Mayhem in the mountains. How violent conflict on the hauts plateaux of South Kivu escalated

This report analyses the history and causes of the escalation of violence on the Hauts Plateaux, a mountainous area located in South Kivu Province, eastern Congo. It argues that this violence can be ascribed to four mechanisms. The first is discourses of ‘ethnic conflict’ and ‘autochthony’. Yet the tendency to see all violence as linked to ethnicity is problematic as it obscures other drivers of conflict and violence and leads to attributing collective responsibility, revenge violence and the blurring of boundaries between armed groups and civilians. The second mechanism is the security dilemma. In part due the perceived partiality of the Congolese army, the presence of armed groups considered ‘ethnic’ prompts counter-mobilization. The third mechanism is militarization, or the tendency of local, national and regional politico-military elites to resort to force to win disputes. The fourth mechanism is the multilayered nature of dynamics of conflict and violence, as local, provincial, national and regional developments alike shape the crisis on the Plateaux. Stemming the violence requires addressing all four mechanisms. However, stabilization initiatives neither account for militarization nor the multiplicity of drivers for conflict and violence. To tackle the crisis, interventions need to acknowledge the role of political-military elites at all levels, including national and regional dynamics

High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among HIV-1 negative men who have sex with men in coastal Kenya

To assess the burden of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in high-risk HIV-1 negative men who have sex with men (MSM) in Africa.

The effect of membership in producer organizations on women's empowerment: Evidence from Kenya

In developing countries, producer organizations (POs) are important for achieving women empowerment mainly through promoting women's access to the organization's resources and services. However, by improving access to markets and technologies, household membership in POs often results in commercialization of smallholder farming, leading to women disempowerment as men take over control of the farm. We use data from dairy smallholders in Kenya to explore the impact of membership in bargaining and processing POs on women empowerment. Applying the Women Empowerment Livestock Index, we capture six domains of empowerment: production; nutrition; resources; income; opportunities; and workload. We find that when a household joins any PO, regardless of whether the man or the woman in the household is the registered member, women achieve a higher control over production decisions, buying and selling of land and cows, use of loans and receiving dairy income. Distinguishing by gender of membership, there is stronger women empowerment when the woman in the household is a member. We also find that woman membership in bargaining POs results in greater empowerment, in terms of ownership of cows, than woman membership in processing POs. The paper suggests that women empowerment is affected by the functional characteristics of POs.</p

Business models of producer organizations

This work is part of the PhD project on producer organizations, social inclusion and food safety, carried under the research program “Local and International business collaboration for productivity and Quality Improvement in Dairy chains in Southeast Asia and East Africa (LIQUID).” The research program was funded by the Netherlands Organisation for Scientific Research’s (NWO) Science for Global Development department (WOTRO) through the Food and Business Global Challenges Programme (GCP). The data were collected from managers and board members of 22 producer organizations(POs) in Meru and Nyandarua counties, Kenya. Information collected covered topics on governance structure of POs, membership, geographical coverage, customers, PO establishment, key functions and services, revenue, costs and value proposition. This dataset was used for examining the business model components of POs and deriving a typology of POs based on the business model components

Timely Response and Containment of 2016 Cholera Outbreak in Northern Zambia

Background: The Northern Province of Zambia has recorded outbreaks of Cholera in Nsumbu area over the years including the year 2008 and 2012. Recently, an outbreak of cholera was reported in Northern Province between March and April 2016. This study aims to document the appropriateness of the response to the cholera outbreak to guide outbreak preparedness and timely response in the future.Method: A prospective study where a team was put in place to investigate an outbreak of diarrhoeal disease of undetermined cause. The team comprising of surveillance, medical, environmental and laboratory staff was formed to investigate this outbreak within the context of cholera an on-going cholera epidemic Lusaka and other parts of Zambia. Stool samples and water samples were taken for laboratory investigations. Various interventions including contact tracing and community sensitisation were employed to contain the outbreak. A descriptive analysis of the data and review of literature was used to determine the quality of detection, investigation and response to this cholera outbreak.Results: Sixty six people were clinically affected 8 of who were laboratory confirmed for strain 01 Ogawa. The case fatality rate (CFR) was 4.5%(3/66). The outbreak was detected and contained within 24 days.Discussion: The CFR was high compared to the WHO standards of a similar scenario in the 2012 outbreak in the same area. Of the 3 deaths, one was brought in dead and a week into the outbreak while the other two died at the health facility. The two fell sick in Congo DR and brought to Kapisha health post for treatment. Although the high CFR indicates inadequate response or poor case management the general response and management of the cases seemed adequate with detection and response within 48 hours of the notification. The interventions employed played a pivotal role in containing the outbreak.Conclusion: Based on the CFR, the response to the outbreak was inadequate. However, the outbreak was generally well managed. The interventions implored as a response to the outbreak and active and rapid response contributed to the containment of the cholera in Nsama district within a short period

Producer organizations, social inclusion and food safety

This work is part of a PhD project on producer organizations, social inclusion and food safety in the Kenyan dairy chains, carried under the research program “Local and International business collaboration for productivity and Quality Improvement in Dairy chains in Southeast Asia and East Africa (LIQUID).” The research program was funded by the Netherlands Organisation for Scientific Research’s (NWO) Science for Global Development department (WOTRO) through the Food and Business Global Challenges Programme (GCP). The data for this PhD project were collected from 595 dairy smallholder farmers in Kenya consisting of 395 members of POs and 200 non-members. Information collected covered topics on the socioeconomic characteristics of farmers such as age, sex, assets ownership and farmers' participation in decision-making in POs. Further, to understand issues of women empowerment, information on ownership, control and access to resources and opportunities was collected as well as workload and time management. Food safety topics like environmental cleaning, cleaning of milk and milking vessels, animal health and hygiene milking practice were asked. Information on food safety was supplemented with key informant interviews with experts in the dairy value chain who identified appropriate food safety measures applied in the Kenyan context and ranked the importance of food safety measures in ensuring milk safety

Predictors of singleton preterm birth using multinomial regression models accounting for missing data: A birth registry-based cohort study in northern Tanzania.

BackgroundPreterm birth is a significant contributor of under-five and newborn deaths globally. Recent estimates indicated that, Tanzania ranks the tenth country with the highest preterm birth rates in the world, and shares 2.2% of the global proportion of all preterm births. Previous studies applied binary regression models to determine predictors of preterm birth by collapsing gestational age at birth to MethodsWe carried out a secondary analysis of cohort data from the KCMC zonal referral hospital Medical Birth Registry for 44,117 women who gave birth to singletons between 2000-2015. KCMC is located in the Moshi Municipality, Kilimanjaro region, northern Tanzania. Data analysis was performed using Stata version 15.1. Assuming a nonmonotone pattern of missingness, data were imputed using a fully conditional specification (FCS) technique under the missing at random (MAR) assumption. Multinomial regression models with robust standard errors were used to determine predictors of moderately to late ([32,37) weeks of gestation) and very/extreme (ResultsThe overall proportion of preterm births among singleton births was 11.7%. The trends of preterm birth were significantly rising between the years 2000-2015 by 22.2% (95%CI 12.2%, 32.1%, pConclusionsThe trends of preterm birth have increased over time in northern Tanzania. Policy decisions should intensify efforts to improve maternal and child care throughout the course of pregnancy and childbirth towards preterm birth prevention. For a positive pregnancy outcome, interventions to increase uptake and quality of ANC services should also be strengthened in Tanzania at all levels of care, where several interventions can easily be delivered to pregnant women, especially those at high-risk of experiencing adverse pregnancy outcomes

Effect of isoniazid preventive therapy on tuberculosis incidence and associated risk factors among HIV infected adults in Tanzania: a retrospective cohort study

Abstract Background Tuberculosis (TB) continues to be the leading cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals in Sub Saharan Africa including Tanzania. Provision of isoniazid preventive therapy (IPT) is one of the public health interventions to reduce the burden of TB among HIV infected persons. However there is limited information about the influence of IPT on TB incidence in Tanzania. This study aimed at ascertaining the effect of IPT on TB incidence and to determine risk factors for TB among HIV positive adults in Dar es Salaam region. Methods A retrospective cohort study was conducted using secondary data of HIV positive adults receiving care and treatment services in Dar es Salaam region from 2011 to 2014. TB incidence rate among HIV positive adults on IPT was compared to those who were not on IPT during the follow up period. Risk factors for incident TB were estimated using multivariate Cox proportional hazards regression model. Results A total of 68,378 HIV positive adults were studied. The median follow up time was 3.4 (IQR = 1.9–3.8) years for patients who ever received IPT and 1.3 (IQR = 0.3–1.3) years among those who never received IPT. A total of 3124 TB cases occurred during 114,926 total person-years of follow up. The overall TB incidence rate was 2.7/100 person-years (95%CI; 2.6–2.8). Patients on IPT had 48% lower TB incidence rate compared to patients who were not on IPT (IRR = 0.52, 95%CI; 0.46–0.59). Factors associated with higher risk for incident TB included; being male (aHR = 1.8, 95% CI; 1.6–2.0), WHO stage III (aHR = 2.7, 95% CI; 2.3–3.3) and IV (aHR = 2.4, 95% CI; 1.9–3.1),being underweight (aHR = 1.7, 95% CI; 1.5–1.9) while overweight (aHR = 0.7, 95% CI; 0.6–0.8), obese (aHR = 0.5, 95% CI; 0.4–0.7), having baseline CD4 cell count between 200 and 350 cells/μl (aHR = 0.7, 95% CI; 0.6–0.8) and CD4 count above 350 cells/μl (aHR = 0.5, 95% CI; 0.4–0.6) were associated with lower risk of developing TB. Conclusion Isoniazid preventive therapy (IPT) has shown to be effective in reducing TB incidence among HIV infected adults in Dar es Salaam. More efforts are needed to increase the provision and coverage of IPT

Predictors of perinatal death in the presence of missing data: A birth registry-based study in northern Tanzania.

BACKGROUND:More than five million perinatal deaths occur each year globally. Despite efforts put forward during the millennium development goals era, perinatal deaths continue to increase relative to under-five deaths, especially in low- and middle-income countries. This study aimed to determine predictors of perinatal death in the presence of missing data using birth registry data from Kilimanjaro Christian Medical Center (KCMC), between 2000-2015. METHODS:This was a retrospective cohort study from the medical birth registry at KCMC referral hospital located in Moshi Municipality, Kilimanjaro region, northern Tanzania. Data were analyzed using Stata version 15.1. Multiple imputation by fully conditional specification (FCS) was used to impute missing values. Generalized estimating equations (GEE) were used to determine the marginal effects of covariates on perinatal death using a log link mean model with robust standard errors. An exchangeable correlation structure was used to account for the dependence of observations within mothers. RESULTS:Among 50,487 deliveries recorded in the KCMC medical birth registry between 2000-2015, 4.2% (95%CI 4.0%, 4.3%) ended in perinatal death (equivalent to a perinatal mortality rate (PMR) of 41.6 (95%CI 39.9, 43.3) deaths per 1,000 births). After the imputation of missing values, the proportion of perinatal death remained relatively the same. The risk of perinatal death was significantly higher among deliveries from mothers who resided in rural compared to urban areas (RR = 1.241, 95%CI 1.137, 1.355), with primary education level (RR = 1.201, 95%CI 1.083, 1.332) compared to higher education level, with <4 compared to ≥4 antenatal care (ANC) visits (RR = 1.250, 95%CI 1.146, 1.365), with postpartum hemorrhage (PPH) (RR = 2.638, 95%CI 1.997, 3.486), abruption placenta (RR = 4.218, 95%CI 3.438, 5.175), delivered a low birth weight baby (LBW) (RR = 4.210, 95%CI 3.788, 4.679), male child (RR = 1.090, 95%CI 1.007, 1.181), and were referred for delivery (RR = 2.108, 95%CI 1.919, 2.317). On the other hand, deliveries from mothers who experienced premature rupture of the membranes (PROM) (RR = 0.411, 95%CI 0.283, 0.598) and delivered through cesarean section (CS) (RR = 0.662, 95%CI 0.604, 0.724) had a lower risk of perinatal death. CONCLUSIONS:Perinatal mortality in this cohort is higher than the national estimate. Higher risk of perinatal death was associated with low maternal education level, rural residence, <4 ANC visits, PPH, abruption placenta, LBW delivery, child's sex, and being referred for delivery. Ignoring missing values in the analysis of adverse pregnancy outcomes produces biased covariate coefficients and standard errors. Close clinical follow-up of women at high risk of experiencing perinatal death, particularly during ANC visits and delivery, is of high importance to increase perinatal survival