Directorate-General for International Cooperation and Development

Difluoromethylornithine (DFMO), a specific, irreversible inhibitor of polyamine biosynthesis shown to be curative in animal models inoculated with various Trypanosoma spp., was evaluated in the Southern Sudan in a preliminary open clinical field trial in patients infected with Trypanosoma brucei gambiense. 20 patients were studied including 18 with late-stage disease involving the central nervous system, 16 of whom were refractory to arsenical treatment. In late-stage disease monotherapy with oral DFMO doses of about 400 mg/kg/day for five to six weeks was associated with disappearance of parasites from cerebrospinal fluid (CSF), decreased CSF WBC counts and protein concentrations and reversal of clinical signs. Side effects associated with this dose regimen included diarrhoea, abdominal discomfort and anaemia, but were seldom sufficiently severe to prompt discontinuing therapy. In early-stage patients about 200 mg/kg/day for six weeks appears adequate to eliminate parasites and reverse clinical symptoms and is well tolerated. Three cases of late-stage sleeping sickness and two of early-stage disease followed up for approximately one and a half to two years after treatment indicated that DFMO monotherapy can be curative. Additional studies are needed to define optimal posology. Inhibition of polyamine biosynthesis is a promising new approach to therapy of trypanosomiasis.

Frameworks can clarify concepts and improve understanding of underlying mechanisms in the domain of health systems research and strengthening. Many existing frameworks have a limited capacity to analyze interactions and equilibriums within a health system overlooking values as an underlying steering mechanism. This paper introduces the health system dynamics framework and demonstrates its application as a tool for analysis and modelling. The added value of this framework is: 1) consideration of different levels of a health system and tracing how interventions or events at one level influence other elements and other levels; 2) emphasizes the importance of values; 3) a central axis linking governance, human resources, service delivery and population, and 4) taking into account the key elements of complexity in analysis and strategy development. We urge the analysis of individual health systems and meta-analysis, for a better understanding of their functioning and strengthening.

Abstract Aim Spatial and temporal biases in species‐occurrence data can compromise broad‐scale biogeographical research and conservation planning. Although spatial biases have been frequently scrutinized, temporal biases and the overall quality of species‐occurrence data have received far less attention. This study aims to answer three questions: (1) How reliable are species‐occurrence data for flowering plants in Africa? (2) Where and when did botanical sampling occur in the past 300 years? (3) How complete are plant inventories for Africa? Location Africa. Methods By filtering a publicly available dataset containing 3.5 million records of flowering plants, we obtained 934,676 herbarium specimens with complete information regarding species name, date and location of collection. Based on these specimens, we estimated inventory completeness for sampling units (SUs) of 25 km × 25 km. We then tested whether the spatial distribution of well‐sampled SUs was correlated with temporal parameters of botanical sampling. Finally, we determined whether inventory completeness in individual countries was related to old or recently collected specimens. Results Thirty‐one per cent of SUs contained at least one specimen, whereas only 2.4% of SUs contained a sufficient number of specimens to reliably estimate inventory completeness. We found that the location of poorly sampled areas remained almost unchanged for half a century. Moreover, there was pronounced temporal bias towards old specimens in South Africa, the country that holds half of the available data for the continent. There, high inventory completeness stems from specimens collected several decades ago. Main conclusions Despite the increasing availability of species occurrence data for Africa, broad‐scale biogeographical research is still compromised by the uncertain quality and spatial and temporal biases of such data. To avoid erroneous inferences, the quality and biases in species‐occurrence data should be critically evaluated and quantified prior to use. To this end, we propose a quantification method based on inventory completeness using easily accessible species‐occurrence data.

Soil is the most important natural resource for life on Earth after water. Given its fundamental role in sustaining the human population, both the availability and quality of soil must be managed sustainably and protected. To ensure sustainable management we need to understand the intrinsic functional capacity of different soils across Europe and how it changes over time. Soil monitoring is needed to support evidence-based policies to incentivise sustainable soil management. To this aim, we assessed which soil attributes can be used as potential indicators of five soil functions; (1) primary production, (2) water purification and regulation, (3) carbon sequestration and climate regulation, (4) soil biodiversity and habitat provisioning and (5) recycling of nutrients. We compared this list of attributes to existing national (regional) and EU-wide soil monitoring networks. The overall picture highlighted a clearly unbalanced dataset, in which predominantly chemical soil parameters were included, and soil biological and physical attributes were severely under represented. Methods applied across countries for indicators also varied. At a European scale, the LUCAS-soil survey was evaluated and again confirmed a lack of important soil biological parameters, such as C mineralisation rate, microbial biomass and earthworm community, and soil physical measures such as bulk density. In summary, no current national or European monitoring system exists which has the capacity to quantify the five soil functions and therefore evaluate multi-functional capacity of a soil and in many countries no data exists at all. This paper calls for the addition of soil biological and some physical parameters within the LUCAS-soil survey at European scale and for further development of national soil monitoring schemes.

Graute U. Local authorities acting globally for sustainable development, Regional Studies. Member states adopted 17 Sustainable Development Goals (SDGs) in 2015 and aimed to adopt a New Urban Agenda during Habitat III in 2016. Related intergovernmental processes aim for a substantial benefit to impact sustainable development at the local level. Despite the high relevance of both processes for local development, local authorities and other Major Groups of stakeholders will only act as observers. This paper analyses why the United Nations acknowledges the relevance of cities while not changing the observer status. The paper claims that the approach may have a negative impact on the realization of objectives. It is suggested to strengthen further the voice of local authorities to increase the problem-solving capacity of multilevel governance of the SDG implementation.

The efficacy and adverse effects of nifurtimox and DFMO in the treatment of sleeping sickness are reviewed. Both new substances constitute effective novel therapeutic agents for gambiense sleeping sickness, including melarsoprol-refractory disease. DFMO is not very active in rhodesiense sleeping sickness and experience with nifurtimox in this form of trypanosomiasis is too limited to draw valid conclusions. The toxicity of nifurtimox and DFMO is not negligible. Optimum dosage and duration of therapy, modes of administration and potential for large scale use are discussed. Some recent results obtained with the classical trypanocide melarsoprol are presented to facilitate comparison. The current availability of several effective late-stage drugs (melarsoprol, nifurtimox and DFMO), that show synergistic activity in experimental models, should allow the establishment of optimum combination treatment regimens.

We conducted a seroprevalence survey among 500 healthy adult donors at Zanzibar National Blood Transfusion Services. Dengue virus IgG seroprevalence was 50.6% and independently associated with age and urban residence. These data will aid in building a surveillance, preparedness, and response plan for dengue virus infections in the Zanzibar Archipelago.

A rapidly increasing uptake of Information and Communication Technologies across the globe, coupled with the uneven levels of readiness of societies to address security challenges associated with this process, has pushed the international community to deal with potential ‘safe havens’ and ‘weakest links’ around the world. Capacity building emerged in international cybersecurity debates as a possible remedy to this problem, also advocated by developing countries and emerging economies, thereby opening the cybersecurity policy community to development actors as well. The purpose of this article is twofold. By presenting conceptual underpinnings of cybersecurity capacity building (CCB), it aims to improve a general understanding of dilemmas and politics associated with its actors, drivers and processes. At the same time, by taking a critical view on the current pace and practice of capacity building in this field, it attempts to inject a more strategic reflection about the process. The article concludes by proposing some ideas for moving forward in establishing a strong CCB community. It highlights the need for institutional investment in ‘cyber knowledge brokers’ at all levels of government and across policies as well as the emergence of a principle-based approach to capacity building in cyberspace with a sustainable outlook towards closing the ‘cyber capacity gap’.

Sub-Saharan Africa has recently undergone, or still do in many countries, a period of transport infrastructure expansion. Current policies are centred on the development of international links, which require large capital-intensive projects and are sometimes economically dubious. This paper reviews the past policies and transport functions since colonial times by placing them in their economic and political context. We find that present strategies have similarities to the ones prevailing in previous periods, where expansion phases dominated by transport-led economic growth theories were followed by a stagnation of Africa’s infrastructure development. In view of the challenges in translating findings from empirical research into right policies, we identify the potential of more balanced and sustainable strategic investments, notably by reinforcing the existing secondary transport networks converging into urban centres.

Abstract Monitoring is essential for conservation of sites, but capacity to undertake it in the field is often limited. Data collected by remote sensing has been identified as a partial solution to this problem, and is becoming a feasible option, since increasing quantities of satellite data in particular are becoming available to conservationists. When suitably classified, satellite imagery can be used to delineate land cover types such as forest, and to identify any changes over time. However, the conservation community lacks (a) a simple tool appropriate to the needs for monitoring change in all types of land cover (e.g. not just forest), and (b) an easily accessible information system which allows for simple land cover change analysis and data sharing to reduce duplication of effort. To meet these needs, we developed a web‐based information system which allows users to assess land cover dynamics in and around protected areas (or other sites of conservation importance) from multi‐temporal medium resolution satellite imagery. The system is based around an open access toolbox that pre‐processes and classifies Landsat‐type imagery, and then allows users to interactively verify the classification. These data are then open for others to utilize through the online information system. We first explain imagery processing and data accessibility features, and then demonstrate the toolbox and the value of user verification using a case study on Nakuru National Park, Kenya. Monitoring and detection of disturbances can support implementation of effective protection, assist the work of park managers and conservation scientists, and thus contribute to conservation planning, priority assessment and potentially to meeting monitoring needs for Aichi target 11.

Abstract One of the main drivers of food insecurity is pests, which are estimated to cause around 40% of crop losses worldwide. We examine the food security effects of plant clinics, a novel agricultural extension model that aims to reduce crop losses due to pests through the provision of demand‐driven plant health diagnostic and advisory services to smallholder farmers. The study is based on survey data from maize‐growing households in Rwanda, where 66 plant clinics have been established. Using switching regression and matching techniques as well as various food security metrics, including the food insecurity experience scale, we find evidence that participation in plant clinics is significantly associated with a reduction in household food insecurity. For instance, among the participating households, plant clinics contribute to a decrease in the period of food shortage by one month and a reduction in the severity of food insecurity by 22 percentage points. We also show that these effects are more pronounced for female‐headed households. Overall, our findings suggest that plant clinics can play an important role in achieving the Sustainable Development Goal 2 of zero hunger.

Abstract: The article concerns the inter‐institutional relations and describes the dynamics between the main EC institutions in the decision‐making process regarding the adoption of the new external action instruments. In 2004, the Commission had proposed a set of new external action instruments as base for the delivery of the Community's external assistance. By that time, the existing instruments amounted to more than 30 different legal instruments, which implicated a loss of efficiency in the management of the EC's external assistance. After 2 years of inter‐institutional negotiations between the European Parliament, Council and the Commission, the new set of instruments was finally adopted. Compared to the initial Commission proposals, the design of the new instruments got significantly reshaped in the course of the inter‐institutional decision‐making procedure. In particular, the European Parliament had gained an unprecedented degree of power over the legislative framework for external spending. Compared to the former range of geographic and thematic regulations, the new external action instruments fundamentally reform the delivery of external financial assistance with their streamlined and simplified structure. They consist of three horizontal instruments to respond to particular needs or crisis situation: an Instrument for Stability, an Instrument for Nuclear Safety Co‐operation) and a European Instrument for Democracy and Human Rights. With regard to geographic coverage, four instruments will implement particular policies: the Instrument for Pre‐accession Assistance, the European Neighbourhood and Partnership Instrument and the Instrument for Development Co‐operation and an Instrument for Co‐operation with Industrialised Countries.

Due to the rapid growth of fossil energy consumption, countries worldwide have paid considerable attention to reducing carbon emissions. Moreover, with economic globalization and trade liberalization, exploring the relationship between foreign trade and carbon emission reduction has become increasingly critical. Exploring this relationship can aid in establishing suitable recommendations for global carbon emission reductions. This paper uses a spatial econometric model and a dynamic panel threshold model to empirically test the spatial effect, nonlinear effect, and heterogeneous effect of foreign trade on global carbon emissions. All the above models are based on the construction of the economic weight matrix of different countries. The results reveal that 1) carbon emissions in various countries exhibit with significant spatial spillover in the overall spatial context; 2) foreign trade has a significant role in promoting carbon emissions in local and similar economic areas, but it has an apparent dual-threshold effect on economic development; and 3) there are significant differences in the impact of foreign trade on carbon emissions in different regions and different periods. Therefore, in the process of global economic integration, based on their development stages and comparative advantages, countries can focus on overall planning and coordination to promote the optimal allocation of resources and reduce carbon emissions.

A cross-sectional survey was conducted to examine factors influencing intention of condom use among 378 clients of female sex workers (FSWs) visiting commercial sex sites in St-Marc and Gonaives, Haiti. Mean age of the study participants was 24 years. A structured questionnaire was used to collect data on socio-demographic characteristics, behaviors, and the theory of planned behavior (TPB) constructs. Seventy-four percentage of clients reported having used condoms with a FSW the last time they had had sexual intercourse. The majority (81.7%) firmly intended to use condoms during the next sexual encounter with a FSW. Multivariate logistic models revealed that subjective norms (odds ratio (OR)=1.75; 95% confidence interval (CI): 1.06-2.88), perceived behavioral control (OR=1.34; 95% CI: 1.09-1.63) and attitudes (OR=1.23; 95% CI: 1.04-1.44) were predictors of intention to use condoms, with norms being more important. Clients having used condoms the last time they had a sexual intercourse with a FSW, were more likely to have the intention to use them in the future (OR=3.17; 95% CI: 1.65-6.10), indicating an adopted behavior. Lastly, having had a previous sexually transmitted infection was associated with intention, suggesting that a negative experience can influence a future behavior. In conclusion, intention to use condoms among the clients of Haitian FSWs was well predicted by TPB constructs. Our findings provide evidence for designing interventions targeted at reducing risky sex behaviors in this population.

Every year, Bangladesh experiences major floods that inundate about one-third of the country. Therefore, flood control projects that comprise earthen dikes and irrigation/drainage systems are built along the major rivers to protect the people living in low-lying areas, stabilize the river banks and improve agricultural productivity. However, the adverse effects of these projects are regularly emphasized, such as environmental degradation and reduction of fishing supplies. The Demographic Surveillance System of the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B) was used to assess the effect of a flood control programme on the mortality of 0-4-year-old children residing in the Matlab study area. Adjusted mortality rates were used in comparing four adjacent child populations residing either inside or outside a flood-control embankment and according to the type of health services provided in this area. Between the periods 1983-86 and 1989-92, the crude child mortality in the total study area decreased by 37%, from 185.9 per 1000 live births to 117.9 per 1000 live births. Following the construction of the embankment, death rates outside were up to 29% higher in 1-4-year-old children and 9% higher for 0-4-year age group compared to the flood-protected area (P < 0.001). Simultaneously, in the same study area, health interventions contributed to a 40% reduction in mortality among children less than 5 years of age in all causes of deaths (P < 0.001). Migration patterns and the effect of distances to the hospital are discussed.

The impact of food taboos-often because of religion-is understudied. In Ethiopia, religious fasting by Orthodox Christians is assumed to be an important impediment for the sustainable development of a competitive dairy sector and desired higher milk consumption, especially by children. However, evidence is limited. Relying on unique data, we shed light on three major issues. First, we observe that the average annual number of fasting days that Orthodox adults are effectively adhering to is 140, less than commonly cited averages. Using this as an estimate for extrapolation, fasting is estimated to reduce annual dairy consumption by approximately 12 percent nationally. Second, farms adapt to declining milk demand during fasting by increased processing of milk into storable products-fasting contributes to larger price swings for these products. We further note continued sales of milk by non-remote farmers and reduced production-by adjusting lactation times for dairy animals-for remote farmers. Third, fasting is mostly associated with increased milk consumption by the children of dairy farmers, seemingly because of excess milk availability during fasting periods. Our results suggest that fasting habits are not a major explanation for the observed poor performance of Ethiopia's dairy sector nor low milk consumption by children. To reduce the impact of fasting on the dairy sector in Ethiopia further, investment is called for in improved milk processing, storage, and infrastructure facilities.

This paper aims to review the guidelines on the importance given to high-density lipoprotein cholesterol (HDL-C) as a risk factor or as threshold and target level in the treatment of dyslipidemia. We developed a strategy with cholesterol-related key words to search for guidelines in the major databases. The Appraisal of Guidelines Research Evaluation (AGREE) instrument was used for the evaluation and inclusion of the guidelines. In total nine guidelines were selected. Almost all selected guidelines consider low HDL-C as a marker of an increased risk for coronary heart disease. However, only few guidelines use the level of HDL-C as a threshold or target level for the treatment of dyslipidemia. The guidelines provide only little information on the management of patients with treatment-induced low HDL-C. Instead of using total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) we consider the use of the ratios of TC to HDL-C or LDL-C to HDL-C as a threshold as well as a target for treatment.

La multiplicité et la perpétuation des conflits en Afrique découragent souvent les tentatives de compréhension du processus conflictuel et de son éventuelle spécificité africaine. Une approche pluridisciplinaire révèle cependant une série de facteurs qui permettent de mieux apprécier les manifestations endémiques de la conflictualité africaine. L’étude de ces différents facteurs ne suffit pas à apporter une explication de la nature de ce processus. C’est en proposant de lui appliquer trois théories économiques, avec ce que cette approche comporte d’arbitraire par la construction de systèmes rationnels, que l’on s’éloigne des manifestations pour appréhender la nature même de la conflictualité. L’introduction, dans l’étude systémique, de nouveaux paramètres d’incertitude favorise encore l’analyse. Dès lors, les modèles produisent leurs effets, les conséquences peuvent être étudiées, et certaines orientations proposées, qui permettent une meilleure prévention des conflits.

Road conditions in Sub-Saharan Africa are typically poor, and only a subset of the newly constructed or rehabilitated roads reach their design life. Truck overloading generally causes this rapid deterioration. In Africa, there are few success stories on the imposition of axle-load limits. This study examines the existing regulations on the Douala-N’Djamena international road, which is the main transport corridor in Central Africa and the backbone for internal transport in Cameroon. It benefits from the detailed existing weighing data recorded since 1998 in the corridor’s 10 weighing stations. This vast amount of traffic data, together with available information on road structure and deterioration over time, has been used to conduct an accurate calculation of load equivalency factors. The HDM 4 model has been applied to three scenarios between 2000 and 2015: (1) no axle-load control, (2) the real situation and (3) no overloading tolerance. Results show that axle-load regulations have been reasonably well applied in Cameroon and have contributed to maintaining the corridor in fair condition. In spite of the fact that significant traffic increases are presently counterbalancing the damage avoided by axle-load limits, benefits provided by axle-load control have been substantial: in the period of 2000–2015, every € invested or spent on axle-load control has generated more than €20 of savings in road user costs and in road maintenance and rehabilitation expenditure, which represents, in absolute terms, more than €500 million.

In this article, we present the process leading to the pilot test of a new primary health care services model in Goma (DRC). This new model proposes the introduction of a multidisciplinary team in the urban health centres to offer comprehensive and better-quality patient care. Our contribution highlights the importance of an in-depth analysis of the urban context for the implementation of a new model of care, and the usefulness of a constructive dialogue and active participation of all relevant stakeholders. Our analysis informs launches new research perspectives on the improvement of health care services access in the urban areas.