Farmers' perceptions on mechanical weeders for rice production in sub-Saharan Africa

Competition from weeds is one of the major biophysical constraints to rice (Oryza spp.) production in sub-Saharan Africa. Smallholder rice farmers require efficient, affordable and labour-saving weed management technologies. Mechanical weeders have shown to fit this profile. Several mechanical weeder types exist but little is known about locally specific differences in performance and farmer preference between these types. Three to six different weeder types were evaluated at 10 different sites across seven countries – i.e., Benin, Burkina Faso, Côte d'Ivoire, Ghana, Nigeria, Rwanda and Togo. A total of 310 farmers (173 male, 137 female) tested the weeders, scored them for their preference, and compared them with their own weed management practices. In a follow-up study, 186 farmers from Benin and Nigeria received the ring hoe, which was the most preferred in these two countries, to use it during the entire crop growing season. Farmers were surveyed on their experiences. The probability of the ring hoe having the highest score among the tested weeders was 71%. The probability of farmers’ preference of the ring hoe over their usual practices – i.e., herbicide, traditional hoe and hand weeding – was 52, 95 and 91%, respectively. The preference of this weeder was not related to gender, years of experience with rice cultivation, rice field size, weed infestation level, water status or soil texture. In the follow-up study, 80% of farmers who used the ring hoe indicated that weeding time was reduced by at least 31%. Of the farmers testing the ring hoe in the follow-up study, 35% used it also for other crops such as vegetables, maize, sorghum, cassava and millet. These results suggest that the ring hoe offers a gender-neutral solution for reducing labour for weeding in rice as well as other crops and that it is compatible with a wide range of environments. The implications of our findings and challenges for out-scaling of mechanical weeders are discussed

medAL-suite: A software solution for creating and deploying complex clinical decision support algorithms.

Sub-optimal healthcare quality in low-resource settings is attributed in part to poor adherence to clinical guidelines. Clinical decision support systems (CDSS) help to integrate guideline-based algorithms into logical workflows and improve adherence to evidence-based recommendations, and hence quality of care. However, the process of translating paper-based guidelines into electronic algorithmic formats is often complex, inefficient, expensive, and error-prone due to reliance on advanced software development skills and clinical knowledge. In response to these challenges, we developed open-source software called the Medical Algorithm Suite (medAL-suite), consisting of four components, with a primary goal of increasing efficiency, accuracy, and transparency of CDSS creation by giving experienced clinicians, rather than software developers, greater control over the process. At the heart of the software suite is the medAL-creator that allows clinicians to design algorithms using a code-free drag-and-drop interface. Algorithms are subsequently automatically deployed in medAL-reader to service level clinicians in health facilities. CDSS implementers use medAL-data and medAL-hub to manage configuration, versioning, and deployment. Since its development, the medAL-suite has been used to digitalize complex primary care guidelines and deployed in large-scale clinical studies in Tanzania, Rwanda, Kenya, Senegal, and India, leading to notable outcomes such as the reduction of inappropriate antibiotic prescriptions and improvement in care quality. Over 300,000 pediatric outpatient consultations have been completed in Rwanda and Tanzania to date using the digital algorithm. The medAL-suite focused on democratized development, process-centric design, point-of-care utility, touch-screen interface, low cost, and low power consumption to contribute to sustainable digital systems in low-resource settings. Important future developments and adaptations as the software evolves should emphasize interoperability and scalability, primarily via integrating CDSS functionality into electronic medical records for a streamlined user experience that supports improved service quality at the point-of-care. Not applicable

Psychosocial benefits of a mentoring program for youth-headed households in Rwanda

In Rwanda, the combined effects of the 1994 genocide and the AIDS pandemic have devastated the lives of children and families. More than 300,000 young people have been “left behind,” not only by parents and other caregivers who have died, but also by extended families and communities who stigmatize and fail to support them. The phenomenon of youth-headed households in the region is a relatively recent development. Despite the long history of fostering in sub-Saharan Africa, family and community safety nets are overstretched. Youth-headed households may be a legitimate coping strategy; however, children living in youth-headed households are less likely to attend school, have greater vulnerability to physical and mental health problems, and may demonstrate behavioral problems and hampered development. Although extended family members are a potential source of support, they are at times also the perpetrators of abuse, exploitation, and property grabbing following the parents’ death. The quasi-experimental study described in this brief tested a model of adult mentorship and support to improve psychosocial outcomes among youth-headed households. The study showed that mentoring can measurably mitigate adverse psychosocial outcomes among youth heads of households

Lived Experience-Led Research Agenda to Address Early Death in People With a Diagnosis of a Serious Mental Illness: A Consensus Statement

Importance People with serious mental illness (SMI), defined as a diagnosis of schizophrenia spectrum disorder, bipolar disorder, or disabling major depressive disorder) die approximately 10 to 25 years earlier than the general population. Objective To develop the first-ever lived experience–led research agenda to address early mortality in people with SMI. Evidence Review A virtual 2-day roundtable comprising 40 individuals convened on May 24 and May 26, 2022, and used a virtual Delphi method to arrive at expert group consensus. Participants responded to 6 rounds of virtual Delphi discussion via email that prioritized research topics and agreement on recommendations. The roundtable was composed of individuals with lived experience of mental health and/or substance misuse, peer support specialists, recovery coaches, parents and caregivers of people with SMI, researchers and clinician-scientists with and without lived experience, policy makers, and patient-led organizations. Twenty-two of 28 (78.6%) of the authors who provided data represented people with lived experiences. Roundtable members were selected by reviewing the peer-reviewed and gray literature on early mortality and SMI, direct email, and snowball sampling. Findings The following recommendations are presented in order of priority as identified by the roundtable participants: (1) improve the empirical understanding of the direct and indirect social and biological contributions of trauma on morbidity and early mortality; (2) advance the role of family, extended families, and informal supporters; (3) recognize the importance of co-occurring disorders and early mortality; (4) redefine clinical education to reduce stigma and support clinicians through technological advancements to improve diagnostic accuracy; (5) examine outcomes meaningful to people with an SMI diagnosis, such as loneliness and sense of belonging, and stigma and their complex relationship with early mortality; (6) advance the science of pharmaceuticals, drug discovery, and choice in medication use; (7) use precision medicine to inform treatment; and (8) redefine the terms system literacy and health literacy. Conclusions and Relevance The recommendations of this roundtable are a starting point for changing practice and highlighting lived experience–led research priorities as an option to move the field forward.publishedVersio

Provider and client perspectives on the use of maternity waiting homes in rural Rwanda.

BACKGROUND: The World Health Organization recommends the implementation of maternity waiting homes (MWH) to reduce delays in access to obstetric care, particularly for high-risk pregnancies and mothers living far from health facilities, and as a result, several countries have rolled out MWHs. However, Rwanda has not implemented this recommendation on a large scale. There is only one MWH in the country, hence a gap in knowledge regarding the potential utilisation and benefits of MWHs. OBJECTIVE: To explore providers' and clients' perspectives on facilitators and barriers to the use of MWH in rural Rwanda. METHODS: We conducted a qualitative study to explore health providers' and clients' perspectives on facilitators and barriers to the use of MWH in Rwanda, between December 2020 and January 2021. We used key informant interviews and focus group discussions to collect data. Data were analysed using NVivo qualitative analysis software version 11. RESULTS: Facilitators included perceptions that the MWH offered either a peaceful and home-like environment, good-quality services, or timely obstetric services, and was associated with good maternal and neonatal outcomes. Barriers included limited awareness of the MWH among pregnant women, fear of health providers to operate the MWH at full capacity, women's lack of autonomy, uncertainty over funding for the MWH, and perceived high user fees. CONCLUSION: The Ruli MWH offers a peaceful environment for pregnant women while providing quality and timely obstetric care, resulting in positive maternal and neonatal outcomes for women. However, its existence and benefits are not widely known, and its use is limited due to inadequate resources. There is a need for increased awareness of the MWH among healthcare providers and the community, and lessons from this MWH could inform the scale up of MWHs in Rwanda

Barriers to the community support of orphans and vulnerable youth in Rwanda

A consistent theme in the literature on interventions for orphans and vulnerable children is the need for community-based care. However, a number of socio-cultural factors may impede community response. In this study, mixed methods are used to elucidate community-level barriers to care for orphans and vulnerable youth in Rwanda. Data from a large survey of youth heads of household on perceptions of marginalization from the community and the factors predicting that marginalization are considered in light of additional data from a survey of adults who volunteered to mentor these youth and focus groups with both community adults and youth heads of household. Results highlight how orphans\u27 impoverished condition, cause of parents\u27 death, and community perceptions of orphan behavior play a role in the marginalization of orphaned youth in Rwanda. Evidence is also offered to show that targeting humanitarian assistance to vulnerable youth may inadvertently lessen the level of community support they receive and contribute to their marginalization. The implications of these data for community-based program approaches are discussed