New Antenatal Model in Africa and India (NAMAI) study: implementation research to improve antenatal care using WHO recommendations

Background: In 2020, an estimated 287 000 women died globally from pregnancy‐related causes and 2 million babies were stillborn. Many of these outcomes can be prevented by quality healthcare during pregnancy and childbirth. Within the continuum of maternal health, antenatal care (ANC) is a key moment in terms of contact with the health system, yet it remains an underutilized platform. This paper describes the protocol for a study conducted in collaboration with Ministries of Health and country research partners that aims to employ implementation science to systematically introduce and test the applicability of the adapted WHO ANC package in selected sites across four countries. Methods: Study design is a mixed methods stepped-wedge cluster randomized implementation trial with a nested cohort component (in India and Burkina Faso). The intervention is composed of two layers: (i) the country- (or state)-specific ANC package, including evidence-based interventions to improve maternal and newborn health outcomes, and (ii) the co-interventions (or implementation strategies) to help delivery and uptake of the adapted ANC package. Using COM-B model, co-interventions support behaviour change among health workers and pregnant women by (1) training health workers on the adapted ANC package and ultrasound (except in India), (2) providing supplies, (3) conducting mentoring and supervision and (4) implementing community mobilization strategies. In Rwanda and Zambia, a fifth strategy includes a digital health intervention. Qualitative data will be gathered from health workers, women and their families, to gauge acceptability of the adapted ANC package and its components, as well as experience of care. The implementation of the adapted ANC package of interventions, and their related costs, will be documented to understand to what extent the co-interventions were performed as intended, allowing for iteration. Discussion: Results from this study aim to build the global evidence base on how to implement quality ANC across different settings and inform pathways to scale, which will ultimately lead to stronger health systems with better maternal and perinatal outcomes. On the basis of the study results, governments will be able to adopt and plan for national scale-up, aiming to improve ANC nationally. This evidence will inform global guidance. Trial registration number: ISRCTN, ISRCTN16610902. Registered 27 May 2022. https://www.isrctn.com/ISRCTN16610902

Prévalence du dessèchement du manguier et evaluation de la fréquence des champignons associés à la maladie au Burkina Faso

Objectif: l’objectif de l’étude est de contribuer au diagnostic du dessèchement du manguier au Burkina Faso. Il s’agit d’une part d’évaluer l’incidence et la sévérité de la maladie sur cinq variétés commerciales provenant du  Nahouri, de la Sissili, du Houet, de la Comoé, du Kénédougou et de la Léraba et d’autre part d’inventorier les espèces de champignons associées aux symptômes de la maladie.Méthodologie et résultats: Une échelle de 1 à 5 a été utilisée pour l’évaluation de l’incidence et de la sévérité du desséchement du manguier dans six provinces du Burkina Faso. Sa prévalence a été évaluée sur cinq variétés commerciales du pays. Les taux d’infections des espèces de champignons ont été calculés à partir des échantillons des manguiers malades. Les résultats révèlent une forte incidence du dessèchement de manguier dans le Nahouri (86%) et une forte sévérité (58,2%). Cependant, les plus faibles valeurs ont été constatées dans la Léraba avec 42,8% d’incidence et 29,8% de sévérité. Le Kénédougou, le Houet, la Comoé et la Sissili ont enregistré des incidences moyennes comprises entre (43,6%) à (81,6%) et de sévérités moyennes entre (30,88%) à (50,8%). La plus forte prévalence (77%) a été enregistrée sur la variété Amélie, suivie de Kent, Keitt, et Lippens. Le plus faible taux (34%) a été observé sur Brooks. Sept espèces de champignons ont été inventoriées. Le plus fort taux d’infection a été enregistré pour le champignon Pestalotiopsis microspora (53,5 %), suivi de Botryodiplodia theobromae, Fusarium sp, Curvularia sp, Aspergillus niger, et de Botrytis cinerea. Le plus faible taux (1.25%) a été noté pour Colletotrichum gloesporiodes.Conclusion et Application: Ces résultats renseignent de l’importance du dessèchement des manguiers ainsi que les espèces de champignons associées à la maladie au Burkina Faso. Des études de caractérisation moléculaire couplées au test de pathogénie devraient permettre d’incriminer les espèces fongiques responsables de la maladie pour mieux la contrôler.Mots clés: Dessèchement, Manguier, Incidence, Sévérité, Champignons, Burkina FasoEnglish Title: Prevalence of mango tree decline and evaluation of fungi frequency associated disease in Burkina FasoEnglish AbstractObjective: The objective of the study is to contribute to the diagnosis of the mango tree decline in Burkina Faso. It is to evaluate incidence and severity of this disease in five commercial varieties from Nahouri, Sissili, Houet, Comoé, Kénédougou and Léraba and to inventory the fungal species associated with the symptoms of the disease.Methodology and results: Incidence and severity of mango tree decline symptoms were calculated according to allotted scale from 1 to 5 on diseased trees. Prevalence was also assessed on Kent, Keitt, Amélie Lippens and Brooks commercial varieties from the six previously mentioned producing provinces of Burkina Faso. Samples of infected plant were collected and incubated for the inventory and infection rate of the fungal species. The frequency of fungal species were also carried out from the different organs of the mango tree. Survey resultsshowed highest mango decline incidence (86%) and severity (58.2%) in the visited orchards of Nahouri. However, least incidence of (42.8%) and severity of (29.8%) were observed in Léraba. Intermediate values of incidence and severity of the desease were observed in Kénédougou, Houet and Comoé. Maximum prevalence of disease (77%) was calculated on cultivar Amélie followed by Kent ; Keitt, and Lippens. The minimum disease incidence (34%) was noted on Brooks. Seven species of fungi were inventoried. The highest frequency was recorded in Pestalotiopsis microspora (53.5%) followed by Botryodiplodia theobromae, Fusarium sp, Curvularia sp, Aspergillus sp and Botrytis cinerea. The least rate (1.25%) were noted in Colletotrichum gloesporiodes.Conclusion and application: These results indicate the importance of the mango decline and the species of fungi associated with the disease in Burkina Faso. Pathogenicity and molecular analyzes should allow to incriminate the fungal species responsible for the disease to better control.Keywords: decline, mango, incidence, severity, fungi, Burkina Fas

Factors Associated with Seasonal Food Insecurity among Small-Scale Subsistence Farming Households in Rural Honduras

In the context of climate change, a nutritional transition, and increased pressures to migrate internally and internationally, this study examined the relationship between seasonal food insecurity and demographic, socioeconomic, and agricultural production factors among small-scale subsistence farmers in rural northern Honduras. Anchored by a partnership with the Fundación para la Investigación Participativa con Agricultores de Honduras (FIPAH) and the Yorito Municipal Health Centre, a cross-sectional household survey was administered in Yorito, Honduras, in July 2014. The study population included 1263 individuals from 248 households across 22 rural communities. A multivariate mixed effects negative binomial regression model was built to investigate the relationship between the self-reported number of months without food availability and access from subsistence agriculture in the previous year (August 2013–July 2014) and demographic, socioeconomic, and agricultural production variables. This study found a lengthier ‘lean season’ among surveyed household than previously documented in Honduras. Overall, 62.2% (95% confidence interval (CI): [59.52, 64.87]) of individuals experienced at least four months of insufficient food in the previous year. Individuals from poorer and larger households were more likely to experience insufficient food compared to individuals from wealthier and smaller households. Additionally, individuals from households that produced both maize and beans were less likely to have insufficient food compared to individuals from households that did not grow these staple crops (prevalence ratio (PR) = 0.83; 95% CI: [0.69, 0.99]). Receiving remittances from a migrant family member did not significantly reduce the prevalence of having insufficient food. As unpredictable crop yields linked to climate change and extreme weather events are projected to negatively influence the food security and nutrition outcomes of rural populations, it is important to understand how demographic, socioeconomic, and agricultural production factors may modify the ability of individuals and households engaged in small-scale subsistence agriculture to respond to adverse shocks