Informal value chain actors' knowledge and perceptions about zoonotic diseases and biosecurity in Kenya and the importance for food safety and public health.

Zoonotic diseases, transmitted from animals to humans, are a public health challenge in developing countries. Livestock value chain actors have an important role to play as the first line of defence in safeguarding public health. However, although the livelihood and economic impacts of zoonoses are widely known, adoption of biosecurity measures aimed at preventing zoonoses is low, particularly among actors in informal livestock value chains in low and middle-income countries. The main objective of this study was to investigate knowledge of zoonoses and adoption of biosecurity measures by livestock and milk value chain actors in Bura, Tana River County, in Kenya, where cattle, camels, sheep and goats are the main livestock kept. The study utilised a mixed methods approach, with a questionnaire survey administered to 154 value chain actors. Additional information was elicited through key informant interviews and participatory methods with relevant stakeholders outside the value chain. Our results found low levels of knowledge of zoonoses and low levels of adherence to food safety standards, with only 37% of milk traders knowing about brucellosis, in spite of a sero-prevalence of 9% in the small ruminants tested in this study, and no slaughterhouse worker knew about Q fever. Actors had little formal education (between 0 and 10%) and lacked training in food safety and biosecurity measures. Adoption of biosecurity measures by value chain actors was very low or non-existent, with only 11% of butchers wearing gloves. There was a gendered dimension, evidenced by markedly different participation in value chains and lower adoption rates and knowledge levels among female actors. Finally, cultural and religious practices were shown to play an important role in exposure and transmission of diseases, influencing perceptions and attitudes to risks and adoption of biosecurity measures.

Are government veterinary paraprofessionals serving the poor? The perceptions of smallholder livestock farmers in Western Kenya.

The liberalization of clinical veterinary services in Kenya introduced new service providers into the animal health service sector. This study examines the perceptions of livestock farmers regarding these service providers and analyses the factors that influence their choice of alternative service providers in Kakamega County. The empirical analysis shows that private animal health assistants were perceived to provide better services than alternative providers because they are more accessible and offer services on credit. Results from a multinomial logit model reveal that more educated, wealthier, and older farmers are more likely to use government services. The study concludes that it is imperative to better target the poor and to integrate private service providers into government animal health programs.

Providing animal health services to the poor in Northern Ghana: rethinking the role of community animal health workers?

The Community Animal Health Workers (CAHWs) system has been promoted as an alternative solution to providing animal health services in marginal areas. Yet, access to quality animal health services still remains a fundamental problem for livestock dependent communities. This paper uses the concepts of accessibility, affordability, and transaction costs to examine the perceptions of livestock keepers about the various animal health service providers. The empirical analysis is based on a survey of 120 livestock-keeping households in the Tolon-Kumbungu and Savelugu-Nanton districts in the Northern Region of Ghana. A multinomial logit model was used to determine the factors that influence households' choice of alternative animal health service providers. The results show that the government para-vets are the most preferred type of animal health service providers while CAHWs are the least preferred. Reasons for this observation include high transaction costs and low performance resulting from limited training. In areas with few or no government para-vets, farmers have resorted to self-treatment or to selling sick animals for consumption, which has undesirable health implications. These practices also result in significant financial losses for farmers. This paper finds that the CAHWs' system is insufficient for providing quality animal health services to the rural poor in marginal areas. Therefore, market-smart alternative solutions requiring strong public sector engagement to support livestock farmers in marginal areas and setting minimum training standards for animal health service providers merit policy consideration.

Nutrition-sensitive lockdowns: conceptual framework and empirical insights from Africa during COVID-19.

Motivation: Countries facing challenges of nutrition security confront a trade-off when dealing with pandemics such as COVID-19. Implementing lockdown measures, widely used worldwide, can help "flatten the curve" (of disease), but such measures may worsen nutrition security. Purpose: We aim to identify and justify nutrition-sensitive lockdown measures to reduce trade-offs with nutrition security. Methods and approach: We propose a conceptual framework which distinguishes eight lockdown measures and six pathways to nutrition security. To demonstrate the relevance of the pathways, we reviewed emerging literature on COVID-19 and nutrition security. We analysed the content of 1,188 newspaper articles on lockdown effects in five African countries - Benin, Ghana, Kenya, Uganda and Zambia. Findings: Some lockdown measures, such as closing workplaces and restricting movement, potentially worsen nutrition far more than others - banning events and public gatherings have far lesser impacts on nutrition. This can be seen from the framework, literature, and is supported by the analysis of newspaper reports in the five countries. Policy implications: It is better when possible to test and trace disease than to lockdown. But when lockdowns are needed, then first recourse should be to measures that have few nutritional consequences, such as banning public events. When more drastic measures are necessary, look to mitigate nutritional harm by, for example, exempting farm labour from restrictions on movement, by replacing school meals with take-home rations, and, above all, providing income support to households most affected and most vulnerable.

'We would rather die from Covid-19 than from hunger' - Exploring lockdown stringencies in five African countries.

Facing COVID-19, African countries were confronted with a dilemma: enacting strict lockdowns to "flatten the curve" could potentially have large effects on food security. Given this catch-22 situation, there was widespread concern that Africa would suffer most from the pandemic. Yet, emerging evidence in early 2021 showed that COVID-19 morbidity remained low, while "biblical famines" have been avoided so far. This paper explores how five African countries maneuvered around the potentially large trade-offs between public health and food security when designing their policy responses to COVID-19 based on a content analysis of 1188 newspaper articles. The findings show that food security concerns played an important role in the public policy debate and influenced the stringency of lockdowns, especially in more democratic countries.

Fruits and Vegetables in International Agricultural Research: A Case of Neglect?

Fruits and vegetables (F+Vs) can play an important role in combatting the problem of the double burden of malnutrition. Agricultural research can help to increase the productivity and the resource-use efficiency of fruit and vegetable production and, thus, reduce prices so that these commodities can become more available to poor households. However, the crops research of the international agricultural research system, including its centerpiece the CGIAR, has so far concentrated mainly on staple grains and starchy food crops, while largely neglecting most F+Vs. None of the current CGIAR centers is specifically dedicated to fruits or vegetables if the convention is followed not to consider cassava, potatoes of all types, and bananas and their relatives as vegetables. The underlying reasons why the CGIAR has not focused on F+Vs are explored in this review. The early emphasis on food staple crops was motivated by the perception that the hunger problems of the era were primarily deficiencies in food energy. The success of the Green Revolution, in which international agricultural research played a key role, stimulated further emphasis on increasing the productivity of staple grains as the major strategy to combat hunger. F+Vs, however, received limited attention. The Asian Vegetable Research and Development Center in Taiwan was created outside the CGIAR system. In the 1990s new centers were added to the CGIAR system, but this opportunity was not used to create a dedicated center for F+Vs. Some informal activities to conduct research on F+Vs also took place in several other CGIAR centers as part of the farming systems research activities, based on the recognition that F+Vs are small but important elements of many farming systems of the developing world. Through an analysis of the reasons why the CGIAR system has tended little to F+Vs, this paper presents an assessment of possible future strategies to better integrate these "neglected" commodities into international agricultural research efforts. The assessment shows that genetic improvement might perhaps best be largely left to the private sector, while international agricultural research could better focus on developing strategies for integrated pest management, biological pest control, and improved water use efficiency, as these are areas where private companies have limited incentives to invest. Moreover, publicly funded research could help to find low-cost solutions for infrastructure-related aspects such as postharvest handling and storage (e.g., cooling and drying), aspects where renewable energy sources have a substantial potential.

Impact of Ethiopia's productive safety net program on household food security and child nutrition: A marginal structural modeling approach.

Safety nets are expanding in African countries as a policy instrument to alleviate poverty and food insecurity. Whether safety nets have improved household food security and child diet and nutrition in sub-Saharan Africa has not been well documented. This paper takes the case of Ethiopia's Productive Safety Net Program (PSNP) and provides evidence of the impact of safety nets on household food security and child nutritional outcomes. Prior studies provide inconclusive evidence as to whether PSNP has improved household food security and child nutrition. These studies used analytical approaches that correct for selection bias but have overlooked the effect of time-varying confounders that might have resulted in biased estimation. Given that household food security status is both the criteria for participation and one of the desirable outcomes of the program, estimating the causal impact of PSNP on household food security and child nutrition is prone to endogeneity due to selection bias and time-varying confounders. Therefore, the objectives of this paper are (1) to examine the impacts of PSNP on household food security, child meal frequency, child diet diversity, and child anthropometry using marginal structural modeling approach that takes into account both selection bias and time-varying confounders and (2) to shed some light on policy and programmatic implications. Results show that PSNP has not improved household food insecurity, child dietary diversity, and child anthropometry despite its positive impact on child meal frequency. Household participation in PSNP brought a 0.308 unit gain on child meal frequency. Given the consequence of food insecurity and child undernutrition on physical and mental development, intergenerational cycle of poverty, and human capital formation, the program would benefit if it is tailored to nutrition-specific and nutrition-sensitive interventions.

Correction: Drought and child undernutrition in Ethiopia: A longitudinal path analysis.

[This corrects the article DOI: 10.1371/journal.pone.0217821.].

Drought and child undernutrition in Ethiopia: A longitudinal path analysis.

BACKGROUND: The increase in the frequency of extreme events due to climate change poses a serious challenge to achieving the Sustainable Development Goal 2 of ending hunger by 2030. While evidence exists on the impact of drought on under-five children, its effect during late childhood and early adolescence remains less investigated. OBJECTIVE: This study estimates the impact of concurrent and long-term exposure to drought on linear growth during late childhood and early adolescence. METHODS: Four rounds (2002-2013) of data from the young lives Cohort Study dataset (n = 2000) was used. The associations of concurrent and long-term exposure to drought and Height-for-age z-score was analysed using structural equation modelling techniques. The study also explored the mediating role of interim period growth in the association of early exposure to drought and undernutrition at later age and the role of the Productive Safety Net Program in buffering the impact of drought on child nutrition. RESULTS: Results show that both concurrent and long-term exposure to drought was negatively associated with Height-for-age z-score (p < 0.001). Exposure to drought at age 5, 8, and 12 years is associated with lower Height-for-age z- score at age 5, 8, and 12 years respectively. Exposure to drought at age 5 years was also negatively associated with Height-for-age z-score at age 12 years (p < 0.001). This association was mainly indirect (89%) and mediated through reduced child growth in subsequent years. Participation in productive safety net program by drought-affected children reduces but does not completely offset the negative effects of drought on Height-for-age z-score (p < 0.1). Moreover, girls were more likely to suffer poor growth than boys. CONCLUSION: Drought exposure after the 1,000 days window could have a lasting impact on child growth. Given the importance of this period for child physical and mental development, children beyond the 1,000 days window should also be a focus of disaster relief programs.

Using process net-map to analyse governance challenges: A case study of livestock vaccination campaigns in Zambia.

The outbreak of livestock diseases in Sub-Saharan African countries is the most critical challenge affecting the development potential of the livestock sector. Vaccination campaigns are one of the most important strategies to deal with this challenge. However, such campaigns are difficult to implement due to major governance challenges, such as delays in the procurement of vaccines and the disbursement of funds. This paper presents an in-depth analysis of these governance challenges, based on a case study of a Livestock Development Animal Health Project in Zambia. The goal was to examine in detail why these problems occur and how they are linked to the implementation procedure. A novel qualitative research tool called Process Net-Map, which is a visual participatory mapping technique was applied. The tool made it possible to develop an understanding of the exact implementation mechanism and to identify the different actors involved, including government officials, private sector companies, and farmers. The study revealed that the complex design of the procurement procedure, the limited capacity of the procuring entity, and a lack of urgency among the actors involved, resulted in the procurement delays. The findings also indicate that the delay in the release of funds arises because of a diversion of funds. Some strategies to improve the efficiency of the procurement process were identified, such as increasing the sense of urgency, building staff capacity, using e-procurement and entering into framework contracts with suppliers. Building sustainable financial capacity in the overall management of public funds seems essential to deal with the challenge of fund diversion. Use of Citizen Report Cards and lobbying political decision markers are some of the mechanisms that farmers can employ to increase their capacity to hold the animal health service providers accountable and demand better services. The problems identified are not only relevant for vaccination programs but are general implementation challenges encountered in developmental programs that involve the distribution of publicly procured inputs.

The Devil is in the Detail: Understanding the Governance Challenges of Implementing Nutrition-Specific Programs on a Large Scale.

Nutrition interventions can play a key role in combatting hidden hunger in developing countries. However, when malnutrition is affecting a large share of the population, such programs need to be implemented on a large scale, which involves major governance challenges, such as absenteeism of staff, elite capture, and leakage of funds or food. This paper discusses the underlying reasons of these governance challenges from a theoretical perspective and proposes a participatory research tool called "Process Net-Map" to analyze these challenges empirically. A case study of India's Integrated Child Development Services Scheme was conducted in Bihar to provide a proof-of-concept of Process Net-Map as a qualitative research tool that is suitable to identify governance challenges in the implementation of large-scale nutrition programs. Applying the Process Net-Map tool made it clear that the "devil is in the detail" when it comes to the implementation of large-scale nutrition interventions. The case study also shows that an understanding of the details of the implementation mechanisms of nutrition programs is essential for designing governance reform options that have good prospects to increase the effectiveness of large-scale nutrition programs in developing countries.

Addressing governance challenges in the provision of animal health services: A review of the literature and empirical application transaction cost theory.

Providing adequate animal health services to smallholder farmers in developing countries has remained a challenge, in spite of various reform efforts during the past decades. The focuses of the past reforms were on market failures to decide what the public sector, the private sector, and the "third sector" (the community-based sector) should do with regard to providing animal health services. However, such frameworks have paid limited attention to the governance challenges inherent in the provision of animal health services. This paper presents a framework for analyzing institutional arrangements for providing animal health services that focus not only on market failures, but also on governance challenges, such as elite capture, and absenteeism of staff. As an analytical basis, Williamson's discriminating alignment hypothesis is applied to assess the cost-effectiveness of different institutional arrangements for animal health services in view of both market failures and governance challenges. This framework is used to generate testable hypotheses on the appropriateness of different institutional arrangements for providing animal health services, depending on context-specific circumstances. Data from Uganda and Kenya on clinical veterinary services is used to provide an empirical test of these hypotheses and to demonstrate application of Williamson's transaction cost theory to veterinary service delivery. The paper concludes that strong public sector involvement, especially in building and strengthening a synergistic relation-based referral arrangement between paraprofessionals and veterinarians is imperative in improving animal health service delivery in developing countries.

Measuring the quality of clinical veterinary services for Cattle: an application of a role play experiment in rural Uganda.

BACKGROUND: The dominance of veterinary paraprofessionals in the animal health markets has been linked to the decline in quality of veterinary services. This study uses a role play experiment to analyze how the interaction of farmers and service providers influences the quality and the demand for clinical services for cattle. The quality of clinical services was measured by scoring the accuracy of the service provider prescribing the appropriate drug for selected cattle diseases. METHODS: The game was played in four rounds. Farmers were given "animal medical card" with the name of the disease written on it both in English and the local language in each round. Service providers were asked to write the clinical signs, and prescribe the drugs. RESULTS: The results show that the ability to identify the signs of different diseases and the accuracy of prescriptions by veterinarians is not significantly different from that of paraprofessionals trained in veterinary science. However, the ability of service providers who are not trained in veterinary medicine to perform these tasks is significantly lower than that of service providers trained in veterinary science. The continued interaction between paraprofessionals and veterinarians gradually leads to an improvement in the ability of paraprofessionals trained in general agriculture and social sciences to perform these tasks. This was not the case for paraprofessionals with no formal training or education. Farmers do not easily change their beliefs about paraprofessionals, even if they receive information on their inability to diagnose diseases correctly and prescribe the correct drugs. Belief updating depends not only on the outcome of the previous round, but also on the gender of the farmer and the livestock production system. CONCLUSION: This paper argues that the slow pace in which farmers update their beliefs about paraprofessionals limits paraprofessionals' willingness to learn or consult with veterinarians. However, the use of "animal health cards" (records of diagnoses and treatments) could induce paraprofessionals to provide services of better quality clinical services for cattle and enable farmers to measure the quality of these services.

Determinants of referrals from paraprofessionals to veterinarians in Uganda and Kenya.

Referrals between paraprofessionals and veterinarians are seen as a solution for improving disease surveillance, detection, and reporting as well as ensuring prudent use of antimicrobial agents in animals. This paper used data collected from paraprofessionals in Kenya and Uganda to identify factors influencing referrals to veterinarians by paraprofessionals using a probit regression model. The results show that the determinants of paraprofessional referrals to veterinarians include the following: paraprofessional's mobile phone ownership, gender, and training, as well as attendance of short term trainings, annual assessments, and membership in paraprofessional associations. The paper argues that legislation or supervision of paraprofessionals as well as expansion of mobile phone ownership by paraprofessionals, supporting the formation of paraprofessional associations, and investing in short term training are important factors for strengthening referrals from paraprofessionals to veterinarians.