Patient and caregiver experiences of living with dementia in Tanzania

Introduction: Tanzania is a low-income country with an increasing prevalence of dementia, which provides challenges for the existing healthcare system. People with dementia often don't receive a formal diagnosis, and with a lack of formal healthcare, are often predominantly supported by family relatives. There are very few published data relating to lived experiences of people with dementia in Tanzania. This study aimed to understand people with dementia, and their caregivers' experiences of living with dementia in Tanzania and the perceived needs of people with dementia.Methods: Qualitative, semi-structured interviews were conducted with 14 people with dementia and 12 caregivers in Moshi, Tanzania. Interviews were audio-recorded, translated, transcribed and analysed using a Framework Analysis approach.Results: Three sub-themes were identified within data describing the experience of 'Living with Dementia in Tanzania': 'Deteriorations in Health', 'Challenges to living with Dementia in Tanzanian Culture', and 'Lack of Support': people with dementia faced challenges due to social isolation, stigmatisation, and lack of caregiver knowledge on how best to provide support. Collectively, these impacted on both the physical and mental health of people with dementia. Misconceptions about dementia aetiology related to age, stresses of daily life and other co-morbidities. People with dementia were motivated to access treatment, exhibiting pluralistic health-seeking behaviours. There was an overall preference for non-pharmacological interventions over medication, with high levels of trust in medical professional opinions.Conclusions: Living with dementia in Tanzania is influenced by both cultural and religious factors. More work is needed to target supplementary healthcare (with efforts to promote accessibility), support for caregivers and public health education about dementia to overcome existent misconceptions and stigma

Field margin vegetation in tropical African bean systems harbours diverse natural enemies for biological pest control in adjacent crops

Non-crop vegetation around farmland can be valuable habitats for enhancing ecosystem services but little is known of the importance of field margins in supporting natural enemies of insect pests in tropical agriculture. This study was conducted in smallholder bean fields in three elevation zones to assess the importance of field margin vegetation to natural enemy populations and movement to the bean crop for biological pest control. The pests and natural enemies were assessed using different coloured water pan traps (to ensure the capture of insects with different colour preferences) and the interactions of the two arthropod groups with the margin vegetation and their movement to the bean crop were monitored using fluorescent dye. Sentinel plants were used to assess predation and parasitism levels. A total of 5003 natural enemies were captured, more in the field margin than within the bean field for low and mid elevation zones, while in the high elevation zone, they were more abundant within the bean field. Pests were more abundant in the crop than margins for all the elevation zones. The use of a dye applied to margin vegetation demonstrated that common natural enemy taxa moved to the crop during the days after dye application. The proportion of dye-marked natural enemies (showing their origin to be margin vegetation) sampled from the crop suggest high levels of spatial flux in the arthropod assemblage. Aphid mortality rates (measured by prey removal and parasitism levels on sentinel plants) did not differ between the field edges and field centre in any of the three elevation zones, suggesting that for this pest taxon, the centre of the fields still receive comparable pest control service as in the field edges. This study found that field margins around smallholder bean fields are useful habitats to large numbers of natural enemy taxa that move to adjacent crops providing biological pest control service

Characterization of hymenopteran parasitoids of aphis fabae in an African smallholder bean farming system through sequencing of COI 'mini-barcodes'

Parasitoids are among the most frequently reported natural enemies of insect pests, particularly aphids. The efficacy of parasitoids as biocontrol agents is influenced by biotic and abiotic factors. For example, hyperparasitoids can reduce the abundance of the primary parasitoids as well as modify their behavior. A field study was conducted at three contrasting elevations on Mount Kilimanjaro, Tanzania, to identify the parasitoids of aphids in smallholder bean farming agroecosystems. Sentinel aphids (Aphis fabae) on potted bean plants (Phaseolus vulgaris) were exposed in 15 bean fields at three elevations for 2 days. The sentinel aphids were then kept in cages in a greenhouse until emergence of the parasitoids, which were collected and preserved in 98% ethanol for identification. Of the 214 parasitoids that emerged from sentinel aphids, the greatest abundance (44.86%) were from those placed at intermediate elevations (1000–1500 m a.s.l), compared to 42.52% from the lowest elevations and only 12.62% from the highest elevation farms. Morphological identification of the parasitoids that emerged from parasitized aphids showed that 90% were Aphidius species (Hymenoptera: Braconidae: Aphidiinae). Further characterization by sequencing DNA ‘mini-barcodes’ identified parasitoids with ≥99% sequence similarity to Aphidius colemani, 94–95% sequence similarity to Pachyneuron aphidis and 90% similarity to a Charipinae sp. in the National Center for Biotechnology Information (NCBI) database. These results confidently identified A. colemani as the dominant primary aphid parasitoid of A. fabae in the study area. A Pachyneuron sp., which was most closely related to P. aphidis, and a Charipinae sp. occurred as hyperparasitoids. Thus, interventions to improve landscapes and farming practice should monitor specifically how to augment populations of A. colemani, to ensure any changes enhance the delivery of natural pest regulation. Further studies are needed for continuous monitoring of the hyperparasitism levels and the dynamics of aphids, primary parasitoids, and secondary parasitoids in different cropping seasons and their implications in aphid control

Knowledge gaps among smallholder farmers hinder adoption of conservation biological control

Conservation biological control uses habitat management to enhance the survival and impact of arthropod natural enemies for pest control. Its advantages are that it relies on native or established invertebrate populations that are adapted to local agricultural ecosystems and conditions. We surveyed 300 farmers in three agro-ecological zones of Kilimanjaro Region, Tanzania to assess farmers’ knowledge of natural enemies, insect pests and pesticide use and ways of accessing agricultural information to identify hurdles to the adoption of conservation biological control measures. Data were collected through face to face interviews using questionnaires and pictures and by using a novel voice-response mobile phone survey. The farmers surveyed regarded almost all insects as pests, with data analyses revealing that 98.7% of farmers were completely unaware of natural enemies. After completing a short training course, however, awareness was transformed, with 80% of farmers recognising beneficial insects and expressing an intention to change farming practices to enhance their survival within the crop. Access to information about synthetic pesticide alternatives was a limiting factor to uptake of biological control measures with 8.7% of farmers reporting no access to agricultural information, while others were mostly dependent on agricultural officers. These findings identified a severe lack of knowledge among smallholder farmers about beneficial insects which will impact adoption of conservation biological control. We recommend improved access to information and knowledge among the technical officers and the smallholder farmers with direct training on agro-ecological intensification for wider adoption of conservation biological control

Beneficial insects are associated with botanically rich margins with trees on small farms

Beneficial insect communities on farms are influenced by site- and landscape-level factors, with pollinator and natural enemy populations often associated with semi-natural habitat remnants. They provide ecosystem services essential for all agroecosystems. For smallholders, natural pest regulation may be the only affordable and available option to manage pests. We evaluated the beneficial insect community on smallholder bean farms (Phaseolus vulgaris L.) and its relationship with the plant communities in field margins, including margin trees that are not associated with forest fragments. Using traps, botanical surveys and transect walks, we analysed the relationship between the floral diversity/composition of naturally regenerating field margins, and the beneficial insect abundance/diversity on smallholder farms, and the relationship with crop yield. More flower visits by potential pollinators and increased natural enemy abundance measures in fields with higher plant, and particularly tree, species richness, and these fields also saw improved crop yields. Many of the flower visitors to beans and potential natural enemy guilds also made use of non-crop plants, including pesticidal and medicinal plant species. Selective encouragement of plants delivering multiple benefits to farms can contribute to an ecological intensification approach. However, caution must be employed, as many plants in these systems are introduced species

A new approach for developing “implementation plans” for cognitive stimulation therapy (CST) in low and middle-income countries: Results from the CST-International study

Background: Even with a strong evidence base, many healthcare interventions fail to be translated to clinical practice due to the absence of robust implementation strategies. For disorders such as Alzheimer's disease and other dementias, access to evidence-based interventions beyond research settings is of great importance. Cognitive Stimulation Therapy (CST) is a brief, group-based intervention, with consistent evidence of effectiveness. Methods: An implementation focused, three-phase methodology was developed using extensive stakeholder engagement. The methods resulted in a standardized Implementation Plan for the successful translation of CST from research to practice. The methodology was developed using the Consolidated Framework for Implementation Research (CFIR) and refined in three countries that vary in levels of economic development and healthcare systems (Brazil, India and Tanzania. Results: Five Implemention Plans for CST were produced. Each plan contained implementation strategies and action plans devised in conjunction with policy professionals, healthcare professionals, people with dementia and family carers, and an international team of researchers and clinicians. Conclusion: This novel methodology can act as a template for implementation studies in diverse healthcare systems across the world. It is an effective means of devising socio-culturally informed Implementation Plans that account for economic realities, health equity and healthcare access

Identifying the right plants for diverse biocontrol agents in tropical smallholder bean farming systems

This research article was published by African Journals OnLine in Vol. 21 No. 1, 2022Biocontrol agents such as predators, parasitoids and pathogens potentially regulate crop pests populations. The agents feed directly on the pests, oviposit in the pest body or cause disease in the pest. While biocontrol has become a commercial enterprise in temperate horticulture, there is much less information on the biocontrol agents present in smallholder agricultural systems in the tropics and little knowledge about the importance of plant diversity in supporting their biocontrol activities. A standardized botanical survey walk combined with observations of plant insect interactions was conducted on field margin vegetation of 24 smallholder fields of common beans (Phaseolus vulgaris L.) in three elevation zones of a tropical ecosystem. Sweep nets were also used to capture the biocontrol agents and stored in 70% ethanol for detailed taxonomy where identification in the field was not possible. A wide range of biocontrol agents interacting with the field margin plants, particularly flowering forbs were revealed. The most preferred field margin plants were Ageratum conyzoides, Commelina benghalensis, Pennisetum purpureum, Panicum maximum and Tripsacum sp. The most common biocontrol agents found to interact with the field margin plants were spiders (Araneae), long-legged flies (Dolichopodidae), predatory and parasitic wasps (Ichneumonids and braconids), hoverflies (Syrphidae) and assassin bugs (Reduviidae). Preferences of the biocontrol agents to certain plant species were similar across all three zones, indicating the importance of such plants in terms of food resources, shelter or nesting sites. The preference of the biocontrol agents to some plant species indicates the need to identify the specific benefits of these species to the biocontrol agents to determine whether non-crop habitat manipulation might enhance natural pest regulation.Biocontrol agents such as predators, parasitoids and pathogens potentially regulate crop pests populations. The agents feed directly on the pests, oviposit in the pest body or cause disease in the pest. While biocontrol has become a commercial enterprise in temperate horticulture, there is much less information on the biocontrol agents present in smallholder agricultural systems in the tropics and little knowledge about the importance of plant diversity in supporting their biocontrol activities. A standardized botanical survey walk combined with observations of plant insect interactions was conducted on field margin vegetation of 24 smallholder fields of common beans (Phaseolus vulgaris L.) in three elevation zones of a tropical ecosystem. Sweep nets were also used to capture the biocontrol agents and stored in 70% ethanol for detailed taxonomy where identification in the field was not possible. A wide range of biocontrol agents interacting with the field margin plants, particularly flowering forbs were revealed. The most preferred field margin plants were Ageratum conyzoides, Commelina benghalensis, Pennisetum purpureum, Panicum maximum and Tripsacum sp. The most common biocontrol agents found to interact with the field margin plants were spiders (Araneae), long-legged flies (Dolichopodidae), predatory and parasitic wasps (Ichneumonids and braconids), hoverflies (Syrphidae) and assassin bugs (Reduviidae). Preferences of the biocontrol agents to certain plant species were similar across all three zones, indicating the importance of such plants in terms of food resources, shelter or nesting sites. The preference of the biocontrol agents to some plant species indicates the need to identify the specific benefits of these species to the biocontrol agents to determine whether non-crop habitat manipulation might enhance natural pest regulation

Development and community-based validation of the IDEA study Instrumental Activities of Daily Living (IDEA-IADL) questionnaire

Background: The dementia diagnosis gap in sub-Saharan Africa (SSA) is large, partly due to difficulties in assessing function, an essential step in diagnosis. Objectives: As part of the Identification and Intervention for Dementia in Elderly Africans (IDEA) study, to develop, pilot, and validate an Instrumental Activities of Daily Living (IADL) questionnaire for use in a rural Tanzanian population to assist in the identification of people with dementia alongside cognitive screening. Design: The questionnaire was developed at a workshop for rural primary healthcare workers, based on culturally appropriate roles and usual activities of elderly people in this community. It was piloted in 52 individuals under follow-up from a dementia prevalence study. Validation subsequently took place during a community dementia-screening programme. Construct validation against gold standard clinical dementia diagnosis using DSM-IV criteria was carried out on a stratified sample of the cohort and validity assessed using area under the receiver operating characteristic (AUROC) curve analysis. Results: An 11-item questionnaire (IDEA-IADL) was developed after pilot testing. During formal validation on 130 community-dwelling elderly people who presented for screening, the AUROC curve was 0.896 for DSM-IV dementia when used in isolation and 0.937 when used in conjunction with the IDEA cognitive screen, previously validated in Tanzania. The internal consistency was 0.959. Performance on the IDEA-IADL was not biased with regard to age, gender or education level. Conclusions: The IDEA-IADL questionnaire appears to be a useful aid to dementia screening in this setting. Further validation in other healthcare settings in SSA is required