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Objective:To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications.Design:A multiple cohort individual data meta-analysis of mortality risk (within 6 months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness and inclusivity in predicting mortality, face validity and compatibility with current standards and practice were assessed and operational consequences were modelled.Setting:Community-based cohort studies in twelve low-income countries between 1977 and 2013 in settings where treatment of wasting was not widespread.Participants:Children aged 6 to 59 months.Results:Of the twelve anthropometric case definitions examined, four (weight-for-age Z-score (WAZ) Z-score Conclusions:A combined case definition detects nearly all deaths associated with severe anthropometric deficits suggesting that therapeutic feeding programmes may achieve higher impact (prevent mortality and improve coverage) by using it. There remain operational questions to examine further before wide-scale adoption can be recommended.

Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby boys have a higher prevalence of undernutrition than girls. This analysis described mortality risk associated with anthropometric deficits (wasting, underweight and stunting) in children 6–59 months by age and sex. We categorised children into younger (6–23 months) and older (24–59 months) age groups. Age and sex variations in near-term (within 6 months) mortality risk, associated with individual anthropometric deficits were assessed in a secondary analysis of multi-country cohort data. A random effects meta-analysis was performed. Data from seven low-or-middle-income-countries collected between 1977 and 2013 were analysed. One thousand twenty deaths were recorded for children with anthropometric deficits. Pooled meta-analysis estimates showed no differences by age in absolute mortality risk for wasting (RR 1.08, p = 0.826 for MUAC < 125 mm; RR 1.35, p = 0.272 for WHZ < −2). For underweight and stunting, absolute risk of death was higher in younger (RR 2.57, p < 0.001) compared with older children (RR 2.83, p < 0.001). For all deficits, there were no differences in mortality risk for girls compared with boys. There were no differences in the risk of mortality between younger and older wasted children, supporting continued inclusion of all children under-five in wasting treatment programmes. The risk of mortality associated with underweight and stunting was higher among younger children, suggesting that prevention programmes might be justified in focusing on younger children where resources are limited. There were no sex differences by age in mortality risk for all deficits.

Where There Is No Engineer – Designing for Community Resilience” is a design initiative coordinated by the Development Technology in the Community (DTC) Research Group, Technological University Dublin (DIT) and Engineers Without Borders (EWB) Ireland. The programme is delivered in partnership with various development partners and Engineers Ireland. It provides participants with the opportunity to learn about design, teamwork and communication through real, inspiring, sustainable and crosscultural development projects. By participating in the programme, students and professionals will have the opportunity to design creative solutions to real life development projects. This initiative formed part of the DIT team submission which received the Inaugural Engineers Ireland Education Award Best in Class 2017. The design brief is based on a set of six global development themes; • Climate Resilient Infrastructure • Self-Supply Water and Sanitation • Community Participatory Health • On and Off (Micro) Grid Energy Systems • Food Security • Applying Big Data in the Community Each theme explores the relationship between People, Technology and the Environment. The setting for this programme varies on an annual basis. The programme is open to students and professionals across the disciplines of engineering, architecture, urban planning, science, business, social science, arts, media etc.

The HIV-1 Envelope glycoprotein (Env) is the sole target for broadly neutralizing antibodies (bnAbs). Env is heavily glycosylated with host-derived N-glycans, and many bnAbs bind to, or are dependent upon, Env glycans for neutralization. Although glycan-binding bnAbs are frequently detected in HIV-infected individuals, attempts to elicit them have been unsuccessful because of the poor immunogenicity of Env N-glycans. Here, we report cross-reactivity of glycan-binding bnAbs with self- and non-self N-glycans and glycoprotein antigens from different life-stages of Schistosoma mansoni. Using the IAVI Protocol C HIV infection cohort, we examine the relationship between S. mansoni seropositivity and development of bnAbs targeting glycan-dependent epitopes. We show that the unmutated common ancestor of the N332/V3-specific bnAb lineage PCDN76, isolated from an HIV-infected donor with S. mansoni seropositivity, binds to S. mansoni cercariae while lacking reactivity to gp120. Overall, these results present a strategy for elicitation of glycan-reactive bnAbs which could be exploited in HIV-1 vaccine development., This project has received funding from the European Union’s Horizon 2020 Research and Innovation program under grant agreement 681137 (to K.J.D. and I.H.), the Medical Research Council (MRC) (to K.J.D. [MR/K024426/1]), The Rosetrees Trust (to K.J.D. [M686]) and Fondation Dormeur, Vaduz (to K.J.D). This research was funded or supported by the National Institute for Health Research Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London and/or the NIHR Clinical Research Facility. The views expressed are those of the authors and not necessarily those of the National Health Service (NHS), the National Institute for Health Research (NIHR), or the Department of Health. N.R. acknowledges funding from Ministry of Science and Education grants CTQ2017-90039-R, RTC-2017-6126-1, and CTQ2011-27874 (fellowship to K.B.) and the Maria de Maeztu Units of Excellence Program from the Spanish State Research Agency (grant MDM-2017-0720). F.A. was funded by the Wellcome Trust (104958/Z/14/Z). J.A. was supported by the Spanish Ministry of Science, Innovation and Universities through the grant PID2019-109395GB-I00. J.A. and S.M. acknowledge support of BBSRC (grant BB/P010660/1). T.H. and S.W. were funded by Biotechnology and Biological Sciences Research Council (BBSRC) Norwich Research Park Doctoral Training Grant BB/M011216/1. IAVI’s work is made possible by generous support from many donors, including the Bill & Melinda Gates Foundation, the Ministry of Foreign Affairs of Denmark, Irish Aid, the Ministry of Finance of Japan in partnership with The World Bank, the Ministry of Foreign Affairs of the Netherlands, the Norwegian Agency for Development Cooperation, the United Kingdom Department for International Development (DFID), and the United States Agency for International Development. The full list of IAVI donors is available at www.iavi.org. Brendan McAtarsney and Jonathan Hare from the IAVI Human Immunology Lab (HIL) for coordinating the samples transfers and shipments. Monica Agromayor and the KCL Nikon Centre for assistance and advice on confocal microscopy. NMRI strain Schistosoma mansoni-infected Biomphalaria glabrata snails were provided by the NIAID Schistosomiasis Resource Center, Rockville, USA.

peer-reviewed Potato is highly productive crop and can provide a cheap and nutritionally-rich staple food. Its potential as a cash generator and source of food is much under-utilized in many emerging economies. In this paper we study the impact of an intervention that introduced improved potato technologies in Chencha, Ethiopia on the livelihoods of smallholder farmers. We collected information through in-depth interviews in order to explore possible pathways of impact on farmers’ livelihoods; and used this information as the basis for designing a household survey. The results show changes in agronomic practices and consumption; these changes were most pronounced among wealthy farmers who participated in the intervention. Farmers used the additional income from potato in different ways: wealthier farmers improved their houses and increased their livestock, whereas poor farmers mainly invested in furniture, cooking utensils, tools and in developing small businesses like selling and buying cereals, milk and weaving products in the local markets. Some wealthy farmers, who did not participate in the project, also derived some indirect benefits from the intervention. This underscores: i) interventions that promote uniform farming technologies in themselves are not always sufficient to improve the livelihoods of poor farmers, and ii) the need to broaden the scope of interventions so as to take into account the resources available to farmers in different wealth categories, and the diversity of strategies that they employ for improving their livelihoods. Our approach allows to understand and describe the different developmental effects of a single technological intervention on the different aspects of farmers’ livelihoods.

PRIMVAC is a VAR2CSA-derived placental malaria vaccine candidate aiming to prevent serious clinical outcomes of Plasmodium falciparum infection during pregnancy. We assessed the safety and immunogenicity of PRIMVAC adjuvanted with Alhydrogel or glucopyranosyl lipid adjuvant in stable emulsion (GLA-SE) in French and Burkinabe women who were not pregnant., Bundesministerium für Bildung und Forschung, through Kreditanstalt für Wiederaufbau, Germany; Inserm, and Institut National de Transfusion Sanguine, France; Irish Aid, Department of Foreign Affairs and Trade, Ireland.

Improving the nutritional content of staple crops through breeding (biofortification) is promoted as cheap and sustainable approach for alleviating vitamin A and other micronutrient deficiencies across the world. Maize is one of the target crops for provitamin A biofortification, since it is a major staple for millions of people in developing countries, and has a great genetic potential for accumulating provitamin A in its grain. This PhD study addressed three research objectives aimed at accelerating the biofortification of maize with provitamin A. To achieve the objectives, a diverse set of inbred lines developed from different crosses having mixed genetic background of temperate and tropical germplasm were employed. In the first research objective, the efficiency of PCR based functional markers proposed for high provitamin A maize breeding was investigated. Out of eight polymorphisms for three key carotenoid biosynthesis genes tested, the 3'TE and 5'TE polymorphisms of the gene crtRB1 showed the strongest association. About 18 percent of the inbred lines studied had the favourable alleles for these two polymorphisms. The second research objective assessed the association of genome-wide SNP markers with provitamin A and non-provitamin A carotenoids using GWAS and pathway level association analysis. This study detected known major and minor effect carotenoid genes (lcyE, crtRB1, ZEP1 and others), plus novel loci, such as ARF20, that may be involved in regulation of carotenoid biosynthesis in maize endsosperm. In the last research objective 24 yellow maize inbred lines were inter-crossed using factorial mating scheme for studying their combining abilities and heterotic effects for carotenoids and key agronomic traits. The result demonstrated the predominance of additive genetic effects in the inheritance of endosperm carotenoid content. Small percentage of non-additive genetic effect was also detected for provitamin A which is important for expression of heterosis in the trait. Hybrids combining good agronomic performance and high provitamin A content were identified. This study will serve as a basis for establishing heterotic pattern in IITA's yellow maize germplasm which is crucial for development of hybrid and synthetic varieties that can meet existing and emerging demands, while incorporating high level of provitamin A in the grain. 2016-05-13

Genetic variation describes naturally occurring genetic differences among individuals of the same species and permits flexibility and survival of a population in the face of changing environmental circumstances, diseases and pests. Genomic variation develops from a combination of evolutionary influences, among them, mutation process and demographic history. Understanding in greater detail the basis of the tremendous phenotypic variability in East African Highland bananas subgroup that are apparently clonal variants of a single original seedling is essential for developing improved breeding strategies for this subgroup. While genetic diversity studies have included cultivars from this subgroup, intra- population structure and phylogenetic relationships per se are still unknown. In addition, none of these studies have attempted to study the evolutionary history and epigenetic polymorphism in this subgroup. In this thesis, I have used EAHB cultivars to assess the genetic variation, population structure and evolutionary history. I focus on the role of DNA methylation as an epigenetic mark that contributes to phenotypic diversity and determine inheritance of DNA methylation patterns in sexual and vegetative propagation models. The results show that despite being phenotypically distinct, these cultivars are strikingly genetically similar with a narrow genetic base. While DNA methylation polymorphisms are common amongst EAHB cultivars, MSAP does not detect any obvious relationship between DNA methylation variation and phenotypic variation in East African Highland bananas. This study demonstrates that the EAHB subgroup has low mutation rates, show past population expansion but may have suffered a genetic bottleneck that may have led to the low genetic diversity. Extensive linkage disequilibrium and balancing selection were observed. Finally, I discovered that EAHB cultivars and Zebrina (wild AA cultivar) underwent a speciation event 928 thousand years and their most recent common ancestor dates back 2980 thousand years ago. 2016-05-13

Background: The importance of understanding the cultural, social, economic, political and historical contexts when working in post conflict fragile states is well documented. Many health and development projects in post conflict South Sudan are significantly hampered by (i) the mismatch between the views of service providers and those of the community, and (ii) because of the misunderstanding of the context. It is not clear in the literature if the health systems in post conflict situations are designed for or adapted to the context, and if they are, to what extent has understanding of the context and demand side barriers been useful in planning for accessible maternal health care services that can reduce the maternal mortality in such settings. Aim: The aim of this research is to gain an in depth understanding of the determinants of, and delays to access to, the maternal health services in a post conflict setting in South Sudan, and to investigate the extent to which health system actors take account of the context in designing a system that incorporates the health care needs of their clients in order to provide accessible maternal health care. Methods: This research applied a qualitative participatory action research approach in two phases. Phase one was to understand the issues around access and utilization of maternal health services using qualitative methods: Participatory Ethnographic Evaluation Research (PEER), and Critical Incident Technique (CIT), and stakeholder interviews. Phase two was interventions to improve the situation through Innovative Participatory Health Education (IPHE) and Participatory Reproductive Health Project Management (PRHPM). Findings: Access to maternal healthcare in the aftermath of conflict is complex. Maternal health is not always a priority, services do not usually match the needs of the people, most of the facilities are not functioning and many healthcare providers are not competent. Voices of hard to reach populations are usually excluded or not heard. Social determinants hugely influence access. Women often do not take decisions that prioritise their health, and even if they take healthy decisions, they do not act on them or act very late. There is a mismatch between stakeholders and service users' perspectives on access to maternal healthcare. Conclusion: Maternal healthcare in South Sudan will not be optimised unless women are cared for in their communities, and are empowered to take decisions about their care at the right time, without waiting for others to make decisions for them. Participatory Health Systems Research approaches strengthen capacity at multiple levels, ensure integrated knowledge translation, engage marginalized communities, and enhance their contribution to identify health needs, plan and design future health services. 2018-03-09

The dire need for eye care services and a dearth of human resources (HR) in sub-Saharan Africa motivated the setting up of new optometry programmes. However, to make a meaningful impact, geographical, gender, economic and educational disparities must additionally be addressed. A qualitative study utilizing purposive sampling to select academic leadership and students from optometry programmes in sub-Saharan Africa was conducted. Individual and focus group interviews produced data that were coded and analysed using a deductive thematic analysis approach. The themes that emerged as contributing to disparities in access through recruitment and selection were institutional barriers (student intake numbers, programme marketing, minimum entry requirements, absence of pre-medical programme) and socio-economic barriers (finance, poor secondary school education, lack of knowledge of optometry, geographic location of institutions, gender). To address equity, institutions should engage with communities, market via community radio stations, offer pre-medical and bridging programmes, partner with governments and private funders to offer loans and bursaries and affirm females and rural applicants in recruitment and selection. In conclusion, universities must be socially accountable in all facets of education including recruitment and selection.

Background: The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare Project (MEP) has established the first optometry training and human resource deployment initiative to address the burden of URE in Lusophone Africa. The nature of the MEP programme provides the opportunity to determine, using Cost Benefit Analysis (CBA), whether investing in the establishment and delivery of a comprehensive system for optometry human resource development and public sector deployment is economically justifiable for Lusophone Africa. Methods: A CBA methodology was applied across the period 2009–2049. Costs associated with establishing and operating a school of optometry, and a programme to address uncorrected refractive error, were included. Benefits were calculated using a human capital approach to valuing sight. Disability weightings from the Global Burden of Disease study were applied. Costs were subtracted from benefits to provide the net societal benefit, which was discounted to provide the net present value using a 3% discount rate. Results: Using the most recently published disability weightings, the potential exists, through the correction of URE in 24.3 million potentially economically productive persons, to achieve a net present value societal benefit of up to $1.1 billion by 2049, at a Benefit-Cost ratio of 14:1. When CBA assumptions are varied as part of the sensitivity analysis, the results suggest the societal benefit could lie in the range of $649 million to $9.6 billion by 2049. Conclusion: This study demonstrates that a programme designed to address the burden of refractive error in Mozambique is economically justifiable in terms of the increased productivity that would result due to its implementation.

Introduction/Purpose: There are almost twelve million children (years) in Mozambique with minimal access to eye care. [1] Annual screening of school children by teachers for uncorrected refractive error is one of the most cost effective health interventions in Sub Saharan Africa.[2] The International Agency for the Prevention of Blindness (IAPB) has recommended that child eye health interventions be incorporated into National School Health Initiatives.[3] In view of the IAPB position this presentation sets out to identify and discuss the main considerations in the design of a child eye health strategy, for the province of Nampula, Mozambique, which aligns itself with broader child health and education strategies. The considerations discussed are relevant to organisations and institutions involved in the provision of primary child eye care through school screening. Methods: A review of published articles and white papers around current international trends in child eye health was performed. The Mozambique national, provincial and district educational and health systems were examined through the 2007 census and other published statistics. Interviews were conducted with representatives of the provincial health and education systems and an external bilateral aid representative. Local potential stakeholders in the child eye health programme were identified and interviewed; these included primary school principals, teachers and representatives from NGOs working locally and nationally. Results: Considerations will be discussed under the following headings: Social; Educational; Community; Health. A School Health policy exists in Mozambique but the implementation of the policy is not consistent in each province. The main considerations in Nampula are the lack of resources in education and health and the extreme poverty in which most children live. Potential areas for positive integration of child eye health were identified in several government run school and community health and education schemes. Conclusion: Highlighting potential barriers and opportunities to programme design ensures that it is sustainable and appropriate to the local setting. Familiarity and engagement with stakeholders in existing child health and educational systems in Nampula, as outlined in this presentation, will inform in the design of a child eye health programme and has the potential enlighten child eye health programme design in other countries. References: 1. UNICEF - Mozambique - Statistics. 2012 16/11/2012]; Available from: http://www.unicef.org/infobycountry/mozambique_statistics.html. 2. Baltussen, R. and A. Smith, Cost effectiveness of strategies to combat vision and hearing loss in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ, 2012. 344: p. e615. 3. Gilbert, C., IAPB Briefing Paper: Integrating eye health into school health programmes, 2011, International Centre for Eye Health, London School of Hygiene and Tropical Medicine.

Introduction: The appropriate education for eye health workers is a key determinant of sustainable eye health care systems, and the solution to avoidable blindness and visual impairment. The Mozambique Eye care Project (MEP), is developing the country's first indigenously trained optometrists using a competency-based education curriculum. Aims: The principal aim is to evaluate the exit clinical competencies of the first optometry graduates in Mozambique and to inform the evaluation of the competency curriculum. Methods: Using UK based competencies as a benchmark; nine final year students were examined to assess competences in six core subjects.Further information about factors relating to their performance in these competencies was gained through semi-structured interviews with course developers and lecturers. Results: All the students were competent at communication, professional conduct and methods of ophthalmic examination. None were competent at visual function and only four at ocular anatomy and binocular vision. Conclusions: a) Student learning experience: Lecturer background and training influenced student training as all the lecturers had trained in different countries. A clinical training protocol need to be implemented to optimise clinical competencies. b) Existing healthcare context:Enhanced training needs should be addressed in clinics with more support staff and time to deal with complex patients. c) Student capacity: Students that are more suitable for the course should be selected.

Background: Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middleincome countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies.Objective: The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa. Methods: We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predictors of job satisfaction and intention to leave. Results: There were statistically significant differences in job satisfaction and intention to leave between the three countries. Approximately 52.1% of health workers in South Africa were satisfied with their jobs compared to 71% from Malawi and 82.6% from Tanzania (x2 =140.3, p

Purpose There is no plan for a national child eye care programme or existing human resource infrastructure to address the immediate challenge of child eye health in Mozambique. Furthermore, the prevalence and incidence of refractive error, visual impairment (VI) and child blindness (CB) in Mozambique is unknown. VI and CB have devastating personal, developmental, economic and other implications for the child, the family, the community and indeed, the nation. This study aims to design, implement and evaluate a school based paediatric vision screening service, to identify those in need of eye health services, among Mozambique’s 11,561,000 children. Methods Primary School Screening took place in three schools in Nampula, Mozambique in September 2010 and March 2011. The children’s vision was screened by an optometry student, optometrist or teacher with a Log MAR 0.3 line at 4 Meters. Ophthalmoscopy was performed on all children. Children who failed to read all 5 letters monocularly had their visual acuity examined on a standard Log Mar chart. If they failed to see the 0.3 line on the standard chart they had a full refraction on site. Children who required refraction were refracted on site. Those needing ophthalmological assessment were referred to Nampula Central Hospital, Ophthalmology Unit. Results These studies found that there is a cohort of students attending school in Nampula who are in need of eyecare service provision. Refractive Error was present among this population tested in these studies but none of the children observed wore spectacles.The training received by these teachers was very brief but teachers appear to have an adequate level of education and interest to undertake vision screening in children. The ideal teacher profile for Vision Officers within schools is trainee teachers who can be taught the basics of vision screening and eye health through their existing studies. The results of this study will inform a regional pilot teacher screening project for Nampula, which will include the addition of “Vision Screening” to teacher training modules at Pedagogical Universities in Nampula, Mozambique, as part of a plan to develop a national child eye care programme for Mozambique.

Purpose Approximately 314 million people worldwide live with low vision and blindness.145 million people's low vision is due to uncorrected refractive errors1.One of the solutions to creating sustainable eye care structures is education of personnel2. The Technological University Dublin (DIT) with ICEE (International Centre of Eyecare Education) is developing and implementing a sustainable model for optometric education and eye care service delivery in Unilurio in Mozambique.The Mozambique Eyecare Project aims to train Mozambique’s first professional optometrists who will provide a sustainable and comprehensive eye-care system as an integral part of the national health system3. Mozambique currently has only 17 ophthalmologists for a population of 21 million and 34 trained Ophthalmic Technicians (OCO) the only two providers of refraction services within the local health system4. The purpose of this research is to evaluate the confidence levels, knowledge and core competencies of the ophthalmic technicians in refraction to provide a better understanding of the existing situation. Method i) Background questionnaire to obtain data on their years of experience and the training they had received. ii) Investigative tools: Confidence levels questionnaire, oral refraction quiz and a refraction competency assessment Results The OCO’s were trained in 3 different institutions, in Cuba, Mozambique and Malawi. The Cuban trained OCO’s had studied refraction to different levels but due to lack of equipment had never practised basic retinoscopy or subjective refraction for astigmatism. They were not competent in performing refractions unsupervised.The ones trained in Mozambique and Malawi had not studied refraction hence were not competent in performing refractions at all. Conclusion By identifying strengths and weaknesses of the OCO’s refraction knowledge and skills, training and continuing education can be tailored accordingly. This information would also allow ICEE and DIT to compare and contrast refraction training for both the student Optometrists and the existing OCO’s to improve overall refraction service provision in Mozambique.

This paper presents results from a national situational analysis. An International Agency for Prevention of Blindness (IAPB) tool was used to map current eye care services recorded including human resource and equipment. Data was analysed against VISION 2020 Human Resource targets.

Faculty recruitment for a Portuguese-language optometry program: experiences and challenges of The Mozambique Eye Care Project Ms Diane Wallace BOptom, MPA University of KawZulu Natal, South Africa Purpose The Mozambique Eyecare Project (MEP) is a unique institutional collaboration in a programme for the development, implementation and evaluation of a regional optometry training model for Portuguese-speaking Africa. The Project was initiated in February 2009 with the first cohort of undergraduate students beginning classes at Lúrio University in Northern Mozambique. This is the first Portuguese-language optometry program in Africa, and with no professionally qualified optometrists locally, faculty had to be recruited from outside the continent. To date, nine optometrists, either Portuguese or Spanish speaking, were recruited from Spain, Portugal and Colombia. This paper will present data related to recruitment of faculty, their interest in joining the Project, experiences and challenges on the Project as well as benefits gained from the experience. Methods Semi-structured interviews were conducted with five expatriate faculties who spent time on the Project between May 2010 and October 2011. Data from all nine faculty was qualitatively analysed for common themes around faculty experiences on the Project. Results Faculty were recruited though professional networks, website postings or word-of-mouth. Five of the nine faculty were Spanish-natives, two Columbian with Spanish as a first language, and two were Portuguese nationals. Only three of the nine faculty had prior university teaching experience, with eight of the nine having post-graduate qualifications. Of these, five were Masters qualified and three had PhD qualifications. Recruits signed either a one year renewable contract or offered short-term availability of one to three months. Only one recruit has extended the one year contract with the majority of stays being three months or less. Experience on the project was described as professionally stimulating and rewarding. The difference in scope of practice, skills and regulation of optometry in the countries represented by faculty presented some challenges in delivering a unified curriculum approach which may be different to one’s own training or experience. Locally, bureaucratic structures and difficulties with transportation were some of the frustrations experienced. Conclusions As optometry is still a developing profession in Portugal, it is difficult to find Portuguese-language optometrists with university teaching experience who are available for long term contributions to such challenging assignments. All faculty noted, however, the personal satisfaction and sense of contribution from working on the project, despite the challenges. Those who had never worked in academia or development before, also acquired a new skills set they could carry into their future careers.

Purpose: There is no plan for a national child eye care programme or existing human resource infrastructure to address the immediate challenge of child eye health in Mozambique.This study aims to design, implement and evaluate a school based pediatric vision screening service, to identify those in need of eye care services, among Mozambique’s 11,561,000 children. Methods: Primary School Screening took place in three schools in Nampula, Mozambique in September 2010 and March 2011. The children’s vision was screened by an optometry student, optometrist or teacher with Log MAR ETDRS letters at 4 Meters. Ophthalmoscopy was performed on all children by qualified optometrists. Children requiring refraction were refracted on site, those needing ophthalmological assessment were referred to the ophthalmologist in Nampula Central Hospital. Results: 770 children were screened in total. The ocular abnormality detection rate was 10.65%, and included 7.40% of children requiring spectacle provision, and the remaining 3.25% requiring referral to the Ophthalmology Unit. The distribution of myopia, hyperopia and astigmatism among children provided spectacles was 28.57%, 12.5% and 58.93% respectively, and overall prevalence in the study sample was 2.21%, 0.91% and 4.29% respectively. Referrals for ocular health abnormalities included, cataract (26.92%), ptosis (23.08%), glaucoma (15.38%). All teachers interviewed are eager to participate in a vision screening programme. Two Primary School Teachers were trained in vision screening. Teachers scored 100% case detection agreement with optometrists and student optometrists, with no noted false positive or false negative referrals. Conclusions: Teachers appear to have an adequate level of education and interest to undertake vision screening in children. This study will inform a regional pilot teacher screening project for Nampula, which will include the addition of “Vision Screening” to teacher training modules at Universidade Pedagogica, Nampula, as part of a plan to develop a national child eye care programme for Mozambique.

Background - The Mozambique Eyecare Programme is funded by Irish Aid and designed to address the need for optometric education in Lusophone Africa. It is a multi-partner collaboration between Universidade Lúrio, Mozambique, Technological University Dublin, Ireland, University of Ulster, Northern Ireland, and The International Centre for Eyecare Education (ICEE) an international Non Government Organisation. A key output from the programme is the development of an optometry school based at Universidade Lúrio, the first of its kind in Mozambique. The aim is to address unmet eye care needs through human resource development. All students enrolled at Universidade Lúrio, including the optometry students, are required to participate in the One Student One Family programme. This initiative aims to improve the public health of disadvantaged communities in Nampula province through information dissemination and increased interaction between health science students and the general public. It also provides the students with the opportunity to interact with the community and apply their theoretical knowledge in the local context. This experience will enhance their patient care and as it is a community informed project, it ensures the wider eyecare programme follows a pro-poor approach. Aim - This paper aims to analyse the lessons learnt from the programme so far. Methods - Surveys and key informant interviews with optometry students, individuals within communities, teaching faculty and partners involved with the Mozambique Eyecare Project will form the basis of the analysis. Results - The results are expected to indicate both the successes and failures of the One Student One Family programme. The results will contribute to the development of a framework to improve the programme in order to achieve the desired outcome of improved community eye health. Conclusion - The Mozambique Eyecare Project is developing human resources in Lusophone Africa through a partnership linking higher education institutions in Europe and Africa. The One Student One Family programme addresses a current deficit in eyecare knowledge within the local community by transferring knowledge from optometry students to the general public. In conclusion, innovative models of education and interaction between students and the community is necessary to address the eye care needs of the country, the region and the continent.

A situational analysis indicates a lack of eye health personnel who can and do refract. The logical course of action would be to train more eye health personnel. A conservative estimated annual burden of URE in lost productivity in Mozambique is $14,486,692. To achieve the V2020 target ratio, an extra 184 workers are needed in six provinces analysed.The analysis assumes the existing personnel are well trained and dedicate time to offering a refraction service. It also assumes that the patient receives the care they require. Other aspects of the situational analysis suggest this is currently not always the case. A more comprehensive analysis would look at the number of work hours each person dedicates to refraction and the outcome.

BACKGROUND Optometric education and resources are drastically deficient in most of Africa, more so in Lusophone Africa where the problem is compounded by language barriers which isolate these countries from related developments in Africa and/or the developed world. The Mozambique Eyecare Programme is a multi-partner collaboration between The International Centre for Eyecare Education (ICEE), Universidade Lúrio in Mozambique, Technological University Dublin, and the University of Ulster in Ireland, designed to address the need for optometric education in Lusophone Africa. AIM This paper aims to document the current situation with regards to human resource development in eyecare in Mozambique and offer analysis of the status and challenges facing the only programme addressing the problem of uncorrected refractive error and low vision in Lusophone Africa through education. METHODS The extent of uncorrected refractive error and existing optometric services in Nampula Province will be extrapolated from the results from a Rapid Assessment of Refractive Error and a situational analysis. The challenges faced by the Mozambique Eyecare Programme will be analysed using results from a baseline survey of students, key informant interviews and analysis of optometric resources available that are published in Portuguese. RESULTS The research into the implementation of the Mozambique Eyecare Programme is ongoing. Results are currently unavailable, but relevant data and analyses emerging from current research within the next 6 months will be presented at the conference. CONCLUSION Human resource development for refractive service delivery in Lusophone Africa is key to the achievement of VISION 2020 goals in this region. Innovative models of education need to take into account the local need, legislative boundaries and situational constraints in order to successfully achieve desired outcomes within specified timeframes.

According to the WHO about 831 million people are visually impaired worldwide, 45 million of them are blind. Most people with visual impairment are older, and females are more at risk at every age, in every part of the world. Uncorrected Refractive Error accounts for over half of all visual impairment. About 87% of the worlds visually impaired live in developing countries. The Mozambique Eyecare Programme (MEP) is a cross institutional collaboration between governments, higher education institutions, non-governmental organisations and corporations. The aims of this Programme are to collaborate to provide a sustainable solution to the problem of avoidable blindness in developing nations, by addressing the significant barrier of local human resource capacity development, through optometric education, research capacity strengthening and the enhancement of specialist knowledge for future collaborations. The MEP is an example of how cross institutional collaborations work effectively and efficiently to address uncorrected refractive error as a leading cause of global blindness and vision impairment. Dissemination of lessons learned will inform collaboration with the government and relevant organisations to integrate outcomes into the development of a National Eyecare Plan in Mozambique and other countries.

BACKGROUND It is increasingly recognised that a well-functioning higher education system is a necessary condition for economic and social development. The sector however needs to considerably strengthen its capacity to make an effective contribution to poverty reduction. The Irish Aid funded Programme of Strategic cooperation is designed to facilitate the systematic integration and expansion of education and research institute engagement in development cooperation. OBJECTIVES This ambitious North-South programme aims to achieve capacity strengthening, through a medium term effort to invest in people, systems and knowledge building. The longer term consolidation of this collaboration aims to foster academic and non-academic leadership in development cooperation for eye care. METHODS The Mozambique Eyecare Project (MEP), a strategic collaboration between Technological University Dublin, University of Ulster, Universidade Lúrio and the International Centre for Eyecare Education have successfully secured Programme funding, and brings eye care to the forefront of Irish Aid’s development agenda. RESULTS The MEP continues to: • initiate collaborative research • enhance teaching and learning across institutions • establish a flourishing cross-institutional network • generate specialist knowledge, research expertise, increased awareness and critical engagement in development cooperation. These successes have already driven policy change in Mozambique including the recognition of a new professional cadre for eye care service delivery. DISCUSSION The higher education sector is seen as a key organ in strengthening governance, research generation and knowledge development, and creating space for independent analysis of development issues to address public sector needs. In funding this initiative, Irish Aid provide formal recognition that poor vision is an indicator of vulnerability, a constraint to sustainable livelihood development and education and more generally implicated in health and poverty complexes. This represents a significant broadening of Irish Aid’s development agenda for Mozambique.

Background : In 2007, the South African government introduced the occupation-specific dispensation (OSD), a financial incentive strategy, to attract, motivate, and retain health professionals in the public sector. Implementation commenced with the nursing sector, but there have been unintended negative consequences. Objective : First, to examine implementation of the OSD for nurses using Hogwood and Gunn’s framework that outlines ‘perfect implementation’ pre-conditions. Second, to highlight the conditions for the successful implementation of financial incentives. Methods : A qualitative case study design using a combination of a document review and in-depth interviews with 42 key informants. Results : The study found that there were several implementation weaknesses. Only a few of the pre-conditions were met for OSD policy implementation. The information systems required for successful policy implementation, such as the public sector human resource data base and the South African Nursing Council register of specialised nurses were incomplete and inaccurate, thus undermining the process. Insufficient attention was paid to time and resources, dependency relationships, task specification, and communication and coordination. Conclusion : The implementation of financial incentives requires careful planning and management in order to avoid loss of morale and staff grievances. Keywords : financial incentives; occupation specific dispensation; nurses; policy implementation; South Africa (Published: 24 January 2013) Citation: Glob Health Action 2013, 6 : 19289 - http://dx.doi.org/10.3402/gha.v6i0.19289