Exploring urban rural interdependence and the impact of climate change in Tanzania and Malawi: final narrative report

Africa is rapidly urbanizing, by 2030 there are projected to be over 759 million African urban dwellers. This poses major challenges for the further provision of infrastructure and services. Alongside this, Africa is particularly vulnerable to climate change and climate variability (CC&CV). As urbanisation and inequality increase, more sophisticated analyses of the linkages and interdependencies between rural and urban areas are emerging. Flows of products, people, knowledge and information, natural resources and money provide strong and dynamic linkages. This action research project explored the relationships and dynamics between rural localities and their linked urban centres, focusing on the agriculture and food innovation systems. It specifically aimed to: Develop a collective understanding of the vulnerabilities, roles, climate-related risks and strategies among interdependent rural and urban communities, local government and other key stakeholders. Collectively develop and test viable options and strategies for key interdependent rural- urban stakeholders in the agriculture and food innovation systems to adapt to CC&CV; and Learn and share lessons for scaling up successful strategies for strengthening adaptive capacity within these interdependent agriculture and food innovation systems

Agricultural Nematology in East and Southern Africa : Problems, Management Strategies and Stakeholder Linkages

This is the peer reviewed version of the following article: Herbert Talwana, et al, ‘Agricultural nematology in East and Southern Africa: problems, management strategies and stakeholder linkages’, Pest Management Science Vol. 72 (2): 226-245, February 2016, which has been published in final form at http://dx.doi.org/10.1002/ps.4104. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. © 2015 Society of Chemical Industry.By 2050, Africa’s population is projected to exceed two billion. Africa will have to increase food production more than 50% in the coming 50 years to meet the nutritional requirements of its growing population. Nowhere is the need to increase agricultural productivity more pertinent than in much of sub-Saharan Africa where it is currently static or declining. Optimal pest management will be essential, because intensification of any system creates heightened selection pressures for pests. Plant-parasitic nematodes and their damage potential are intertwined with intensified systems and can be an indicator of unsustainable practices. As soil pests, nematodes are commonly overlooked or misdiagnosed, particularly where appropriate expertise and knowledge transfer systems are meager or inadequately funded. Nematode damage to roots results in less efficient root systems that are less able to access nutrients and water, which can produce symptoms typical of water or nutrient deficiency, leading to misdiagnosis of the underlying cause. Damage in subsistence agriculture is exacerbated by growing crops on degraded soils and in areas of low water retention where strong root growth is vital. This review focuses on the current knowledge of economically important nematode pests affecting key crops, nematode control methods, and the research and development needs for sustainable management, stakeholder involvement and capacity building in the context of crop security in East and Southern Africa, especially Kenya, Tanzania, Uganda and Zimbabwe.Peer reviewe

Lay and healthcare providers’ experiences to inform future of respectful maternal and newborn care in Tanzania and Malawi: An Appreciative Inquiry

Objectives Disrespectful care, which remains prevalent in low and middle-income countries (LMICs), acts as a barrier to women accessing skilled birth attendance, compromising care when services are available. Building on what was positive in facilities, we aimed to explore lay and healthcare providers’ experience of respectful care to inform future interventions. Setting Five maternity facilities in Mwanza Tanzania and Lilongwe Malawi. Participants 94 participants in Malawi (N=46) and Tanzania (N=48) including 24 women birthing live baby within the previous 12 months; 22 family members and 48 healthcare providers who regularly provided maternity care in the included facilities Design The study was guided by Appreciative Inquiry (AI). Semistructured, one-to-one interviews were conducted between January and December 2019. Interviews were audio-recorded, translated where necessary, transcribed verbatim, and analysed using the framework approach. Results Four main themes describing participants positive experience and their vision of respectful care were identified: (1) empathic healthcare provider–woman interactions including friendly welcome and courteous language, well-timed appropriate care and information sharing, (2) an enabling environment, characterised by improvement of physical environment, the use of screens, curtains and wall partitions for privacy, availability of equipment and provision of incentives to staff, (3) supportive leadership demonstrated by the commitment of the government and facility leaders to provision of respectful care, ensuring availability of guidelines and policies, supportive supervision, reflective discussion and paying staff salaries timely, (4) providers’ attitudes and behaviours characterised by professional values through readiness, compassionate communication and commitment. Conclusion The positive experiences of service users, families and healthcare providers provided insight into key drivers of respectful care in facilities in Tanzania and Malawi. Interventions targeting improved environment and privacy, healthcare provider communication and developing positive leadership structures in facilities could provide the basis for sustained improvement in respectful and dignified maternal and newborn care in LMICs

Preparing Institutions to Implement Harmonized Medicine and Nursing Curricula Through the Use of Cross-Institutional Faculty Developers.

BACKGROUND: Effective implementation of new curricula requires faculty to be knowledgeable about curriculum goals and have the appropriate pedagogical skills to implement the curriculum, even more so if the new curriculum is being deployed at multiple institutions. In this paper, we describe the process of creating a common faculty development program to train cross-institutional faculty developers to support the implementation of national harmonized medicine and nursing curricula. METHODS: A five-step approach was used, including a cross-institutional needs assessment survey for faculty development needs, the development of a generic faculty development program, the identification and training of cross-institutional faculty educators, and the implementation of cross-institutional faculty capacity-building workshops. RESULTS: A list of common cross-cutting faculty development needs for teaching and learning was identified from the needs assessment survey and used to develop an accredited, cross-institutional faculty development program for competency-based learning and assessment. A total of 24 cross-institutional faculty developers were identified and trained in 8 core learning and assessment workshops. A total of 18 cross-institutional and 71 institutional workshops were conducted, of which 1292 faculty members and 412 residents were trained, and three cross-institutional educational research projects were implemented. CONCLUSION: The success attained in this study shows that the use of cross-institutional faculty developers is a viable model and sustainable resource that can be used to support the implementation of harmonized national curricula

Women’s preferences for antenatal care in Tanzania: a discrete choice experiment

Background: The stillbirth rate in Tanzania remains high. Greater engagement with antenatal care may help to reduce stillbirths. We investigated which characteristics of antenatal care clinics are preferred by pregnant women in Tanzania. Methods: We conducted an unlabelled discrete choice experiment (DCE) with think-aloud interviews. Participants were pregnant women, regardless of parity/gestation, from the Mwanza and Manyara regions of Tanzania. We asked participants to choose which of two hypothetical antenatal clinics they would rather attend. Clinics were described in terms of transport mode, cleanliness, comfort, visit content, and staff attitude. Each participant made 12 choices during the experiment, and a purposively selected sub-set simultaneously verbalised the rationale for their choices. We analysed DCE responses using a multinomial logit model adjusted for study region, and think-aloud data using the Framework approach. Results: We recruited 251 participants split evenly between the 2 geographical regions. Staff attitude was the most important attribute in clinic choice and dominated the think-aloud narratives. Other significant attributes were mode of transport (walking was preferred) and content of clinic visit (preference was stronger with each additional element of care provided). Cleanliness of the clinic was not a significant attribute overall and the think-aloud exercise identified a willingness to trade-off cleanliness and comfort for respectful care. Conclusion: Women would prefer to attend a clinic with kind staff which they can access easily. This study suggests that exploration of barriers to providing respectful care, and enabling staff to deliver it, are important areas for future investment. The DCE shows us what average preferences are; antenatal care that is aligned with identified preferences should increase uptake and engagement versus care which does not acknowledge them

Respectful care an added extra: a grounded theory study exploring intrapartum experiences in Zambia and Tanzania

Background Quality of maternal and newborn care is integral to positive clinical, social and psychological outcomes. Respectful care is an important component of this but is suboptimum in many low-income settings. A renewed energy among health professionals and academics is driving an international agenda to eradicate disrespectful health facility care around the globe. However, few studies have explored respectful care from different vantage points. Methods We used Strauss and Corbin’s grounded theory methodology to explore intrapartum experiences in Tanzania and Zambia. In-depth interviews were conducted with 98 participants (48 women, 18 partners, 21 health-providers and 11 key stakeholders), resulting in data saturation. Analysis involved constant comparison, comprising three stages of coding: open, axial and selective. The process involved application of memos, reflexivity and positionality. Results Findings demonstrated that direct and indirect social discrimination led to inequity of care. Health-providers were believed to display manipulative behaviours to orchestrate situations for their own or the woman’s benefit, and were often caring against the odds, in challenging environments. Emergent categories were related to the core category: respectful care, an added extra, which reflects the notion that women did not always expect or receive respectful care, and tolerated poor experiences to obtain services believed to benefit them or their babies. Respectful care was not seen as a component of good quality care, but a luxury that only some receive. Conclusion Both quality of care and respectful care were valued but were not viewed as mutually inclusive. Good quality treatment (transactional care) was often juxtaposed with disrespectful care; with relational care having a lower status among women and healthcare providers. To readdress the balance, respectful care should be a predominant theme in training programmes, policies and audits. Women’s and health-provider voices are pivotal to the development of such interventions

The tipping point of antenatal engagement: a qualitative grounded theory in Tanzania and Zambia

Background Effective antenatal care is fundamental to the promotion of positive maternal and new-born outcomes. International guidance recommends an initial visit in the first trimester of pregnancy, with a minimum of four antenatal visits in total: the optimum schedule being eight antenatal contacts. In low- and middle-income countries, many women do not access antenatal care until later in pregnancy and few have the recommended number of contacts. Aim To gain understanding of women’s antenatal experiences in Tanzania and Zambia, and the factors that influence antenatal engagement. Methods The study was underpinned by Strauss’s grounded theory methodology. Interviews were conducted with 48 women, 16 partners, 21 health care providers and 11 stakeholders, and analysed using constant comparison. Findings The core category was ‘The tipping point of antenatal engagement’, supported by four categories: awareness of health benefits, experiential motivators, influential support, and environmental challenges. Although participants recognised the importance of antenatal care to health outcomes, individual motivations and external influences determined attendance or non-attendance. The ‘tipping point’ for antenatal engagement occurred when women believed that any negative impact could be offset by tangible gain. For some women non-attendance was a conscious decision, for others it was an unchallenged cultural norm. Conclusion A complex interplay of factors determines antenatal engagement. Short-term modifiable factors to encourage attendance include the development of strategies for increasing respectful care; use of positive women’s narratives, and active community engagement. Further research is required to develop innovative, cost-effective care models that improve health literacy and meet women’s needs

Preparing Institutions to Implement Harmonized Medicine and Nursing Curricula Through the Use of Cross-Institutional Faculty Developers

Doreen Anna Mloka,1 Francis Sakita,2 Irene Kida Minja,3 Haruna Dika,4 Edith AM Tarimo,5 Nathanael Sirili,6 Lillian Teddy Mselle,7 Rodrick Richard Kisenge,8 Philip Sasi,9 Livuka Nsemwa,10 Delfina R Msanga,11 Einoti Yohana Matayan,12 Nicholaus Bartholomeo Ngowi,13 Mainen Julius Moshi,14 John Bartlett,15 Sarah B Macfarlane,16 Ephata Kaaya,17 Patricia S O’Sullivan18 1Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Emergency Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 3Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 4Department of Anatomy, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 5Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Department of Development Studies, Muhimbili University of Health and Allied Sciences, School of Public Health and Social Sciences, Dar es Salaam, Tanzania; 7Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 8Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 9Department of Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 10Department of Nursing and Midwifery, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 11Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 12Department of Ophthalmology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 13Department of Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 14Department of Biological and Preclinical Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 15Department of Global Health and Medicine, Duke University, Durham, NC, USA; 16Department of Global Health Sciences, University of San Francisco California, San Francisco, CA, USA; 17Department of Pathology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 18Office of Research and Development in Medical Education, University of San Francisco California, San Francisco, CA, USACorrespondence: Doreen Anna Mloka, Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, P.O. Box 650013, Dar es Salaam, Tanzania, Tel +255712459528, Email [email protected]: Effective implementation of new curricula requires faculty to be knowledgeable about curriculum goals and have the appropriate pedagogical skills to implement the curriculum, even more so if the new curriculum is being deployed at multiple institutions. In this paper, we describe the process of creating a common faculty development program to train cross-institutional faculty developers to support the implementation of national harmonized medicine and nursing curricula.Methods: A five-step approach was used, including a cross-institutional needs assessment survey for faculty development needs, the development of a generic faculty development program, the identification and training of cross-institutional faculty educators, and the implementation of cross-institutional faculty capacity-building workshops.Results: A list of common cross-cutting faculty development needs for teaching and learning was identified from the needs assessment survey and used to develop an accredited, cross-institutional faculty development program for competency-based learning and assessment. A total of 24 cross-institutional faculty developers were identified and trained in 8 core learning and assessment workshops. A total of 18 cross-institutional and 71 institutional workshops were conducted, of which 1292 faculty members and 412 residents were trained, and three cross-institutional educational research projects were implemented.Conclusion: The success attained in this study shows that the use of cross-institutional faculty developers is a viable model and sustainable resource that can be used to support the implementation of harmonized national curricula.Keywords: faculty development across institution

Community Perception on Climate change and its adaptation Strategies at Nachingwea District – Lindi Region

The study assessed farmer‘s perception on impact of climate change and its adaptation strategies at Nachingwea District in five divisions Namambo, Ruponda, Lionja, Naipanga and Mbondo. Data were collected by using structured interview schedule administered on 260 Households randomly selected from five divisions in the study area. Description and analysis of data were carried out using frequency counts, percentages means and tables, while multiple regression was used to test the hypothesis. Majority of farmers are much aware of climate change, about 91.5% were aware of the climate change and their impacts, only 8.5% do not; though they emphasize on the bad events of flood that happen in some years back that 54.2% of respondents have long years of experiencing climate change. Farmers indicate problems associated to effect of climate change whereby about 39.3% reported to have low yield of crops, 17.2% stunted growth, 15.2% drying of seedling after germination, 13.1% ease spread of pest and diseases attack on crops and 15.2% ineffectiveness of agricultural chemicals used due to delay in rainfall. Extension services were reported as inadequate and under capacitated to provide education on better agricultural practices, climate change, and environmental conservation. Educational programme tailored to meet the climatic information needs of farmers to enable them cope with the emerging challenges to enhance their production. Support on micro financing was found critical to with the establishment of credit facilities non-restrictive agricultural loans from banks. It is therefore, recommended that government and stakeholders should put up educational programme tailored to meet the climatic information needs of farmers to enable them cope with the emerging challenges to enhance their production.

Assessment of Tourism Competitive Advantage of UNESCO World Heritage Sites in Tanzania: A case study of Serengeti National Park from 2000-2018

The main objective of this study was to assess tourism competitive advantage of UNESCO world natural heritage sites in Tanzania. Tourism is a vital source of both public as well as private income, source of foreign exchange earnings. It is one of the most important sectors in generating employment opportunities to unskilled, semi-skilled and skilled human resources. Despite of all threat the natural environment where the natural heritage resources exist faces due to natural and or human activity, UNESCO world heritage sites have been in maintaining the consistence of being conserved and protected due to their potentiality to human history, economic and life in general. In order to fulfil the objectives of this study, secondary data were used whereby various relating study were used, reports on the same topic and magazine. The study found that UNESCO world heritage sites has brought about many contribution not only to Tourism but also to the community and the surrounded environment economically and environmentally. According to the findings, the study concluded that, heritage attractions sites present many opportunities and strategies to overcome challenges for sustainable tourism development. Many of the attractions, however, need a great deal of work in terms of rehabilitation, management and promotion. Since different attractions are under the supervision of many different agencies, it is important to take a comprehensive approach that creates and sustains management program. The study recommends that tourism management plans have to be developed and implemented on a pilot basis, which can develop into a sustainable financing mechanism for the management and protection of these important resources