and control conditions on pathogen spread were determined in a single-field multiplication site. High disease pressure, through large vector populations and disease in the surrounding area, combined with poor roguing practice, resulted in unsuccessful disease suppression. However, fields may produce sufficiently clean material for replanting if these factors can be overcome. Assessing the sustainability of a low-pressure system over multiple harvests, well-managed fields were found to maintain low disease levels, although producing sufficient cuttings may prove challenging. Replanting fields from the previous harvest does not lead to degeneration of planting material, only cutting numbers, and the importation of new clean material is not necessarily required. It is recommended that multiplication sites are only established in areas of low disease pressure and vector population density, and the importance of training in field management is emphasized. Cultivars displaying strong foliar symptoms are to be encouraged, as these allow for effective roguing, resulting in negative selection against the disease and reducing its spread. Finally, efforts to increase plant multiplication rates, the number of cuttings that can be obtained from each plant, have a significant impact on the sustainability of sites, as this represents the primary limiting factor to success

Cassava brown streak disease and the sustainability of a clean seed system.

One method of reducing disease in crops is the dissemination of disease-free planting material from a multiplication site to growers. This study assesses the validity and sustainability of this method for cassava brown streak disease, a threat to cassava crops across East Africa. Using mathematical modelling, the effects of different environmental and control conditions on pathogen spread were determined in a single-field multiplication site. High disease pressure, through large vector populations and disease in the surrounding area, combined with poor roguing practice, resulted in unsuccessful disease suppression. However, fields may produce sufficiently clean material for replanting if these factors can be overcome. Assessing the sustainability of a low-pressure system over multiple harvests, well-managed fields were found to maintain low disease levels, although producing sufficient cuttings may prove challenging. Replanting fields from the previous harvest does not lead to degeneration of planting material, only cutting numbers, and the importation of new clean material is not necessarily required. It is recommended that multiplication sites are only established in areas of low disease pressure and vector population density, and the importance of training in field management is emphasized. Cultivars displaying strong foliar symptoms are to be encouraged, as these allow for effective roguing, resulting in negative selection against the disease and reducing its spread. Finally, efforts to increase plant multiplication rates, the number of cuttings that can be obtained from each plant, have a significant impact on the sustainability of sites, as this represents the primary limiting factor to success

Limits of phytosanitation and host plant resistance towards the control of cassava viruses in Uganda

Published online: 30 Sept 2017Cassava (Manihot esculenta Crantz) and the viruses that infect it, notably cassava mosaic virus and cassava brown streak viruses, have a unique history of co-evolution and co-existence. While cassava originated in South America, both viruses and the diseases they cause have largely been limited to the East African region, where they have, and continue to be key yield-robbing stresses. For sustainable control, we assume that deployment of resistant varieties when carefully combined with phytosanitation will combat these viruses. We have thus generated empirical data and tested the limits, i.e., how long this strategy can last. This entailed the comparison of elite cassava varieties, one set of virus-indexed tissue culture plantlets, and the other set, re-cycled planting materials under farmer’s cyclic propagation for 6-23 years. Trials were established at diverse sites in Uganda. We observed that both officially-released and unofficially-released cassava varieties are common in farmer’s fields; these varieties have varying susceptibility levels to viruses. Worrisome was that some officially-released varieties like NASE 3 registered cassava mosaic disease (CMD) incidences of up to 71% (virus-indexed), which was not any different from its re-cycled counterparts. Other varieties like NASE 14 have maintained high levels of CMD resistance six years after official release. Predominant re-cycled cassava varieties notably TME 204, I92/0057, TME 14, and to a limited extent NASE 14, are key reservoirs for cassava brown streak disease (CBSD) associated viruses. These findings highlight the limits of phytosanitation, i.e., in areas like Kaberamaido associated with high CMD pressure, varieties NASE 1 and NASE 3 can not be recommended; on the contrary, these varieties can be deployed in Kalangala, where they can survive with phytosanitation. And for CBSD, the findings justify the urgent need for phytosanitation (community-led) and development of varieties with higher levels of resistance and/or tolerance, as no immune variety has so far been identified

Why do women not use antenatal services in low and middle income countries? A metasynthesis of qualitative studies

Background: Almost 50% of women in low & middle income countries (LMIC’s) don’t receive adequate antenatal care. Women’s views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the findings are not easily transferable. We aimed to inform the development of future antenatal care programmes through a synthesis of findings in all relevant qualitative studies. Methods and Findings: Using a pre-determined search strategy, we identified robust qualitative studies reporting on the views and experiences of women in LMIC’s who received inadequate antenatal care. We used meta-ethnographic techniques to generate themes and a line of argument synthesis. We derived policy relevant hypotheses from the findings. We included 21 papers representing the views of more than 1230 women from 15 countries. Three key themes were identified: ‘Pregnancy as socially risky and physiologically healthy’; ‘Resource use and survival in conditions of extreme poverty’and ‘Not getting it right first time’. The line of argument synthesis describes a dissonance between programme design and cultural contexts that may restrict access and discourage return visits. We hypothesize that centralized, risk-focused antenatal care programmes may be at odds with the resources, beliefs and experiences of pregnant women who underuse antenatal services. Conclusions: Our findings suggest that there may be a mis-alignment between current antenatal provision and the social and cultural context of some women in LMIC’s. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences are likely to be underused, especially when attendance generates increased personal risks of lost family resource or physical danger during travel; when the promised care is not delivered due to resource constraints; and when women experience covert or overt abuse in care settings

Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

<p>Abstract</p> <p>Background</p> <p>Geographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders.</p> <p>Methods</p> <p>This quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented.</p> <p>Results</p> <p>Motorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing.</p> <p>Conclusions</p> <p>Transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.</p

Insight into implementation of facility-based integrated management of childhood illness strategy in a rural district of Sindh, Pakistan

Background Integrated management of childhood illnesses (IMCI) strategy has been proven to improve health outcomes in children under 5 years of age. Pakistan, despite being in the late implementation phase of the strategy, continues to report high under-five mortality due to pneumonia, diarrhea, measles, and malnutrition - the main targets of the strategy. Objective The study determines the factors influencing IMCI implementation at public-sector primary health care (PHC) facilities in Matiari district, Sindh, Pakistan. Design An exploratory qualitative study with an embedded quantitative strand was conducted. The qualitative part included 16 in-depth interviews (IDIs) with stakeholders which included planners and policy makers at a provincial level (n=5), implementers and managers at a district level (n=3), and IMCI-trained physicians posted at PHC facilities (n=8). Quantitative part included PHC facility survey (n=16) utilizing WHO health facility assessment tool to assess availability of IMCI essential drugs, supplies, and equipments. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequencies were calculated for health facility survey data. Results The major factors reported to enhance IMCI implementation were knowledge and perception about the strategy and need for separate clinic for children aged under 5 years as potential support factors. The latter can facilitate in strategy implementation through allocated workforce and required equipments and supplies. Constraint factors mainly included lack of clear understanding of the strategy, poor planning for IMCI implementation, ambiguity in defined roles and responsibilities among stakeholders, and insufficient essential supplies and drugs at PHC centers. The latter was further substantiated through health facilities\u27 survey findings, which indicated that none of the facilities had 100% stock of essential supplies and drugs. Only one out of all 16 surveyed facilities had 75% of the total supplies, while 4 out of 16 facilities had 56% of the required IMCI drug stock. The mean availability of supplies ranged from 36.6 to 66%, while the mean availability of drugs ranged from 45.8 to 56.7%. Conclusion Our findings indicate that the Matiari district has sound implementation potential; however, bottlenecks at health care facility and at health care management level have badly constrained the implementation process. An interdependency exists among the constraining factors, such as lack of sound planning resulting in unclear understanding of the strategy; leading to ambiguous roles and responsibilities among stakeholders which manifest as inadequate availability of supplies and drugs at PHC facilities. Addressing these barriers is likely to have a cumulative effect on facilitating IMCI implementation. On the basis of these findings, we recommend that the provincial Ministry of Health (MoH) and provincial Maternal Neonatal and Child Health (MNCH) program jointly assess the situation and streamline IMCI implementation in the district through sound planning, training, supervision, and logistic support

Assessing community perspectives of the community based education and service model at Makerere University, Uganda: a qualitative evaluation

<p>Abstract</p> <p>Background</p> <p>Community partnerships are defined as groups working together with shared goals, responsibilities, and power to improve the community. There is growing evidence that these partnerships contribute to the success and sustainability of community-based education and service programs (COBES), facilitating change in community actions and attitudes. Makerere University College of Health Sciences (MakCHS) is forging itself as a transformational institution in Uganda and the region. The College is motivated to improve the health of Ugandans through innovative responsive teaching, provision of service, and community partnerships. Evaluating the COBES program from the community perspective can assist the College in refining an innovative and useful model that has potential to improve the health of Ugandans.</p> <p>Methods</p> <p>A stratified random sample of 11 COBES sites was selected to examine the community’s perception of the program. Key Informant Interviews of 11 site tutors and 33 community members were completed. The data was manually analyzed and themes developed.</p> <p>Results</p> <p>Communities stated the students consistently engaged with them with culturally appropriate behaviour. They rated the student’s communication as very good even though translators were frequently needed. Half the community stated they received some feedback from the students, but some communities interpreted any contact after the initial visit as feedback. Communities confirmed and appreciated that the students provided a number of interventions and saw positive changes in health and health seeking behaviours. The community reflected that some programs were more sustainable than others; the projects that needed money to implement were least sustainable. The major challenges from the community included community fatigue, and poor motivation of community leaders to continue to take students without compensation.</p> <p>Conclusions</p> <p>Communities hosting Makerere students valued the students’ interventions and the COBES model. They reported witnessing health benefits of fewer cases of disease, increased health seeking behavior and sustainable healthcare programs. The evidence suggests that efforts to standardize objectives, implement structural adjustments, and invest in development of the program would yield even more productive community interactions and a healthcare workforce with public health skills needed to work in rural communities.</p

Poor newborn care practices - a population based survey in eastern Uganda

BACKGROUND: Four million neonatal deaths are estimated to occur each year and almost all in low income countries, especially among the poorest. There is a paucity of data on newborn health from sub-Saharan Africa and few studies have assessed inequity in uptake of newborn care practices. We assessed socioeconomic differences in use of newborn care practices in order to inform policy and programming in Uganda. METHODS: All mothers with infants aged 1-4 months (n = 414) in a Demographic Surveillance Site were interviewed. Households were stratified into quintiles of socioeconomic status (SES). Three composite outcomes (good neonatal feeding, good cord care, and optimal thermal care) were created by combining related individual practices from a list of twelve antenatal/essential newborn care practices. Multiple logistic regression analysis was used to identify determinants of each dichotomised composite outcome. RESULTS: There were low levels of coverage of newborn care practices among both the poorest and the least poor. SES and place of birth were not associated with any of the composite newborn care practices. Of newborns, 46% had a facility delivery and only 38% were judged to have had good cord care, 42% optimal thermal care, and 57% were considered to have had adequate neonatal feeding. Mothers were putting powder on the cord; using a bottle to feed the baby; and mixing/replacing breast milk with various substitutes. Multiparous mothers were less likely to have safe cord practices (OR 0.5, CI 0.3 - 0.9) as were mothers whose labour began at night (OR 0.6, CI 0.4 - 0.9). CONCLUSION: Newborn care practices in this setting are low and do not differ much by socioeconomic group. Despite being established policy, most neonatal interventions are not reaching newborns, suggesting a "policy-to-practice gap". To improve newborn survival, newborn care should be integrated into the current maternal and child interventions, and should be implemented at both community and health facility level as part of a universal coverage strategy