Development and utilization of a decision support tool for the optimization of fertilizer application in smallholder farms in Uganda

This paper presents the development and pilot of the Fertilizer Optimization Tool (FOT), a decision support tool for use by extension agents in  advising smallholder farmers in Uganda in applying optimum (rather than maximum) fertilizer by considering the farmers’ financial abilities. The FOT is made up of three components which includes, the optimizer tool, the nutrient substitution table, and a fertilizer calibration tool. The FOT was developed using field trial data collected on specific agro-ecological zones and mapped using global positioning systems in 13 Sub-Saharan Africa countries. The FOT provides site- and farmer-specific fertilizer recommendations, providing both economic and environmental benefits. Results are based on a survey of 241 households, 57 technical personnel and tracking of 33 FOT users over a 3-season period. Results show a progressive shift in farmers’ attitude towards the value of fertilizer. More FOT users (71%) disagreed with the statement that fertilizers destroy soils, compared with  non-FOT users (52%). Crop yields (tons/ha) were significantly higher for crops receiving fertilizers compared to those not. While it is generally accepted that using fertilizer improves crop response and achieves better yields, the value of FOT was reported in terms of rationalization of investment by farmers. The average seasonal investment was approx. $43, giving a return on investment of over 107%. Given the evidence  generated from Uganda, there is a need for considering out scaling the FOT technology to other countries in Africa, which are faced with the same challenges of low fertilizer use among smallholder farmers. Using the mobile FOT app provides a further cost-effective opportunity to out scale the approach to benefit more smallholder farmers in sub-Saharan Africa. Further development of the FOT is suggested, particularly in the wake of increased focus on multi-nutrient fertilizer blends, and the need to adjust for soil PH, moisture, and long-term impacts of nutrient substitution. Key words: decision support tool, fertilizer optimization tool, precision agriculture, site-specific fertilizer recommendation

Bringing sustainable agricultural intensification practices and technologies to scale through campaign-based extension approaches: lessons from Africa Soil Health Consortium

Open Access Article; Published online: 19 Sep 2021Sustainable agricultural intensification (SAI) practices have been developed with the aim of increasing agricultural productivity. However, most of them are not achieving their potential because of low adoption, linked to limited extension support to make them known and accessible by end-users. This paper reviews the effectiveness of the Africa Soil Health Consortium (ASHC) extension-based campaigns, contributing knowledge for formulating novel and cost-effective extension approaches. Results show that ASHC campaigns achieved scale of farmer reach and spurred adoption of promoted SAI technologies. Adoption levels for a range of practices were at least 20%, which favourably compares with reported adoption rates for the training and visit extension approach; 1-7% and 11-21% for complex and simple practices respectively. In comparison to a single channel, exposure to multiple communication approaches was associated with higher uptake of promoted practices and technologies, and also increased participation of men, women and youth, by addressing inherent differences in access to, proficiency with, and preferences of communication channels. Success factors associated with ASHC campaigns were; the deployment of multiple and complementary information channels; harnessing public-private partnerships to establish sustainable input supply chains; and development of localized content and fit-for-purpose information materials to facilitate information diffusion

Integrated management of HIV, diabetes, and hypertension in sub-Saharan Africa (INTE-AFRICA): a pragmatic cluster-randomised, controlled trial

BACKGROUND: In sub-Saharan Africa, health-care provision for chronic conditions is fragmented. The aim of this study was to determine whether integrated management of HIV, diabetes, and hypertension led to improved rates of retention in care for people with diabetes or hypertension without adversely affecting rates of HIV viral suppression among people with HIV when compared to standard vertical care in medium and large health facilities in Uganda and Tanzania. METHODS: In INTE-AFRICA, a pragmatic cluster-randomised, controlled trial, we randomly allocated primary health-care facilities in Uganda and Tanzania to provide either integrated care or standard care for HIV, diabetes, and hypertension. Random allocation (1:1) was stratified by location, infrastructure level, and by country, with a permuted block randomisation method. In the integrated care group, participants with HIV, diabetes, or hypertension were managed by the same health-care workers, used the same pharmacy, had similarly designed medical records, shared the same registration and waiting areas, and had an integrated laboratory service. In the standard care group, these services were delivered vertically for each condition. Patients were eligible to join the trial if they were living with confirmed HIV, diabetes, or hypertension, were aged 18 years or older, were living within the catchment population area of the health facility, and were likely to remain in the catchment population for 6 months. The coprimary outcomes, retention in care (attending a clinic within the last 6 months of study follow-up) for participants with either diabetes or hypertension (tested for superiority) and plasma viral load suppression for those with HIV (>1000 copies per mL; tested for non-inferiority, 10% margin), were analysed using generalised estimating equations in the intention-to-treat population. This trial is registered with ISCRTN 43896688. FINDINGS: Between June 30, 2020, and April 1, 2021 we randomly allocated 32 health facilities (17 in Uganda and 15 in Tanzania) with 7028 eligible participants to the integrated care or the standard care groups. Among participants with diabetes, hypertension, or both, 2298 (75·8%) of 3032 were female and 734 (24·2%) of 3032 were male. Of participants with HIV alone, 2365 (70·3%) of 3365 were female and 1000 (29·7%) of 3365 were male. Follow-up lasted for 12 months. Among participants with diabetes, hypertension, or both, the proportion alive and retained in care at study end was 1254 (89·0%) of 1409 in integrated care and 1457 (89·8%) of 1623 in standard care. The risk differences were -0·65% (95% CI -5·76 to 4·46; p=0·80) unadjusted and -0·60% (-5·46 to 4·26; p=0·81) adjusted. Among participants with HIV, the proportion who had a plasma viral load of less than 1000 copies per mL was 1412 (97·0%) of 1456 in integrated care and 1451 (97·3%) of 1491 in standard care. The differences were -0·37% (one-sided 95% CI -1·99 to 1·26; pnon-inferiority<0·0001 unadjusted) and -0·36% (-1·99 to 1·28; pnon-inferiority<0·0001 adjusted). INTERPRETATION: In sub-Saharan Africa, integrated chronic care services could achieve a high standard of care for people with diabetes or hypertension without adversely affecting outcomes for people with HIV. FUNDING: European Union Horizon 2020 and Global Alliance for Chronic Diseases