Search

Concepts can provide researchers and communities with common ground for communicating and building understandings about the world. However, researchers who engage with communities often encounter unexpected interpretations of concepts in the field. This article introduces Community Concept Drawing (CCD), a participatory visual method aimed at facilitating a deep understanding of how local communities make sense of complex concepts often central to social research. We present the methodological foundations, protocol, and utility of CCD while drawing examples from our case studies in Senegal, Nepal, Morocco, and Kenya to examine the concept of empowerment. While CCD was created to open opportunities for studying empowerment within the field of international development, this article concludes by offering applications for using CCD to examine other concepts in various fields of study.

Background Nepal is attempting to eliminate malaria by 2026. Despite decreased malaria burden in Nepal between 2004 and 2018, studies have shown that some malaria indicators are increasing in certain parts of the country and that malaria has shifted to previously non-endemic areas. The objective of this study is to analyze the spatio-temporal patterns of malaria in Nepal from 2005 to 2018, following the introduction of Long-Lasting Insecticidal Nets (LLINs) as vector control intervention. Methods Data describing five different malaria indicators were obtained from annual reports of the Department of Health Services of the Government of Nepal: incidence of Indigenous Malaria, Imported Malaria, PV ( Plasmodium vivax) Malaria, PF ( Plasmodium falciparum) Malaria, and Total Malaria. Spatial variation in temporal trend method was employed in SaTScan software to detect the unusually high or low temporal trends of malaria indicators, and to generate their spatio-temporal clusters. Results All five indicators revealed spatiotemporal clusters of increasing malaria. Indigenous Malaria increased by 113.71% in a cluster of three mountainous districts where malaria was previously non-endemic. Most clusters of Imported Malaria had an increasing trend. The most prominent cluster included Kathmandu, the capital, where Imported Malaria increased by 156.22%. PV and PF Malaria also had clusters with an increasing trend. There were two clusters of Total Malaria with an increasing trend. Even though some clusters had decreasing trends in malaria indicators, the rate of decrease incidence in the clusters was lower than that outside the clusters. Conclusion The overall malaria burden is decreasing in Nepal as the country progresses closer to the elimination deadline. However, several spatiotemporal clusters showed increasing trends of malaria incidence. Furthermore, in clusters where a decreasing incidence trend was observed, the rate of decrease was far lower than the rate outside the cluster. Thus, it is necessary to focus vector control interventions in all these clusters. This information can help public health officials to make decisions for implementing vector control interventions to successfully eliminate malaria form the country.

Access to veterinary services is important in Karamoja, northeastern part of Uganda, as livestock is a primary source of livelihood. Gender is often overlooked in animal health programs, let alone intersectionality. However, given the socio-cultural intricacies of Karamoja, ignoring these factors may hinder animal vaccination practices, limiting the success of programs designed to control and prevent animal diseases, such as peste des petits ruminants (PPR). The study used qualitative research methods, including focus group discussions, individual interviews, and key informant interviews in a participatory research approach to investigate the constraints faced by livestock keepers when accessing vaccines. The study was carried out in Abim, Amudat, Kotido, and Moroto, four districts in the Karamoja Subregion of Uganda. A modified version of the socio-ecological model (SEM) blended with an intersectional approach were used as frameworks to analyze underlying individual, social and structural determinants of vaccine access with intersecting factors of social inequalities. The results show there are seven intersecting factors that influence access to vaccination the most. These are: gender, ethnicity, geographic location, age, physical ability, marital status, and access to education. The impact of these intersections across the different levels of the SEM highlight that there are vast inequalities within the current system. Access to vaccines and information about animal health was most limited among women, widows, the elderly, the disabled, geographically isolated, and those with unfavorable knowledge, attitudes, and practices about vaccination. Cultural norms of communities were also important factors determining access to PPR vaccines. Norms that burden women with household chores and beliefs that women cannot manage livestock, combined with gender-based violence, leaves them unable to participate in and benefit from the livestock vaccine value chain. Trainings and sensitization on gendered intersectional approaches for those involved in the distribution and delivery of vaccines are necessary to avoid exacerbating existing inequalities in Karamoja.

As online classes became the norm in many countries as a response to the COVID-19 pandemic, the concern for child and adolescent mental health became an issue of concern. This study evaluates the differences in the psychosocial status of school children based on engagement in in-person or Emergency Remote Education (ERE) and assessed the prevalence and predictors of symptom-derived risk levels for anxiety, depression, and obsessive-compulsive disorders (OCD). Cross-sectional data were collected from students at a Florida K-12 school and their household members through an online survey conducted in October 2020 (n = 145). No significant difference was found between ERE and in-person learning for risk of anxiety, depression, or OCD. Prevalence of students presenting as at risk for anxiety, depression, and OCD was 42.1%, 44.8%, and 41.4%. Several student factors (e.g., child sex, school level) and parental factors (e.g., parental COVID-19 attitudes) were associated with students presenting as at risk for anxiety, depression, or OCD, child’s participation in sports was protective against all three outcomes. Participation in sports was found to be protective against risk of anxiety (aOR = 0.36, CI = 0.14–0.93), depression (aOR = 0.38, CI = 0.15–0.93), and OCD (aOR = 0.31, CI = 0.11–0.85).

Background Given the emerging literature regarding the impacts of lockdown measures on mental health, this study aims to describe the psychosocial health of school-aged children and adolescents during the COVID-19 Safer-at-Home School mandates. Methods A cross-sectional study was conducted in April 2020 (n = 280) among K-12 students at a research school in North Central Florida. Bivariate analysis and logistic and multinomial logistic regression models were used to examine socio-demographic and knowledge, attitude, and practice (KAP) predictors of indicators of anxiety-related, depressive, and obsessive-compulsive disorder(OCD)-related symptoms. Outcomes (anxiety, OCD, and depressive related symptoms) were measured by indices generated based on reported symptoms associated with each psychosocial outcome. Results Loss of household income was associated with increased risk for all three index-based outcomes: depressive symptoms [aOR = 3.130, 95% CI = (1.41–6.97)], anxiety-related symptoms [aOR = 2.531, 95%CI = (1.154–5.551)], and OCD-related symptoms [aOR = 2.90, 95%CI = (1.32–6.36)]. Being female was associated with being at higher risk for depressive symptoms [aOR = 1.72, 95% CI = (1.02–2.93)], anxiety-related symptoms [aOR = 1.75, 95% CI = (1.04–2.97)], and OCD-related symptoms [aOR = 1.764, 95%CI = (1.027–3.028)]. Parental practices protective against COVID-19 were associated with children being at higher risk of depressive symptoms [aOR = 1.55, 95% CI = (1.04–2.31)]. Lower school level was associated with children being at higher risk of anxiety-related and OCD-related symptoms. Conclusions As the COVID-19 pandemic continues, schools should prioritize mental health interventions that target younger, female students, and children of families with income loss. Limiting the spread of COVID-19 through school closure may exacerbate negative psychosocial health outcomes in children, thus school administrators should move quickly to target those at greatest risk.

Women’s empowerment is a driving concept in gender and development scholarship. This scholarship often engages quantitative indices of evaluation that are unable to account for culturally specific meaning and nuance that shape local understandings of empowerment. Recent efforts within the field of international development are attempting to create methodological mechanisms for capturing this nuance. This study employs one such method, Community Concept Drawing (CCD), in rural villages within Kenya, Senegal, and Nepal. Findings indicate significant differences between the field sites in the local conceptualization of empowerment. Cross-examination of site-specific data yields an understanding of how cultural norms and values shape local perceptions of empowerment in ways that are critical for research that engages gendered understandings. Furthermore, such analysis is critical to a more accurate understanding of the locally specific context of gender inequity.

This study describes coronavirus test positivity rates among elementary, middle, and high school student contacts of confirmed COVID-19 cases in a Florida county where schools required a negative test on day 9 before return to school on day 10.

Among livestock species, poultry and small ruminants are of particular importance to rural women in low- and middle-income countries, as means to generate income, provide nutritious food for the family, accumulate wealth, and confer social status. Newcastle disease (ND) and Peste des Petits Ruminants (PPR) are widespread livestock diseases of poultry and small ruminants, respectively. While both diseases are vaccine preventable, numerous constraints limit the availability of and access to livestock vaccines, especially among the most vulnerable populations in developing countries. The literature on equity and effectiveness of livestock vaccine distribution systems has emphasized many of these constraints, however a gendered analysis and deeper understanding of the vaccine system remain insufficient. This paper applies a gendered and intersectional transformational approach, or GITA, to highlight how gender and other social factors affect the provision and utilization of vaccines for ND and PPR diseases in the region of Kaffrine, Senegal. We first articulate and describe the vaccine value chains (VVCs) for these diseases in Kaffrine, and then analyze the gendered and intersectional dynamics at different nodes of the VVCs, including actors at the national level, through the regional and district levels, down to providers of animal health at community level and the livestock keepers themselves. Our findings indicate that actors’ various experiences are shaped and defined mainly by rigid gender norms, location and remoteness, and to a lesser degree by other social stratifications of age, ethnicity, and livelihood. Given the significant role that gender norms play in the livestock vaccine value chains, differences according to the livestock species, regulation of vaccine administration, and vaccine distribution systems emerge as highly relevant for understanding barriers that women specifically face within the livestock vaccination system.

Purpose: The purpose of this paper is to utilize data collected from Advancing women’s participation in livestock vaccine value chains in Nepal, Senegal and Uganda (Advance) during 2020-2021 to assess the impacts of COVID-19 safety measures on animal health, including livestock vaccinations, veterinary services, and livestock-related research activities in these countries. Methods: Country coordinators from each of three countries provided weekly reports to Principal Investigators on national COVID-19 regulations, beginning in May 2020. Interviews with country coordinators were conducted during spring 2021 via Zoom to provide additional contextual information regarding the impact of COVID-19 in each country. Information collected during interviews and through weekly reports was analyzed qualitatively to document a historic timeline of COVID-19 policy changes and associated impact on both human and animal health. Results: The main themes that were analyzed in weekly country reports and country coordinator interviews were compliance, politics, access to care, and agriculture. All three countries experienced similar trajectories, with small differences in reporting and spikes for COVID-19 cases and a COVID-19 vaccine rollout starting in the spring of 2021. Conclusions: Fluctuations in lockdown policies, employment, and travel restrictions created additional barriers to access of livestock vaccines, animal supplies, and veterinary services in all three countries. Livestock vaccine services were completely halted in some countries because of travel restrictions and disruptions in the supply chain created by the COVID-19 pandemic. Veterinary services were also limited as a result of travel restraints and market closures. Given the global dependence of rural livelihoods on livestock, additional research is needed to examine the near- and long-term impacts of COVID-19 on livestock populations, especially women, and services including livelihoods, gender norms, veterinary services, and livestock-related research activities globally.

BACKGROUND AND OBJECTIVES: Malnutrition is a significant contributor to child morbidity and mortality globally. Egg consumption has been associated with improved child nutrition yet is rare in rural, resource-poor settings. We test the effects of a culturally tailored behavior change intervention to increase child egg consumption. METHODS: A 3-arm cluster randomized controlled trial was conducted in rural Burkina Faso with 260 mother-child dyads. Children aged 4 to 17 months from 18 villages were included; those with reported history of malnutrition or egg allergy were excluded. Each child in the full intervention arm received 4 chickens, and mothers received the 10-month behavior change package. Participants in the partial intervention arm received only the behavior change package. RESULTS: In this analysis of 250 children, the full (β = 4.3; P = 6.6 × 10−12) and the partial (β = 1.0; P = .02) interventions significantly increased egg consumption. The full intervention also significantly increased poultry production (β = 11.6; 95% confidence interval 8.3–15; P = 1.1 × 10−5) and women’s decision-making about eggs (β = .66; P = .02), and significantly decreased wasting (β = .58; P = .03) and underweight (β = .47; P = .02). CONCLUSIONS: The culturally tailored behavior change package significantly increased child egg consumption. When coupled with the gift of chickens, the behavior change intervention yielded a greater increase in egg consumption and significantly reduced wasting and underweight. Behavior change strategies to increase egg consumption should be considered among nutrition and health programs in resource-poor settings where poultry is available.

Background According to the Internal Displacement Monitoring Centre report on global human displacement, Ethiopia has the highest number of newly displaced people forced to flee their homes. Displaced people have arrived in other regions, sometimes leading to conflict. Several regions in Ethiopia experience on-going ethnic tensions and violence between tribes, which leaves smallholder farmers suspicious of any outside activities in their locale, assuming other ethnic groups may harm them. Changes in the central Ethiopian government have also led to suspicion of non-local agencies. The Campylobacter Genomics and Enteric Dysfunction (CAGED) research project’s objective is to improve the incomes, livelihoods and nutrition of smallholder farmers and was conducted during this period of increasing violence. The project aims to assess the impact of reducing exposure to chicken excreta on young children’s gut health and growth. This paper does not report empirical findings from CAGED, but is part of a series that aims to identify challenges in humanitarian research and reports on mitigation strategies during this research. Discussion This research is important to determine whether Campylobacter infection in chicken’s contributes to illness and stunting in children. However, violence against other researchers in different parts of Ethiopia led to mistrust and lack of engagement by the community with the researchers. Some reactions were so hostile that the team was fearful about returning to some households. As a result, the team designed strategies to respond, including establishing two types of community advisory boards. One used pre-existing village elder structures and another was composed of village youth. Data collection team members received training in principles of ethics, consent, and crisis management, and were provided on-going support from local and international principal investigators and the study’s ethics advisor. Conclusion The hostility and mistrust led to fear among the data collectors. These and the resulting strategies to address them resulted in delays for the research. However, the interventions taken resulted in successful completion of the field activities. Moreover, the lessons learned from this project are already being implemented with other projects being conducted in various parts of Ethiopia.

In many low‐income countries, such as Burkina Faso, rates of malnutrition are high among children. Research indicates that animal source foods may provide important elements to improve growth and development of young children, especially during periods of rapid development, such as the first 1,000 days of life. The Un Oeuf study is designed to test an innovative behaviour change communication strategy to increase egg consumption in children 6–24 months in Burkina Faso, thereby improving dietary diversity and nutritional outcomes. This 1‐year cluster randomised controlled trial tests whether the gifting of chickens by a community champion directly to a child, combined with a behaviour change package of integrated poultry management and human nutrition trainings, can significantly increase egg consumption among children under 2 years in rural communities where egg consumption is very low. The nutrition‐sensitive behaviour change package is designed to increase egg consumption through improving livestock production, women's empowerment and food security at the household level. This paper presents a detailed account of the study design and protocol for the Un Oeuf study, alongside a description of the study population. Baseline data show a study population with high rates of malnutrition (stunting 21.6%, wasting 10.8% and underweight 20.4%) and a very low rate of egg consumption—less than 10% among children. Although poultry production is quite common, egg consumption is low reportedly because of cultural norms, including widespread practice of allowing eggs to hatch and a lack of knowledge about the nutritional benefits of egg consumption.

Background Childhood stunting and malnutrition condemn millions of people globally to a life of disadvantage and cognitive and physical impairment. Though increasing egg consumption is often seen as an important solution for low and middle income countries (including Ethiopia), emerging evidence suggests that greater exposure to poultry feces may also inhibit child growth due to the effects of enteric bacteria, especially Campylobacter, on gut health. Methods In this rapid ethnographic study, we explored village poultry production, child dietary practices, and environmental hygiene conditions as they relate to Campylobacter risk and intervention in 16 villages in Haramaya Woreda, Eastern Ethiopia. Results In the study area, we found that women assumed primary responsibility to care for both chickens and children: in feeding, housing, and healthcare. Most chickens were free-range local indigenous breeds, and flock sizes were small and unstable due to epidemics, seasonal trends, reproductive patterns, and lack of food. Generally, eggs were seen as “too luxurious” to be eaten, and were predominantly sold at local markets for scarce cash, despite high malnutrition rates. Local narratives of extreme poverty, social dietary norms, parental fatalism, and lack of “dietary consciousness” (as it was called) were invoked to explain this. We found that homesteads were highly contaminated with human and animal feces. Although community members viewed chicken feces and poultry gastrointestinal contents as particularly noxious in comparison to other animals because of their feeding behaviour, they did not relate them to any particular disease. Shared human-animal housing and childcare practices place children at high risk of exposure to enteric bacteria from animal manure, despite daily routines designed to manage the domestic landscape. Conclusions Addressing childhood stunting and malnutrition through egg production in rural landscapes like Haramaya must navigate three distinct health and care regimes: for children, chickens, and home environments. Interventions should be based on a holistic approach to social and economic empowerment, one that considers both women and men and integrates nutrition, health, and community change as its overarching goal.

Malnutrition and micronutrient deficiencies are significant public health problems in the Central Asian country of Tajikistan, with over 26% of children under age 5 being stunted and 30% being anemic. The Khatlon Province is the country’s largest agricultural area where people are often dependent on home gardens to ensure food security. The proximity of households to resources such as markets, roads, and infrastructure can affect food availability, diets, and diversity of agricultural products for consumption. This study aims to evaluate whether the remoteness of a household affects the production, consumption, and acquisition of specific crops among households in Khatlon Province, Tajikistan. A remote household was defined as one that is distant from markets and the main center of population, difficult to travel to, and has limited resources. This cross-sectional study used a household survey and focus groups to measure crop production, consumption, and food acquisition. Household surveys were administered to 107 households in six Khatlon districts and 15 focus groups were conducted in various rural villages within Khatlon. Data was analyzed using a two-sample t-test for the household surveys and NVivo software for capturing major themes within the focus groups. Results revealed that there was no statistically significant difference when comparing households for remoteness in regard to crop production, frequency of consumption, and acquisition. Frequency of food consumption was similar when comparing remoteness but significantly decreased among all households when the crop was not in season. Programs that increase agricultural knowledge about production and extended growing season are extremely beneficial to improve nutrition in these vulnerable households. Additionally, gender-related concerns were discovered within the qualitative data such as the double burden of working to maintain crops as well as managing a household. Therefore, interventions based around agricultural production and acquisition should target women.

Climate change is projected to have profound effects on nutritional outcomes, particularly among children under five in developing countries, where small-scale, subsistence farming and livestock production supports a majority of livelihoods. An underlying mechanism by which climate change will negatively affect nutrition is through increased food insecurity, as both crop and livestock production are threatened by changing patterns of rainfall and temperature. Climate information services (CIS) provide short and long-term weather and climate forecasts through a variety of means with the aim of increasing smallholder farmers’ ability to cope and adapt to a changing environment. CIS can be used to increase climate-smart agriculture (CSA) practices, which in turn can increase agricultural productivity and farmer resilience, while simultaneously reducing greenhouse gas emissions. Through household surveys, focus group activities, and participant observation, this research investigates linkages between CIS, uptake of CSA practices, and household food security through investigation of four research sites, two in Senegal and two in Kenya. The research sites were selected based on their various levels of engagement in CIS programs sponsored by the CGIAR Research Program on Climate Change, Agriculture, and Food Security (CCAFS) at the time research was conducted. The role of gender dynamics in the relationship between CIS, CSA, and food security is also explored through 1) sex-disaggregated quantitative from household surveys, and 2) sex-disaggregated qualitative data focus groups, which focuses in part on conceptualization of women’s empowerment. Findings indicate that farmers are receiving CIS and are using that information to make changes in farming practices, without major differences between men and women. This research suggests that CCAFS-CIS interventions may be leading to adoption of CSA practices; however, no direct correlation between receipt of CIS and use of CSA practices was found, nor was a relationship established between use of CSAs and food security. These findings are inconclusive, however, given the near complete coverage of CIS and widespread food insecurity across sites. Importantly, participants did not ascribe their knowledge of CSA practices to CIS, and the important role of social and informal networks as a source of climate information emerges as an important area of additional exploitation for increased uptake of CSA for improved food security. Keywords: Climate information services, Climate smart agriculture, Food security, Gender, Empowerment

This study analyzes findings from a rapid-response community-based qualitative research initiative to study the content of Ebola-related communications and the transmission of Ebola-related behaviors and practices through mass media communications and social learning in Monrovia, Liberia during August-September 2014. Thirteen neighborhoods in the common Monrovia media market were studied to appraise the reach of health communications and outreach regarding Ebola prevention and response measures. A World Health Organization (WHO) research team collected data on social learning and Ebola knowledge, attitudes, and practices through focus group-based discussions and key informant interviews over a 14-day period to assess the spread of information during a period of rapidly escalating crisis. Findings show that during a 2-week period, Monrovia neighborhood residents demonstrated rapid changes in beliefs about the source of Ebola, modes of contagion, and infection prevention and control (IPC) practices, discarding incorrect information. Changes in practices tended to lag behind the acquisition of learning. Findings also show that many continued to support conspiracy theories even as correct information was acquired. The implications for community engagement are substantial: (1) Under conditions of accelerating mortality, communities rapidly assimilate health information and abandon incorrect information; (2) Behavior change is likely to lag behind changes in beliefs due to local physical, structural, sociocultural, and institutional constraints; (3) Reports of "resistance" in Monrovia during the Ebola response were overstated and based on a limited number of incidents, and failed to account for specific local conditions and constraints.

A team of interdisciplinary researchers undertook a mixed methods, participatory epidemiology (PE) based study as part of a pilot project for localized control of Peste des petits ruminants (PPR), a small ruminant disease of high socio-economic impact. Mixed methods research combines qualitative and quantitative methods, allowing iterative comparison of results to arrive at a more comprehensive and informed outcome. In this study, the use of PE and a household survey (HHS) resulted in contradictory results. However, the mixed methods approach also facilitated the detection and the explanation of bias in the HHS, which may have gone undetected and unexplored had only one method been used. Results show that logistical constraints leading to a failure to apply key aspects of the sampling strategy led to problematic gender/ethnic composition of the HHS sample population. Additionally, while PE findings on local disease and terminology were integrated during HHS development and training, there is apparent measurement error related to enumerator bias in HHS results, possibly due to insufficient respondent understanding or a lack of analytic clarity. The extensive nature of the PE, surveillance methodologies used in the initial site assessment, and formative research for the HHS allowed for a critical analysis and interpretation of HHS results as well as reflection on the research process. The findings of this paper underscore the (1) flexibility and utility of participatory methods, (2) the importance of mixed methods research in designing health interventions, and (3) the necessity of tight integration of study design with team planning for implementation of research in environments such as Karamoja, Uganda. If all three are to be achieved not only researchers but funders must provide these space and structure beginning in the study design phase. These findings are relevant in many places, but have particular importance for international, interdisciplinary teams working from various on-and-off-site locations with traditional or indigenous knowledge systems.

Globally, communities are increasingly impacted by the stressors of climate change. In response, people may adapt to maintain their livelihoods and overall health and nutrition. However, the relationship between climate adaptation and human nutrition is poorly understood and results of adaptation are often unclear. We investigated the relationship between adaptation and child nutrition, in Eswatini (formerly Swaziland) during an extreme drought. Households varied in both adaptation behavior and household resources and we found that, overall, households that adapted had better child nutrition than those that didn&rsquo, t adapt. When controlling for the influence of household capital, we found that more vulnerable households, those with greater dependence on natural resources and lower income, had a stronger positive relationship between adaptation and nutrition than less vulnerable households. We also found that some adaptations had stronger positive relationships with nutrition than others. In our system, the adaptation that most strongly correlated with improved nutrition, selling chickens, most likely benefits from local social networksand consistent demand, and performed better than other adaptations. Our results emphasize the need to measure adaptation outcomes and identify and support the types of adaptations are most likely to improve nutrition in the future.

Understanding factors that hinder vaccination, including logistical and social constraints, is critical to finding the most effective approach for the global eradication of peste des petits ruminants (PPR). Vaccination projects should analyze the supply chain and take it into consideration when planning and creating a vaccination strategy. Adequate supply chain management of the PPR vaccine could lead to reduced cost, increased availability, and the construction of a data platform for other livestock vaccines. Integrating the supply chain of PPR vaccine with other veterinary or health commodities could reduce cost, as well as increase uptake. The use of a thermostable vaccine could potentially have a positive impact on the eradication of PPR in remote areas, such as the Karamoja subregion in Uganda, as it did with rinderpest across Sub Saharan Africa. In terms of vaccine delivery, the use of community animal health workers (CAHWs) could be beneficial in certain areas, such as the Karamoja subregion of Uganda, by alleviating supply chain constraints in the last-mile delivery, as well as increasing coverage and uptake. A gendered approach to livestock vaccines should also be considered, as decision-making power regarding livestock vaccination is gendered in many various contexts. The PPR eradication strategy-as well as other livestock vaccination programs-would be more effective and efficient if the supply chain management were considered as a key component in the process and efforts tailored, accordingly.

BackgroundThe United Nations Sustainable Development Goals stress the importance of equitable partnerships in research and practice that integrate grass-roots knowledge, leadership, and expertise. However, priorities for health research in low-and-middle income countries are set almost exclusively by external parties and priorities, while end-users remain "researched on" not "researched with". This paper presents the first stage of a Community-Based Participatory Research-inspired project to engage communities and public-health end-users in setting a research agenda to improve health in their community.MethodsPhotovoice was used in Kuc, Gulu District, Uganda to engage community members in the selection of a research topic for future public health research and intervention. Alcohol-Use Disorders emerged from this process the health issue that most negatively impacts the community. Following identification of this issue, a cross-sectional survey was conducted using the Alcohol Use Disorder Identification Test (n = 327) to triangulate Photovoice findings and to estimate the prevalence of Alcohol-Use Disorders in Kuc. Logistic regression was used to test for associations with demographic characteristics and Alcohol-Use Disorders.ResultsPhotovoice generated four prominent themes, including alcohol related issues, sanitation and compound cleanliness, water quality and access, and infrastructure. Alcohol-Use Disorders were identified by the community as the most important driver of poor health. Survey results indicated that 23.55% of adults in Kuc had a probable Alcohol Use Disorder, 16.45 percentage points higher than World Health Organization estimates for Uganda.ConclusionsCommunity members engaged in the participatory, bottom-up approach offered by the research team to develop a research agenda to improve health in the community. Participants honed in on the under-researched and underfunded topic of Alcohol-Use Disorders. The findings from Photovoice were validated by survey results, thereby solidifying the high prevalence of Alcohol-Use Disorders as the health outcome that will be targeted through future long-term research and partnership.

The Women's Empowerment in Agriculture Index (WEAI) has been in use since 2012 and is widely recognized as one of the most rigorous tools to measure women's empowerment as a direct or indirect result of interventions from development projects. Changes to the WEAI have been ongoing and recent adaptations include measuring effects of interventions to improve livestock value chains on women's empowerment, as well as livestock related research. A multidisciplinary team of researchers at ILRI and Emory University developed the Women's Empowerment in Livestock Index (WELI), a new index to assess the empowerment of women in the livestock sector. While the WELI has been piloted in both Honduras and Tanzania, this article provides details on the latter case only. Currently, the Feed the Future Innovation Lab for Livestock Systems has employed the Abbreviated-Women's Empowerment in Agriculture Index (A-WEAI) to examine female decision-making in various projects from animal care knowledge and practices to feeding practices for children. Additionally, the development of the Project-Women Empowerment in Agriculture Index, currently in pilot testing, may allow for more insight into scaling existing projects. This article will discuss the adaptation and use of the WEAI for livestock research in Tanzania and Uganda, as well as future uses for contextually measuring women livestock producers' empowerment.

Global efforts such as the Sustainable Development Goals recognize and underscore the significant role that human nutrition has on individual health and population-level development. Consequently, interdisciplinary and multi-stakeholder groups, such as the Global Alliance for Improving Nutrition and the Scaling Up Nutrition Movement, have been established to reduce under-nutrition, particularly in children and pregnant women. The concept of nutrition-sensitive agriculture has grown significantly in recent years, and the evidence indicates that integration of nutritional outcomes into agriculture programs has allowed these efforts to make important contributions to the reduction of malnutrition. However, when considering livestock as a subset of agricultural research and programming, nutritional objectives have been less effectively integrated into research and programming. The repercussions of this missed opportunity are exacerbated by the unique nutritional value of animal source foods (ASF) and its potential to increase dietary diversity and improve nutrition and health. Through a set of expert interviews with researchers and development practitioners in the areas of livestock and/or human nutrition, this article identifies factors that make livestock research and programs nutrition-sensitive and factors associated with livestock research/programs that fail to be nutrition-sensitive. Results indicate that an overly narrow focus on nutritional indicators, such as stunting, and target population (children) have hindered the uptake of nutrition-sensitive approaches. Experts indicate that interdisciplinary teams, longer and more iterative funding cycles, and integration of behavior change are elements livestock programs that successfully integrate nutrition. Implications of these and other findings for donors, researchers, and practitioners are presented.

Globally, two billion people suffer from micronutrient deficiencies, 151 million children under five suffer from stunting, and millions more have impaired cognitive development related to poor nutrition. This is partly due to insufficient consumption of animal-sourced foods (ASF), which supply multiple bioavailable nutrients that are lacking in the cereal-based diets of the poor. Yet, reports like the one recently published by the EAT-Lancet Commission, solely focus on the threat of ASF consumption on sustainability and human health, overestimate and ignore the tremendous variability in the environmental impact of livestock production, and fail to adequately include the experience of marginalized women and children in low- and middle-income countries whose diets regularly lack the necessary nutrients. Yet animal-source foods have been described by the World Health Organization as the best source of high-quality nutrient-rich food for children aged 6–23 months. Livestock and ASF are vital to sustainability as they play a critical role in improving nutrition, reducing poverty, improving gender equity, improving livelihoods, increasing food security, and improving health. The nutritional needs of the world's poor, particularly women and children, must be considered in sustainability debates.

Livestock holders experience increased food insecurity because of climate change. We argue that development programs, public health specialists, and practitioners must critically examine gendered impacts of climate change to improve food security of livestock producers. This review illustrates the differential experiences of men and women and how vulnerability, adaptive capacity, exposure and sensitivity to climatic stimuli are gendered in distinct ways between and among livestock holding communities. We propose a gendered conceptual framework for understanding the impact of climate change on food security among livestock holders, which highlights potential pathways of vulnerability and points of intervention to consider in global health strategies for improving household food security.

There is a need for research that explores the perceptions of health concerns from a local perspective, so that where appropriate and deemed necessary, medical interventions and educational initiatives can be effectively designed to respond to public needs, misconceptions, or behavioural practices. Initial pilot needs assessments conducted in the Coastal Ouest region of Haiti alluded to a belief that vaginal illness related to water quality is a major concern among community members. Cultural perceptions of vaginal illness related to water quality were explored with maximum variability sampling among community members and key informants. Participants were selected based on age, gender, socioeconomic status, occupation, and medical training. Beliefs surrounding vaginal illness and water quality were allowed to arise through open-ended, semi-structured interviews conducted with the use of qualified translators. Haitian study participants shared the belief that water is related to vaginal illness, with 81% of Haitian participants expressing the belief that water is a direct cause of vaginal illness. Vaginal illness is a frequent complaint among Haitian women seeking gynaecological care, though very little qualitative research exists on how women seek to prevent or treat these illnesses. The current research indicates that the additional monitoring of shared household water sources used for personal hygiene, in the absence of piped household water, is a potential public health concern related to vaginal illness in Haiti. Further research is needed to determine how public health messaging in the region may influence perceptions of risk and behaviours related to water and personal hygiene.

Interdisciplinary science benefits from frameworks that bridge different perspectives and methodological approaches in order to understand and solve complex problems. This article applies the double exposure framework to analyse how economic and environmental change drives recent political instability and food crises in Niger and the resultant implications for the food security of pastoral populations. Findings illustrate how processes of global change are undermining the historic resilience of pastoral communities within the region. Community and regional responses to new and unfamiliar conditions have resulted in heighted political instability that limits pastoralists’ ability to cope with future shocks.

The goal of this study was to assess morbidity, mortality, and health-seeking behaviours during the 2014 Ebola outbreak in Monrovia, Liberia. This study examined commonly reported symptoms of illness, pre-clinical diagnostic practices, typical healthcare-seeking strategies, and health resources available to populations, in order to identify salient needs and gaps in healthcare that would inform local emergency response efforts. Semi-structured interviews were conducted with household members in four Monrovia neighbourhoods. Researchers used a multi-stage cluster approach to recruit participants. Within 555 households sampled, 505 individuals were reported sick (69%) or recently sick (38%) or deceased (7%). Common self-diagnoses included malaria, hypertension, influenza, typhoid, and Ebola. The most cited health-seeking strategy was to purchase medications from the private sector. Respondents also obtained healthcare from community members known to have medical experience. Findings suggest that non-formal healthcare systems played an important role in managing morbidity during the West African Ebola virus disease (EVD) outbreak. Lay community members engaged in complex assessments of health symptoms and sought biomedical care at rates perhaps higher than anticipated during the response. This study highlights how informal networks of healthcare providers can play an important role in preventing and curbing future emerging disease outbreaks.

Purpose Recent national public health agendas, such as Healthy People 2010, call for improved public health surveillance and health promotion programs for people with disabilities and their caregivers. The goal of this study was to understand the public health impact of caregiving on health-related quality of life (HRQoL) using population-level data. Design & Methods A cross-sectional study design was used. 184,450 adults surveyed during the 2000 national Behavioral Risk Factor Surveillance System survey formed the sample. Binary logistic regression models ascertained differences between caregivers and non-caregivers in reporting reduced (“fair” or “poor”) health. Ordinary least squares regression (OLS) and multinomial logistic regression models examined the influence of caregiving status on HRQoL, measured as categories of healthy days reported in the last 30 days and the number of days reported as physical and mental health not good in the last 30 days. Results Sixteen percent (16%) of the survey respondents were caregivers. There was an interaction effect between caregiving status and age of the caregiver. In the fully adjusted models, caregivers

Background The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia. Methodology/Principal Findings This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia – one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support. Conclusions/Significance Local communities’ strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection., Author Summary In this study the authors analyzed data from the 2014 Ebola outbreak in Monrovia and Montserrado County, Liberia. The data were collected for the purposes of program design and evaluation by the World Health Organization (WHO) and the Government of Liberia (GOL), in order to identify: (1) local knowledge about EVD, (2) local responses to the outbreak, and (3) community-based innovations to contain the virus. At the time of data collection, the international Ebola response had little insight into how much local Liberian communities knew about Ebola, and how communities managed the epidemic when they could not get access to care due to widespread hospital and clinic closures. Methods included 15 focus group discussions with community leaders from areas with active Ebola cases. Participants were asked about best practices and what they were currently doing to manage EVD in their respective communities, with the goal of developing conceptual models of local responses informed by local narratives. Findings reveal that communities responded to the outbreak in numerous ways that both supported and discouraged formal efforts to contain the spread of the disease. This research will inform global health policy for both this, and future, epidemic and pandemic responses.

Background Overall, disparities exist in preventive health care services for people with disabilities compared with other Americans. Little is known about the effects of caregiving on preventive services use. This study examines caregiver characteristics and influence on the use of preventive services for people with disabilities. Methods The 2000-2001 Behavioral Risk Factor Surveillance System of 25 states included 5486 self-reported respondents with disabilities who were surveyed for preventive care use. Multivariate logistic regression adjusted for demographic and functional status of these respondents. Results Among the subset of the respondents with caregivers, those with paid caregivers were significantly more likely to receive an influenza vaccination (adjusted odds ratio [OR], 1.49; 95% confidence interval [CI], 1.08-1.93). Among those with a caregiver, those with a spouse/partner caregiver were also significantly more likely to receive an influenza vaccination (adjusted OR, 1.33; 95% CI, 1.05-1.69) or PPV (adjusted OR, 1.59; 95% CI, 1.41-2.38) compared with those with “other” as their caregiver. Women with disabilities with a spouse/partner caregiver were significantly more likely to have ever had a Pap test (adjusted OR, 3.13; 95% CI, 1.41-6.67) or mammogram (adjusted OR, 1.85; 95% CI, 1.23-2.70) than those with “other” relative caregiver. Those respondents who reported “rarely adequate” caregiver satisfaction were significantly more likely to have self-reported ever having colon cancer screening compared with those with a usually adequate caregiver. The majority of results did not show consistent evidence of caregiver benefit, and a fair number of the associations were not statistically significant. Conclusion The findings suggest that having a caregiver is not consistently associated with self-report of ever using preventive services. However, this study suggests that caregiver characteristics are associated with preventive care for people with disabilities. For influenza vaccination, our results showed that paid caregivers were more likely to provide preventive care to individuals with disability than a spouse or partner, which were more likely to provide more preventive care than those with “other” caregiver. Given the number of comparisons, we consider these results to be preliminary and require more confirmation in other population data.