The multiplicity of malaria transmission: a review of entomological inoculation rate measurements and methods across sub-Saharan Africa

Plasmodium falciparum malaria is a serious tropical disease that causes more than one million deaths each year, most of them in Africa. It is transmitted by a range of Anopheles mosquitoes and the risk of disease varies greatly across the continent. The "entomological inoculation rate" is the commonly-used measure of the intensity of malaria transmission, yet the methods used are currently not standardized, nor do they take the ecological, demographic, and socioeconomic differences across populations into account. To better understand the multiplicity of malaria transmission, this study examines the distribution of transmission intensity across sub-Saharan Africa, reviews the range of methods used, and explores ecological parameters in selected locations. It builds on an extensive geo-referenced database and uses geographical information systems to highlight transmission patterns, knowledge gaps, trends and changes in methodologies over time, and key differences between land use, population density, climate, and the main mosquito species. The aim is to improve the methods of measuring malaria transmission, to help develop the way forward so that we can better assess the impact of the large-scale intervention programmes, and rapid demographic and environmental change taking place across Africa

Are health systems interventions gender blind? examining health system reconstruction in conflict affected states

Background Global health policy prioritizes improving the health of women and girls, as evident in the Sustainable Development Goals (SDGs), multiple women’s health initiatives, and the billions of dollars spent by international donors and national governments to improve health service delivery in low-income countries. Countries recovering from fragility and conflict often engage in wide-ranging institutional reforms, including within the health system, to address inequities. Research and policy do not sufficiently explore how health system interventions contribute to the broader goal of gender equity. Methods This paper utilizes a framework synthesis approach to examine if and how rebuilding health systems affected gender equity in the post-conflict contexts of Mozambique, Timor Leste, Sierra Leone, and Northern Uganda. To undertake this analysis, we utilized the WHO health systems building blocks to establish benchmarks of gender equity. We then identified and evaluated a broad range of available evidence on these building blocks within these four contexts. We reviewed the evidence to assess if and how health interventions during the post-conflict reconstruction period met these gender equity benchmarks. Findings Our analysis shows that the four countries did not meet gender equitable benchmarks in their health systems. Across all four contexts, health interventions did not adequately reflect on how gender norms are replicated by the health system, and conversely, how the health system can transform these gender norms and promote gender equity. Gender inequity undermined the ability of health systems to effectively improve health outcomes for women and girls. From our findings, we suggest the key attributes of gender equitable health systems to guide further research and policy. Conclusion The use of gender equitable benchmarks provides important insights into how health system interventions in the post-conflict period neglected the role of the health system in addressing or perpetuating gender inequities. Given the frequent contact made by individuals with health services, and the important role of the health system within societies, this gender blind nature of health system engagement missed an important opportunity to contribute to more equitable and peaceful societies

Autonomous adaptation to global environmental change in peri-urban settlements: Evidence of a growing culture of innovation and revitalisation in Mathare Valley Slums, Nairobi

The growth of peri-urban areas is increasingly recognised as a dominant planning and urban design challenge for the 21st century. In burgeoning poor urban settlements growing on city margins, autonomous adaptation strategies are often the only measures to respond to increasing climatic and compounding stressors. Yet, in both research and practice there remains lack of understanding regarding the dynamics of adaptation and risk reduction at the level of the community. In this paper, we argue urban slums are ideal places to consider adaptation because they offer examples of more extreme social-ecological stress than one finds in more established communities – the kind we can anticipate more broadly in the face of climate change. A framework for identifying local adaptation processes is presented and applied to analyse the case of Mathare Valley Slums in Nairobi, Kenya – a densely populated suburb, where residents are regularly exposed to flooding from heavy rainfall. Findings reveal that slums, often viewed as illegitimate, makeshift, and temporary settlements, are places experienced by many residents as permanent communities characterised by rapid environmental change. Processes of adaptation in Mathare have become institutionalised through time, as a new generation of people imagine themselves staying and (re)organise to achieve a higher level of functioning through various strategies to reduce risk. Innovative and revitalising adaptation occurs as residents shift from employing more generic and expected coping strategies, such as evacuating homes or economic diversification, to creating “gated” communities and savings schemes to maintain and improve the settlement, despite uncertain tenure. Both formal and informal institutions, such as youth groups, play an important role in governing such heterogeneous localities, incrementally upgrading the slum and providing critical public services. Long-term residents' increasing recognition of the permanence of the slum community and its stressful conditions appears to lead to more collective action toward adaptation pathways. However, this is in marked contrast to the dominant non-local perspective of Mathare's status as both impermanent and illegal, which prevails among government officials. As such, strategies are generally not incorporated into planned interventions. While progressive policies designed to reduce risk exist, they remain nascent in their establishment and fail to benefit slumdwellers. The case illustrates the need to incorporate the wealth of knowledge, techniques, and experience extant at the community level in the development of adaptation planning