SOCIO-ECONOMIC IMPACT OF BIOTECHNOLOGY APPLICATIONS: SOME LESSONS FROM THE PILOT TISSUE-CULTURE (TC) BANANA PRODUCTION PROMOTION PROJECT IN KENYA, 1997-2002

This article is based on a socio-economic impact study of the introduction and adoption of tissue-culture (tc) technology in banana production in Kenya. It attempts to demonstrate that a prudent introduction and promotion of a new biotechnological innovation in farming can make a positive contribution to the socio-economic status of resource poor farmers in a developing country, such as Kenya. Adoption of tc technology in banana production in Kenya is considered a good example of biotechnological applications in agriculture. Hence the article hopes to make a contribution to recent debates at international levels as to whether biotechnology can make a difference in uplifting the living standards of people in the third world (Qaim, 1999; Graff, et al 2002; Qaim, et al 2002) by showing that it actually does so, using experiences from Kenya. The study utilizes both primary and secondary data sources. The results show that tc-banana production is relatively more capital intensive than non-tc banana production (re: about 70% fixed costs for tc banana versus about 49% fixed costs for non-tc banana). However, tc-banana production is found to offer relatively much higher financial returns than non-tc banana production. The high profitability of tc-banana production relative to traditional (non-tc) banana production and other farm enterprises in the pilot tc-banana project area in Kenya demonstrates the importance of biotechnological applications in rural development and shows that biotechnology can make a difference in uplifting the living standards of people in the third world. Therefore, efforts to promote tc-banana production in Kenya are justifiable from both food security and economic criteria.Biotechnology and Tissue-Culture (tc) Banana, Adoption, Socio-economic Impact, Rural Development, Third World, Kenya., Crop Production/Industries, Research and Development/Tech Change/Emerging Technologies,

Understanding the relationship dynamics between female sex workers and their intimate partners in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report presents findings from a qualitative study examining vulnerability to HIV and the prevention needs of men involved in intimate relationships with female sex workers (FSW) in Kumasi, Ghana. The study was conducted by a collaborative team of researchers from Boston University’s Center for Global and Health and Development (CGHD), Kwame Nkrumah University of Science and Technology (KNUST), and FHI 360. It is the last of nine small qualitative studies conducted under the Operations Research among Key Populations in Ghana project designed to gather in-depth, personal information from members of key populations about their vulnerability to HIV and other threats to their health and well-being. This project was funded by the United States Agency for International Development Ghana in collaboration with the Ghana AIDS Commission (GAC). The findings will be used to strengthen harm reduction interventions for sex workers and their intimate partners. Intimate partners of FSW are a population of growing interest in Ghana, where interventions focused on sex workers and both their paying and non-paying partners are being implemented by FHI 360 and other local organizations with support from the GAC and USAID. In 2012 Boston University and KNUST conducted a qualitative study looking at the backgrounds, living conditions, vulnerabilities, and HIV prevention needs of young female sex workers in Kumasi. Most (22/24) of the young women participating in in-depth interviews reported having a boyfriend or intimate partner, and half reported either never or only sometimes using condoms with these partners (1). In addition, quantitative data from two previous integrated bio-behavioral surveillance studies (IBBSS) conducted in 2009 and 2011 provide critical data showing the degree to which these men and their female partners (both those involved in sex work and others) are highly vulnerable to HIV and other sexually transmitted infections. The specific objectives were to: explore the emotional, financial and other power dynamics within these relationships; describe the sexual behaviors and HIV knowledge and vulnerabilities of both partners; and document the perceived availability and accessibility of social support and health services.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Research report: Exploring the beliefs, attitudes, and behaviors of MSM engaged in substance use and transactional sex in Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report presents findings from a qualitative study examining the vulnerability to HIV of young men who have sex with men (MSM) in Kumasi, Ghana, and their prevention needs. The study was jointly conducted in Kumasi, Ghana’s second largest urban center, by Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST). It was carried out as a component of Project SEARCH funded by the United States Agency for International Development. The study was designed and conducted in collaboration with FHI 360 (formerly Family Health International (FHI)), an international non‐governmental organization based in the capital city of Accra which operates programs targeting MSM and other key populations in Kumasi, and the Ghana AIDS Commission (GAC). Preventing HIV among key populations in Ghana is a major goal for the National AIDS Control Program (NACP) and the GAC.1 MSM are a particularly stigmatized population in Ghana, in part because male‐to‐male sex has traditionally been viewed as illegal, making them a difficult yet critical to reach population with HIV/AIDS‐related services. This qualitative study was conducted in order to enhance understanding of the beliefs, attitudes, and behaviors of adolescent and young MSM (aged 15‐29). In this population, we particularly sought to focus on two sub‐groups: MSM who engage in transactional sex and those who use alcohol or illicit substances (hereinafter “substances”). The specific objectives were to explore: 1) the types and extent of substance use by MSM; 2) the overlap between substance use and transactional sex among MSM; 3) the beliefs and attitudes related to substance use and transactional sex; 4) knowledge and risk behaviors of both subgroups. The study’s broader goal was to collect and analyze in‐depth data that can be used to improve the outreach and effectiveness of local programs that aim to reach these groups with important HIV prevention and treatment information and with services appropriate to their needs.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Attitudes and behaviors among older MSM in Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report provides the findings of a qualitative study that explored vulnerability to HIV of men who have sex with men (MSM) in Kumasi, Ghana. It is the second of two related studies focusing on MSM. The first study, “Exploring the beliefs, attitudes, and behaviors of MSM engaged in substance use and transactional sex in Ghana,”1 focused on adolescent and young adult MSM aged 15 to 29 years. This companion study focused on ‘older MSM’, encompassing individuals aged 30 years and above. This research was conducted by a collaborative team comprised of researchers from Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST). The team conducted this research in Kumasi, Ghana’s second largest urban center. It is a component of the ‘Operations Research for Key Populations in Ghana’ Program funded by the United States Agency for International Development (USAID). We designed and carried out the study in collaboration with FHI 360, an organization based in the capital of Accra that operates programs targeting MSM and other high‐risk individuals in Ghana, as well as the Ghana AIDS Commission (GAC). Reducing vulnerability to HIV infection among high‐risk populations in Ghana is a major goal for the National AIDS Control Program (NACP) and the GAC. MSM are highly stigmatized in Ghana, in part because male‐to‐male sex is illegal. This makes it extremely challenging to understand the challenges these men face and ensure that they have access to HIV‐ and AIDS‐related services. We designed this qualitative study to add to what is known about the beliefs, attitudes, and behaviors of older MSM in Ghana. We focused on two groups among older MSM: those aged 30‐39 years and those aged 40 years and above. Given the need for more data on these groups to better reach them with effective HIV prevention and treatment information, the study aimed to explore: 1) How older MSM find their sex partners; 2) Their views of HIV risk; 3) Their risky behaviors, including those situations in which they are most likely to engage in risky sex; 4) HIV‐related services they receive; and 5) What services would be most helpful to them. The broad goal of the study was to collect and analyze in‐depth data in order to improve the outreach and effectiveness of local programs that aim to reach older MSM with important HIV prevention and treatment information and with services appropriate to their needs.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Informing HIV prevention efforts targeting Liberian youth: a study using the PLACE method in Liberia

BackgroundPreventing HIV infection among young people is a priority for the Liberian government. Data on the young people in Liberia are scarce but needed to guide HIV programming efforts.MethodsWe used the Priorities for Local AIDS Control Efforts (PLACE) method to gather information on risk behaviors that young people (ages 14 to 24) engage in or are exposed to that increase their vulnerability for HIV infection. Community informants identified 240 unique venues of which 150 were visited and verified by research staff. 89 of the 150 venues comprised our sampling frame and 571 females and 548 males were interviewed in 50 venues using a behavioral survey.ResultsNinety-one percent of females and 86% of males reported being sexually active. 56% of females and 47% of males reported they initiated sexual activity before the age of 15. Among the sexually active females, 71% reported they had received money or a gift for sex and 56% of males reported they had given money or goods for sex. 20% of females and 6% males reported that their first sexual encounter was forced and 15% of females and 6% of males reported they had been forced to have sex in the past year. Multiple partnerships were common among both sexes with 81% females and 76% males reporting one or more sex partners in the past four weeks. Less than 1% reported having experiences with injecting drugs and only 1% of males reporting have sex with men. While knowledge of HIV/AIDS was high, prevention behaviors including HIV testing and condom use were low.ConclusionYouth-focused HIV efforts in Liberia need to address transactional sex and multiple and concurrent partnerships. HIV prevention interventions should include efforts to meet the economic needs of youth

Informing HIV prevention efforts targeting Liberian youth: a study using the PLACE method in Liberia

BACKGROUND: Preventing HIV infection among young people is a priority for the Liberian government. Data on the young people in Liberia are scarce but needed to guide HIV programming efforts. METHODS: We used the Priorities for Local AIDS Control Efforts (PLACE) method to gather information on risk behaviors that young people (ages 14 to 24) engage in or are exposed to that increase their vulnerability for HIV infection. Community informants identified 240 unique venues of which 150 were visited and verified by research staff. 89 of the 150 venues comprised our sampling frame and 571 females and 548 males were interviewed in 50 venues using a behavioral survey. RESULTS: Ninety-one percent of females and 86% of males reported being sexually active. 56% of females and 47% of males reported they initiated sexual activity before the age of 15. Among the sexually active females, 71% reported they had received money or a gift for sex and 56% of males reported they had given money or goods for sex. 20% of females and 6% males reported that their first sexual encounter was forced and 15% of females and 6% of males reported they had been forced to have sex in the past year. Multiple partnerships were common among both sexes with 81% females and 76% males reporting one or more sex partners in the past four weeks. Less than 1% reported having experiences with injecting drugs and only 1% of males reporting have sex with men. While knowledge of HIV/AIDS was high, prevention behaviors including HIV testing and condom use were low. CONCLUSION: Youth-focused HIV efforts in Liberia need to address transactional sex and multiple and concurrent partnerships. HIV prevention interventions should include efforts to meet the economic needs of youth

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa