Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas

Mapping child growth failure across low- and middle-income countries

Child growth failure (CGF), manifested as stunting, wasting, and underweight, is associated with high 5 mortality and increased risks of cognitive, physical, and metabolic impairments. Children in low- and middle-income countries (LMICs) face the highest levels of CGF globally. Here we illustrate national and subnational variation of under-5 CGF indicators across LMICs, providing 2000–2017 annual estimates mapped at a high spatial resolution and aggregated to policy-relevant administrative units and national levels. Despite remarkable declines over the study period, many LMICs remain far from the World Health 10 Organization’s ambitious Global Nutrition Targets to reduce stunting by 40% and wasting to less than 5% by 2025. Large disparities in prevalence and rates of progress exist across regions, countries, and within countries; our maps identify areas where high prevalence persists even within nations otherwise succeeding in reducing overall CGF prevalence. By highlighting where subnational disparities exist and the highest-need populations reside, these geospatial estimates can support policy-makers in planning locally 15 tailored interventions and efficient directing of resources to accelerate progress in reducing CGF and its health implications

Mapping exclusive breastfeeding in Africa between 2000 and 2017.

Exclusive breastfeeding (EBF)-giving infants only breast-milk (and medications, oral rehydration salts and vitamins as needed) with no additional food or drink for their first six months of life-is one of the most effective strategies for preventing child mortality1-4. Despite these advantages, only 37% of infants under 6 months of age in Africa were exclusively breastfed in 20175, and the practice of EBF varies by population. Here, we present a fine-scale geospatial analysis of EBF prevalence and trends in 49 African countries from 2000-2017, providing policy-relevant administrative- and national-level estimates. Previous national-level analyses found that most countries will not meet the World Health Organization's Global Nutrition Target of 50% EBF prevalence by 20256. Our analyses show that even fewer will achieve this ambition in all subnational areas. Our estimates provide the ability to visualize subnational EBF variability and identify populations in need of additional breastfeeding support

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Preservice Teachers Taking Action: Enacting Teaching Practices and Pedagogical Theories in an After-School Literacy Club Field Experience

This article examines the teaching practices and pedagogical theories preservice teachers (PSTs) enacted in a newly designed after-school literacy club field placement. We draw from sociocultural and activity theories to analyze data collected in the qualitative study that examined the following research questions: (1) What teaching practices do PSTs enact in an after-school literacy club field placement? (2) What pedagogical theories guide their choices about which teaching practices they enact in the after-school literacy club field placement? and (3) In what ways does this field placement afford and constrain PSTs’ appropriation of these practices and theories? Findings consider three ways that the field experience afforded—and at times also constrained—the opportunities made available for PSTs to enact teaching practices and pedagogical theories related to their learning in coursework including learning from and with fellow PSTs, developing ownership over curriculum, and making connections to university coursework. </jats:p

Instructional Chains as a Method for Examining the Teaching and Learning of Argumentative Writing in Classrooms

We propose “instructional chaining” as an analytic method for capturing and describing key instructional episodes enacted by expert writing teachers to foster the recontextualization over time of the social practices of argumentative writing through process-oriented instructional approaches. The article locates instructional chaining within a sociocultural framework and argues for conceptualizing learning to write as the recontextualization of social practices of writing in classroom settings. To illustrate the use of instructional chaining to study the effects of teaching on learning argumentative writing, we describe the processes employed to construct an instructional chain for a unit of literary argumentation in a 12th grade English language arts classroom. We conclude with a discussion of two potential uses of instructional chains as units of analysis for both quantitative and qualitative analyses to study patterns of teaching and learning across many classrooms. </jats:p

With regret: The genre of teachers' public resignation letters

In recent years, in blogs and online news sites, a novel genre has emerged. Understanding this genre the public teacher resignation letter is the primary investigation explored here. Through examination of 22 viral public resignation letters, and utilizing Genre Theory and moves analysis, research questions included: (1) What are the common features of this genre, as demonstrated in the teacher-writers' moves and submoves? (2) When describing the state of education today, what particular sub-moves do teacher writers utilize, and to what ends? Findings indicate remarkable similarity between the moves teacher writers make in their letters, including, for example, building expertise and ethos, explaining the state of education today, and identifying abandonment. Authors also made use of sub-moves like metaphors, emotional appeals, and language of defiance and resistance. Our analysis reveals (1) how the teachers are writing and what work their letters do, (2) what they're writing about and what this reveals about current neoliberal policies, and (3) where we see implications of their writing for various audiences. (C) 2017 Elsevier Inc. All rights reserved