Can a gender-sensitive integrated poultry value chain and nutrition intervention increase women's empowerment among the rural poor in Burkina Faso?

Understanding the types of food systems interventions that foster women's empowerment and the types of women that are able to benefit from different interventions is important for development policy. SELEVER was a gender- and nutrition-sensitive poultry production intervention implemented in western Burkina Faso from 2017 to 2020 that aimed to empower women. We evaluated SELEVER using a mixed-methods cluster-randomized controlled trial, which included survey data from 1763 households at baseline and endline and a sub-sample for two interim lean season surveys. We used the multidimensional project-level Women's Empowerment in Agriculture Index (pro-WEAI), which consists of 12 binary indicators, underlying count versions of 10 of these, an aggregate empowerment score (continuous) and a binary aggregate empowerment indicator, all for women and men. Women's and men's scores were compared to assess gender parity. We also assessed impacts on health and nutrition agency using the pro-WEAI health and nutrition module. We estimated program impact using analysis of covariance (ANCOVA) models and examined whether there were differential impacts by flock size or among those who participated in program activities (treatment on the treated). Program impacts on empowerment and gender parity were null, despite the program's multipronged and gender-sensitive approach. Meanwhile, results of the in-depth gender-focused qualitative work conducted near the project mid-point found there was greater awareness in the community of women's time burden and their economic contributions, but it did not seem that awareness led to increased empowerment of women. We reflect on possible explanations for the null findings. One notable explanation may be the lack of a productive asset transfer, which have previously been shown to be essential, but not sufficient, for the empowerment of women in agricultural development programs. We consider these findings in light of current debates on asset transfers. Unfortunately, null impacts on women's empowerment are not uncommon, and it is important to learn from such findings to strengthen future program design and delivery.

COVID-19 mobility restrictions and stay-at-home behaviour in 2020 were associated with higher retail food prices worldwide.

COVID-19 policy responses have included mobility restrictions, and many people have chosen to stay at home to avoid exposure. These actions have ambiguous impacts on food prices, lowering demand for food away from home and perishables, while increasing supply costs for items where workers are most affected by the pandemic. We use evidence from 160 countries to identify the net direction and magnitude of association between countries' real cost of all food and mobility restriction stringency. We investigate the deviation of each month's price level in 2020 from that month's average price level during the previous three years and find that an increase in mobility restriction stringency from no restrictions to most restrictive is associated with an increase in the real cost of all food of more than one percentage point across all models. We then examine the relationship between retail food price levels by food group and stay-at-home behaviour around markets in 36 countries and find positive associations for non-perishables, dairy and eggs.

Development and validation of a health and nutrition module for the project-level Women's Empowerment in Agriculture Index (pro-WEAI+HN).

Agricultural development projects increasingly aim to improve health and nutrition outcomes, often by engaging women. Although evidence shows such projects can improve women's and children's health and nutrition and empower women, little is known about their impacts on women's health- and nutrition-related agency and the extent to which impacts emerge through women's empowerment, largely due to a lack of instruments that measure the dimensions of women's agency that are directly relevant to health and nutrition outcomes. We developed an optional, complementary module for the project-level women's empowerment in agriculture index (pro-WEAI) to measure health- and nutrition-related agency (pro-WEAI + HN). Our method for developing related indicators used data collected from six agricultural development programmes implemented across Bangladesh, Burkina Faso and Mali (pooled sample = 12,114) and applied psychometric analysis (exploratory and confirmatory factor analysis) and the Alkire-Foster methodology. Results revealed seven indicators covering women's agency in the areas of her own health and diet; her health and diet during pregnancy; her child's diet; breastfeeding and weaning; purchasing food and health products; and acquiring food and health products. Multigroup confirmatory factor analysis revealed measurement invariance across contexts and samples. Tests of association (Cramer's V) and redundancy suggest that the pro-WEAI + HN indicators measured aspects of agency that are distinct from the core pro-WEAI. The uptake of these indicators in studies of nutrition-sensitive agricultural development projects may strengthen the evidence on how such programming can enhance women's empowerment to improve health and nutrition outcomes for themselves and their children.

The Role of Food and Beverage Companies in Transforming Food Systems: Building Resilience at Multiple Scales.

Food and beverage companies are increasingly aware of the risks posed by climate change and many are interested in addressing them by building resilience along their supply chains. Financial incentives for environmental, social, and governance criteria further motivate mitigation action by firms. To achieve sustainable outcomes, human and ecological systems must be managed for resilience. The scientific community and food and beverage firms must collaborate in the development of measurable and verifiable indicators that support adaptation and mitigation action along food supply chains. This article identifies 3 areas in which a synergistic progress would set a resilient trajectory toward sustainability: 1) incentives for sustainable intensification, 2) expanded reporting standards, and 3) pre-competitive collaborations. Incremental, clear, and measurable steps can be taken to adapt food supply chains to the pressing challenges imposed by climate change, mitigate further emissions, and bring producers and consumers along in the journey towards planetary health.

Do tradeoffs among dimensions of women's empowerment and nutrition outcomes exist? Evidence from six countries in Africa and Asia.

Although women's empowerment and gender equality are often linked with better maternal and child nutrition outcomes, recent systematic reviews find inconclusive evidence. This paper applies a comparable methodology to data on the Women's Empowerment in Agriculture Index (WEAI), an internationally-validated measure based on interviews of women and men within the same household, from six countries in Africa and Asia to identify which dimensions of women's empowerment are related to household-, woman-, and child-level dietary and nutrition outcomes. We examine relationships between women's empowerment and household-level dietary diversity; women's dietary diversity and BMI; and child-related outcomes, controlling for woman, child, and household characteristics. We also test for differential associations of women's empowerment with nutrition outcomes for boys and girls. We find few significant associations between the aggregate empowerment scores and nutritional outcomes. The women's empowerment score is positively associated only with child HAZ, while lower intrahousehold inequality is associated with a higher likelihood of exclusive breastfeeding and higher HAZ but with lower BMI. However, analysis of the subdomain indicators finds more significant associations, suggesting that tradeoffs exist among different dimensions of empowerment. Women's empowerment accounts for a small share of the variance in nutritional outcomes, with household wealth and country-level factors accounting for the largest share of the variation in household and women's dietary diversity. In contrast, most of the variation in child outcomes comes from child age. Improving nutritional outcomes requires addressing the underlying determinants of poor nutrition in addition to empowering women and improving gender equality.

Corrigendum to "Development of the project-level Women's Empowerment in Agriculture Index (pro-WEAI)" [World Development 122 (2019) 675-692].

[This corrects the article DOI: 10.1016/j.worlddev.2019.06.018.].

Measurement properties of the project-level Women's Empowerment in Agriculture Index.

Women's empowerment is a process that includes increases in intrinsic agency (power within); instrumental agency (power to); and collective agency (power with). We used baseline data from two studies-Targeting and Realigning Agriculture for Improved Nutrition (TRAIN) in Bangladesh and Building Resilience in Burkina Faso (BRB)-to assess the measurement properties of survey questions operationalizing selected dimensions of intrinsic, instrumental, and collective agency in the project-level Women's Empowerment in Agricultural Index (pro-WEAI). We applied unidimensional item-response models to question (item) sets to assess their measurement properties, and when possible, their cross-context measurement equivalence-a requirement of measures designed for cross-group comparisons. For intrinsic agency in the right to bodily integrity, measured with five attitudinal questions about intimate partner violence (IPV) against women, model assumptions of unidimensionality and local independence were met. Four items showed good model fit and measurement equivalence across TRAIN and BRB. For item sets designed to capture autonomy in income, intrinsic agency in livelihoods activities, and instrumental agency in: livelihoods activities, the sale or use of outputs, the use of income, and borrowing from financial services, model assumptions were not met, model fit was poor, and items generally were weakly related to the latent (unobserved) agency construct. For intrinsic and instrumental agency in livelihoods activities and for instrumental agency in the sale or use of outputs and in the use of income, items sets had similar precision along the latent-agency continuum, suggesting that similar item sets could be dropped without a loss of precision. IRT models for collective agency were not estimable because of low reported presence and membership in community groups. This analysis demonstrates the use of IRT methods to assess the measurement properties of item sets in pro-WEAI, and empowerment scales generally. Findings suggest that a shorter version of pro-WEAI can be developed that will improve its measurement properties. We recommend revisions to the pro-WEAI questionnaire and call for new measures of women's collective agency.

Development of the project-level Women's Empowerment in Agriculture Index (pro-WEAI).

With growing commitment to women's empowerment by agricultural development agencies, sound methods and indicators to measure women's empowerment are needed to learn which types of projects or project-implementation strategies do and do not work to empower women. The Women's Empowerment in Agriculture Index (WEAI), which has been widely used, requires adaptation to meet the need for monitoring projects and assessing their impacts. In this paper, the authors describe the adaptation and validation of a project-level WEAI (or pro-WEAI) that agricultural development projects can use to identify key areas of women's (and men's) disempowerment, design appropriate strategies to address identified deficiencies, and monitor project outcomes related to women's empowerment. The 12 pro-WEAI indicators are mapped to three domains: intrinsic agency (power within), instrumental agency (power to), and collective agency (power with). A gender parity index compares the empowerment scores of men and women in the same household. The authors describe the development of pro-WEAI, including: (1) pro-WEAI's distinctiveness from other versions of the WEAI; (2) the process of piloting pro-WEAI in 13 agricultural development projects during the Gender, Agriculture, and Assets Project, phase 2 (GAAP2); (3) analysis of quantitative data from the GAAP2 projects, including intrahousehold patterns of empowerment/disempowerment; and (4) a summary of the findings from the qualitative work exploring concepts of women's empowerment in the project sites. The paper concludes with a discussion of lessons learned from pro-WEAI and possibilities for further development of empowerment metrics.

Patients' and Clinicians' Perceptions of Antibiotic Prescribing for Upper Respiratory Infections in the Acute Care Setting.

Reducing inappropriate prescribing is key to mitigating antibiotic resistance, particularly in acute care settings. Clinicians' prescribing decisions are influenced by their judgments and actual or perceived patient expectations. Fuzzy trace theory predicts that patients and clinicians base such decisions on categorical gist representations that reflect the bottom-line understanding of information about antibiotics. However, due to clinicians' specialized training, the categorical gists driving clinicians' and patients' decisions might differ, which could result in mismatched expectations and inefficiencies in targeting interventions. We surveyed clinicians and patients from 2 large urban academic hospital emergency departments (EDs) and a sample of nonpatient subjects regarding their gist representations of antibiotic decisions, as well as relevant knowledge and expectations. Results were analyzed using exploratory factor analysis (EFA) and multifactor regression. In total, 149 clinicians (47% female; 74% white), 519 online subjects (45% female; 78% white), and 225 ED patients (61% female; 56% black) completed the survey. While clinicians demonstrated greater knowledge of antibiotics and concern about side effects than patients, the predominant categorical gist for both patients and clinicians was "why not take a risk," which compares the status quo of remaining sick to the possibility of benefit from antibiotics. This gist also predicted expectations and prior prescribing in the nonpatient sample. Other representations reflected the gist that "germs are germs" conflating bacteria and viruses, as well as perceptions of side effects and efficacy. Although individually rational, reliance on the "why not take a risk" representation can lead to socially suboptimal results, including antibiotic resistance and individual patient harm due to adverse events. Changing this representation could alter clinicians' and patients' expectations, suggesting opportunities to reduce overprescribing.

Global increase and geographic convergence in antibiotic consumption between 2000 and 2015.

Tracking antibiotic consumption patterns over time and across countries could inform policies to optimize antibiotic prescribing and minimize antibiotic resistance, such as setting and enforcing per capita consumption targets or aiding investments in alternatives to antibiotics. In this study, we analyzed the trends and drivers of antibiotic consumption from 2000 to 2015 in 76 countries and projected total global antibiotic consumption through 2030. Between 2000 and 2015, antibiotic consumption, expressed in defined daily doses (DDD), increased 65% (21.1-34.8 billion DDDs), and the antibiotic consumption rate increased 39% (11.3-15.7 DDDs per 1,000 inhabitants per day). The increase was driven by low- and middle-income countries (LMICs), where rising consumption was correlated with gross domestic product per capita (GDPPC) growth (P = 0.004). In high-income countries (HICs), although overall consumption increased modestly, DDDs per 1,000 inhabitants per day fell 4%, and there was no correlation with GDPPC. Of particular concern was the rapid increase in the use of last-resort compounds, both in HICs and LMICs, such as glycylcyclines, oxazolidinones, carbapenems, and polymyxins. Projections of global antibiotic consumption in 2030, assuming no policy changes, were up to 200% higher than the 42 billion DDDs estimated in 2015. Although antibiotic consumption rates in most LMICs remain lower than in HICs despite higher bacterial disease burden, consumption in LMICs is rapidly converging to rates similar to HICs. Reducing global consumption is critical for reducing the threat of antibiotic resistance, but reduction efforts must balance access limitations in LMICs and take account of local and global resistance patterns.

Categorical Risk Perception Drives Variability in Antibiotic Prescribing in the Emergency Department: A Mixed Methods Observational Study.

BACKGROUND: Adherence to evidence-based antibiotic therapy guidelines for treatment of upper respiratory tract infections (URIs) varies widely among clinicians. Understanding this variability is key for reducing inappropriate prescribing. OBJECTIVE: To measure how emergency department (ED) clinicians' perceptions of antibiotic prescribing risks affect their decision-making. DESIGN: Clinician survey based on fuzzy-trace theory, a theory of medical decision-making, combined with retrospective data on prescribing outcomes for URI/pneumonia visits in two EDs. The survey predicts the categorical meanings, or gists, that individuals derive from given information. PARTICIPANTS: ED physicians, residents, and physician assistants (PAs) who completed surveys and treated patients with URI/pneumonia diagnoses between August 2014 and December 2015. MAIN MEASURES: Gists derived from survey responses and their association with rates of antibiotic prescribing per visit. KEY RESULTS: Of 4474 URI/pneumonia visits, 2874 (64.2%) had an antibiotic prescription. However, prescribing rates varied from 7% to 91% for the 69 clinicians surveyed (65.2% response rate). Clinicians who framed therapy-prescribing decisions as a categorical choice between continued illness and possibly beneficial treatment ("why not take a risk?" gist, which assumes antibiotic therapy is essentially harmless) had higher rates of prescribing (OR 1.28 [95% CI, 1.06-1.54]). Greater agreement with the "antibiotics may be harmful" gist was associated with lower prescribing rates (OR 0.81 [95% CI, 0.67-0.98]). CONCLUSIONS: Our results indicate that clinicians who perceive prescribing as a categorical choice between patients remaining ill or possibly improving from therapy are more likely to prescribe antibiotics. However, this strategy assumes that antibiotics are essentially harmless. Clinicians who framed decision-making as a choice between potential harms from therapy and continued patient illness (e.g., increased appreciation of potential harms) had lower prescribing rates. These results suggest that interventions to reduce inappropriate prescribing should emphasize the non-negligible possibility of serious side effects.

Gene Expression Profiling of Tumors From Heavily Pretreated Patients With Metastatic Cancer for the Selection of Therapy: A Pilot Study.

BACKGROUND: Recently, it has been shown that it is possible to identify tumor profiles of sensitivity for potentially useful drugs, both conventional and experimental, based on whole oligonucleotide microarray gene expression studies in heavily pretreated patients with metastatic solid tumors. METHODS: Fresh-frozen tumor biopsies for molecular profiling (MP) were obtained from patients with advanced and refractory cancer. Total tumor and control tissue RNA was hybridized to a whole human genome oligonucleotide microarray. Differentially expressed genes interacting with potential therapeutic targets were identified. Results were complemented with DNA sequencing of selected driver genes and with immunohistochemistry and fluorescent "in situ" hybridization. The results were used to guide experimental treatment. RESULTS: MP assays led to a potentially active available drug in 91.2% of the patients. The median number of available active drugs per tumor was 5 (range, 1 to 9). Nine treated patients were not evaluable for response. Partial response was observed in 18 patients (33%), stable disease in 22 patients (40%) (clinical benefit rate of 73%), and progression in 15 (27%). Overall median progression-free survival and overall survival were 8 and 13 months, respectively. CONCLUSION: MP-guided therapy is feasible and seems to improve the clinical outcome of extensively pretreated patients but prospective and confirmatory trials are needed.

Case Series Study of Invasive Pulmonary Aspergillosis.

Diagnosis of invasive pulmonary aspergillosis (IPA) is challenging. The objective of the study was to assess the value of microbiological tests to the diagnosis of IPA in the absence of non-specific radiological data. A retrospective study of 23 patients with suspicion of IPA and positivity of some microbiological diagnostic tests was performed. These tests included conventional microbiological culture, detection of Aspergillus galactomannan (GM) antigen and in some patients (1 â†’ 3)-ß-D-glucan (BDG) and Aspergillus fumigatus DNA using the LightCycler® SeptiFast test. In 10 patients with hematological malignancy, 6 cases were considered 'probable' and 4 'non-classifiable.' In 8 patients with chronic lung disease, 7 cases were classified as 'probable' and 1 as 'proven,' and in 5 patients with prolonged ICU stay (>7 days), there were 2 'proven' cases, 2 'non-classifiable' and 1 putative case. Microbiological culture was positive in 17 cases and 18 Aspergillus spp. were isolated (one mixed culture). A. fumigatus was the most frequent (44.4%) followed by A. tubingensis. The Aspergillus galactomannan (GM) antigen assay was positive in 21 cases (91.3%). The GM antigen and the (1 â†’ 3)-ß-D-glucan (BDG) assays were both performed in 12 cases (52.2%), being positive in 9. The SeptiFast test was performed in 7 patients, being positive in 4. In patients with non-classifiable pulmonary aspergillosis and one or more positive microbiological tests, radiological criteria may not be considered a limiting factor for the diagnosis of IPA.

Epidemiología, factores de riesgo y sensibilidad in vitro en candidemias por especies diferentes de Candida albicans / Epidemiology, risk factors and in vitro susceptibility in candidaemia due to non-Candida albicans species

Antecedentes. La infección fúngica invasora ha aumentado en los últimos años por el incremento de los factores de riesgo; la candidemia es la principal manifestación clínica. Candida albicans es la especie más frecuente, aunque actualmente se ha observado un aumento en otras especies del género. Objetivos. Analizar la epidemiología, los factores de riesgo y la sensibilidad antifúngica de los aislamientos en hemocultivos de especies de Candida diferentes de C.albicans en nuestro hospital en los últimos 12años. Métodos. Se estudiaron retrospectivamente las características epidemiológicas de 107 pacientes con candidemia ingresados en nuestro hospital. Se determinó la sensibilidad de las especies de Candida al fluconazol, el itraconazol, el voriconazol, la anfotericinaB, la 5-fluorocitosina, la caspofungina, la micafungina y la anidulafungina mediante el método de microdilución Sensititre Yeast One (Izasa, España). Resultados. De los 109 aislamientos, 59 correspondieron a las siguientes especies de Candida (diferentes de C.albicans): 25 Candida parapsilosis complex, 14 Candida glabrata complex, 13 Candida tropicalis, 4 Candida krusei, una Candida lipolytica, una Candida membranaefaciens y una Candida pulcherrima. El factor de riesgo más frecuente en adultos y niños con candidemias por estas especies fue ser portador de catéter. El 8,5% de estos aislamientos fueron resistentes al fluconazol. Conclusiones. El resultado de nuestro trabajo confirma la necesidad de conocer la epidemiología de las especies de Candida diferentes de C.albicans, su sensibilidad in vitro y los factores de riesgo asociados, especialmente en pacientes con dichos factores (AU)

Background. Invasive fungal infection (IFI) has increased in recent years due to there being a greater number of risk factors. IFI caused by Candida is the most frequent, and although Candida albicans is the most isolated species, there is currently a decrease of C. albicans and an increase of other species of the genus. Aims. To analyse the epidemiology, risk factors, and antifungal susceptibility of blood culture isolates of non-C.albicans Candida species in our hospital in the last 12years. Methods. A retrospective study was conducted on 107 patients with candidaemia admitted to our hospital. Candida isolates susceptibility to fluconazole, itraconazole, voriconazole, amphotericinB, 5-fluorocytosine, caspofungin, micafungin, and anidulafungin was determined by means of a microdilution technique (Sensititre Yeast One; Izasa, Spain). Results. From a total of 109 strains, 59 belonged to non-C. albicans Candida species: 25 Candida parapsilosis complex, 14 Candida glabrata complex, 13 Candida tropicalis, 4 Candida krusei, 1 Candida lipolytica, 1 Candida membranaefaciens, and 1 Candida pulcherrima. The most common risk factor in adults and children was catheter use. It was observed that 8.5% of those non-C.albicans strains were resistant to fluconazole. Conclusions. The results of this work confirm that it is necessary to know the epidemiology of non-C.albicans Candida species, the in vitro susceptibility of the species involved, and the main risk factors, especially in patients with predisposing conditions (AU)

[Epidemiology, risk factors and in vitro susceptibility in candidaemia due to non-Candida albicans species]. / Epidemiología, factores de riesgo y sensibilidad in vitro en candidemias por especies diferentes de Candida albicans.

BACKGROUND: Invasive fungal infection (IFI) has increased in recent years due to there being a greater number of risk factors. IFI caused by Candida is the most frequent, and although Candida albicans is the most isolated species, there is currently a decrease of C. albicans and an increase of other species of the genus. AIMS: To analyse the epidemiology, risk factors, and antifungal susceptibility of blood culture isolates of non-C.albicans Candida species in our hospital in the last 12years. METHODS: A retrospective study was conducted on 107 patients with candidaemia admitted to our hospital. Candida isolates susceptibility to fluconazole, itraconazole, voriconazole, amphotericinB, 5-fluorocytosine, caspofungin, micafungin, and anidulafungin was determined by means of a microdilution technique (Sensititre Yeast One; Izasa, Spain). RESULTS: From a total of 109 strains, 59 belonged to non-C. albicans Candida species: 25 Candida parapsilosis complex, 14 Candida glabrata complex, 13 Candida tropicalis, 4 Candida krusei, 1 Candida lipolytica, 1 Candida membranaefaciens, and 1 Candida pulcherrima. The most common risk factor in adults and children was catheter use. It was observed that 8.5% of those non-C.albicans strains were resistant to fluconazole. CONCLUSIONS: The results of this work confirm that it is necessary to know the epidemiology of non-C.albicans Candida species, the in vitro susceptibility of the species involved, and the main risk factors, especially in patients with predisposing conditions.