Theory-driven formative research to inform the design of a national sanitation campaign in Tanzania - Household Interview Guide

There are gaps in global understanding about how to design and implement interventions to improve sanitation. This formative research study provided insights for the subsequent redesign of a government-led national sanitation campaign targeting rural populations in Tanzania. The Behaviour Centred Design approach was used to investigate the determinants of toilet building, improvement and use. Varied, novel, and interactive research tools were employed in fifty-five households in two regions of rural Tanzania. Results were analysed to articulate a Theory of Change, which then informed intervention design

Theory-driven formative research to inform the design of a national sanitation campaign in Tanzania.

INTRODUCTION: There are gaps in global understanding about how to design and implement interventions to improve sanitation. This formative study provided insights for the subsequent redesign of a government-led national sanitation campaign targeting rural populations in Tanzania. METHODS: The Behaviour Centred Design approach was used to investigate the determinants of toilet building, improvement and use. Varied, novel, and interactive research tools were employed in fifty-five households in two regions of rural Tanzania. Results were analysed to articulate a Theory of Change, which then informed intervention design. RESULTS: Participants valued hard work, enterprise, and improving their lives over many years. They wanted better toilets but felt no urgency to act quickly. A common emotional motivator for improving toilets was to protect children from disease (Nurture) but this was insufficient to drive rapid change. Disgust with traditional toilets meant they were built at a distance from the house: an 'out of sight, out of mind' attitude. Other powerful motives included the desire to improve living conditions (Create), and to become a modern Tanzanian (Status), albeit without 'showing off'. Construction costs and water scarcity were the main stated barriers. Receiving information about realistic costs, support accessing materials, and visiting better latrines elsewhere were commonly reported reasons for improving latrines. CONCLUSIONS: The resulting Theory of Change recommended that the intervention should surprise people with a novel conversation about toilets, promote toilets as a means of conferring status, and introduce a perceived urgency to 'act now'. It should suggest that modest improvements would lead to a better life. Feelings of disgust and fear with poor quality toilets should be amplified, and barriers lessened through promoting transformational toilet improvements, and improving access to modern toilet products. This research provided considerable insight into sanitation behaviours in rural Tanzania, which informed creative intervention design

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Evaluation of an Inexpensive Handwashing and Water Treatment Program in Rural Health Care Facilities in Three Districts in Tanzania, 2017

Unsafe water, sanitation, and hygiene (WASH) conditions in healthcare facilities (HCFs) can increase the risk of disease transmission, yet WASH coverage is inadequate in HCFs in most low- and middle-income countries. In September 2017, we conducted a baseline survey of WASH coverage in 100 HCFs in three rural Tanzanian districts. Based on needs calculated from the baseline, we distributed handwashing and drinking water stations, soap, and chlorine solution; we repeated the survey 10 months later. The intervention improved coverage with handwashing stations (82% vs. 100%, p &lt; 0.0001), handwashing stations with water (59% vs. 96%, p &lt; 0.0001), handwashing stations with soap and water (19% vs. 46%, p &lt; 0.0001), and handwashing stations with soap and water within 5 m of latrines (26% vs. 53%, p &lt; 0.0001). Coverage of drinking water stations increased from 34% to 100% (p &lt; 0.0001) HCFs with at least one drinking water station with free chlorine residual (FCR) &gt; 0.2mg/ml increased from 6% to 36% (p &lt; 0.0001), and in a sample of HCFs, detectable E. coli in stored drinking water samples decreased from 46% to 5% (p &lt; 0.001). Although the program increased access to handwashing stations, drinking water stations, and safe drinking water in HCFs in rural Tanzania, modest increases in soap availability and water treatment highlighted persistent challenges

Contributing to the debate on categorising shared sanitation facilities as 'unimproved': An account based on field researchers' observations and householders' opinions in three regions, Tanzania.

Health risks associated with poor sanitation behaviours continue to be reported mostly from low-income countries (LICs). Reports show that various factors limit many people from accessing and using improved latrines, forcing some to opt for sharing latrines with neighbours, others practicing open defecation. Meanwhile, debate prevails on whether shared latrines should be categorised as unimproved according to WHO/UNICEF-JMP criteria. We contribute to this debate based on results from a study undertaken in three regions, Tanzania.Data were collected through observations in 1,751 households with latrines, coupled with collection of opinions from heads of such households regarding the latrine-sharing practices. Bivariate and multivariate logistic regression analyses were performed to assess associations between the outcome and possible predictor variables.Of all 1,751 latrines, 14.6% were shared. Among the shared latrines, 74.2% were found being generally clean as compared to 69.2% of the non-shared ones. Comparing the shared and non-shared latrines, the non-shared latrines were significantly less likely to be found with floors built with permanent materials (OR = 0.73, 95% CI: 0.55, 0.98); washable floors (OR = 0.69; 95% CI: 0.51, 0.93); and lockable doors (OR = 0.73; 95% CI: 0.56, 0.95). Shared latrines were less likely to have floors with faecal matter, functional handwashing facilities (HWFs), HWFs with running water, and roofs; albeit the differences in all these scenarios were not statistically significant. Respondents expressed desire for improved latrines, but also did not find it wrong to share latrines if cleanliness was maintained.Having an 'improved' latrine remains important as JMP recommends, but based on our study findings, we argue that possessing a non-shared latrine neither guarantees safety to its users nor its categorisation as 'improved'. Instead, the state of the latrine, the construction technology used and the behaviours of the users may be more important

Isolation and characterization of beneficial soil microorganisms from Mediterranean regions to use in agroecosystems.

Anthropogenic activities pose a significant threat to the natural capital of the soil which includes its fertility, biodiversity and ability to support ecosystems. In this context the use of indigenous beneficial soil microbiota can firmly increase the resilience of these systems. Under field conditions plants interact with a multitude of microorganisms. Among them plant growth-promoting bacteria (PGPB) and arbuscular mycorrhizal fungi (AMF) represent a fundamental component of soil fertility through their role in plant growth, health and productivity. The main goal of the PRIMA project is to promote support a farming system that boosts the efficiency of water use and aid soil conservation and fertility in arid and semiarid climates, compatible with the development of smallholder conservation agriculture by introducing the rational use of beneficial soil microbiota and an intercropping system using perennial such as cactus pear and short-term species such as Leguminosae and cereals. In the present work, it is reported the isolation, the molecular identification, and the physiological characterization of rhizospheric bacteria from three Morocco sites differing for their climatic conditions (humid, semi-arid and arid) as well as the isolation and the molecular identification of AMF spores from Algeria and Tunisia. To find good PGPB candidates that will be later applied in field conditions, different assays on the bacterial strains, such as growth compatibility test and germination and in vivo tests using sorghum plants, have been carried out. Finally, the AMF spores have been propagated to obtain a pure inoculum that will be tested individually or in consortium on different plant species. Simultaneously in vivo test on cactus pear inoculated or not with AMF was carried out. The aim of this experiment is to observe if the presence of the mycorrhizal fungi can improve the development and stress resistance of the plants during the early growth stages