Rural Subsistence Farmers Research Articles

Rural household vulnerability to climate risk in Uganda

Vulnerability assessment is fundamental for informing adaptation to climate change policy. The aim of this study is to evaluate the vulnerability of rural subsistence farmers in Uganda to climate risk. A mixed methods approach used semi-structured and guided interviews, and participatory techniques to explore perception, livelihood response and socio-economic status. Perception of climate risk varied, with wealthier farmers perceiving drought as highest risk, whilst poorer farmers perceived extreme heavy rainfall. Farmers implemented many general livelihood coping and anticipatory responses (54.7 %) to perceived impacts from drought, rainfall variability and extreme heavy rainfall. Examples included food storage, livestock maintenance and planting drought-resistant varieties. Other responses (45.3 %) were specific to individual climatic events, and farmers had no response to cope with rainfall variability. Climate risk was not the only driver of vulnerability. Soil infertility, pests and diseases, and economic instability also sustained decreasing trends in income. Adaptive capacity of households differed with external and internal attributes of sensitivity. Farmers with more land, education, access to governmental extension, a non-farm livelihood, larger households and older age had more capacity to buffer shock through increased assets and entitlements than poorer farmers who were more likely to engage in opportunistic behaviour like casual labouring. Few livelihood responses associated with perceived threat from the climate indicating response to a broader range of stressors. Conclusions determined inequality in livelihood response as a fundamental driver in households’ ability to cope and adapt to climate risk.

Biologically Based Methods for Control of Fumonisin-Producing Fusarium Species and Reduction of the Fumonisins.

Infection by the fumonisin-producing Fusarium spp. and subsequent fumonisin contamination of maize adversely affect international trade and economy with deleterious effects on human and animal health. In developed countries high standards of the major food suppliers and retailers are upheld and regulatory controls deter the importation and local marketing of fumonisin-contaminated food products. In developing countries regulatory measures are either lacking or poorly enforced, due to food insecurity, resulting in an increased mycotoxin exposure. The lack and poor accessibility of effective and environmentally safe control methods have led to an increased interest in practical and biological alternatives to reduce fumonisin intake. These include the application of natural resources, including plants, microbial cultures, genetic material thereof, or clay minerals pre- and post-harvest. Pre-harvest approaches include breeding for resistant maize cultivars, introduction of biocontrol microorganisms, application of phenolic plant extracts, and expression of antifungal proteins and fumonisin degrading enzymes in transgenic maize cultivars. Post-harvest approaches include the removal of fumonisins by natural clay adsorbents and enzymatic degradation of fumonisins through decarboxylation and deamination by recombinant carboxylesterase and aminotransferase enzymes. Although, the knowledge base on biological control methods has expanded, only a limited number of authorized decontamination products and methods are commercially available. As many studies detailed the use of natural compounds in vitro, concepts in reducing fumonisin contamination should be developed further for application in planta and in the field pre-harvest, post-harvest, and during storage and food-processing. In developed countries an integrated approach, involving good agricultural management practices, hazard analysis and critical control point (HACCP) production, and storage management, together with selected biologically based treatments, mild chemical and physical treatments could reduce fumonisin contamination effectively. In rural subsistence farming communities, simple, practical, and culturally acceptable hand-sorting, maize kernel washing, and dehulling intervention methods proved to be effective as a last line of defense for reducing fumonisin exposure. Biologically based methods for control of fumonisin-producing Fusarium spp. and decontamination of the fumonisins could have potential commercial application, while simple and practical intervention strategies could also impact positively on food safety and security, especially in rural populations reliant on maize as a dietary staple.

Mycotoxin contamination of home-grown maize in rural northern South Africa (Limpopo and Mpumalanga Provinces)

ABSTRACTThe aim of this study was to assess mycotoxin contamination of crops grown by rural subsistence farmers over two seasons (2011 and 2012) in two districts, Vhembe District Municipality (VDM, Limpopo Province) and Gert Sibande District Municiality (GSDM, Mpumalanga Province), in northern South Africa and to evaluate its impact on farmers’ productivity and human and animal health. A total of 114 maize samples were collected from 39 households over the two seasons and were analysed using a validated liquid chromatography-tandem mass spectrometry mycotoxins method. Aflatoxin B1 (AFB1) occurrence ranged from 1 to 133 µg kg−1 in VDM while AFB1 levels in GSDM were less than 1.0 µg kg−1 in all maize samples. Fumonisin B1 levels ranged from 12 to 8514 µg kg−1 (VDM) and 11–18924 µg kg−1 (GSDM) in 92% and 47% positive samples, respectively, over both seasons. Natural occurrence and contamination with both fumonisins and aflatoxins in stored home-grown maize from VDM was significantly (p < 0.0001) higher than from GSDM over both seasons.

Global Burden of Leptospirosis: Estimated in Terms of Disability Adjusted Life Years.

BackgroundLeptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis can cause life-threatening disease, there is no global burden of disease estimate in terms of Disability Adjusted Life Years (DALYs) available.Methodology/Principal FindingsWe utilised the results of a parallel publication that reported global estimates of morbidity and mortality due to leptospirosis. We estimated Years of Life Lost (YLLs) from age and gender stratified mortality rates. Years of Life with Disability (YLDs) were developed from a simple disease model indicating likely sequelae. DALYs were estimated from the sum of YLLs and YLDs. The study suggested that globally approximately 2·90 million DALYs are lost per annum (UIs 1·25–4·54 million) from the approximately annual 1·03 million cases reported previously. Males are predominantly affected with an estimated 2·33 million DALYs (UIs 0·98–3·69) or approximately 80% of the total burden. For comparison, this is over 70% of the global burden of cholera estimated by GBD 2010. Tropical regions of South and South-east Asia, Western Pacific, Central and South America, and Africa had the highest estimated leptospirosis disease burden.Conclusions/SignificanceLeptospirosis imparts a significant health burden worldwide, which approach or exceed those encountered for a number of other zoonotic and neglected tropical diseases. The study findings indicate that highest burden estimates occur in resource-poor tropical countries, which include regions of Africa where the burden of leptospirosis has been under-appreciated and possibly misallocated to other febrile illnesses such as malaria.

Global Morbidity and Mortality of Leptospirosis: A Systematic Review.

BackgroundLeptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status.Methodology/Principal FindingsWe conducted a systematic review of published morbidity and mortality studies and databases to extract information on disease incidence and case fatality ratios. Linear regression and Monte Carlo modelling were used to obtain age and gender-adjusted estimates of disease morbidity for countries and Global Burden of Disease (GBD) and WHO regions. We estimated mortality using models that incorporated age and gender-adjusted disease morbidity and case fatality ratios. The review identified 80 studies on disease incidence from 34 countries that met quality criteria. In certain regions, such as Africa, few quality assured studies were identified. The regression model, which incorporated country-specific variables of population structure, life expectancy at birth, distance from the equator, tropical island, and urbanization, accounted for a significant proportion (R2 = 0.60) of the variation in observed disease incidence. We estimate that there were annually 1.03 million cases (95% CI 434,000–1,750,000) and 58,900 deaths (95% CI 23,800–95,900) due to leptospirosis worldwide. A large proportion of cases (48%, 95% CI 40–61%) and deaths (42%, 95% CI 34–53%) were estimated to occur in adult males with age of 20–49 years. Highest estimates of disease morbidity and mortality were observed in GBD regions of South and Southeast Asia, Oceania, Caribbean, Andean, Central, and Tropical Latin America, and East Sub-Saharan Africa.Conclusions/SignificanceLeptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those for other causes of haemorrhagic fever. Highest morbidity and mortality were estimated to occur in resource-poor countries, which include regions where the burden of leptospirosis has been underappreciated.

Adaptive governance: Livelihood innovation for climate resilience in Uganda

Adaptive governance is the use of novel approaches within policy to support experimentation and learning. Social learning reflects the engagement of interdependent stakeholders within this learning. Much attention has focused on these concepts as a solution for resilience in governing institutions in an uncertain climate; resilience representing the ability of a system to absorb shock and to retain its function and form through reorganisation. However, there are still many questions to how these concepts enable resilience, particularly in vulnerable, developing contexts. A case study from Uganda presents how these concepts promote resilient livelihood outcomes among rural subsistence farmers within a decentralised governing framework. This approach has the potential to highlight the dynamics and characteristics of a governance system which may manage change. The paper draws from the enabling characteristics of adaptive governance, including lower scale dynamics of bonding and bridging ties and strong leadership. Central to these processes were learning platforms promoting knowledge transfer leading to improved self-efficacy, innovation and livelihood skills. However even though aspects of adaptive governance were identified as contributing to resilience in livelihoods, some barriers were identified. Reflexivity and multi-stakeholder collaboration were evident in governing institutions; however, limited self-organisation and vertical communication demonstrated few opportunities for shifts in governance, which was severely challenged by inequity, politicisation and elite capture. The paper concludes by outlining implications for climate adaptation policy through promoting the importance of mainstreaming adaptation alongside existing policy trajectories; highlighting the significance of collaborative spaces for stakeholders and the tackling of inequality and corruption.

Systematic review of current efforts to quantify the impacts of climate change on undernutrition

Malnutrition is a challenge to the health and productivity of populations and is viewed as one of the five largest adverse health impacts of climate change. Nonetheless, systematic evidence quantifying these impacts is currently limited. Our aim was to assess the scientific evidence base for the impact of climate change on childhood undernutrition (particularly stunting) in subsistence farmers in low- and middle-income countries. A systematic review was conducted to identify peer-reviewed and gray full-text documents in English with no limits for year of publication or study design. Fifteen manuscripts were reviewed. Few studies use primary data to investigate the proportion of stunting that can be attributed to climate/weather variability. Although scattered and limited, current evidence suggests a significant but variable link between weather variables, e.g., rainfall, extreme weather events (floods/droughts), seasonality, and temperature, and childhood stunting at the household level (12 of 15 studies, 80%). In addition, we note that agricultural, socioeconomic, and demographic factors at the household and individual levels also play substantial roles in mediating the nutritional impacts. Comparable interdisciplinary studies based on primary data at a household level are urgently required to guide effective adaptation, particularly for rural subsistence farmers. Systemization of data collection at the global level is indispensable and urgent. We need to assimilate data from long-term, high-quality agricultural, environmental, socioeconomic, health, and demographic surveillance systems and develop robust statistical methods to establish and validate causal links, quantify impacts, and make reliable predictions that can guide evidence-based health interventions in the future.

Retinopathy in type 1 diabetes mellitus: Major differences between rural and urban dwellers in northwest Ethiopia

AimTo audit levels of diabetes-related eye disease in Type 1 diabetes mellitus (T1DM) patients in northwest Ethiopia. In particular to establish whether, despite identical clinical goals, major differences between the physically demanding life-style of rural subsistence farmers and the sedentary life-style of urban dwellers would influence the prevalence of diabetes-related eye complications. MethodsA robust infrastructure for chronic disease management that comprehensively includes all rural dwellers was a pre-requisite for the investigation. A total of 544 T1DM were examined, representing 80% of all T1DM patients under regular review at both the urban and rural clinics and representative of patient age and gender (62.1% male, 37.9% female) of T1DM patients from this region; all were supervised by the same clinical team. Eye examinations were performed for visual acuity, cataract and retinal changes (retinal photography). HbA1c levels and the presence or absence of hypertension were recorded. Results/conclusionsUrban and rural groups had similar prevalences of severe visual impairment/blindness (7.0% urban, 5.2% rural) and cataract (7.3% urban, 7.1% rural). By contrast, urban dwellers had a significantly higher prevalence of retinopathy compared to rural patients, 16.1% and 5.0%, respectively (OR 2.9, p<0.02, after adjustment for duration, age, gender and hypertension). There was a 3-fold greater prevalence of hypertension in urban patients, whereas HbA1c levels were similar in the two groups. Since diabetic retinopathy is closely associated with microvascular disease and endothelial dysfunction, the possible influences of hypertension to increase and of sustained physical activity to reduce endothelial dysfunction are discussed.

Poor clinical outcomes for HIV infected children on antiretroviral therapy in rural Mozambique: need for program quality improvement and community engagement.

IntroductionResidents of Zambézia Province, Mozambique live from rural subsistence farming and fishing. The 2009 provincial HIV prevalence for adults 15–49 years was 12.6%, higher among women (15.3%) than men (8.9%). We reviewed clinical data to assess outcomes for HIV-infected children on combination antiretroviral therapy (cART) in a highly resource-limited setting.MethodsWe studied rates of 2-year mortality and loss to follow-up (LTFU) for children <15 years of age initiating cART between June 2006–July 2011 in 10 rural districts. National guidelines define LTFU as >60 days following last-scheduled medication pickup. Kaplan-Meier estimates to compute mortality assumed non-informative censoring. Cumulative LTFU incidence calculations treated death as a competing risk.ResultsOf 753 children, 29.0% (95% CI: 24.5, 33.2) were confirmed dead by 2 years and 39.0% (95% CI: 34.8, 42.9) were LTFU with unknown clinical outcomes. The cohort mortality rate was 8.4% (95% CI: 6.3, 10.4) after 90 days on cART and 19.2% (95% CI: 16.0, 22.3) after 365 days. Higher hemoglobin at cART initiation was associated with being alive and on cART at 2 years (alive: 9.3 g/dL vs. dead or LTFU: 8.3–8.4 g/dL, p<0.01). Cotrimoxazole use within 90 days of ART initiation was associated with improved 2-year outcomes Treatment was initiated late (WHO stage III/IV) among 48% of the children with WHO stage recorded in their records. Marked heterogeneity in outcomes by district was noted (p<0.001).ConclusionsWe found poor clinical and programmatic outcomes among children taking cART in rural Mozambique. Expanded testing, early infant diagnosis, counseling/support services, case finding, and outreach are insufficiently implemented. Our quality improvement efforts seek to better link pregnancy and HIV services, expand coverage and timeliness of infant diagnosis and treatment, and increase follow-up and adherence.

Multiple mycotoxin exposure determined by urinary biomarkers in rural subsistence farmers in the former Transkei, South Africa

Subsistence farmers are exposed to a range of mycotoxins. This study applied novel urinary multi-mycotoxin LC-MS/MS methods to determine multiple exposure biomarkers in the high oesophageal cancer region, Transkei, South Africa. Fifty-three female participants donated part of their maize-based evening meal and first void morning urine, which was analysed both with sample clean-up (single and multi-biomarker) and by a 'dilute-and-shoot' multi-biomarker method. Results were corrected for recovery with LOD for not detected. A single biomarker method detected fumonisin B1 (FB1) (87% incidence; mean±standard deviation 0.342±0.466 ng/mg creatinine) and deoxynivalenol (100%; mean 20.4±49.4 ng/mg creatinine) after hydrolysis with β-glucuronidase. The multi-biomarker 'dilute-and-shoot' method indicated deoxynivalenol-15-glucuronide was predominantly present. A multi-biomarker method with β-glucuronidase and immunoaffinity clean-up determined zearalenone (100%; 0.529±1.60 ng/mg creatinine), FB1 (96%; 1.52±2.17 ng/mg creatinine), α-zearalenol (92%; 0.614±1.91 ng/mg creatinine), deoxynivalenol (87%; 11.3±27.1 ng/mg creatinine), β-zearalenol (75%; 0.702±2.95 ng/mg creatinine) and ochratoxin A (98%; 0.041±0.086 ng/mg creatinine). These demonstrate the value of multi-biomarker methods in measuring exposures in populations exposed to multiple mycotoxins. This is the first finding of urinary deoxynivalenol, zearalenone, their conjugates, ochratoxin A and zearalenols in Transkei.

Mycological Analysis and Multimycotoxins in Maize from Rural Subsistence Farmers in the Former Transkei, South Africa

Maize harvested in the Centane region of the former Transkei, Eastern Cape Province, South Africa, by subsistence farmers has been shown over many seasons to be contaminated with fumonisin mycotoxins. However, there are limited data on the presence of other mycotoxins. Two multimycotoxin LC-MS/MS methods were applied to good and moldy maize samples, as separated by the farmers themselves from the 2011 harvest. One method involved extract cleanup on multitoxin immunoaffinity columns before LC-MS/MS analysis for aflatoxins, fumonisins, deoxynivalenol (DON), zearalenone (ZEN), and T-2 and HT-2 toxins. The other method was based on a "dilute-and-shoot" approach for the above mycotoxins and a wide range of other fungal secondary metabolites. Both methods showed high incidences of fumonisins B1 and B2 (FB1 and FB2) in good maize (100% for both by the first method, means were 2083 and 927 μg/kg for the two analogues; 93% for both by the second method, positive means of 2764 and 1050 μg/kg, respectively). All samples of moldy maize were contaminated (mean FB1 of 27.64 and 35.98 mg/kg, respectively; mean FB2 of 10.58 and 14.14 mg/kg, respectively). Comparison of the two methods for FB1 and FB2 over the entire range of samples gave R(2) values 0.9144 and 0.8859, respectively. Low levels of DON were found by both methods (positive means of 12 and 4.7 μg/kg in good maize, respectively, and of 14 and 5.8 μg/kg in moldy maize, respectively). ZEN was determined with positive means of 108 and 25 μg/kg in good maize, respectively, and of 111 and 135 μg/kg in moldy maize, respectively. No aflatoxins, OTA, or T-2 or HT-2 toxins were detected. A wide range of other Fusarium , Aspergillus , Alternaria , and Penicillium mycotoxins and secondary metabolites were determined.

Land, power and peace: Tenure formalization, agricultural reform, and livelihood insecurity in rural Rwanda

Land tenure and agricultural reforms are essential components of postwar development. The importance of land use and management systems to livelihood stability and economic growth is especially relevant in Rwanda, where eighty per cent of the population depends on subsistence agriculture in a rural system plagued by conflict over holdings and decreasing production. In response to increases in population pressure, soil erosion, and the desire for state-backed tenure security, in 2009 the Government of Rwanda implemented a series of large-scale land and agricultural reforms intended to transform the rural system away from subsistence production to a commercially oriented sector of professional farmers. Beyond the mandatory registration and formalization of informal tenure regimes, agricultural reforms require all farmers to consolidate their holdings and intensify agricultural production by planting only those seeds approved and provided by the Government. While introduced as ‘pro-poor’ policies aimed at increasing production and reducing conflict over holdings, this paper argues that the simultaneous and aggressive implementation of registration and crop intensification has significantly reduced the land tenure and food security of subsistence households. Although decreasing production and increasing conflict over holdings validate the need to reorganize land use and management systems throughout Rwanda, the rapid and forceful implementation of tenure and agricultural policies is unnecessarily undermining the livelihood stability of rural subsistence farmers, as well as the sustainability of government-led reforms.

Unintended effects of technology on climate change adaptation: an historical analysis of water conflicts below Andean Glaciers

Climate change adaptation measures can generate long-term unintended consequences, as this paper demonstrates through an empirical case study of water conflicts at Lake Parón in Peru’s Cordillera Blanca mountain range. This decade-long struggle culminated in 2008 when a coalition of local groups (stakeholders) from the Cruz de Mayo and Caraz communities in the Callejón de Huaylas seized control of the Lake Parón reservoir from a private multinational corporation, Duke Energy. This clash over Parón’s water in the Llullán and Santa River watersheds emerged much earlier than climatic-hydrologic models had predicted, and it occurred, this paper argues, largely because of previously successful climate adaptation measures. The drainage tunnel and floodgates originally installed at Parón in the 1980s to prevent a climate-related outburst flood led to unintended or perverse outcomes because these technological artifacts subsequently allowed a diversity of stakeholders—including rural subsistence farmers, urban residents, national park officials, tourism promoters, the state energy company Electroperú, and Duke Energy—to manage water differently depending on their priorities and the existing governance structures. Neoliberal reforms that altered state-society-environment relations in Peru played a key role in these changing stakeholder power dynamics that were reflected in the management of water infrastructure at Parón. Examining this water conflict that emerged from the unintended effects of climate adaptation demonstrates not only how technology and society are mutually constitutive, but also why the politics of technologies must be considered more carefully in the analysis of social-ecological systems, hydro-social cycles, and climate change adaptation.

Jerome Kabakyenga: prioritising rural health research in Uganda

Jerome Kabakyenga: prioritising rural health research in Uganda

Disparities in the prevalence of child undernutrition in Malawi – a crosssectional perspective

Background. Child undernutrition is a significant public health problem in Malawi.Objective. To determine the localisation of underweight, stunting and wasting in three main agricultural development divisions (ADDs) in Malawi.Design. Descriptive population-based cross-sectional study.Setting. Rural subsistence farming communities in Mzuzu, Lilongwe and Blantyre ADDs.Subjects. Children aged 6 - 59.9 months.Outcome measures. Anthropometric measurements were taken to determine the mean weight-for-age z-scores (WAZ), height-for-age z-scores (HAZ) and weight-for-height z-scores (WHZ). The prevalences of underweight, stunting and wasting were also determined.Results. The mean WAZ of children from Mzuzu ADD was significantly higher than that of children from Lilongwe ADD (-1.04 v. -1.43, p = 0.001) and Blantyre ADD (-1.04 v. -1.32, p = 0.03). Similarly, children from Mzuzu ADD had significantly higher WHZ than their counterparts from Lilongwe (0.22 v. -0.04, p = 0.021) and Blantyre ADDs (0.22 v. -0.09, p = 0.003). There were no significant between-group differences in mean HAZ ( F = 2.73, p = 0.07). The prevalence of underweight was significantly lower in Mzuzu ADD (16.9%) than Blantyre (25.3%) and Lilongwe (31.3%) ADDs ( 2 = 11.95, p = 0.003). Likewise, stunting was significantly lower in Mzuzu ADD (46.6%) than Blantyre (53.8%) and Lilongwe (61.3%) ADDs ( 2 = 8.71, p = 0.013). There were no differences in the prevalence of either stunting or underweight between Lilongwe and Blantyre ADDs.Conclusion. The differences in prevalence of malnutrition among preschool children in the three agro-ecological zones may result from differences in ecological, demographic, social, economic and other pressures that these populations are exposed to. As Malawi decentralises most of its public services, there is a need for nutrition and health managers in specific areas to formulate uniquely localised programmes to deal effectively with the gravity and presumed diverse causes of nutrition problems. Some blanket national interventions are less likely to help in addressing local problems.

Attitudes to Food Gardening from a Generational Perspective

The paper sheds light on why older gardeners want to grow their own food and younger people do not. Only since the coming of democracy in 1994 has the potential of food gardens attracted the attention of South African development practitioners and policy makers. Sustainable food garden projects build on a culture of gardening that has its roots in rural subsistence farming. While food gardens were commonly regarded as a tool for rural development, rapid migration to the cities has introduced urban cultivation as a strategy to provide food and income security for the urban poor. This case study reports in-depth discussions with twenty active older gardeners in a small town in the predominantly rural Eastern Cape Province of South Africa. The highly motivated gardeners cited reasons for growing food that went beyond basic needs for food security and livelihoods and included aesthetics, morality, and health and well-being. However, they attributed mainly negative attitudes to the younger generation that aspires to a modern lifestyle which excludes food gardening. Follow-up group interviews with young people confirmed these attributions. The discussion focuses on intergenerational transmission of values and its implications for sustainable community development.

Synergies between veterinarians and para-professionals in the public and private sectors: organisational and institutional relationships that facilitate the process of privatising animal health services in developing countries.

The delivery of veterinary services in most developing countries was, until recently, considered to be the responsibility of the public sector. However, over the past four decades, economic constraints and the imposition of structural adjustment policies (SAPs) have led to a gradual decline in public sector investment in real terms and thus a reduction in the quality and quantity of services available to livestock keepers. Many governments acknowledged that they were no longer able to provide services that were essentially of a 'private good' nature and introduced radical policy changes which sought to introduce the concepts of a market orientated approach towards agriculture and livestock production in particular. The role of government, in the future, would be to provide a reduced range of essential 'public good' services and to create a favourable environment in which the private sector could become established as a provider of 'private good' services and at the same time act as a partner in carrying out certain public functions under contract or 'sanitary mandates'. In almost all developing countries, however, these policy changes were not accompanied by appropriate development strategies. The reasons for this are complex. Firstly, SAPs may be considered to have been foisted upon governments by donors and are thus perceived by many policy-makers as the cause of financial problems, rather than a solution to them. Secondly, most animal health senior policy-makers in the public sector have been trained as veterinarians and lack the required management skills to plan change effectively. Furthermore, as regards clinical veterinary service delivery, especially in rural or more remote areas, the solution fostered by donor investment, which involves deregulation and the deployment of privately operating para-professionals, is often perceived as a threat to the veterinary profession and might result in limiting access to international markets for the trade of livestock and livestock products. An informal delivery system has gained a foothold in many developing countries in the absence of a well-planned strategy for the privatisation of animal health services. Most governments would now acknowledge that this presents a greater risk than the deployment of well-regulated and effectively supervised para-professionals. This paper explores some of the principal challenges facing policy-makers in their efforts to bridge the transition from full state provision of animal health services to the formation of a partnership with the private sector. Governments and donors need to take active steps to facilitate the process of privatisation of animal health services, especially those targeting the poorer rural subsistence and pastoralist farming systems. This would entail an initial investment in developing the necessary management skills at all levels in the delivery system. Thereafter, further investment would be required to allow the changes to be managed using tools such as the strategic planning cycle. Should sufficient resources be made available to allow the full participation of all stakeholders in the delivery of animal health services, appropriate institutions and effective organisational relationships addressing all the more important issues will have to be identified. The paper then proceeds to describe how different livestock production systems determine the level of demand for animal health services. If these services are to be provided on a financially sustainable basis, they must be tailored to meet actual rather than perceived demand. Identifying an appropriate model for animal health service delivery thus requires careful analysis of the production system to be targeted. Governments and donors can play a useful role in providing resources for this type of study as well as for appropriate market studies, business planning, training and access to soft loans. Finally, as regards regulation, as the law stands today, many activities currently practised by para-professionals are classified as 'acts of veterinary medicine or surgery' and may only legally be performed by qualified and registered veterinarians. The concept of 'principal' and 'subsidiary' legislation provides the necessary flexibility in the regulation of the delivery of animal health services to accommodate the rapid changes taking place in this environment today. Deregulation involves the delegation of responsibility for the performance of a defined range of veterinary interventions to para-professionals under the 'supervision' or 'direction' of a registered veterinarian. The author illustrates how the experiences of a number of projects in Tanzania were used to propose a definition of 'supervision' in law. The definition offers an opportunity to overcome the fear of compromising standards of delivery of animal health services through the deployment of para-professionals. In addition, such functioning provides employment opportunities for private veterinarians in rural areas where access to formal primary animal health services would otherwise be denied and may contribute to the process of quality assurance of national veterinary services in developing countries.

HEALTH SCREENING OF OLDER PEOPLE: A RURAL AFRICAN EXPERIENCE

To the Editor: The population of the world that is more than 65 years of age is rising by 2.5% per annum. Most of this growth is projected to occur in so-called developing countries.1 However, current health policies focus on infant and maternal health. There have been few published studies of older people in Africa, and their health problems are ill-defined.2 We screened the health of the older residents of three villages, Keneba, Kanton Kunda, and Manduar, The Gambia, West Africa. Keneba has been the setting for tropical health and nutrition research by the UK Medical Research Council (MRC) for more than 40 years.3 The villagers are Muslim rural subsistence farmers. They live in single-story houses within compounds based on family ties. There is no electricity or running water. All of the villages' citizens were identified by a census. A representative sample of 106 subjects (55 women and 51 men) older than 59 years of age was selected using random number tables. Subjects were interviewed at home by a field-worker using a structured questionnaire. Data were collected on socioeconomic status and personal health. Subjects were asked about their experience of 18 symptoms over the preceding 14 days.4 An assessment of daily living (ADL) score was derived from a standard questionnaire.4 Locally appropriate questions about physical independence — bathing, dressing, feeding, walking outdoors — were asked, as were questions relating to instrumental independence — fetching water, making a fire, and working in the fields. A nine-question abbreviated mental test score (MTS) was also devised.4 A clinical examination was performed in the subjects' own homes. Results are presented as summary statistics for men and women. Differences between the sexes were analyzed using X2, Fisher's exact and Mann Whitney tests where appropriate. The total population of the three villages was 3054, of whom 2298 were resident during the study. 7.2% of the population were aged greater than 59 (124 women and 98 men), comprising 9.7% of the residents. Data from the questionnaire are summarized in Table 1. More than 90% of subjects were married. Divorce was more common among men (P < .01); widowhood was more common among women (P < .001). Two-thirds of subjects were working. The most commonly reported symptoms were tiredness (84%), headache (71%), fever (66%), poor memory (63%), poor appetite (62%), and visual problems (59%). As noted by Heikkinen,4 women reported more symptoms than men (median of 8 versus 6 (P < .05)). Headache (P < .001) and poor appetite (P < .002) were more common in women. Urine problems (P < .001) and loss of power (P < .05) were more common in men. However, among Gambian men, this was probably misinterpreted as impotence. The distribution of ADL scores was skewed. The maximum of 21 was scored by 43%, and 74% scored higher than 18 of 21. Fifty-four percent of subjects had the maximum MTS score. The median for men was higher than for women (P < .005), which probably reflects a difference in formal education. There was no significant relationship between reported symptoms or clinical findings and MTS or ADL scores. The results of physical examination are shown in Table 2. The prevalence (95% confidence interval) of severe dental caries was 79% (71/87); 72% (68/76) had cataract; 59% (54/64) had corneal scarring; 29% (20/38) were hypertensive (BP greater than 159/94 mm Hg). Signs of osteoarthritis were present in 71% (63/80) and more common in women at the shoulders (P < .002) and the knees (P < .005). That the older people in this community remain independent is confirmed by high ADL scores. There is a high level of social and economic support from the extended family, similar to that found in Zimbabwe by Wilson.2 For more than 20 years, European doctors have provided free treatment at the MRC clinic, with proven benefits to children and women of child-bearing age.5 However, though 80% of our elderly subjects had been seen within the previous 6 months at the clinic, 42 (40%) had untreated conditions likely to benefit from treatment. The combination of examining the eyes and blood pressure and urine testing identify the majority of treatable conditions, and this level of screening does not require medical staff. It could be performed by community nurses working in rural clinics. Unfortunately, ADL, MTS, and symptom scores are not sensitive at the individual level in screening for those with medical needs. As the older African population grows, the need for treatment of noncommunicable diseases will increase. Appropriate training of medical and paramedical staff is required, and the costs of treatment must be anticipated.

Seroprevalence of Toxocara canis infection in tropical Venezuela

An enzyme-linked immunosorbent assay (ELISA) was used to determine the seroprevalence of Toxocara canis infection in different socio-economic groups of the tropical population of Venezuela. The lack of definitive independent diagnostic criteria for toxocariasis required the establishment of operational upper limits of normality for Toxocara ELISA values, based upon their log-normalized distribution in a presumptive “non-toxocariasis” sub-population. Only 1 · 8% of urban subjects of medium-high socio-economic level were considered to be clearly positive in Toxocara ELISA, compared to 20 · 0% of urban slum dwellers, 25 · 6% rural subsistence farmers and 34 · 9% Amazon Indians. As the test was performed using excretory-secretory antigen, and under conditions of competitive inhibition by soluble extracts of non-homologous parasites, co-infection by common intestinal helminths, protozoa or other organisms did not give rise to false positive results. However, strong cross-reactivity with Onchocerca volvulus may have influenced the prevalence figure obtained for the Amazon Indians. These results indicate that T. canis is yet another parasite that is widely distributed in economically underprivileged tropical populations.

Seasonal changes in activity, birth weight and lactational performance in rural Gambian women

The activity of 81 pregnant, lactating and non-pregnant, non-lactating women in the rural subsistence farming village of Keneba, The Gambia, was measured for 12 months using a combination of 24-hour activity recall and activity diaries. During the course of pregnancy women became gradually less active and in the month before giving birth were 25% less active than non-pregnant, non-lactating women and lactating women when women in the month after birth were excluded. There were striking seasonal changes in activity. During the dry season, from January to April, lactating women were active 55% of the 15-hour working day. At the start of the farming season in June and July this figure increased to 92%. Similar changes were observed in the pregnant women whose activity increased from a mean 50% in April to 83% in June. The period of intense activity coincided with a general shortage of food and increased incidence of disease. The intense activity of pregnant women in the farming season coupled with the low food intakes are most probably the main factors responsible for the striking fall in birth weights observed at this time of the year. Reduced lactational performance was apparent in relation to high activity when it necessitated the mother regularly spending much of the day away from her child. FAO/WHO-recommended energy intakes during pregnancy and lactation are inappropriate for this community.