CCAFS East Africa Regional Science Workshop Report

The East Africa regional program of the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS) hosted a three-day workshop to engage with partners from agricultural research, agricultural extension, climate services and products, food security, and early warning systems in East Africa. The overall objective of the workshop was to plan and develop thematic research to support climate risk management, adaptation and mitigation options in East Africa, resulting in four to five project concepts that can be supported as seed participatory action research (PAR) activities. From these seed activities, CCAFS intends to build longer term projects from those with the greatest potential to deliver bigger outcomes and impact. The workshop built on the regional needs for research and priorities identified from previous national and regional workshops in 2011

Induction of humoral immune response to multiple recombinant Rhipicephalus appendiculatus antigens and their effect on tick feeding success and pathogen transmission

BACKGROUND: Rhipicephalus appendiculatus is the primary vector of Theileria parva, the etiological agent of East Coast fever (ECF), a devastating disease of cattle in sub-Saharan Africa. We hypothesized that a vaccine targeting tick proteins that are involved in attachment and feeding might affect feeding success and possibly reduce tick-borne transmission of T. parva. Here we report the evaluation of a multivalent vaccine cocktail of tick antigens for their ability to reduce R. appendiculatus feeding success and possibly reduce tick-transmission of T. parva in a natural host-tick-parasite challenge model. METHODS: Cattle were inoculated with a multivalent antigen cocktail containing recombinant tick protective antigen subolesin as well as two additional R. appendiculatus saliva antigens: the cement protein TRP64, and three different histamine binding proteins. The cocktail also contained the T. parva sporozoite antigen p67C. The effect of vaccination on the feeding success of nymphal and adult R. appendiculatus ticks was evaluated together with the effect on transmission of T. parva using a tick challenge model. RESULTS: To our knowledge, this is the first evaluation of the anti-tick effects of these antigens in the natural host-tick-parasite combination. In spite of evidence of strong immune responses to all of the antigens in the cocktail, vaccination with this combination of tick and parasite antigens did not appear to effect tick feeding success or reduce transmission of T. parva. CONCLUSION: The results of this study highlight the importance of early evaluation of anti-tick vaccine candidates in biologically relevant challenge systems using the natural tick-host-parasite combination

Sanitation and hygiene status of butcheries in Kampala district, Uganda

There is a growing trend in the consumption of animal products such as meat in the developing world especially due to a growing population, urbanization and rising incomes. This poses a risk of food borne illnesses from meat consumption due to poor sanitation and hygiene. The purpose of this study was to assess the sanitation and hygiene status of butcheries in Kampala district, Uganda. The study was cross-sectional in design and involved quantitative data collection methods. The study units were butcheries from which one respondent was randomly selected to answer the questionnaire. An observational checklist was used to assess the status of sanitation and hygiene of the butcheries. Data were entered and analysed in Epi Info 3.5.1 statistical software. A total of 73 butcheries were visited, 51 (69.9%) of which were permanent structures, 7 (9.6%) semi-permanent and 15 (20.5%) temporary. Observations revealed that 24 (32.9%) butcheries had cracked walls and 66 (90.4%) had damaged floors. The main water source used by the butcheries was tap 67 (91.8%) with the rest collecting water from nearby protected springs. Hand washing facilities were present in 56 (76.7%) of the butcheries of which only 5 (6.8%) had soap for hand washing. Only 19 (26.0%) of the butcheries had receptacles for waste storage. Cleaning practices varied among butchers with 55 (75.3%) cleaning their butcheries daily. Most of the equipment (pangas and knives) found in the butcheries 66 (90.4%) were clean. Regarding personal hygiene, 57 (78.1%) of the respondents wore clean clothes, 65 (89.0%) had short finger nails and only 23 (31.5%) had personal protective wear. From the study, it was observed that the sanitation and hygiene status of butcheries in Kampala district was poor. There is, thus, need for the local authority to put in place stringent measures to ensure proper hygiene and sanitation which will reduce on the risks of meat contamination.Key words: butcheries, hygiene, knowledge, sanitation, Ugand

Attitude and practice of health care providers towards autopsies in children under five years at Kenyatta National Hospital

Background: Attitude and practice of health care professionals toward autopsy are important as they will give information regarding factors that contribute to the low rate of autopsies in children under five years.Objective: To evaluate the attitude and practice of health care providers towards autopsies in children under five years.Design: Cross-sectional hospital based descriptive survey.Setting: General paediatrics wards and newborn unit at Kenyatta National Hospital, Nairobi, Kenya.Subjects: Health care providers working at the Kenyatta National Hospital paediatric wards and newborn unit.Results: The study enrolled 95 health care providers. Majority (69.5%) of health care providers showed a positive attitude towards autopsy. Consultants and paeadiatric residents had a more positive attitude compared to interns (p< 0.001) and nurses (p=O.Oll). Clinical experience of> 15 years was associated with a more positive attitude. The main barriers to obtaining consent were lack of formal training in obtaining consent and failure of autopsy results to be availed in a timely manner.Conclusions: Health care providers had a positive attitude to autopsy which was significantly associated with their cadre and years of experience. The main reasons given for not obtaining consent for autopsy were lack of formal training in obtaining consent and failure to obtain autopsy results in timely manner

Shorter treatment for minimal tuberculosis (TB) in children (SHINE): A study protocol for a randomised controlled trial

BACKGROUND: Tuberculosis (TB) in children is frequently paucibacillary and non-severe forms of pulmonary TB are common. Evidence for tuberculosis treatment in children is largely extrapolated from adult studies. Trials in adults with smear-negative tuberculosis suggest that treatment can be effectively shortened from 6 to 4 months. New paediatric, fixed-dose combination anti-tuberculosis treatments have recently been introduced in many countries, making the implementation of World Health Organisation (WHO)-revised dosing recommendations feasible. The safety and efficacy of these higher drug doses has not been systematically assessed in large studies in children, and the pharmacokinetics across children representing the range of weights and ages should be confirmed. METHODS/DESIGN: SHINE is a multicentre, open-label, parallel-group, non-inferiority, randomised controlled, two-arm trial comparing a 4-month vs the standard 6-month regimen using revised WHO paediatric anti-tuberculosis drug doses. We aim to recruit 1200 African and Indian children aged below 16 years with non-severe TB, with or without HIV infection. The primary efficacy and safety endpoints are TB disease-free survival 72 weeks post randomisation and grade 3 or 4 adverse events. Nested pharmacokinetic studies will evaluate anti-tuberculosis drug concentrations, providing model-based predictions for optimal dosing, and measure antiretroviral exposures in order to describe the drug-drug interactions in a subset of HIV-infected children. Socioeconomic analyses will evaluate the cost-effectiveness of the intervention and social science studies will further explore the acceptability and palatability of these new paediatric drug formulations. DISCUSSION: Although recent trials of TB treatment-shortening in adults with sputum-positivity have not been successful, the question has never been addressed in children, who have mainly paucibacillary, non-severe smear-negative disease. SHINE should inform whether treatment-shortening of drug-susceptible TB in children, regardless of HIV status, is efficacious and safe. The trial will also fill existing gaps in knowledge on dosing and acceptability of new anti-tuberculosis formulations and commonly used HIV drugs in settings with a high burden of TB. A positive result from this trial could simplify and shorten treatment, improve adherence and be cost-saving for many children with TB. Recruitment to the SHINE trial begun in July 2016; results are expected in 2020

An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Continued inequities in coverage, low quality of care, and high out-of-pocket expenses for health services threaten attainment of Millennium Development Goals 4 and 5 in many sub-Saharan African countries. Existing health systems largely rely on input-based supply mechanisms that have a poor track record meeting the reproductive health needs of low-income and underserved segments of national populations. As a result, there is increased interest in and experimentation with results-based mechanisms like supply-side performance incentives to providers and demand-side vouchers that place purchasing power in the hands of low-income consumers to improve uptake of facility services and reduce the burden of out-of-pocket expenditures. This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities. Methods: Data presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated. Results: The findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages.Conclusions: Accrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program

Performance of community health workers and associated factors in a rural community in Wakiso district, Uganda

Background: Community health workers (CHWs) continue to play a crucial role in supporting health service delivery globally. Several CHW programmes around the world face vast challenges which affect their performance. Objectives: This study assessed the performance of CHWs and associated factors in a rural community in Wakiso district, Uganda. Methods: This was a cross-sectional study that employed a structured questionnaire to collect quantitative data from 201 CHWs in Wakiso district. The main study variable was CHW performance based on various roles carried out by CHWs. Multivariable logistic regression in STATA was used to establish the predictors of CHW performance. Results: Only 40 (19.9%) of the CHWs had a high performance which was associated with having attended additional / refresher trainings [AOR=12.79 (95% CI: 1.02-159.26)], and having attained secondary level education and above [AOR=3.93 (95% CI: 1.17-13.24)]. CHWs who were married [AOR=0.29 (95% CI: 0.09-0.94)] were less likely to perform highly. Among CHWs who had received essential medicines for treatment of childhood illnesses, the majority 90.3% (112/124) had experienced stock-outs in the 6 months preceding the study. Despite the majority of CHWs 198 (98.5%) stating that being motivated was very important in their work, only 91 (45%) said that they were motivated. Conclusions: Additional / refresher trainings are necessary to enhance performance of CHWs. In addition, level of education should be considered while selecting CHWs. The health system challenges of low motivation of CHWs as well as stock-out of medicines need to be addressed to support their work

Chronic Diseases in North-West Tanzania and Southern Uganda. Public Perceptions of Terminologies, Aetiologies, Symptoms and Preferred Management

Research outputs produced to support a quantitative population survey, quantitative health facility survey, focus groups and in-depth interviews performed by the projec