Axel Drescher

Participatory mapping of target areas to enable operational larval source management to suppress malaria vector mosquitoes in Dar es Salaam, Tanzania

BackgroundHalf of the population of Africa will soon live in towns and cities where it can be protected from malaria by controlling aquatic stages of mosquitoes. Rigorous but affordable and scaleable methods for mapping and managing mosquito habitats are required to enable effective larval control in urban Africa.MethodsA simple community-based mapping procedure that requires no electronic devices in the field was developed to facilitate routine larval surveillance in Dar es Salaam, Tanzania. The mapping procedure included (1) community-based development of sketch maps and (2) verification of sketch maps through technical teams using laminated aerial photographs in the field which were later digitized and analysed using Geographical Information Systems (GIS).ResultsThree urban wards of Dar es Salaam were comprehensively mapped, covering an area of 16.8 km2. Over thirty percent of this area were not included in preliminary community-based sketch mapping, mostly because they were areas that do not appear on local government residential lists. The use of aerial photographs and basic GIS allowed rapid identification and inclusion of these key areas, as well as more equal distribution of the workload of malaria control field staff.ConclusionThe procedure developed enables complete coverage of targeted areas with larval control through comprehensive spatial coverage with community-derived sketch maps. The procedure is practical, affordable, and requires minimal technical skills. This approach can be readily integrated into malaria vector control programmes, scaled up to towns and cities all over Tanzania and adapted to urban settings elsewhere in Africa.

Fighting for the right to use wastewater: what drives the use of untreated wastewater in a peri-urban village of Faisalabad, Pakistan?

This case study from Chakera village, Faisalabad City, Pakistan describes the transition from canal-water irrigation to wastewater irrigation over a period of several decades. It shows that while the initial motivation for wastewater use was water scarcity and a lack of choice, farmers soon realized there were benefits associated with this alternative water supply. In the subsequent decades, they made great efforts and overcame organizational, infrastructural and legal obstacles to establish wastewater irrigation as the only irrigation on most of the villages agricultural area.

Complementary school garden, nutrition, water, sanitation and hygiene interventions to improve children's nutrition and health status in Burkina Faso and Nepal: a study protocol.

BackgroundMalnutrition and intestinal parasitic infections are common among children in Burkina Faso and Nepal. However, specific health-related data in school-aged children in these two countries are scarce. In the frame of a larger multi-stakeholder project entitled “Vegetables go to School: Improving Nutrition through Agricultural Diversification” (VgtS), a study has been designed with the objectives to: (i) describe schoolchildren’s health status in Burkina Faso and Nepal; and to (ii) provide an evidence-base for programme decisions on the relevance of complementary school garden, nutrition, water, sanitation and hygiene (WASH) interventions.Methods/DesignThe studies will be conducted in the Centre Ouest and the Plateau Central regions of Burkina Faso and the Dolakha and Ramechhap districts of Nepal. Data will be collected and combined at the level of schools, children and their households. A range of indicators will be used to examine nutritional status, intestinal parasitic infections and WASH conditions in 24 schools among 1144 children aged 8–14 years at baseline and a 1-year follow-up. The studies are designed as cluster randomised trials and the schools will be assigned to two core study arms: (i) the ‘complementary school garden, nutrition and WASH intervention’ arm; and the (ii) ‘control’ arm with no interventions. Children will be subjected to parasitological examinations using stool and urine samples and to quality-controlled anthropometric and haemoglobin measurements. Drinking water will be assessed for contamination with coliform bacteria and faecal streptococci. A questionnaire survey on nutritional and health knowledge, attitudes and practices (KAP) will be administered to children and their caregivers, also assessing socioeconomic, food-security and WASH conditions at household level. Focus group and key-informant interviews on children’s nutrition and hygiene perceptions and behaviours will be conducted with their caregivers and school personnel.DiscussionThe studies will contribute to fill a data gap on school-aged children in Burkina Faso and Nepal. The data collected will also serve to inform the design of school-based interventions and will contribute to deepen the understanding of potential effects of these interventions to improve schoolchildren’s health in resource-constrained settings. Key findings will be used to provide guidance for the implementation of health policies at the school level in Burkina Faso and Nepal.Trial registrationISRCTN17968589 (date assigned: 17 July 2015)

Food coping strategies in northern Ghana. A socio-spatial analysis along the urban–rural continuum

BackgroundFood insecurity is a worrying challenge worldwide, with sub-Sahara Africa most affected. Literature reveals that in developing countries, food insecurity is a largely ‘‘managed process’’, meaning people are active participants in responding to the risks they face in life. This paper focuses on how households cope with food shortages and how these food coping strategies vary along the urban–rural continuum. A transect approach was used to guide data collection in and around the city of Tamale in northern Ghana. A total of 19 Focus Group discussions, having eight participants each (four women, four men), were conducted between March and May 2014. Additionally, three qualitative in-depth interviews were also conducted, one each in the urban, periurban and rural area.ResultsIn periurban and rural areas, gathering of wild food and selling of charcoal was widely practised, while in urban areas, most households tended to reduce the number of meals as a more frequent coping strategy. The study identified five coping strategies along the urban–rural continuum as the most severe in times of food insecurity, namely skipping a whole day without food, borrowing, buying food on credit, consuming seed stock and restricting adult intake in favour of children. Hunting, consuming less preferred food, taking occasional jobs and engaging in small trading were considered as not severe.ConclusionsStudy results reveal that food coping strategies vary from one spatial entity to another in terms of frequency, severity and coping strategy indices along the urban–rural continuum. This information is useful for indicators to predict crisis (early warning), to understand shortfalls in access to adequate food (assessment), to allocate resources (targeting) or to track the impact of interventions (monitoring and evaluation).

Women’s dietary diversity scores and childhood anthropometric measurements as indices of nutrition insecurity along the urban-rural continuum in Ouagadougou, Burkina Faso

Background Malnutrition is still prevalent worldwide, and its severity, which differs between regions and countries, has led to international organisations proposing its inclusion in the global development framework that will succeed the Millennium Development Goals (post-2015 framework). In Sub-Saharan Africa, malnutrition is particularly severe, among women and children under 5 years. The prevalence of malnutrition has been reported worldwide, differing from region to region and country to country. Nevertheless, little is known about how malnutrition differs between multiple locations along an urban–rural continuum. Objective A survey was carried out in and around Ouagadougou, Burkina Faso, between August and September 2014 to map household nutrition insecurity along the urban–rural continuum, using a transect approach to guide the data collection. Design Transects of 70 km long and 2 km wide directed radially from the city centre outwards were laid, and data were collected from randomly selected households along these transects. Womens dietary diversity scores (WDDSs) were calculated from a sample of 179 women of reproductive age (15–49 years) from randomly selected households. Additionally, anthropometric data (height/length and weight) of 133 children under 5 years of age were collected along the same transects for the computation of anthropometric indices. Results We found that relative proportions of the nutrition indices such as stunting, wasting and underweight varied across the urban–rural continuum. Rural households (15%) had the highest relative proportion of WDDS compared with urban households (11%) and periurban households (8%). There was a significant association between children under 5 years’ nutritional status (wasting, stunting and underweight) and spatial location (p=0.023). The level of agricultural activities is a possible indicator of wasting in children aged 6–59 months (p=0.032). Conclusion Childhood undernutrition certainly has a spatial dimension that is highly influenced by the degree of urbanity, which should be taken into consideration in policy formulation and implementation.

Contribution of urban and periurban agriculture to household food and nutrition security along the urban–rural continuum in Ouagadougou, Burkina Faso

There is growing evidence of urban poverty in and around cities in sub-Saharan Africa in the form of food and nutrition insecurity. Although many studies have been done across sub-Saharan Africa on urban agriculture, food and nutrition insecurity, little is known about the association of urban agriculture to household food and nutrition insecurity along the urban–rural continuum, especially in West African cities. Therefore, a survey was carried out between August and September 2014 in and around Ouagadougou (Burkina Faso), using a transect approach to guide the data collection. The purpose of this study was to understand the dynamics of urban, periurban and rural agriculture and its association with household food and nutrition insecurity. A total of 240 households participated in the survey. From these households, data were collected on 179 women of reproductive age (15–49 yr) and 133 children under the age of 5 yr to compute Womens Dietary Diversity Scores (WDDS) and other anthropometric indices. The results of this study provide a general picture of crop production which is inclined to subsistence and income generation. Households in rural and periurban areas were more engaged in crop and livestock production compared with their urban area counterparts. Households in periurban areas had the highest relative proportion (54%) of food insecurity (household food insecurity access scale (HFIAS) > 11), compared with urban areas (39%) and rural areas (45%). At the same time the periurban households had the highest relative proportion of stunting and wasting prevalence compared with urban and rural households. Households in the rural areas had the highest dietary diversity (WDDS ≥ 6), compared with periurban and urban households. Households keeping livestock significantly experienced less wasting (weight-for-height index (WHZ)) (coef = −0.15; P = 0.008) by a factor of 0.15, and overweight (body mass index (BMI)-for-age (BAZ)) (coef = −0.12; P = 0.015) by a factor of 0.12 compared with households not doing livestock keeping. Households involved in crop production significantly experienced more food insecurity, HFIAS (coef. = 2.55; P = 0.042) by a factor of 2.55 compared with households without crop production. The complexity of periurban areas coupled with the scourge of food and nutrition insecurity will require more periurban agriculture and food policy consideration.