Farmers’ perceptions of orange-fleshed sweetpotato: Do common beliefs about sweetpotato production and consumption really matter?

Efforts to combat vitamin A deficiency in developing countries have focused on the promotion of growing and consuming orange-fleshed sweetpotato (OFSP), among other crops. Past studies have found increased intake and even incomes among households that have been reached with information about nutritional benefits of OFSP. Consequently, efforts to scale up the production and consumption of OFSP are on-going in several African countries where vitamin A deficiency is a major problem. However, to date, few studies have systematically examined farmers’ perceptions and attitudes towards some of the attributes of OFSP. This paper interrogates some of the beliefs about the production and consumption of sweetpotato in general, and OFSP, in particular. It uses data generated using multi-stage sampling technique and involving 732 households in the Lake zone of Tanzania. The households were stratified into project participants (the intervention group) and non-participants (the control group). Within each household, data were collected from a male or female adult member (usually spouses) through personal interviews. Overall, 455 project participants and 277 non-participants were interviewed. This study uses both descriptive and exploratory factor analysis to assess some common beliefs about sweetpotato production and consumption. Contrary to the common beliefs, the study finds that sweetpotato is an important food crop to producing households, and that the common negative beliefs about sweetpotato production and consumption are not widely held. This study, therefore, recommends the need to upscale and out-scale efforts to sensitize farmers about the nutritional benefits of growing and consuming OFSP to counter the common negative beliefs about sweetpotato. In particular, educating farmers on the health effects of inadequate intake of Vitamin A and the importance of OFSP as its source can greatly influence their perceptions about OFSP. Further, there is need to increase efforts at breeding aimed at supplying the multiple desirable table and postharvest attributes of orange-fleshed sweetpotato, in addition to focusing on agronomic traits. For sub-Saharan Africa, such attributes include taste, storability of the tubers, dry matter content, and sugar content.Keywords: Sweetpotato, attributes, nutritional benefits, common beliefs, farmer perceptions, Tanzani

Early indirect impact of COVID-19 pandemic on utilisation and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya: A cross-sectional study

The paper determined the initial impact of COVID-19 pandemic on reproductive, maternal, newborn, child and adolescent health (RMNCAH) services in Kenya. Hospital data for the first four months (March-June 2020) of the pandemic and the equivalent period in 2019 were compared using two-sample test of proportions. Despite the global projections for worse indicators, there were no differences in monthly mean (±SD) attendance between March-June 2019 vs 2020 for antenatal care (400,191.2±12,700.0 vs 384,697.3±20,838.6), hospital births (98,713.0±4,117.0 vs 99,634.5±3,215.5), family planning attendance (431,930.5±19,059.9 vs 448,168.3±31,559.8), post-abortion care (3,206.5±111.7 vs 448,168.3±31,559.8) and pentavalent 1 immunisation (114,701.0±3,701.1 vs 110,915.8±7,209.4), p>0.05. However, there were significant increases in FP utilisation among young people (25.7% to 27.0%), injectable (short-term) FP method uptake (58.2% to 62.3%), caesarean section rate (14.6% to 15.8%), adolescent maternal deaths (6.2% to 10.9%) and fresh stillbirths (0.9% to 1.0%) with a reduction in implants (long-term) uptake (16.5% to 13.0%) (p<0.05). With uncertainty around the duration of the pandemic, strategies to mitigate against catastrophic indirect maternal health outcomes are urgently needed. (Afr J Reprod Health 2021; 25[6]: 76-87)

Networks, incentives and technology adoption: evidence from a randomised experiment in Uganda

We use data from a randomised experiment in Uganda to examine effects of incentives on the decision to adopt drought-tolerant maize varieties (DTMVs) and mechanisms through which effects occur. We find that social recognition (SR) incentives to a random subset of trained farmers – disseminating farmers (DFs) – increase knowledge transmission from DFs to their co-villagers and change information networks of both DFs and their neighbours. SR also increases DFs’ likelihood of adopting DTMVs. However, the corresponding results for private material rewards are not conclusively strong. We find no evidence that incentives for knowledge diffusion increase the likelihood of co-villagers adopting DTMVs

The feasibility of integrating alcohol risk-reduction counseling into existing VCT services in Kenya

This pretest-posttest separate-sample study with intervention and comparison groups documented the abilities and willingness of trained voluntary counseling and testing (VCT) service providers to integrate alcohol screening and risk reduction counseling into their routine service delivery. Pre-test (n=1073) and post-test data (n=1058) were collected from different clients exiting from 25 VCT centers. A 12-month intervention that required all VCT providers from the intervention groups to screen all VCT clients for their alcohol use and offer them brief risk reduction alcoholrelated counseling was implemented. At post-test, the intervention group clients (n=456) had better study outcomes than the comparison group clients (n=602). Intervention clients were more likely to report that their VCT service provider had: asked them about their alcohol use (83% vs. 41%:

Task Sharing and Shifting to Provide Pathology Diagnostic Services: The Kenya Fine-Needle Aspiration Biopsy Cytology and Bone Marrow Aspiration and Trephine Biopsy Training Program

Purpose: Fine-needle aspiration biopsy (FNAB) cytology is a simple, inexpensive, and accurate diagnostic test for benign, infectious, and malignant lesions of the breast, thyroid, lymph nodes, and other organs. Similarly, bone marrow aspiration and trephine (BMAT) biopsy procedures are relatively simple and inexpensive techniques that are important for diagnosing and monitoring many hematologic diseases including leukemias and lymphomas. However, the scarcity of pathologists in Kenya limits patient access to these simple diagnostic tests. We describe a task sharing and shifting program that sought to improve the provision of FNABs and BMAT biopsies in tertiary public hospitals in Kenya. Methods: Between January 2016 and February 2017, we trained pathologists, pathology residents, and technologists from the University of Nairobi and Aga Khan University Hospital, Nairobi, in FNAB and BMAT biopsies, who in turn trained pathologists, medical officers (MO), clinical officers (CO), and technologists at five tertiary public hospitals. The program involved curriculum development, training workshops, the establishment of new and strengthening existing FNAB and BMAT biopsy clinics, interim site visits, audits, and stakeholder workshops. Results: Fifty-one medical personnel at the tertiary hospitals were trained. The FNAB numbers increased by 41% to 1,681, with 139 malignant diagnoses (7.1%). BMAT biopsy numbers increased by 268% to 140, with 34 malignant cases. Between 60% and 100% of the FNAB and BMAT biopsy procedures were performed by MO and CO over the project period. One new FNAB and two new BMAT biopsy clinics were established. Conclusion: This project demonstrates a successful model of task sharing and shifting from specialist pathologists to MO and CO that improved access to important FNAB and BMAT biopsy services in a low-resource setting

Results and Impacts of the Integrated Land and Water Management for Adaptation to Climate Variability and Change (ILWAC) Project: Evaluation Report

The objective of the evaluation was to assess the results and impacts of the activities of all ILWAC Trust Fundfinanced projects in West Africa using a selected subset, to identify key lessons learned, and to document best climatesmart practices for scaling up. The study entailed participatory evaluation of the results and impacts of various interventions geared towards integrated water resources management for climate change and variability preparedness in West Africa. In this respect, the study identified key lessons learned and documented best climate-resilient practices for scaling up and dissemination to multiple stakeholders in the West African region. 1. Agriculture remains the backbone for sustaining livelihoods in West Africa but faces numerous challenges. Agriculture is an important source of income, food and raw materials in West Africa, employing more than half of the region’s population, which culminated in the adoption of the Comprehensive Africa Agriculture Development Programme (CAADP) in 2003. Few countries, however, have managed to mobilize their agriculture sector to deliver on development outcomes such as food and nutrition security, poverty reduction, economic growth, job creation, youth employment and industrialization. Agriculture is vulnerable to climate change, resulting from sensitivity and exposure to climate shocks and lack of capacity to cope with and adapt to such changes. ILWAC evaluation study results from household surveys, focus group discussions and key informant interviews indicate that agricultural productivity in the region remains low, lagging far behind other regions of the world. Contributors to such low productivity include incidence of climate risks (drought, floods and high temperatures), pests and diseases, low technology adoption, limited access to financial services, limited access to markets and market information and limited access to good road networks (Plate 1). All the aforementioned contributors are valid denominators for all the seven ILWAC project areas that were evaluated. 2. Farmers in West Africa are particularly vulnerable to climatic shocks because of their high dependence on rainfed agriculture for their livelihoods. There is an evident lack of access to formal safety nets as indicated by farmers in Senegal (ENRACCA-WA) and Burkina Faso (AmREACCAF and APESS) projects. Climate change has already exerted significant impacts in the region. Since the 1970s, the region has experienced the occurrence of many droughts. Temperatures have increased in the second half of the 20th Century, especially in the latter 20 years of the same period. Farmers reported drought (about 40% of treatment and control groups), as the most prevalent climatic shock experienced over the last five years, followed by erratic rainfall, floods and invasion of crop pests and locusts. We identified eleven coping strategies, out of which three strategies were categorized based on a gradient of severity of food insecurity into low, moderate, and high food insecurity. During low food insecurity, households employ food-maximizing strategies such as purchasing food and eating less food and involving a low commitment of domestic resources that all enable quick recovery of households once the crisis eases. In times of moderate food insecurity, a greater commitment of household resources is increasingly required to meet subsistence needs. Coping strategies developed by households include sale of food reserves, use of savings, sale of livestock, borrowing food, and borrowing money (from friends, relatives, private lenders and banks). During high food insecurity, strategies are a sign of failure to cope with the food crisis and may involve drastic options that may undermine their future ability to prevent, mitigate, cope, and recover from shocks. Households adopt sale of assets such as land and homes, keeping children home from school, food aid and migration. The use of irrigation and rainfall water harvesting for agriculture remain low, despite prevalent droughts and widespread rainfed agricultural practices. One of the reasons is that most farming communities are far from rivers: hence considerable investment is required to develop irrigation in many project areas. 3. Although farmers use various strategies highlighted above, they will need support to double their efforts with innovative climate- smart agricultural practices and technologies to remain food secure. Areas where ILWAC interventions were targeted showed positive results, but broader efforts to scale out the successes are needed to achieve a greater impact. Overall, the ILWAC project beneficiaries reported higher adoption rates of climate-smart practices, demonstrating a favourable impact of the project. However, low awareness of the most appropriate technologies to cope with climate shocks was reported across all study areas yet, the region is expected to experience increasing climatic shocks with total precipitation predicted to increase for the most part more notably between July and October by 2050. Increases in precipitation are predicted to cause crop damages and floods. Overall, temperatures will rise by about 2°C to 3°C over the same time period. Higher temperatures of 3°C to 6°C are projected for the end of the 21st century (Niang et al., 2014). Despite these impending changes, few farmers have adjusted their farming strategies in response to climate risks, owing to limited knowledge on appropriate adaptation options and low endowment with production resources. As a result, ILWAC interventions were targeted to reverse these challenges. Their successful implementation showed positive results, which are largely limited to specific areas of implementation. Therefore, broader scaling out ILWAC interventions provided success stories tailored to specific contexts (biophysical and socio- economic); hence offered lessons and opportunities for replicating the bright spots with a regional approach. Across the seven projects, evaluation results indicated a couple of selected successes in the region (Plate 1). Selected successes make up potential candidates for scaling up climate-smart agricultural technologies and practices, and innovative approaches notably, including: i. Innovation platforms as a pillar for change: The successful establishment of innovation platforms across all project countries was evident but have remained largely underdeveloped and not utilized to their full potential. Platforms provided a framework for sharing knowledge on adaptation innovations to climate change, providing a good entry point for technology dissemination in target areas across all project countries. The study showed that the innovation platform model can offer the potential to organize stakeholders to address the objective of improving the livelihood of their members. IPs, however, need a strong voice to demand the needed services from service providers, negotiate and advocate for collective interests with the private sector and government. The use of a participatory development communication (PDC) within IPs would greatly increase their sustainability; ii. Increased human and institutional capacity for stakeholders: The enhancement of capacity for diverse stakeholder groups, including farmers, players in all segments of priority value chains, extension agents, policymakers and researchers (All project countries) resulted in significant positive results such as increased capacity towards awareness of CSA technologies and application of appropriate adaptation measures in their communities. This highlights the need to prioritize linkages amongst farmer organizations, extension and agricultural research; iii. Integrated landscape approaches for natural resources management provided exponential benefits: The pioneering of integrated land and water management for adaptation to climate variability and change improved management of natural resources in specific target countries, for example, in Burkina Faso, the relative reduction in sedimentation by up to 70%; and that in reduced runoff by up to 30% which helped improve the farmers’ agricultural practices and livelihoods (AmREACCAF-Burkina Faso). This also increased storage of water in the Boura reservoir through avoided sedimentation. Beyond water provision for household use, these reservoirs serve as key food baskets for fisheries and irrigation for households; iv. Integrated and diversified options offered opportunities to increase resilience and unlock the potential for rural smallholder livelihoods: The ILWAC project improved implementation of innovative agronomic interventions that substantially reduced the yield gap for millet for example the use of improved crop varieties (drought tolerant and early maturing) resulted in a 10 fold yield increase in grain biomass (ENRACCASenegal). Additional strategies include soil amendments in the form of organic and inorganic fertilizer sources, weed control practices as well as improved storage techniques (ISFM-Benin); Household enterprise diversification with agroforestry tree species enhanced the resilience of smallholder communities with climatesmart benefits such as windbreaks, these modified the micro-climate of the area that enhanced food security and revenue generation within target communities, increased farmer adaptive capacity and overall soil health attributes (ENRACCA- Senegal). 5. Women empowerment resulted in improved rural livelihoods: Improved gender dynamics regarding the roles, activities and representativeness within the selected projects had a positive impact on women empowerment for all project countries. There are numerous ways by which women were empowered e.g. conducting off-season vegetable cultivation allowed women to fetch increased returns (3 times than the normal price) in the off-season months. There were efforts to promote increased participation of women in the projects, offering opportunities to freely express themselves, highlight their needs and specific experiences. However, participation of women in leadership positions was generally low (less than 10%). In addition, women were able to benefit from the capacity building provided by the project, and access technologies and inputs resulting in higher production and subsequent incomes than before. Male-headed households were more likely to practice more CSA technologies by a factor of about 1 compared to female headed households. There was evidence of better access to financial services and training through village savings and loan associations, and gender empowerment. A key attribute of the assessed projects was that for the most part, women farmers were not well organized into interest groups with the capacity to promote their interests and engage in advocacy activities geared at influencing policy for their ultimate benefit. This was a missed opportunity especially in the context of existing innovation platforms that needs concerted efforts and strengthening. 6. More economic and social safety nets for smallholder livelihoods beyond ILWAC beneficiaries are needed: ILWAC enhanced farmers’ access to climate-resilient and low-emission practices and technologies, including crop, livestock, soil and water management options and energy saving technologies. ILWAC increased the number of CSA practices implemented by three practices more compared to non-participation. Results further showed that education level is associated with higher income. Higher value assets such as livestock did also significantly influenced income. ILWAC increased significantly the value of assets to almost 90%; a factor attributable to additional assets that were distributed to farmer groups such as the case of Gambia, Senegal and Sierra Leone. This study therefore confirms that more assets in ILWAC supported households offered better livelihood options than those in the control group. Results further show that male-headed households have a higher value of assets than female-headed households. On the overall, although participation in ILWAC increased income by 19%, there remains room for further improvement amongst the ILWAC beneficiaries given the lower differences in the economic domain for sustainable intensification exemplified before and after the ILWAC project on Plate 2. Likewise, Plate 2 highlights that better options are needed in the social domain to ensure that ILWAC beneficiaries can significantly gain from social dividends (e.g. strengthened farmer groups, collective action, and shared labor). Given the highlighted successes among the ILWAC beneficiaries, efforts will be needed to scale these bright spots beyond the ILWAC beneficiaries to wider geographical coverages. 7. There is need for concerted efforts towards supporting technical, financial, institutional and governance needs within the target countries in order to make community livelihoods more resilient to climate change. Despite the recorded successes there remains room for improvement in several institutional and governance realms. Farmers in the project sites are faced by poor extension, with the ratio of government paid extension officers to that of farmers being low, only 33% of the households have access to extension service. This has a negative impact on the quality of extension services being offered and building adaptive capacity to deal with climate change. A significant challenge remains in all project countries to get the technologies widely used due to the lack of a suitable enabling environment among others — extension services, financial resources, infrastructure, risk management and cross-sectoral linkages. Farmers are further constrained by having limited access to climatic information. Effective research and innovation are also needed to continuously improve practices and technologies. This calls for a policy recommendation where concerted efforts are needed to mobilize financial resources and build the capacity of West African researchers, policy-makers and institutions to understand, carry out and use good quality data towards informed decision making and scenario analyses (Also see evidence revealed by Plate 2).Enabling policy and institutional environment can provide the conditions and incentives for scaling out