Competing interests, clashing ideas, and institutionalizing influence: insights into the political economy of malaria control from seven African countries

This article explores how malaria control in sub-Saharan Africa is shaped in important ways by political and economic considerations within the contexts of aid-recipient nations and the global health community. Malaria control is often assumed to be a technically driven exercise: the remit of public health experts and epidemiologists who utilize available data to select the most effective package of activities given available resources. Yet research conducted with national and international stakeholders shows how the realities of malaria control decision-making are often more nuanced. Hegemonic ideas and interests of global actors, as well as the national and global institutional arrangements through which malaria control is funded and implemented, can all influence how national actors respond to malaria. Results from qualitative interviews in seven malaria-endemic countries indicate that malaria decision-making is constrained or directed by multiple competing objectives, including a need to balance overarching global goals with local realities, as well as a need for National Malaria Control Programmes to manage and coordinate a range of non-state stakeholders who may divide up regions and tasks within countries. Finally, beyond the influence that political and economic concerns have over programmatic decisions and action, our analysis further finds that malaria control efforts have institutionalized systems, structures and processes that may have implications for local capacity development

Policy options to streamline the carbon market for agricultural nitrous oxide emissions

The majority of emissions of nitrous oxide – a potent greenhouse gas (GHG) – are from agricultural sources, particularly nitrogen fertilizer applications. A growing focus on these emission sources has led to the development in the United States of GHG offset protocols that could enable payment to farmers for reducing fertilizer use or implementing other nitrogen management strategies. Despite the development of several protocols, the current regional scope is narrow, adoption by farmers is low, and policy implementation of protocols has a significant time lag. Here we utilize existing research and policy structures to propose an ‘umbrella’ approach for nitrogen management GHG emissions protocols that has the potential to streamline the policy implementation and acceptance of such protocols. We suggest that the umbrella protocol could set forth standard definitions common across multiple protocol options, and then modules could be further developed as scientific evidence advances. Modules could be developed for specific crops, regions, and practices. We identify a policy process that could facilitate this development in concert with emerging scientific research and conclude by acknowledging potential benefits and limitations of the approach. Key policy insights Agricultural greenhouse gas market options are growing, but are still underutilized Streamlining protocol development through an umbrella process could enable quicker development of protocols across new crops, regions, and practices Effective protocol development must not compromise best available science and should follow a rigorous pathway to ensure appropriate implementation

Interventions to improve district-level routine health data in low-income and middle-income countries: a systematic review

Background Routine health information system(s) (RHIS) facilitate the collection of health data at all levels of the health system allowing estimates of disease prevalence, treatment and preventive intervention coverage, and risk factors to guide disease control strategies. This core health system pillar remains underdeveloped in many low-income and middle-income countries. Efforts to improve RHIS data coverage, quality and timeliness were launched over 10 years ago. Methods A systematic review was performed across 12 databases and literature search engines for both peer-reviewed articles and grey literature reports on RHIS interventions. Studies were analysed in three stages: (1) categorisation of RHIS intervention components and processes; (2) comparison of intervention component effectiveness and (3) whether the post-intervention outcome improved above the WHO integrated disease surveillance response framework data quality standard of 80% or above. Results 5294 references were screened, resulting in 56 studies. Three key performance determinants - technical, organisational and behavioural - were proposed as critical to RHIS strengthening. Seventy-seven per cent [77%] of studies identified addressed all three determinants. The most frequently implemented intervention components were € providing training' and € using an electronic health management information systems'. Ninety-three per cent [93%] of pre-post or controlled trial studies showed improvements in one or more data quality outputs, but after applying a standard threshold of >80% post-intervention, this number reduced to 68%. There was an observed benefit of multi-component interventions that either conducted data quality training or that addressed improvement across multiple processes and determinants of RHIS. Conclusion Holistic data quality interventions that address multiple determinants should be continuously practised for strengthening RHIS. Studies with clearly defined and pragmatic outcomes are required for future RHIS improvement interventions. These should be accompanied by qualitative studies and cost analyses to understand which investments are needed to sustain high-quality RHIS in low-income and middle-income countries

What makes an operational Farm Soil Carbon Code? Insights from a global comparison of existing soil carbon codes using a structured analytical framework

Soils have the potential to sequester and store significant amounts of carbon, contributing towards climate change mitigation. Soil carbon markets are now emerging to pay farmers for changes in land use or management that absorb carbon from the atmosphere, governed by codes that ensure additionality, permanence and non-leakage whilst protecting against unintentional reversals. This paper represents the first global comparative analysis of agricultural soil carbon codes, providing new insights into the wide range of approaches currently used to govern these emerging markets internationally. To do this, the paper first develops an analytical framework for the systematic comparison of codes, which could be applied to the analysis of codes in other land uses and habitats. This framework was then used to identify commonalities and differences in methods, projects, administration and commercialisation and associated code documents for 12 publicly available codes from the UK, France, Australia, USA and international bodies. Codes used a range of mechanisms to manage: additionality (including legal, adoption, financial viability and investment tests); uncertainty and risks around soil carbon sequestration (including minimum permanence periods, carbon buffers, contractual arrangements and/or insurance policies); leakage (including restriction of eligible practices and monitoring to subtract leakage from verified sequestration); baselines (including multi-year and variable buffers based on empirical data or models); measurement, reporting and verification methods (stipulating time intervals, methods, data sources and assessments of uncertainty); auditing; resale of carbon units; stakeholder engagement; and approaches to ensure market integrity (such as buyer checks). The paper concludes by discussing existing MRV methods and codes that could be adapted for use in the UK and evaluates the need for an over-arching standard for soil carbon codes in the UK, to which existing codes and other schemes already generating soil carbon credits could be assessed and benchmarked

Feasibility trial evaluation of a peer volunteering active aging intervention: ACE (Active, Connected, Engaged)

© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. BACKGROUND: ACE (Active, Connected, Engaged) is a theory-informed, pragmatic intervention using peer volunteering support to promote active ageing in socially disengaged, inactive older adults. This study aimed to establish ACE's feasibility and acceptability. METHODS: Fifty-four older adults were recruited as either peer volunteers (activators; n = 15) or participants (ACEs; n = 39). Participants were randomized to one-to-one support from an activator (ACEs-Intervention [ACEs-I]) or a waiting-list control group (ACEs-Control [ACEs-C]). Activators supported ACEs-I to get out more and engage with local activities. Objectively measured physical activity (PA), lower limb function, and number of out of house activities were assessed at baseline and post-intervention. A mixed-methods process evaluation assessed changes in confidence to get out and about, social support, autonomy, competence, and relatedness. RESULTS: Eighty-two percent of ACEs (mean age = 73.7 years [SD 7.3]) and all activators completed assessments at both baseline and post-intervention (6 months). ACEs-I reported more out of house activities (M [SD] = 6.34 [4.15]). ACEs-I increased physical function post-intervention (M [SD] = 9.8 [2.3]). ACEs-I reported improved well-being and vitality and increased confidence to get out and about, confidence in the face of specific barriers, knowledge of local initiatives, and perceived social support post-intervention. Activators, although sufficiently active at baseline, increased their PA further. ACE was well-accepted and easy to deliver. CONCLUSIONS: ACE is an acceptable and feasible intervention for helping socially disengaged older people to get out and about more, improve their confidence, and engage more with their community

Longer fixation duration while viewing face images

The spatio-temporal properties of saccadic eye movements can be influenced by the cognitive demand and the characteristics of the observed scene. Probably due to its crucial role in social communication, it is argued that face perception may involve different cognitive processes compared with non-face object or scene perception. In this study, we investigated whether and how face and natural scene images can influence the patterns of visuomotor activity. We recorded monkeys’ saccadic eye movements as they freely viewed monkey face and natural scene images. The face and natural scene images attracted similar number of fixations, but viewing of faces was accompanied by longer fixations compared with natural scenes. These longer fixations were dependent on the context of facial features. The duration of fixations directed at facial contours decreased when the face images were scrambled, and increased at the later stage of normal face viewing. The results suggest that face and natural scene images can generate different patterns of visuomotor activity. The extra fixation duration on faces may be correlated with the detailed analysis of facial features

Density of Healthcare Providers and Patient Outcomes: Evidence from a Nationally Representative Multi-Site HIV Treatment Program in Uganda

This study examined the association between density of healthcare providers and patient outcomes using a large nationally representative cohort of patients receiving combination antiretroviral therapy (cART) in Uganda.Objective: We examined the association between density of healthcare providers and patient outcomes using a large nationally representative cohort of patients receiving combination antiretroviral therapy (cART) in Uganda. Design: We obtained data from The AIDS Support Organization (TASO) in Uganda. Patients 18 years of age and older who initiated cART at TASO between 2004 and 2008 contributed to this analysis. The number of healthcare providers per 100 patients, the number of patients lost to follow-up per 100 person years and number of deaths per 100 person years were calculated. Spearman correlation was used to identify associations between patient loss to follow-up and mortality with the healthcare provider-patient ratios. Results: We found no significant associations between the number of patients lost to follow-up and physicians (p = 0.45), nurses (p = 0.93), clinical officers (p = 0.80), field officers (p = 0.56), and healthcare providers overall (p = 0.83). Similarly, no significant associations were observed between mortality and physicians (p = 0.65), nurses (p = 0.49), clinical officers (p = 0.73), field officers (p = 0.78), and healthcare providers overall (p = 0.73). Conclusions: Patient outcomes, as measured by loss to follow-up and mortality, were not significantly associated with the number of doctors, nurses, clinical officers, field officers, or healthcare providers overall. This may suggest that that other factors, such as the presence of volunteer patient supporters or broader political or socioeconomic influences, may be more closely associated with outcomes of care among patients on cART in Uganda

How useful are malaria risk maps at the country level? Perceptions of decision-makers in Kenya, Malawi and the Democratic Republic of Congo

BackgroundDeclining malaria prevalence and pressure on external funding have increased the need for efficiency in malaria control in sub-Saharan Africa (SSA). Modelled Plasmodium falciparum parasite rate (PfPR) maps are increasingly becoming available and provide information on the epidemiological situation of countries. However, how these maps are understood or used for national malaria planning is rarely explored. In this study, the practices and perceptions of national decision-makers on the utility of malaria risk maps, showing prevalence of parasitaemia or incidence of illness, was investigated.MethodsA document review of recent National Malaria Strategic Plans was combined with 64 in-depth interviews with stakeholders in Kenya, Malawi and the Democratic Republic of Congo (DRC). The document review focused on the type of epidemiological maps included and their use in prioritising and targeting interventions. Interviews (14 Kenya, 17 Malawi, 27 DRC, 6 global level) explored drivers of stakeholder perceptions of the utility, value and limitations of malaria risk maps.ResultsThree different types of maps were used to show malaria epidemiological strata: malaria prevalence using a PfPR modelled map (Kenya); malaria incidence using routine health system data (Malawi); and malaria prevalence using data from the most recent Demographic and Health Survey (DRC). In Kenya the map was used to target preventative interventions, including long-lasting insecticide-treated nets (LLINs) and intermittent preventive treatment in pregnancy (IPTp), whilst in Malawi and DRC the maps were used to target in-door residual spraying (IRS) and LLINs distributions in schools. Maps were also used for operational planning, supply quantification, financial justification and advocacy. Findings from the interviews suggested that decision-makers lacked trust in the modelled PfPR maps when based on only a few empirical data points (Malawi and DRC).ConclusionsMaps were generally used to identify areas with high prevalence in order to implement specific interventions. Despite the availability of national level modelled PfPR maps in all three countries, they were only used in one country. Perceived utility of malaria risk maps was associated with the epidemiological structure of the country and use was driven by perceived need, understanding (quality and relevance), ownership and trust in the data used to develop the maps

March 1955

Presidents Report - Frank P. Dunlap (page 1) The Student Purdue Serves - Dr. N. M. Parkhurst (2) A Student Reports - Bill Roach (4) Corrective Management of Shrubs - H. W. Gilbert (5) Nutrient Absorption by Plants - J. R. Watson Jr. (7) Disease Development is Slow - Dr. Wm. Klomparens (10) Poa Annua Control with Arsenic Materials - W. H. Daniel (11) Labor Relations - Cincinnati Country Club - John McCoy (14) Labor Policies at my Course - Ernest Schneider (15) Labor Policies at my Course - Don Strand (16) Nitrogen Use and Why - Robert M. Williams (17) Fertilizing Greens and Why - Don Likes(18) Nitrogen Use and Why - Lawrence Huber (20) Report on Experimental Green - Taylor Boyd (21) Experiences with Fairway Improvements - Ray Davis (23) Fairway Improvement Program - Bert Rost (24) Experiences on Merion Bluegrass - Carl Habenicht (24) Merion Bluegrass Experiences - P. E. Drachman (25) Zoysia for Lawns and Nurseries - P. E. Drachman (27) Preparation for Mortorized Carts - James W. Brandt (28) Preparing for Motorized Carts - Carl Bretzlaff (29) Merion Bluegrass Experiences - Ben O. Warren (31) Pennlu Distribution - W. H. Daniel(32) Zoysia for Midwest Lawns - W. H. Daniel (34) Crabgrass Prevention and Control - W. H. Daniel (36) Plant Carbohydrates Must Balance Nitrogen - M. R. Teel (39) Put Yourself in His Place - Fred Grau (40) Nitrogen Use and Why Wm. E. Lyons (45) The Management of Bentgrass Fairways - O. J. Noer (49) Fairway Improvement Program O. W. Young (52) Experiences with Zoysia - Ferank Dinelli (53