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IntroductionDespite many institutions gaining access to improved water sanitation and hygiene (WASH) services, childcare centres in informal settlements have low access and poor condition of WASH services. It is imperative to understand how existing actors and social networks operate in the WASH sector in childcare centres in Nairobi's informal settlements.ObjectiveTo empirically map and understand how different actors within informal settlements influence the provision of adequate and quality water, sanitation and hygiene services within childcare centres in Nairobi's informal settlements.MethodsThis was a qualitative study. We conducted an ethnographic study using governance diaries with 24 participants from Korogocho and Viwandani informal settlements in Nairobi, Kenya. The governance diaries approach involved conducting bi-weekly governance in-depth interviews (IDIs) with study participants for 4 months, complemented with observations, reflections, participant diaries and informal discussions. We used a framework analysis which is partly deductive, informed by the governance framework and stakeholder framework.ResultsSocial accountability actors were individuals or groups involved in WASH service provision in childcare centres. The actors included both key actors (actors who are primary to meeting the day-to-day WASH service needs of children) and non-key actors (actors operating in the WASH sector but not always present for day-to-day provision in childcare centres). The key actors were unanimously identified as childcare centre owners/teachers and parents/guardians as they had a more direct role in the provision of WASH services in childcare centres. The actors had direct, possible or desired networks, with the direct networks portrayed more by the parents and childcare centre owners, whose roles included acting as a voice and responding to the WASH service needs of children as it relates to access and quality. Centre owners had more power/authority over WASH services for children in childcare centres than the parents. Key actors derived power by their discretion depending on whether a decision was beneficial to children or not. Lastly, the interest of key actors were diverse ranging from income generation, access to WASH services by children, compliance with government regulations, and promotion of child health, to the prevention of the spread of diseases.ConclusionOur study highlights that parents and childcare owners play an important role in WASH service provision. While service providers and other players may be statutorily given primary responsibilities for WASH provision, and more visible in official standing, among study participants they are not seen as primary actors but secondary players with ancillary responsibilities. We conclude that WASH service provision in child care centres may be realised when key actors have a voice and work within networks to demand WASH services from desired networks including the government. We also conclude that developing more direct networks and converting desired and potential networks into direct networks in WASH service provision is critical for the success of WASH service delivery. Lastly, actors in WASH services in childcare centres may need to collaborate in identifying potential avenues for strengthening existing networks that enhance access and quality of WASH services in childcare centres.

HIV positivity yield declined against increasing testing volumes in Zimbabwe, from 20% (1.65 million tests) in 2011 to 6% (3 million tests) in 2018. A screening tool was introduced to aid testers to identify clients likely to obtain a positive diagnosis of HIV. Consequently, testing volumes declined to 2.3 million in 2019 but positivity declined to 5% prompting the evaluation and validation of the tool to improve its precision in predicting positivity yield. A cross-sectional study was conducted. Sixty-four sites were randomly selected where all reporting clients (18+ years) were screened and tested for HIV. Participant responses and test outcomes were documented and uploaded to excel. Multivariable analysis was used to determine the performance of individual, combination questions and screening criteria to achieve >/ = 90% sensitivity for a new screening tool. We evaluated 13 questions among 7,825 participants and obtained 95.7% overall sensitivity, ranging from 3.9% [(95%CI:2.5,5.9) sharing sharp objects] to 86.8% [(95%CI:83.8,89.5) self-perception of risk] for individual questions. A 5-question tool was developed and validated among 2,116 participants. The best combination (self-perception of risk, partner tested positive, history of ill health, last tested >/ = 3months and symptoms of an STI) scored 94.1% (95%CI:89.4,97.1) sensitivity, 18% reduction in testing volumes and 11 Number Needed to Test (NNT). A screening in criteria that combine previously testing >/ = 3 months with a yes to any of the 4 remaining questions was analysed and sensitivity ranged from 89.9% (95%CI:84.4,94.0) for last tested >/ = 3months and sexual partner positive, to 93.5% (95%CI:88.7,96.7) for last tested >/ = 3months and self-perceived risk We successfully developed, evaluated and validated an HIV screening tool. High sensitivity and the fifth reduction in testing volume were acceptable attributes to enhance testing efficiency and effective limited resource utilisation. Screened out clients will be identified through frequent screening and self-testing options.

Smallholder maize and wheat production systems are characterized by high drudgery. On-farm trials were run for three seasons in Ethiopia. The study assessed the effect of 2 WT direct seeding and growing season on (1) soil quality, and (2) maize and wheat productivity, energy and protein gains, and gross margins, on smallholder farms in Ethiopia. For the wheat crop, the effect of different soil types and agroecological conditions on productivity was assessed. The treatments in paired plots were (i) conventional ploughing practice and (ii) no-till (NT). Soil properties, crop yield, nutrition gains and gross margins were determined. No-till improved soil properties in the short term. No-till produced 1210–1559 kg ha−1 grain, 18–29 GJ ha−1 energy and 121–194 kg ha−1 proteins, and generated 358–385 US$ ha−1 more than the conventional practice in the maize system. In the wheat system, no-till treatment had 341–1107 kg ha−1 grain, 5–16 GJ ha−1 energy and 43–137 kg ha−1 proteins, and generated 230–453 US$ ha−1 more than conventional practice. No-till can be more productive and profitable in the Ethiopian maize and wheat-based cropping systems.

This paper describes a global research programme on the complex systemic connections between urban development and health. Through transdisciplinary methods the Complex Urban Systems for Sustainability and Health (CUSSH) project will develop critical evidence on how to achieve the far-reaching transformation of cities needed to address vital environmental imperatives for planetary health in the 21st Century. CUSSH’s core components include: (i) a review of evidence on the effects of climate actions (both mitigation and adaptation) and factors influencing their implementation in urban settings; (ii) the development and application of methods for tracking the progress of cities towards sustainability and health goals; (iii) the development and application of models to assess the impact on population health, health inequalities, socio-economic development and environmental parameters of urban development strategies, in order to support policy decisions; (iv) iterative in-depth engagements with stakeholders in partner cities in low-, middle- and high-income settings, using systems-based participatory methods, to test and support the implementation of the transformative changes needed to meet local and global health and sustainability objectives; (v) a programme of public engagement and capacity building. Through these steps, the programme will provide transferable evidence on how to accelerate actions essential to achieving population-level health and global climate goals through, amongst others, changing cities’ energy provision, transport infrastructure, green infrastructure, air quality, waste management and housing.

Introduction: In order to meet the sustainable development goals targets of sanitation, countries aim to increase access to safely managed sanitation services for its citizens. Safely managed sanitation services refers to improved sanitation technologies that are not shared with other households and where excreta is treated and disposed; or stored, transported and treated off-site. In most Sub-Saharan Africa (SSA) countries, on-site sanitation facilities such as latrines and septic tanks are common, with low-income urban settlements mainly using pit latrines. However, little is documented about the management of sludge from these facilities, especially in low income settlements in secondary and emerging cities. This lack of data is a major hindrance to public health, development and planning efforts by governments and planning agencies. This study specifically assesses practices and challenges along the sanitation value chain related to containment, emptying, transportation, treatment and recycling of fecal sludge.Methods: The study was carried out in low income settlements in Nakuru, a secondary city in Kenya. Over half the population in Nakuru live in low income areas and majority of these residents use pit latrines. A case study design was selected for this study and data was collected using qualitative methods. Data was collected through In-depth interviews and Focus Group Discussions using in depth interview guide and focus group discussion guides that had questions on sanitation practices along the value chain, challenges, opportunities available, and recommendations for improvement. Analysis was done through content analysis by reading the transcripts multiple times to gain a sense of the flow of the discussion. Thereafter, coding was done by following emergent issues and thereafter categories were identified which formed the basis for providing a picture of FWM practices in the settlements.Results: On site sanitation facilities are dominant in the settlements, but they are few and are shared by several households. These facilities were unclean, and they filled up at a fast rate because of the high number of users. The latrines were emptied by manual emptiers who used mechanized equipment but complemented with manual emptying using buckets. Sludge was transported to a central collection point using large and small scale means of transportation, before transfer to the treatment site for final treatment and disposal. Various stakeholders are involved in capacity building of emptiers as well as in the transportation, treatment and disposal of fecal sludge in the settlements. Challenges along the stages of the value chain included negative community perceptions and attitudes toward fecal sludge management.Conclusion: The results highlight the need to address the challenges along the chain by involvement of state and non-state actors. Low income areas have high populations and thus contribute huge amounts of fecal sludge. Deliberate efforts to consolidate such data from low income areas will result in availability of data, and informed decision making for stakeholders at national and international levels.

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives.

Introduction People living in slums face several challenges to access healthcare. Scarce and low-quality public health facilities are common problems in these communities. Costs and prevalence of catastrophic health expenditures (CHE) have also been reported as high in studies conducted in slums in developing countries and those suffering from chronic conditions and the poorest households seem to be more vulnerable to financial hardship. The COVID-19 pandemic may be aggravating the economic impact on the extremely vulnerable population living in slums due to the long-term consequences of the disease. The objective of this review is to report the economic impact of seeking healthcare on slum-dwellers in terms of costs and CHE. We will compare the economic impact on slum-dwellers with other city residents.Methods and analysis This scoping review adopts the framework suggested by Arksey and O’Malley. The review is part of the accountability and responsiveness of slum-dwellers (ARISE) research consortium, which aims to enhance accountability to improve the health and well-being of marginalised populations living in slums in India, Bangladesh, Sierra Leone and Kenya. Costs of accessing healthcare will be updated to 2020 prices using the inflation rates reported by the International Monetary Fund. Costs will be presented in International Dollars by using purchase power parity. The prevalence of CHE will also be reported.Ethics and dissemination Ethical approval is not required for scoping reviews. We will disseminate our results alongside the events organised by the ARISE consortium and international conferences. The final manuscript will be submitted to an open-access international journal. Registration number at the Research Registry: reviewregistry947.

The purpose of this conceptual study is to analyse the political economy of Zimbabwe’s development aid trajectory from 1980 to 2013. The discussion unfolds around four historical epochs: colonial legacy, land and independence from 1980 to 1990; the Economic Structural Adjustment Programme (ESAP) 1991–2000; The Multi-Party Democracy period 2001–2008 and the Government of National Unity (GNU) 2008–2013. In doing so, the discourse offers a critical discussion of the factors that have characterised the flow of aid to Zimbabwe. It also explores the historical, socio-economic and political events that shaped development policies and outcomes in Zimbabwe from 1980 to 2013. The study also explores the scale, interaction and impact of aid flow to Zimbabwe. This study is purely qualitative and uses documentary reviews as part of the literature review to extrapolate the relevant data. In this study, we argue that the flow of aid is politically motivated. The study recommends that the Zimbabwean government should come up with a robust aid coordination policy in order to fully guide the inflow of donor aid.

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives.