Natural resource integrity: A resilient community on the degraded slopes of Mount Elgon takes on mending its broken landscape

The once beautiful foothills of Mount Elgon, in eastern Uganda are today seriously degraded, with excessive water run-offs and landslides becoming regular occurrences. Restoring the health and productive potential of the agroecosystem had become a dire need of those, mostly women, who stayed to farm it. By challenging the status quo and doing things differently, the Kapchorwa District Landcare Chapter (KADLACC) has been helping this farming community over the past fifteen years to manage its natural resources more sustainably, as well as more profitably. By building on the innovation skills of the community, by helping it address local challenges and by empowering the women of the community to manage their natural resources in sustainable ways, the platform has helped to restore much of what has been lost in recent decades. Before the platform was established, crops, properties, infrastructure and even lives were regularly destroyed. Trees and other vegetation were removed indiscriminately to make room for farms and settlements. Fragile soils were exposed to the agents of erosion. Heavily sloped land was tilled. Women, although providing up to 90% of the agricultural labour force, had little decision-making power. Household incomes and food security declined steeply, along with soil fertility and women’s engagement. With the establishment of KADLACC, twin journeys towards land restoration and women’s empowerment began. Community members were quick to support the entire process. Awareness of women’s rights was raised through consultative processes from village to sub-county levels, engaging individual farmers, farmer groups, local government officials and external actors. Community members, through farmer learning cycles, were linked to trained facilitators. This helped farmers and farmer groups consolidate their grassroots understanding of the challenges they faced and the options they could employ to address them. Livelihood goals were linked to conservation goals. Local-level policy reforms helped define and encourage women’s ownership and control over land. Over these 15 years, community by-laws supporting watershed management, land restoration and agroforestry practices have been developed and implemented. Women have been given greater priority in natural resource management decision-making. Some 300 women displaced from their land have been granted access to collective land for organic and horticultural farming. And by improving this community’s access to agricultural and information services, KADLACC has helped this farm community significantly improve its productivity, while restoring the integrity of its natural resource base

Comparison of demographic and clinical characteristics between pulmonary and extra-pulmonary tuberculosis patients in Kiambu County, 2012-2015

Background: Tuberculosis (TB) continues to be a public health challenge globally. The most common organ to be involved is the lung although it can affect any organ in the body. The diagnosis of extra-pulmonary TB (EPTB) has faced many challenges mainly due to inadequate expertise to diagnose or lack of equipment for diagnosis.Objective: To compare the demographic and clinical characteristics between pulmonary and extrapulmonary tuberculosis in Kiambu CountyDesign: Retrospective cross-sectional studySetting: Kiambu County, KenyaSubjects: Tuberculosis patients notified in TIBU surveillance systemResults: Of the 15, 833 patients analyzed, 2,704 (17%) had extra-pulmonary tuberculosis. Male to female ratio was 1:1.7 in PTB and 1:1.3 in EPTB patients. There was declining trend of TB cases notified over the years for both PTB and EPTB. Pleural TB accounted for 38% with TB lymphadenitis accounting for 14% of the EPTB subtypes. TB-HIV co-infection was higher among EPTB (36%) compared to PTB (30%). The treatment success rate was 85% and 86% among PTB and EPTB cases respectively. The mortality was 10% among EPTB and 5% in PTB cases. The 5-14 age category were more likely to developing EPTB compared to PTB (AOR 4.67 95% CI (1.5-13.99). Kabete zone was most affected with EPTB (AOR 2.11(1.19-2.74) while a protective factor was observed among the HIV positive clients (AOR 0.58 (0.43 - 0.78)Conclusion: There was a general decline in cases for both EPTB and PTB. However, the age category most affected was 5-14 years. The co-infectivity rate was higher among the EPTB patients compared to the PTB patients. High index of suspicion and appropriate diagnostic tools are needed in evaluation particularly in EPTB which will assist in early management of the patients. ART uptake could play a big role in protecting HIV positive clients from getting EPTB

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

The cost‐effectiveness of prophylaxis strategies for individuals with advanced HIV starting treatment in Africa

Introduction Many HIV‐positive individuals in Africa have advanced disease when initiating antiretroviral therapy (ART) so have high risks of opportunistic infections and death. The REALITY trial found that an enhanced‐prophylaxis package including fluconazole reduced mortality by 27% in individuals starting ART with CD4 <100 cells/mm3. We investigated the cost‐effectiveness of this enhanced‐prophylaxis package versus other strategies, including using cryptococcal antigen (CrAg) testing, in individuals with CD4 <200 cells/mm3 or <100 cells/mm3 at ART initiation and all individuals regardless of CD4 count. Methods The REALITY trial enrolled from June 2013 to April 2015. A decision‐analytic model was developed to estimate the cost‐effectiveness of six management strategies in individuals initiating ART in the REALITY trial countries. Strategies included standard‐prophylaxis, enhanced‐prophylaxis, standard‐prophylaxis with fluconazole; and three CrAg testing strategies, the first stratifying individuals to enhanced‐prophylaxis (CrAg‐positive) or standard‐prophylaxis (CrAg‐negative), the second to enhanced‐prophylaxis (CrAg‐positive) or enhanced‐prophylaxis without fluconazole (CrAg‐negative) and the third to standard‐prophylaxis with fluconazole (CrAg‐positive) or without fluconazole (CrAg‐negative). The model estimated costs, life‐years and quality‐adjusted life‐years (QALY) over 48 weeks using three competing mortality risks: cryptococcal meningitis; tuberculosis, serious bacterial infection or other known cause; and unknown cause. Results Enhanced‐prophylaxis was cost‐effective at cost‐effectiveness thresholds of US$300 and US$500 per QALY with an incremental cost‐effectiveness ratio (ICER) of US$157 per QALY in the CD4 <200 cells/mm3 population providing enhanced‐prophylaxis components are sourced at lowest available prices. The ICER reduced in more severely immunosuppressed individuals (US$113 per QALY in the CD4 <100 cells/mm3 population) and increased in all individuals regardless of CD4 count (US$722 per QALY). Results were sensitive to prices of the enhanced‐prophylaxis components. Enhanced‐prophylaxis was more effective and less costly than all CrAg testing strategies as enhanced‐prophylaxis still conveyed health gains in CrAg‐negative patients and savings from targeting prophylaxis based on CrAg status did not compensate for costs of CrAg testing. CrAg testing strategies did not become cost‐effective unless the price of CrAg testing fell below US$2.30. Conclusions The REALITY enhanced‐prophylaxis package in individuals with advanced HIV starting ART reduces morbidity and mortality, is practical to administer and is cost‐effective. Efforts should continue to ensure that components are accessed at lowest available prices

Late Presentation With HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial.

This article has been accepted for publication in Clinical Infectious Diseases Published by Oxford University PressBackground: Severely immunocompromised human immunodeficiency virus (HIV)-infected individuals have high mortality shortly after starting antiretroviral therapy (ART). We investigated predictors of early mortality and "late presenter" phenotypes. Methods: The Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children ≥5 years of age with CD4 counts .1). Results: Among 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P < .04). Receiving enhanced antimicrobial prophylaxis independently reduced mortality (P = .02). Of five late-presenter phenotypes, Group 1 (n = 355) had highest mortality (25%; median CD4 count, 28 cells/µL), with high symptom burden, weight loss, poor mobility, and low albumin and hemoglobin. Group 2 (n = 394; 11% mortality; 43 cells/µL) also had weight loss, with high white cell, platelet, and neutrophil counts suggesting underlying inflammation/infection. Group 3 (n = 218; 10% mortality) had low CD4 counts (27 cells/µL), but low symptom burden and maintained fat mass. The remaining groups had 4%-6% mortality. Conclusions: Clinical and laboratory features identified groups with highest mortality following ART initiation. A screening tool could identify patients with low CD4 counts for prioritizing same-day ART initiation, enhanced prophylaxis, and intensive follow-up. Clinical Trials Registration: ISRCTN43622374.REALITY was funded by the Joint Global Health Trials Scheme (JGHTS) of the UK Department for International Development, the Wellcome Trust, and Medical Research Council (MRC) (grant number G1100693). Additional funding support was provided by the PENTA Foundation and core support to the MRC Clinical Trials Unit at University College London (grant numbers MC_UU_12023/23 and MC_UU_12023/26). Cipla Ltd, Gilead Sciences, ViiV Healthcare/GlaxoSmithKline, and Merck Sharp & Dohme donated drugs for REALITY, and ready-to-use supplementary food was purchased from Valid International. A. J. P. is funded by the Wellcome Trust (grant number 108065/Z/15/Z). J. A. B. is funded by the JGHTS (grant number MR/M007367/1). The Malawi-Liverpool–Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine (grant number 101113/Z/13/Z) and the Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi (grant number 203077/Z/16/Z) are supported by strategic awards from the Wellcome Trust, United Kingdom. Permission to publish was granted by the Director of KEMRI. This supplement was supported by funds from the Bill & Melinda Gates Foundation

Justice in the Forest: Rural Livelihood and Forest Law Enforcement

There has been considerable growing internationalconcern with illegal forest activities over the lastdecade or so. Illegal forest activities are said tocause massive environmental destruction, deprivegovernments of billions of dollars in lost revenuesand generally undermine the rule of law.The concern for illegal activities in forest thathave resulted in deforestation has, in turn, led toincreased studies in the existing forest laws. Thesestudies have recently suggested that many forestrylaws and regulations can discriminate against smallproducers and that a large number of people dependon small-scale illegal forestry activities to survive. Ithas, therefore, been postulated that enforcing theselaws might potentially harm poor people. It is alsofeared that some government authorities wouldselectively target small producers, truck drivers andforestry workers rather than the big players who areresponsible for most of the real problems.As a result of these concerns, the Centrefor International Forestry Research (CIFOR)commissioned exploratory studies drawn from sixcountries (Bolivia, Cameroon, Canada, Honduras,Indonesia and Nicaragua) to help think through theselegal issues in practice and in different contexts. Thestudies were coordinated and reports synthesizedinto the present final report. The findings of thereport can be summarized in the following thematicareas

Emission data from combustion of rice husk briquettes

This data is for measurement of NOx, SOx, CO2 and CxHy from combustion of carbonized rice husk briquettes in a fixed bed. The measurement were done for various air mass fluxes and biochar ratios

Soot formation in methyl esters

The data presented are numerical investigation of soot formation in five methyl esters. This include methyl linolenate (MLe), methyl stearate (MS), methyl oleate (MO), methyl linoleate (MLi) and methyl palmitate (MP). The study was done in co-flow jet flames. ANSYS software was used to carried out the simulation.THIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV

Combustion of carbonized and non-carbonized rice husk briquettes in a fixed bed

This data are experimental results for combustion of carbonized and non-carbonized rice husk briquettes in a fixed bed. It contains results for temperature distribution in the bed for various briquettes samples, namely, 25 % carbonized/ 75 % non-carbonized, 50 % carbonized/ 50 % non-carbonized, 75 % carbonized/ 25 % non-carbonized and 100 % carbonized/ 0 % non-carbonized. It also has mass loss history results for the four mixtures.THIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV

Emission data from combustion of rice husk briquettes

This data is for measurement of NOx, SOx, CO2 and CxHy from combustion of carbonized rice husk briquettes in a fixed bed. The measurement were done for various air mass fluxes and biochar ratios.THIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV