The Effect of Distance to Formal Health Facility on Childhood Mortality in Rural Tanzania, 2005-2007.

Major improvements are required in the coverage and quality of essential childhood interventions to achieve Millennium Development Goal Four (MDG 4). Long distance to health facilities is one of the known barriers to access. We investigated the effect of networked and Euclidean distances from home to formal health facilities on childhood mortality in rural Tanzania between 2005 and 2007. A secondary analysis of data from a cohort of 28,823 children younger than age 5 between 2005 and 2007 from Ifakara Health and Demographic Surveillance System was carried out. Both Euclidean and networked distances from the household to the nearest health facility were calculated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on child mortality. Children who lived in homes with networked distance>5 km experienced approximately 17% increased mortality risk (HR=1.17; 95% CI 1.02-1.38) compared to those who lived <5 km networked distance to the nearest health facility. Death of a mother (HR=5.87; 95% CI 4.11-8.40), death of preceding sibling (HR=1.9; 95% CI 1.37-2.65), and twin birth (HR=2.9; 95% CI 2.27-3.74) were the strongest independent predictors of child mortality. Physical access to health facilities is a determinant of child mortality in rural Tanzania. Innovations to improve access to health facilities coupled with birth spacing and care at birth are needed to reduce child deaths in rural Tanzania

Thinking outside the plot: monitoring forest biodiversity for social-ecological research

Protecting biodiversity, either for its own sake or for its value to humanity, is a principal goal of conservation efforts worldwide. For this reason, many studies on the social science of resource management and governance seek to quantify biodiversity outcomes. Here, we focus on the International Forestry Resources and Institutions program to demonstrate some of the challenges of quantitative biodiversity assessment and suggest ways to overcome them. One of this program's research goals is to understand the causes of biodiversity loss, which is explicitly assessed using plot-based forest sampling. Plot-based methods to capture biodiversity changes require huge amounts of data. Even if sampling is sufficient, existing protocols can only capture changes in the types of species actually sampled, typically trees. Other elements of biodiversity are not censused, including animals, herbs, shrubs, fungi, and epiphytes that may provide medicine, food, wildlife habitat, trade items, or cultural goods. Using case studies of two sites in Uganda, we demonstrate that more spatially extensive surveys targeting multiple types of data can give a broader picture of forest status and changes than can plot-based sampling alone; many relevant variables can be observed while traveling among plot points with little additional effort. Reviewing the ecological literature, we identify correlates of forest status that can supplement plot-based sampling. These include large trees, epiphyte-laden trees, culturally or commercially valuable species, large stumps, and evidence of hunting and trapping. Further, data elicited from local resource users can play an important role in biodiversity monitoring. These findings suggest that effective biodiversity monitoring may be within easier reach than previously thought, although robust comparisons among sites remains a challenge, especially when climate, soils, or site history differ greatly

MARKET SURVEY OF MONDIA WHYTEI (MULONDO) ROOTS IN KAMPALA CITY, UGANDA

This study explored the consumers’ and vendors’ perceptions about Mondia whitei roots, in Kampala city, Uganda; determined the marketing margins and the market flow of the roots in the city; documented demand and supply opportunities as well as challenges to marketing of the roots by the vendors. Seventy vendors and 70 consumers of the roots were administered with semi-structured questionnaires. Results showed that M. whytei roots are largely perceived as sexual stimulant, appetiser, flavours for food and drinks, and stimulant for milk production in lactating mothers. Majority of the vendors (74%) and consumers (85%) perceived the trade in the roots as worthwhile. Men and adolescent boys were reported to be the main consumers. Retailers who buy the roots directly from collectors and later sell to consumers dominate the trade. The average price charged per piece and a kilogram of roots increases from collectors, middlemen and to the retailers. The average retail price was US $0.12 per piece of the root and US$ 1.50 per kg of the roots. Collectors charged the lowest price (US $0.06 and US$ 0.60 per piece and a kilogram of the roots respectively) though their profit margins remained the highest (50%). Several demand and supply opportunities exist for M. whytei roots and these included few sexual stimulant accepted alternatives to M. whytei roots in Kampala city; consumers’ willingness to pay high prices when the roots are scarce, and a large number of M. whytei roots gatherers that could promote the cultivation of this plant for the market. Challenges, such as seasonal low supply of the roots, and unorganised market structure, hamper the trade in M. whytei roots. There is a need for experimental research on efficacies of the perceived uses of the roots reported in this study. The possibility of value addition to the roots sold should be investigated

Farmers\u27 Attitudes Towards On-Farm Cultivation of Indigenous Fruit Trees in Adwari Sub-County, Lira District, Uganda

This study was conducted in Adwari sub-county, Lira district to (i) determine the conservation status and threats to indigenous fruit trees (IFTs), (ii) assess farmers’ attitudes towards IFT cultivation, (iii) documents local knowledge on propagation and management of IFTs, and (iv) identify opportunities and constraints to promotion of IFTs cultivation. Semi-structured questionnaires were administered to a total of 120 randomly selected respondents. MINITAB statistical package was used to analyze the data. Logistic regression analysis was performed to show the influence of socio-economic characteristics on farmers’ towards their attitudes to plant IFTs. The population of IFTs was found to be generally declining. The major reasons for decline were charcoal burning and firewood collection. Although, majority of farmers had positive attitudes towards cultivation of IFTs, their attitudes were influenced by gender, education level, farm size and occupation status. Lack of clear markets for indigenous fruits, unclear information about their food values, lack of seedlings in local nurseries, and dearth of information propagation techniques were the major hindrance to cultivation of IFTs. There is a need especially by local governments and local councils to formulate clear strategies on conservation of IFTs for example by establishing a community nursery and propagation center for IFTs. There is a need to address the issue of marketing and pricing of indigenous tree fruit products. Lastly, there is a need of further study to analyze the market environment for indigenous tree fruits compared with alternative possibilities such as exotic fruits or agricultural crops

Comparison of Parametric and Nonparametric Methods for Analyzing the Bias of a Numerical Model

Numerical models are presently applied in many fields for simulation and prediction, operation, or research. The output from these models normally has both systematic and random errors. The study compared January 2015 temperature data for Uganda as simulated using the Weather Research and Forecast model with actual observed station temperature data to analyze the bias using parametric (the root mean square error (RMSE), the mean absolute error (MAE), mean error (ME), skewness, and the bias easy estimate (BES)) and nonparametric (the sign test, STM) methods. The RMSE normally overestimates the error compared to MAE. The RMSE and MAE are not sensitive to direction of bias. The ME gives both direction and magnitude of bias but can be distorted by extreme values while the BES is insensitive to extreme values. The STM is robust for giving the direction of bias; it is not sensitive to extreme values but it does not give the magnitude of bias. The graphical tools (such as time series and cumulative curves) show the performance of the model with time. It is recommended to integrate parametric and nonparametric methods along with graphical methods for a comprehensive analysis of bias of a numerical model

Social autopsy: INDEPTH Network experiences of utility, process, practices, and challenges in investigating causes and contributors to mortality

<p>Abstract</p> <p>Background</p> <p>Effective implementation of child survival interventions depends on improved understanding of cultural, social, and health system factors affecting utilization of health care. Never the less, no standardized instrument exists for collecting and interpreting information on how to avert death and improve the implementation of child survival interventions.</p> <p>Objective</p> <p>To describe the methodology, development, and first results of a standard social autopsy tool for the collection of information to understand common barriers to health care, risky behaviors, and missed opportunities for health intervention in deceased children under 5 years old.</p> <p>Methods</p> <p>Under the INDEPTH Network, a social autopsy working group was formed to reach consensus around a standard social autopsy tool for neonatal and child death. The details around 434 child deaths in Iganga/Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda and 40 child deaths in Dodowa HDSS in Ghana were investigated over 12 to 18 months. Interviews with the caretakers of these children elicited information on what happened before death, including signs and symptoms, contact with health services, details on treatments, and details of doctors. These social autopsies were used to assess the contributions of delays in care seeking and case management to the childhood deaths.</p> <p>Results</p> <p>At least one severe symptom had been recognized prior to death in 96% of the children in Iganga/Mayuge HDSS and in 70% in Dodowa HDSS, yet 32% and 80% of children were first treated at home, respectively. Twenty percent of children in Iganga/Mayuge HDSS and 13% of children in Dodowa HDSS were never taken for care outside the home. In both countries most went to private providers. In Iganga/Mayuge HDSS the main delays were caused by inadequate case management by the health provider, while in Dodowa HDSS the main delays were in the home.</p> <p>Conclusion</p> <p>While delay at home was a main obstacle to prompt and appropriate treatment in Dodowa HDSS, there were severe challenges to prompt and adequate case management in the health system in both study sites in Ghana and Uganda. Meanwhile, caretaker awareness of danger signs needs to improve in both countries to promote early care seeking and to reduce the number of children needing referral. Social autopsy methods can improve this understanding, which can assist health planners to prioritize scarce resources appropriately.</p

Mixed-method study to assess the feasibility, acceptability and early effectiveness of the Hospital to Home programme for follow-up of high-risk newborns in a rural district of Central Uganda: a study protocol.

INTRODUCTION: A follow-up programme designed for high-risk newborns discharged from inpatient newborn units in low-resource settings is imperative to ensure these newborns receive the healthiest possible start to life. We aim to assess the feasibility, acceptability and early outcomes of a discharge and follow-up programme, called Hospital to Home (H2H), in a neonatal unit in central Uganda. METHODS AND ANALYSIS: We will use a mixed-methods study design comparing a historical cohort and an intervention cohort of newborns and their caregivers admitted to a neonatal unit in Uganda. The study design includes two main components. The first component includes qualitative interviews (n=60 or until reaching saturation) with caregivers, community health workers called Village Health Team (VHT) members and neonatal unit staff. The second component assesses and compares outcomes between a prospective intervention cohort (n=100, born between July 2019 and September 2019) and a historical cohort (n=100, born between July 2018 and September 2018) of infants. The historical cohort will receive standard care while the intervention cohort will receive standard care plus the H2H intervention. The H2H intervention comprises training for healthcare workers on lactation, breast feeding and neurodevelopmentally supportive care, including cue-based feeding, and training to caregivers on recognition of danger signs and care of their high-risk infants. Infants and their families receive home visits until 6 months of age, or longer if necessary, by specially trained VHTs. Quantitative data will be analysed using descriptive statistics and regression analysis. All results will be stratified by cohort group. Qualitative data will be analysed guided by Braun and Clarke's thematic analysis technique. ETHICS AND DISSEMINATION: This study protocol was approved by the relevant Ugandan ethics committees. All participants will provide written informed consent. We will disseminate through peer-reviewed publications and key stakeholders and public engagement. TRIAL REGISTRATION NUMBER: ISRCTN51636372; Pre-result

Improvements on Restricted Insecticide Application Protocol for Control of Human and Animal African Trypanosomiasis in Eastern Uganda

African trypanosomes constrain livestock and human health in Sub-Saharan Africa, and aggravate poverty and hunger of these otherwise largely livestock-keeping communities. To solve this, there is need to develop and use effective and cheap tsetse control methods. To this end, we aimed at determining the smallest proportion of a cattle herd that needs to be sprayed on the legs, bellies and ears (RAP) for effective Human and Animal African Trypanosomiasis (HAT/AAT) control.; Cattle in 20 villages were ear-tagged and injected with two doses of diminazene diaceturate (DA) forty days apart, and randomly allocated to one of five treatment regimens namely; no treatment, 25%, 50%, 75% monthly RAP and every 3 month Albendazole drench. Cattle trypanosome re-infection rate was determined by molecular techniques. ArcMap V10.3 was used to map apparent tsetse density (FTD) from trap catches. The effect of graded RAP on incidence risk ratios and trypanosome prevalence was determined using Poisson and logistic random effect models in R and STATA V12.1 respectively. Incidence was estimated at 9.8/100 years in RAP regimens, significantly lower compared to 25.7/100 years in the non-RAP regimens (incidence rate ratio: 0.37; 95% CI: 0.22-0.65; P>0.001). Likewise, trypanosome prevalence after one year of follow up was significantly lower in RAP animals than in non-RAP animals (4% vs 15%, OR: 0.20, 95% CI: 0.08-0.44; P>0.001). Contrary to our expectation, level of protection did not increase with increasing proportion of animals treated.; Reduction in RAP coverage did not significantly affect efficacy of treatment. This is envisaged to improve RAP adaptability to low income livestock keepers but needs further evaluation in different tsetse challenge, HAT/AAT transmission rates and management systems before adopting it for routine tsetse control programs

Thinking outside the plot: monitoring forest biodiversity for social-ecological research

Protecting biodiversity, either for its own sake or for its value to humanity, is a principal goal of conservation efforts worldwide. For this reason, many studies on the social science of resource management and governance seek to quantify biodiversity outcomes. Here, we focus on the International Forestry Resources and Institutions program to demonstrate some of the challenges of quantitative biodiversity assessment and suggest ways to overcome them. One of this program's research goals is to understand the causes of biodiversity loss, which is explicitly assessed using plot-based forest sampling. Plot-based methods to capture biodiversity changes require huge amounts of data. Even if sampling is sufficient, existing protocols can only capture changes in the types of species actually sampled, typically trees. Other elements of biodiversity are not censused, including animals, herbs, shrubs, fungi, and epiphytes that may provide medicine, food, wildlife habitat, trade items, or cultural goods. Using case studies of two sites in Uganda, we demonstrate that more spatially extensive surveys targeting multiple types of data can give a broader picture of forest status and changes than can plot-based sampling alone; many relevant variables can be observed while traveling among plot points with little additional effort. Reviewing the ecological literature, we identify correlates of forest status that can supplement plot-based sampling. These include large trees, epiphyte-laden trees, culturally or commercially valuable species, large stumps, and evidence of hunting and trapping. Further, data elicited from local resource users can play an important role in biodiversity monitoring. These findings suggest that effective biodiversity monitoring may be within easier reach than previously thought, although robust comparisons among sites remains a challenge, especially when climate, soils, or site history differ greatly

Spatial Variation of WRF Model Rainfall Prediction over Uganda

Rainfall is a major climatic parameter affecting many sectors such as health, agriculture and water resources. Its quantitative prediction remains a challenge to weather forecasters although numerical weather prediction models are increasingly being used for rainfall prediction. The performance of six convective parameterization schemes, namely the Kain-Fritsch scheme, the Betts-Miller-Janjic scheme, the Grell-Deveny scheme, the Grell-3D scheme, the Grell-Fretas scheme, the New Tiedke scheme of the weather research and forecast (WRF) model regarding quantitative rainfall prediction over Uganda is investigated using the root mean square error for the March-May (MAM) 2013 season. The MAM 2013 seasonal rainfall amount ranged from 200 mm to 900 mm over Uganda with northern region receiving comparatively lower rainfall amount (200–500 mm); western Uganda (270–550 mm); eastern Uganda (400–900 mm) and the lake Victoria basin (400–650 mm). A spatial variation in simulated rainfall amount by different convective parameterization schemes was noted with the Kain-Fritsch scheme over estimating the rainfall amount over northern Uganda (300–750 mm) but also presented comparable rainfall amounts over the eastern Uganda (400–900 mm). The Betts-Miller-Janjic, the Grell-Deveny, and the Grell-3D underestimated the rainfall amount over most parts of the country especially the eastern region (300–600 mm). The Grell-Fretas captured rainfall amount over the northern region (250–450 mm) but also underestimated rainfall over the lake Victoria Basin (150–300 mm) while the New Tiedke generally underestimated rainfall amount over many areas of Uganda. For deterministic rainfall prediction, the Grell-Fretas is recommended for rainfall prediction over northern Uganda while the Kain-Fritsch scheme is recommended over eastern region