The Impact of Land Tenure Security on a Livelihood Intervention for People Living with HIV in Western Kenya.

Few studies have explored land access, a structural driver of health, and women's participation in livelihood interventions to improve food security and HIV outcomes. This qualitative study, embedded within Shamba Maisha (NCT02815579)-a randomized controlled trial (RCT) examining the impact of a multisectoral intervention among farmers living with HIV in western Kenya-sought to explore the influence of perceived access to and control of land on agricultural productivity, investments, and benefits. Thirty in-depth interviews (IDIs) were conducted with purposively sampled men and women, 3 to 6 months after receiving intervention inputs; data were deductively and inductively coded and analyzed. Farming practices and participation in Shamba Maisha were dependent on land tenure and participants' perceived strength of claim over their land, with participants who perceived themselves to be land insecure less likely to make long-term agricultural investments. Land tenure was influenced by a number of factors and posed unique challenges for women which negatively impacted uptake and success in the intervention. Data underscore the importance of secure land tenure for the success of similar interventions, especially for women; future interventions should integrate land security programming for improved outcomes for all.

Basal forebrain dynamics during a tactile discrimination task.

The nucleus basalis (NB) is a cholinergic neuromodulatory structure that projects liberally to the entire cortical mantle and regulates information processing in all cortical layers. Here, we recorded activity from populations of single units in the NB as rats performed a whisker-dependent tactile discrimination task. Over 80% of neurons responded with significant modulation in at least one phase of the task. Such activity started before stimulus onset and continued for seconds after reward delivery. Firing rates monotonically increased with reward magnitude during the task, suggesting that NB neurons are not indicating the absolute deviation from expected reward amounts. Individual neurons also encoded significant amounts of information about stimulus identity. Such robust coding was not present when the same stimuli were delivered to lightly anesthetized animals, suggesting that the NB neurons contain a sensorimotor, rather than purely sensory or motor, representation of the environment. Overall, these results support the hypothesis that neurons in the NB provide a value-laden representation of the sensorimotor state of the animal as it engages in significant behavioral tasks.

Neurophobia in Africa: Survey responses from fifteen African countries.

OBJECTIVE: To assess the prevalence of "neurophobia," or fear of the neurosciences and neurology, and perceptions of neurology education among medical trainees in African countries. BACKGROUND: Perceptions of neurology and characterization of neurophobia have been studied among medical trainees around the world. However, few studies on neurophobia have been conducted in African countries despite having a disproportionately high burden of neurological disease and fewer neurologists per capita than all other world regions. DESIGN/METHODS: We conducted a cross-sectional survey of medical students and post-graduate trainees in internal medicine and pediatrics across Africa. A 23-item online survey containing multiple-choice, Likert-scale, and free-response questions was adapted from prior literature, translated into English and French, and distributed through listservs and social media. RESULTS: 294 surveys were completed by 197 medical students and 97 post-graduate trainees from 15 countries, with the greatest representation from Zambia (n = 110), Nigeria (n = 54) and Kenya (n = 35). One-fifth of respondents endorsed interest in a future career in neurology while 36% reported discomfort with neurology and almost one-third endorsed neurophobia. Participants rated neurology as the most difficult compared to six other medical subspecialties (p < 0.001) and rated their confidence managing patients with neurological complaints lower than other medical subspecialties except rheumatology (p < 0.005). CONCLUSIONS: Medical trainees in multiple African countries endorse fear and discomfort with the subject of neurology. Strategies to mitigate neurophobia, including investments in neurological educational, diagnostic and treatment capacity, are needed to increase the number of medical trainees pursuing careers in neurology.

"When I Eat Well, I Will Be Healthy, and the Child Will Also Be Healthy": Maternal Nutrition among HIV-Infected Women Enrolled in a Livelihood Intervention in Western Kenya.

BACKGROUND: Food insecurity remains a major obstacle to achieving health and well-being for individuals living with HIV in western Kenya. Studies have shown that pregnant women are vulnerable to experiencing food insecurity worldwide, with significant consequences for both maternal and child health. The Shamba Maisha cluster randomized controlled trial in western Kenya (which means "farming for life" in Swahili) tested the effects of a multisectoral livelihood intervention consisting of agricultural and finance trainings, farm inputs, and a loan on health and food security among 746 farmers living with HIV in Kisumu, Homa Bay, and Migori Counties. OBJECTIVES: We conducted a qualitative substudy within the Shamba Maisha trial to understand the experiences and perspectives of pregnant women living with HIV enrolled in the trial. METHODS: Thirty women who had experienced a pregnancy during the Shamba Maisha study period, comprising 20 women in the intervention arm and 10 women in the control arm, completed in-depth interviews using a semistructured interview guide. RESULTS: Intervention participants interviewed noted improvements in maternal nutrition compared with previous pregnancies, which they attributed to the livelihood intervention. Key identified pathways to improved nutrition included improved access to vegetables, increased variety of diet through vegetable sales, and improved nutritional awareness. Women in the intervention arm also perceived increased weight gain compared with prior pregnancies and increased strength and energy throughout pregnancy. CONCLUSIONS: Livelihood interventions represent a promising solution to alleviate food insecurity for pregnant women in order to improve maternal and child health outcomes.This trial was registered at clinicaltrials.gov as NCT02815579.