The importance of gender analysis in research for health systems strengthening

This editorial discusses a collection of papers examining gender across a range of health policy and systems contexts, from access to services, governance, health financing, and human resources for health. The papers interrogate differing health issues and core health systems functions using a gender lens. Together they produce new knowledge on the multiple impacts of gender on health experiences and demonstrate the importance of gender analyses and gender sensitive interventions for promoting well-being and health systems strengthening. The findings from these papers collectively show how gender intersects with other axes of inequity within specific contexts to shape experiences of health and health seeking within households, communities and health systems; illustrate how gender power relations affect access to important resources; and demonstrate that gender norms, poverty and patriarchy interplay to limit women’s choices and chances both within household interactions and within the health sector. Health systems researchers have a responsibility to promote the incorporation of gender analyses into their studies in order to inform more strategic, effective and equitable health systems interventions, programmes, and policies. Responding to gender inequitable systems, institutions, and services in this sector requires an ‘all hands-on deck’ approach. We cannot claimto take a ‘people-centred approach’ to health systems if the status quo continues

Management of Banana Xanthomonas Wilt: Evidence from impact of adoption of cultural control practices in Uganda

Banana Xanthomonas Wilt (BXW) is an important emerging and non-curable infectious plant pathogen in sub-Saharan Africa that can cause up to 100% yield loss, negatively impacting sustainable access to food and income to more than 100 million banana farmers. This study disentangles adopters into partial and full adopters to investigate the factors that are relevant to sustain the adoption process of BXW control practices and quantifies the impact of adopting the practices. Data from a randomly selected sample of 1200 banana farmers in Uganda where the disease is endemic was used. A multinomial logit model was used to determine the factors affecting adoption of control practices and augmented inverse probability weighting was employed to estimate the impacts of adoption on banana productivity and sales. Results show that training a woman farmer and having diverse sources of information about BXW control practices increased adoption of the control practices and reduced the disease incidences. Farmers who adopted all the recommended control practices achieved significantly the highest values of banana production and sales. We conclude that improving information access through farmers’ preferred communication channels, having women-inclusive trainings, and a combination of cultural practices are effective ways for sustaining adoption of the control practices

A noninvasive method for quantifying cerebral blood flow by hybrid PET/MRI

Although PET with 15O-water is the gold standard for imaging cerebral blood flow (CBF), quantification requires measuring the arterial input function (AIF), which is an invasive and noisy procedure. To circumvent this problem, we propose a noninvasive PET/MRI approach that eliminates the need to measure AIF by using global CBF determined by phase-contrast (PC) MRI as a reference region. This approach not only is noninvasive but also involves no additional imaging time, because PC MRI and 15O-water PET are acquired simultaneously. The purpose of this study was to test the accuracy of this hybrid method in an animal model in which AIF was measured directly and CBF was varied by changing the arterial CO2 tension. Methods: PET and MRI data were simultaneously acquired in juvenile pigs at hypocapnia (n 5 5), normocapnia (n 5 5), and hypercapnia (n 5 4). CBF was measured by the MRI reference method and by PET alone using an MRI-compatible blood sampling system to measure AIF. Results: Global CBF estimates from PC MRI and 15O-water PET agreed well, with a correlation coefficient of 0.9 and a slope of 0.88. Strong positive correlations (R2 . 0.96) were also found between regional CBF generated by the PET-only and the MRI-reference methods. Conclusion: These findings demonstrate the accuracy of this hybrid PET/MRI approach, which might prove useful in patients for whom obtaining accurate CBF measurements is challenging

Impaired cerebrovascular function in coronary artery disease patients and recovery following cardiac rehabilitation

© 2016 Anazodo, Shoemaker, Suskin, Ssali, Wang and St. Lawrence. Coronary artery disease (CAD) poses a risk to the cerebrovascular function of older adults and has been linked to impaired cognitive abilities. Using magnetic resonance perfusion imaging, we investigated changes in resting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to hypercapnia in 34 CAD patients and 21 age-matched controls. Gray matter volume (GMV)s were acquired and used as a confounding variable to separate changes in structure from function. Compared to healthy controls, CAD patients demonstrated reduced CBF in the superior frontal, anterior cingulate (AC), insular, pre- and post-central gyri, middle temporal, and superior temporal regions. Subsequent analysis of these regions demonstrated decreased CVR in the AC, insula, post-central and superior frontal regions. Except in the superior frontal and precentral regions, regional reductions in CBF and CVR were identified in brain areas where no detectable reductions in GMV were observed, demonstrating that these vascular changes were independent of brain atrophy. Because aerobic fitness training can improve brain function, potential changes in regional CBF were investigated in the CAD patients after completion of a 6-months exercise-based cardiac rehabilitation program. Increased CBF was observed in the bilateral AC, as well as recovery of CBF in the dorsal aspect of the right AC, where the magnitude of increased CBF was roughly equal to the reduction in CBF at baseline compared to controls. These exercise-related improvements in CBF in the AC is intriguing given the role of this area in cognitive processing and regulation of cardiovascular autonomic control

Approaches to the effective utilization of Haplochromis spp. from Lake Victoria. I. Chemical composition in relation to utilization

There are over 150 species of the cichlid genus Huplochrornis in Lake Victoria constituting a major underexploited food resource. As an aid to the processing of the deepwater stock, chemical composition data were obtained for the whole fish (separated into weight groups) and for the head, viscera, flesh and residual portions separately. Data are reported for lipid content, fatty acid composition, crude protein, true protein, amino acid composition, ash and moisture content

A mixed methods and triangulation model for increasing the accuracy of adherence and sexual behaviour data: the Microbicides Development Programme.

Background: The collection of accurate data on adherence and sexual behaviour is crucial in microbicide (and other HIV-related) research. In the absence of a "gold standard" the collection of such data relies largely on participant self-reporting. After reviewing available methods, this paper describes a mixed method/triangulation model for generating more accurate data on adherence and sexual behaviour in a multi-centre vaginal microbicide clinical trial. In a companion paper some of the results from this model are presented [1].Methodology/Principal Findings: Data were collected from a random subsample of 725 women (7.7% of the trial population) using structured interviews, coital diaries, in-depth interviews, counting returned gel applicators, focus group discussions, and ethnography. The core of the model was a customised, semi-structured in-depth interview. There were two levels of triangulation: first, discrepancies between data from the questionnaires, diaries, in-depth interviews and applicator returns were identified, discussed with participants and, to a large extent, resolved; second, results from individual participants were related to more general data emerging from the focus group discussions and ethnography. A democratic and equitable collaboration between clinical trialists and qualitative social scientists facilitated the success of the model, as did the preparatory studies preceding the trial. The process revealed some of the underlying assumptions and routinised practices in "clinical trial culture" that are potentially detrimental to the collection of accurate data, as well as some of the shortcomings of large qualitative studies, and pointed to some potential solutions.Conclusions/Significance: The integration of qualitative social science and the use of mixed methods and triangulation in clinical trials are feasible, and can reveal (and resolve) inaccuracies in data on adherence and sensitive behaviours, as well as illuminating aspects of "trial culture" that may also affect data accuracy

Ebola in the context of conflict affected states and health systems: Case studies of Northern Uganda and Sierra Leone

Ebola seems to be a particular risk in conflict affected contexts. All three of the countries most affected by the 2014-15 outbreak have a complex conflict-affected recent history. Other major outbreaks in the recent past, in Northern Uganda and in the Democratic Republic of Congo are similarly afflicted although outbreaks have also occurred in stable settings. Although the 2014-15 outbreak in West Africa has received more attention than almost any other public health issue in recent months, very little of that attention has focused on the complex interaction between conflict and its aftermath and its implications for health systems, the emergence of the disease and the success or failure in controlling it. The health systems of conflict-affected states are characterized by a series of weaknesses, some common to other low and even middle income countries, others specifically conflict-related. Added to this is the burden placed on health systems by the aggravated health problems associated with conflict. Other features of post conflict health systems are a consequence of the global institutional response. Comparing the experience of Northern Uganda and Sierra Leone in the emergence and management of Ebola outbreaks in 2000-1 and in 2014-15 respectively highlights how the various elements of these conflict affected societies came together with international agencies responses to permit the outbreak of the disease and then to successfully contain it (in Northern Uganda) or to fail to do so before a catastrophic cost had been incurred (in Sierra Leone). These case studies have implications for the types of investments in health systems that are needed to enable effective response to Ebola and other zoonotic diseases where they arise in conflict- affected settings.sch_iih9pub3969pu

Feasibility of simultaneous whole-brain imaging on an integrated PET-MRI system using an enhanced 2-point Dixon attenuation correction method.

PURPOSE: To evaluate a potential approach for improved attenuation correction (AC) of PET in simultaneous PET and MRI brain imaging, a straightforward approach that adds bone information missing on Dixon AC was explored. METHODS: Bone information derived from individual T1-weighted MRI data using segmentation tools in SPM8, were added to the standard Dixon AC map. Percent relative difference between PET reconstructed with Dixon+bone and with Dixon AC maps were compared across brain regions of 13 oncology patients. The clinical potential of the improved Dixon AC was investigated by comparing relative perfusion (rCBF) measured with arterial spin labeling to relative glucose uptake (rPETdxbone) measured simultaneously with (18)F-flurodexoyglucose in several regions across the brain. RESULTS: A gradual increase in PET signal from center to the edge of the brain was observed in PET reconstructed with Dixon+bone. A 5-20% reduction in regional PET signals were observed in data corrected with standard Dixon AC maps. These regional underestimations of PET were either reduced or removed when Dixon+bone AC was applied. The mean relative correlation coefficient between rCBF and rPETdxbone was r = 0.53 (p \u3c 0.001). Marked regional variations in rCBF-to-rPET correlation were observed, with the highest associations in the caudate and cingulate and the lowest in limbic structures. All findings were well matched to observations from previous studies conducted with PET data reconstructed with computed tomography derived AC maps. CONCLUSION: Adding bone information derived from T1-weighted MRI to Dixon AC maps can improve underestimation of PET activity in hybrid PET-MRI neuroimaging

Does gender matter in effective management of plant disease epidemics? Insights from a survey among rural banana farming households in Uganda

Crop diseases significantly suppress plant yields and in extreme cases wipe out entire crop species threatening food security and eroding rural livelihoods. It is therefore critical to estimate the extent to which shocks like disease epidemics can affect food availability and the capacity of smallholder farmers to mitigate and reverse the effects of such shocks. This study utilizes sex-disaggregated data from 341 households in Uganda to analyze: first, gender and access to agricultural resources and their control; second, whether men and women in the targeted banana-farming communities share similar perceptions toward the effectiveness of the banana Xanthomonas wilt (BXW) control technologies and their respective information dissemination pathways; third, whether gender and farmer perceptions influence on farm adoption of BXW management practices. Lastly, it determines the impact of adoption of BXW control practices on food security. Results show that whereas most household assets are jointly owned, men have more individual ownership, control, and decision-making on income from household assets than women. Perceptions on effectiveness of BXW control practices and communication channels also differed between men and women. Men rated cutting down of infected plants to be more effective than women, but tissue culture, removal of male buds and disinfecting of farm tools were perceived to be equally effective by both men and women. In addition, apart from newspapers which were more effective in delivering BXW information to men, we found no differences in the effectiveness of other BXW information sources. More importantly, the study finds both gender and farmer perceptions on BXW control to significantly affect adoption of BXW control practices and household food security. For better and sustainable management of plant epidemics in Uganda, it is therefore critical that existing gender-based and underlying perception constraints are addressed

Selection of cooking banana genotypes for yield and black Sigatoka resistance in different locations in Uganda

It is imperative to systematically evaluate new banana genotypes in different locations before national release. This enables selection and recommendation of superior genotypes as new varieties for a wider range of environments. The objective of the present study was to select banana genotypes with stable and high performance for bunch yield and leaf black Sigatoka resistance. Eleven cooking banana genotypes developed by the Uganda National Agricultural Research Organization in collaboration with Bioversity International, and two check varieties were evaluated in multi-location preliminary yield trials in Uganda. Data collected were analyzed using Additive Main Effects and Multiplicative Interaction (AMMI) model, AMMI Stability Value, and Genotype Selection Index (GSI). Genotype × location interaction was significant for all the traits assessed. Most of the new genotypes had low interaction effects with locations for bunch yield (69.2%) and black Sigatoka (92.3%). The most stable genotypes for bunch yield were NABIO815, NABIO1117, NABIO216 and NABIO306 whereas for black Sigatoka resistance, were NABIO1011, NABIO815, NABIO1009 and NABIO216. Using the GSI that defines the most desirable genotypes as those that combine high agronomic performance and stability across environments, four genotypes (NABIO306, NABIO1011, NABIO808 and NABIO1009) were selected. These genotypes, in addition to their high performance for agronomic traits and stability, had soft and yellow fruit pulp on cooking, and will be advanced on farm for further evaluatio