A comparison of two population-based household surveys in Uganda for assessment of violence against youth

Violence is associated with health-risk behaviors, potentially contributing to gender-related HIV incidence disparities in sub-Saharan Africa. Previous research has demonstrated that violence, gender, and HIV are linked via complex mechanisms that may be direct, such as through forced sex, or indirect, such as an inability to negotiate safe sex. Accurately estimating violence prevalence and its association with HIV is critical in monitoring programmatic efforts to reduce both violence and HIV. We compared prevalence estimates of violence in youth aged 15–24 years from two Ugandan population-based cross-sectional household surveys (Uganda Violence Against Children Survey 2015 [VACS] and Uganda Population-based HIV Impact Assessment 2016–2017 [UPHIA]), stratified by gender. UPHIA violence estimates were consistently lower than VACS estimates, including lifetime physical violence, recent intimate partner physical violence, and lifetime sexual violence, likely reflecting underestimation of violence in UPHIA. Multiple factors likely contributed to these differences, including the survey objectives, interviewer training, and questionnaire structure. VACS may be better suited to estimate distal determinants of HIV acquisition for youth (including experience of violence) than UPHIA, which is crucial for monitoring progress toward HIV epidemic control.

Measuring Self-Reported Access to Assistive Technology Using the WHO Rapid Assistive Technology Assessment (rATA) Questionnaire: Protocol for a Multi-Country Study

In 2018, the World Health Assembly adopted a resolution on improving access to assistive technology (AT), and mandated the WHO to prepare a global report on assistive technology based on the best available evidence and international experience. As limited data on access to AT at country and global levels were available, there was a need to conduct representative population surveys in order to inform the development of the global report, national AT programs, and global initiatives. The objective of this protocol is to describe a multi-country study of access to assistive technology in six self-reported areas: use, source, payer, satisfaction, unmet need, and barriers. In collaboration with WHO Regional and Country offices, Member States, and other stakeholders, the Assistive Technology Access team in WHO coordinates the study. Data are collected through household surveys using the rapid Assistive Technology Assessment (rATA) questionnaire. Findings from the surveys will be published in the global report.

A model for reconstructing trends and distribution in age at first sex from multiple household surveys with reporting biases

Age at first sex (AFS) is a key indicator for monitoring sexual behaviour risk for HIV and sexually transmitted diseases. Reporting of AFS data, however, suffer social-desirability and recall biases which obscure AFS trends and inferences constructed from it. We illustrated examples of the biases using data from multiple nationally-representative Demographic and Health Surveys household surveys conducted between 1992 and 2019 in Ethiopia (4 surveys), Guinea (4 surveys), Senegal (8 surveys), and Zambia (8 surveys). Based on this, we proposed a time-to-event, interval censored model for the AFS that uses overlapping reports by the same birth cohort in successive surveys to adjust reporting biases. The three-parameter log-skew-logistic distribution described the asymmetric and nonmonotonic hazard exhibited by empirical AFS data. In cross-validation analysis, incorporating a term for AFS reporting bias as a function of age improved model predictions for the trend of AFS over birth cohorts. The interquartile range for the AFS was 16 years to 23 years for Ethiopian and Senegalese women and 15 years to 20 years for Guinean and Zambian men. Median AFS increased by around one to 1.5 years between the 1960 and 1989 birth cohorts for all four datasets. Younger male respondents tended to report a younger AFS while female respondents tended to report an older AFS than when asked in later surveys. Above age 30, both male and female respondents tended to report older AFS compared to when surveyed in their late twenties. Simulations validated that the model recovers the trend in AFS over birth cohorts in the presence of reporting biases. At least three surveys are needed to obtain reliable trend estimate for a 20-years trend. Mis-specified reference age at which reporting is assumed unbiased did not affect the trend estimate but resulted in biased estimates for the median AFS in the most recent birth cohorts.

Acceptability of Rectal Artesunate as pre-referral treatment for severe malaria in children under 5 years by health workers and caregivers in the Democratic Republic of the Congo, Nigeria and Uganda

Background In children below 6 years with suspected severe malaria who are several hours from facilities providing parenteral treatment, pre-referral rectal artesunate (RAS) is recommended by the World Health Organization to prevent death and disability. A number of African countries are in the process of rolling out quality-assured RAS for pre-referral treatment of severe malaria at community-level. The success of RAS depends, among other factors, on the acceptability of RAS in the communities where it is being rolled-out. Yet to date, there is limited literature on RAS acceptability. This study aimed to determine the acceptability of RAS by health care providers and child caregivers in communities where quality assured RAS was rolled out. Methods This study was nested within the comprehensive multi-country observational research project Community Access to Rectal Artesunate for Malaria (CARAMAL). The CARAMAL project was implemented in the Democratic Republic of the Congo (DRC), Nigeria, and Uganda between 2018 and 2020. Data from three different sources were analysed to understand RAS acceptability: Interviews with health workers during three healthcare provider surveys, with caregivers of children under 5 years of age during three household surveys, and with caregivers of children who were recently treated with RAS and enrolled in the CARAMAL Patient Surveillance System. Results RAS acceptability was high among all interviewed stakeholders in the three countries. After the roll-out of RAS, 97-100% heath care providers in DRC considered RAS medication as very good or good, as well as 98-100% in Nigeria and 93-100% in Uganda. Majority of caregivers whose children had received rectal artesunate for pre-referral management of severe malaria indicated that they would want to get the medication again, if their child had the same illness (99.8% of caregivers in DRC, 100% in Nigeria and 99.9% in Uganda). Further, using data from three household surveys, 67-80% of caregivers whose children had not received RAS considered the medication as useful. Conclusion RAS was well accepted by health workers and child caregivers in DRC, Nigeria and Uganda. Acceptability is unlikely to be an obstacle to the large-scale roll-out of RAS in the studied settings.

Livelihood Strategies Shape Vulnerability of Households' Food Security to Climate in Senegal

We integrate long-term observations of rainfall and repeat, large-scale, nationwide household surveys of nutrition and socio-economic status to assess the vulnerability of food security to climate in Senegal. We use a mixed methods approach and a vulnerability framework to explain how it is that food security is on average lower, and more variable year-to-year, in the climatologically wetter south and east of the country than in the drier western center and north. We find that it is sensitivity to climate that explains the spatial variation in food security, while exposure explains its temporal variation, but only where sensitivity is high. While households in the western center and north, geographically closer to the political and economic center of action, are less dependent on livelihoods based on climate-sensitive activities, notably agriculture, these activities still dominate in the more remote, landlocked and at times conflict-ridden south and east, where sensitivity to the vagaries of rainfall persists. As they work to strengthen the resilience of climate-sensitive activities, food security and climate-risk management projects and policies should move beyond simplistic, deterministic assumptions about how climate affects food security outcomes, and invest in livelihood diversification to increase rural income and reduce vulnerability of food security to climate.

Understanding the Requirements for Surveys to Support Satellite-Based Crop Type Mapping: Evidence from Sub-Saharan Africa

This paper provides recommendations on how large-scale household surveys should be conducted to generate the data needed to train models for satellite-based crop type mapping in smallholder farming systems. The analysis focuses on maize cultivation in Malawi and Ethiopia, and leverages rich, georeferenced plot-level data from national household surveys that were conducted in 2018–20 and integrated with Sentinel-2 satellite imagery and complementary geospatial data. To identify the approach to survey data collection that yields optimal data for training remote sensing models, 26,250 in silico experiments are simulated within a machine learning framework. The best model is then applied to map seasonal maize cultivation from 2016 to 2019 at 10-m resolution in both countries. The analysis reveals that smallholder plots with maize cultivation can be identified with up to 75% accuracy. Collecting full plot boundaries or complete plot corner points provides the best quality of information for model training. Classification performance peaks with slightly less than 60% of the training data. Seemingly little erosion in accuracy under less preferable approaches to georeferencing plots results in the total area under maize cultivation being overestimated by 0.16–0.47 million hectares (8–24%) in Malawi.

The Technopolitics of Mapping Dar es Salaam: An examination of the technological and political motivations of the Humanitarian OpenStreetMap Team

Mapping has long formed a key part of development work, from recording household surveys, participatory mapping exercises, and PRA projects. Now though the sector is full of new actors- mapping and tech companies as well as NGOs- monitoring through drones and satellite images, alongside employing more traditional methods. Many of these new players were born from NGOs and companies who started as ‘crisis mappers. Short-term ‘crisis mapping’ projects have become a regular part of humanitarian response following a disaster. The short-term nature of such actions, and the need for stable employment/profits, has led to an increasing trend for the same organizations and companies to either remain on the ground producing maps or to move into new areas as part of a pre-emptive mapping practice, inserting themselves into the wider international development ecosystem. This research, centered on Tanzania, examines how HOTOSM has attempted to pivot towards working as a development organization that creates maps for prevention of crisis, but also wider socio-economic outputs. The research used interviews to explore the interplay between technology and micro/macro politics around the mapping of Dar es Salaam. Examining how HOTOSM its role, and how they position their map-making within the context of Dar es Salaam. Findings suggest that HOTOSM is still underdeveloped as an organization and lacks the maturity to create true participatory models of working.