Somalia Water and Land Information

Long and temporally consistent rainfall time series are essential in climate analyses and applications. Rainfall data from station observations are inadequate over many parts of the world due to sparse or non‐existent observation networks, or limited reporting of gauge observations. As a result, satellite rainfall estimates have been used as an alternative or as a supplement to station observations. However, many satellite‐based rainfall products with long time series suffer from coarse spatial and temporal resolutions and inhomogeneities caused by variations in satellite inputs. There are some satellite rainfall products with reasonably consistent time series, but they are often limited to specific geographic areas. The Climate Hazards Group Infrared Precipitation (CHIRP) and CHIRP combined with station observations (CHIRPS) are recently produced satellite‐based rainfall products with relatively high spatial and temporal resolutions and quasi‐global coverage. In this study, CHIRP and CHIRPS were evaluated over East Africa at daily, dekadal (10‐day) and monthly time‐scales. The evaluation was done by comparing the satellite products with rain‐gauge data from about 1,200 stations. The CHIRP and CHIRPS products were also compared with two similar operational satellite rainfall products: the African Rainfall Climatology version 2 (ARC2) and the Tropical Applications of Meteorology using Satellite data (TAMSAT). The results show that both CHIRP and CHIRPS products are significantly better than ARC2 with higher skill and low or no bias. These products were also found to be slightly better than the latest version of the TAMSAT product at dekadal and monthly time‐scales, while TAMSAT performed better at the daily time‐scale. The performance of the different satellite products exhibits high spatial variability with weak performances over coastal and mountainous regions.

BACKGROUND: Keeping girls in school offers them protection against early marriage, teen pregnancy, and sexual harms, and enhances social and economic equity. Studies report menstruation exacerbates school-drop out and poor attendance, although evidence is sparse. This study qualitatively examines the menstrual experiences of young adolescent schoolgirls. METHODS AND FINDINGS: The study was conducted in Siaya County in rural western Kenya. A sample of 120 girls aged 14-16 years took part in 11 focus group discussions, which were analysed thematically. The data gathered were supplemented by information from six FGDs with parents and community members. Emergent themes were: lack of preparation for menarche; maturation and sexual vulnerability; menstruation as an illness; secrecy, fear and shame of leaking; coping with inadequate alternatives; paying for pads with sex; and problems with menstrual hygiene. Girls were unprepared and demonstrated poor reproductive knowledge, but devised practical methods to cope with menstrual difficulties, often alone. Parental and school support of menstrual needs is limited, and information sparse or inaccurate. Girls' physical changes prompt boys and adults to target and brand girls as ripe for sexual activity including coercion and marriage. Girls admitted 'others' rather than themselves were absent from school during menstruation, due to physical symptoms or inadequate sanitary protection. They described difficulties engaging in class, due to fear of smelling and leakage, and subsequent teasing. Sanitary pads were valued but resource and time constraints result in prolonged use causing chafing. Improvised alternatives, including rags and grass, were prone to leak, caused soreness, and were perceived as harmful. Girls reported 'other girls' but not themselves participated in transactional sex to buy pads, and received pads from boyfriends. CONCLUSIONS: In the absence of parental and school support, girls cope, sometimes alone, with menarche in practical and sometimes hazardous ways. Emotional and physical support mechanisms need to be included within a package of measures to enable adolescent girls to reach their potential.

ABSTRACT Recent special reports on climate extremes have shown evidences of changes in the patterns of climate extremes at global, regional and local scales. Understanding the characteristics of climate extremes at regional and local levels is critical not only for the development of preparedness and early warning systems, but is also fundamental in the development of any adaptation strategies. There is still very limited knowledge regarding the past, present and future patterns of climate extremes in the Greater Horn of Africa ( GHA ). This study, which was supported by the World Bank Global Facility for Disaster Reduction and Recovery ( WB‐GFDRR ) and implemented by the World Meteorological Organization, was organized in terms of three workshops with three main objectives; (1) analysis of daily rainfall and temperature extremes for ten countries in the GHA region using observed in situ data running from 1971 to 2006, (2) assessing whether the United Kingdom Met‐office and Hadley centre Providing REgional Climates for Impact Studies ( UK‐PRECIS ) modelling system can provide realistic representation of the past and present climate extremes as observed by available in situ data, and (3) studying the future regional climate extremes under different scenarios to further assess the expected changes in climate extremes. This paper, therefore, uses the outputs of these workshops and also includes post‐workshop analyses to assess the changes of climate extremes within the GHA . The results showed a significant decrease in total precipitation in wet days greater than 1 mm and increasing warm extremes, particularly at night, while cold extremes are decreasing. Considering a combination of geophysical models and satellite gravimetry observations from the Gravity Recovery and Climate Experiment ( GRACE ) mission in the frame of GRACE daily Kalman‐smoothing models, for the years 2002 to 2010, we explored a decline in total water storage variations over the GHA .

OBJECTIVES: Conduct a feasibility study on the effect of menstrual hygiene on schoolgirls' school and health (reproductive/sexual) outcomes. DESIGN: 3-arm single-site open cluster randomised controlled pilot study. SETTING: 30 primary schools in rural western Kenya, within a Health and Demographic Surveillance System. PARTICIPANTS: Primary schoolgirls 14-16 years, experienced 3 menses, no precluding disability, and resident in the study area. INTERVENTIONS: 1 insertable menstrual cup, or monthly sanitary pads, against 'usual practice' control. All participants received puberty education preintervention, and hand wash soap during intervention. Schools received hand wash soap. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary: school attrition (drop-out, absence); secondary: sexually transmitted infection (STI) (Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoea), reproductive tract infection (RTI) (bacterial vaginosis, Candida albicans); safety: toxic shock syndrome, vaginal Staphylococcus aureus. RESULTS: Of 751 girls enrolled 644 were followed-up for a median of 10.9 months. Cups or pads did not reduce school dropout risk (control=8.0%, cups=11.2%, pads=10.2%). Self-reported absence was rarely reported and not assessable. Prevalence of STIs in the end-of-study survey among controls was 7.7% versus 4.2% in the cups arm (adjusted prevalence ratio (aPR) 0.48, 0.24 to 0.96, p=0.039), 4.5% with pads (aPR=0.62; 0.37 to 1.03, p=0.063), and 4.3% with cups and pads pooled (aPR=0.54, 0.34 to 0.87, p=0.012). RTI prevalence was 21.5%, 28.5% and 26.9% among cup, pad and control arms, 71% of which were bacterial vaginosis, with a prevalence of 14.6%, 19.8% and 20.5%, per arm, respectively. Bacterial vaginosis was less prevalent in the cups (12.9%) compared with pads (20.3%, aPR=0.65, 0.44 to 0.97, p=0.034) and control (19.2%, aPR=0.67, 0.43 to 1.04, p=0.075) arm girls enrolled for 9 months or longer. No adverse events were identified. CONCLUSIONS: Provision of menstrual cups and sanitary pads for ∼1 school-year was associated with a lower STI risk, and cups with a lower bacterial vaginosis risk, but there was no association with school dropout. A large-scale trial on menstrual cups is warranted. TRIAL REGISTRATION: ISRCTN17486946; Results.

BACKGROUND: Between 2005 and 2050, the human population is forecast to grow by 2.7 billion, with the vast majority of this growth occurring in low income countries. This growth is likely to have significant social, economic and environmental impacts, and make the achievement of international development goals more difficult. The measurement, monitoring and potential mitigation of these impacts require high resolution, contemporary data on human population distributions. In low income countries, however, where the changes will be concentrated, the least information on the distribution of population exists. In this paper we investigate whether satellite imagery in combination with land cover information and census data can be used to create inexpensive, high resolution and easily-updatable settlement and population distribution maps over large areas. METHODOLOGY/PRINCIPAL FINDINGS: We examine various approaches for the production of maps of the East African region (Kenya, Uganda, Burundi, Rwanda and Tanzania) and where fine resolution census data exists, test the accuracies of map production approaches and existing population distribution products. The results show that combining high resolution census, settlement and land cover information is important in producing accurate population distribution maps. CONCLUSIONS: We find that this semi-automated population distribution mapping at unprecedented spatial resolution produces more accurate results than existing products and can be undertaken for as little as $0.01 per km(2). The resulting population maps are a product of the Malaria Atlas Project (MAP: http://www.map.ox.ac.uk) and are freely available.

Conflicts related to livestock raiding are not new phenomena in many pastoral societies in the Horn of Africa. Traditionally, various pastoral communities use raiding as a cultural practice for restocking of herds, especially after periods of drought or outbreaks of diseases. However, in recent years, livestock raiding has become more frequent, violent and destructive. This paper elucidates, first, the motives behind the current livestock raiding, and second, it analyses how conflict affects livelihoods of pastoral communities. Between 2008 and 2011, focus group discussions and interviews were carried out with 376 members of the Turkana and Pokot communities and key informants. The study findings suggest that hunger and drought impacting on availability and access of resources are critical raiding motives among the Turkana, while increasing wealth and payment of dowry are the most important motives for the Pokot community. Violent conflict poses a significant threat to pastoral livelihoods which are already under pressure from recurrent drought, diseases and political marginalisation. The direct impact of violent raiding is felt in terms of loss of human life and property, reduction in livestock numbers, limited access to water and pasture resources and forced migration. Indirectly, violent conflicts create a strong and omnipresent perception of insecurity which results in ineffective resource utilisation, reduced mobility, food insecurity and closure of markets and schools. These factors combined undermine adaptation strategies and pastoralism altogether. Hence, a framework of conflict mitigation is needed which addresses the specific raiding motives of each group.

The largest remaining biophysical water challenge is whether there is enough fresh water to sustain global food production and service natural ecosytems. Focussing on the drought-prone savannahs and small-scale farming, this paper argues that the crucial resource is vapour flow, not "blue" water, and there are grounds for optimism if resource management can be improved.

BACKGROUND: There have been resurgent efforts in Africa to estimate the public health impact of malaria control interventions such as insecticide treated nets (ITNs) following substantial investments in scaling-up coverage in the last five years. Little is known, however, on the effectiveness of ITN in areas of Africa that support low transmission. This hinders the accurate estimation of impact of ITN use on disease burden and its cost-effectiveness in low transmission settings. METHODS AND PRINCIPAL FINDINGS: Using a stratified two-stage cluster sample design, four cross-sectional studies were undertaken between March-June 2007 across three livelihood groups in an area of low intensity malaria transmission in South Central Somalia. Information on bed net use; age; and sex of all participants were recorded. A finger prick blood sample was taken from participants to examine for parasitaemia. Mantel-Haenzel methods were used to measure the effect of net use on parasitaemia adjusting for livelihood; age; and sex. A total of 10,587 individuals of all ages were seen of which 10,359 provided full information. Overall net use and parasite prevalence were 12.4% and 15.7% respectively. Age-specific protective effectiveness (PE) of bed net ranged from 39% among <5 years to 72% among 5-14 years old. Overall PE of bed nets was 54% (95% confidence interval 44%-63%) after adjusting for livelihood; sex; and age. CONCLUSIONS AND SIGNIFICANCE: Bed nets confer high protection against parasite infection in South Central Somalia. In such areas where baseline transmission is low, however, the absolute reductions in parasitaemia due to wide-scale net use will be relatively small raising questions on the cost-effectiveness of covering millions of people living in such settings in Africa with nets. Further understanding of the progress of disease upon infection against the cost of averting its consequent burden in low transmission areas of Africa is therefore required.

BACKGROUND: Major gaps remain - especially in low- and middle-income countries - in the realization of comprehensive, community-based mental health care. One potentially important yet overlooked opportunity for accelerating mental health reform lies within emergency situations, such as armed conflicts or natural disasters. Despite their adverse impacts on affected populations' mental health and well being, emergencies also draw attention and resources to these issues and provide openings for mental health service development. CASE DESCRIPTION: Cases were considered if they represented a low- or middle-income country or territory affected by an emergency, were initiated between 2000 and 2010, succeeded in making changes to the mental health system, and were able to be documented by an expert involved directly with the case. Based on these criteria, 10 case examples from diverse emergency-affected settings were included: Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, occupied Palestinian territory, Somalia, Sri Lanka, and Timor-Leste. DISCUSSION AND EVALUATION: These cases demonstrate generally that emergency contexts can be tapped to make substantial and sustainable improvements in mental health systems. From these experiences, 10 common lessons learnt were identified on how to make this happen. These lessons include the importance of adopting a longer-term perspective for mental health reform from the outset, and focusing on system-wide reform that addresses both new-onset and pre-existing mental disorders. CONCLUSIONS: Global progress in mental health care would happen more quickly if, in every crisis, strategic efforts were made to convert short-term interest in mental health problems into momentum for mental health reform.

Abstract The increasing block tariff (IBT) is among the most widely used tariffs by water utilities, particularly in developing countries. This is due in part to the perception that the IBT can effectively target subsidies to low‐income households. Combining data on households' socioeconomic status and metered water use, this paper examines the distributional incidence of subsidies delivered through the IBT in Nairobi, Kenya. Contrary to conventional wisdom, we find that high‐income residential and nonresidential customers receive a disproportionate share of subsidies and that subsidy targeting is poor even among households with a private metered connection. We also find that stated expenditure on water, a commonly used means of estimating water use, is a poor proxy for metered use and that previous studies on subsidy incidence underestimate the magnitude of the subsidy delivered through water tariffs. These findings have implications for both the design and evaluation of water tariffs in developing countries.

BACKGROUND: Somalia has been ravaged by more than two decades of armed conflict causing immense damage to the country's infrastructure and mass displacement and suffering among its people. An influx of humanitarian actors has sought to provide basic services, including health services for women and children, throughout the conflict. This study aimed to better understand the humanitarian health response for women and children in Somalia since 2000. METHODS: The study utilized a mixed-methods design. We collated intervention coverage data from publically available large-scale household surveys and we conducted 32 interviews with representatives from government, UN agencies, NGOs, and health facility staff. Qualitative data were analyzed using latent content analysis. RESULTS: The available quantitative data on intervention coverage in Somalia are extremely limited, making it difficult to discern patterns or trends over time or by region. Underlying sociocultural and other contextual factors most strongly affecting the humanitarian health response for women and children included clan dynamics and female disempowerment. The most salient operational influences included the assessment of population needs, donors' priorities, and insufficient and inflexible funding. Key barriers to service delivery included chronic commodity and human resource shortages, poor infrastructure, and limited access to highly vulnerable populations, all against the backdrop of ongoing insecurity. Various strategies to mitigate these barriers were discussed. In-country coordination of humanitarian health actors and their activities has improved over time, with federal and state-level ministries of health playing increasingly active roles. CONCLUSIONS: Emerging recommendations include further exploration of government partnerships with private-sector service providers to make services available throughout Somalia free of charge, with further research on innovative uses of technology to help reaches remote and inaccessible areas. To mitigate chronic skilled health worker shortages, more operational research is needed on the expanded use of community health workers. Persistent gaps in service provision across the continuum must be addressed, including for adolescents, for example. The is also a clear need for longer term development focus to enable the provision of health and nutrition services for women and children beyond those included in recurrent emergency response.

BACKGROUND: There is broad agreement that antenatal care (ANC) interventions, skilled attendance at birth and management of complications arising after delivery are key strategies that can tackle the high burden of maternal mortality in sub-Saharan Africa. In Kenya, utilisation rate of these services has remained low despite a government policy on free maternal care. The present study sought to understand what factors are leading to the low healthcare seeking during pregnancy, child birth and postnatal period in Siaya County in Kenya. METHODS: Six Focus Group Discussions were conducted with 50 women attending ANC in 6 public primary healthcare facilities. Participants were drawn from a sample of 200 women who were eligible participants in a Conditional Cash Transfer project aimed at increasing utilization of healthcare services during pregnancy and postnatal period. Interviews were conducted at the health facilities, recorded, transcribed and analysed using thematic analysis. RESULTS: Multiple factors beyond the commonly reported distance to health facility and lack of transportation and finances explained the low utilization of services. Emergent themes included a lack of understanding of the role of ANC beyond the treatment of regular ailments. Women with no complicated pregnancies therefore missed or went in late for the visits. A missed health visit contributed to future missed visits, not just for ANC but also for facility delivery and postnatal care. The underlying cause of this relationship was a fear of reprimand from the health staff and denial of care. The negative attitude of the health workers explained the pervasive fear expressed by the participants, as well as being on its own a reason for not making the visits. The effect was not just on the woman with the negative experience, but spiraled and affected the decision of other women and their social networks. CONCLUSIONS: The complexity of the barriers to healthcare visits implies that narrow focused solutions are unlikely to succeed. Instead, there should broad-based solutions that focus on the entire continuum of maternal care with a special focus on ANC. There is an urgent need to shift the negative attitude of healthcare workers towards their clients.

OBJECTIVE: To assess life-saving and disability-preventing surgical services (including emergency, trauma, obstetrics, anaesthesia) of health facilities in Somalia and to assist in the planning of strategies for strengthening surgical care systems. DESIGN: Cross-sectional survey. SETTING: Health facilities in all 3 administrative zones of Somalia; northwest Somalia (NWS), known as Somaliland; northeast Somalia (NES), known as Puntland; and south/central Somalia (SCS). PARTICIPANTS: 14 health facilities. MEASURES: The WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was employed to capture a health facility's capacity to deliver surgical and anaesthesia services by investigating four categories of data: infrastructure, human resources, interventions available and equipment. RESULTS: The 14 facilities surveyed in Somalia represent 10 of the 18 districts throughout the country. The facilities serve an average patient population of 331 250 people, and 12 of the 14 identify as hospitals. While major surgical procedures were provided at many facilities (caesarean section, laparotomy, appendicectomy, etc), only 22% had fully available oxygen access, 50% fully available electricity and less than 30% had any management guidelines for emergency and surgical care. Furthermore, only 36% were able to provide general anaesthesia inhalation due to lack of skills, supplies and equipment. Basic supplies for airway management and the prevention of infection transmission were severely lacking in most facilities. CONCLUSIONS: According to the results of the WHO Tool for Situational Analysis to Assess Emergency and Essential Surgical Care survey, there exist significant gaps in the capacity of emergency and essential surgical services in Somalia including inadequacies in essential equipment, service provision and infrastructure. The information provided by the WHO tool can serve as a basis for evidence-based decisions on country-level policy regarding the allocation of resources and provision of emergency and essential surgical services.

Abstract The European flood alert system (EFAS) achieves early flood warnings for large to medium‐size river basins with lead times of 10 days. This is based on probabilistic weather forecasts, the exceedance of alert thresholds and persistence. The methodologies have been tested for different events and time scales in mid‐latitude basins in Europe. In this article, the transferability of the EFAS‐methodologies to equatorial African basins is assessed with the analysis of the Juba–Shabelle river basin as an example using a variety of different meteorological data sources. In this context, ERA‐40 and CHARM have been used for the calculation of climatologies; re‐forecasts of the current operational European Centre for Medium‐Range Weather Forecasts model provided hindcasts of historic flood events. The results show that flood events have been detected successfully in more than 85% of all cases, with a high accuracy in terms of timing and magnitude. Copyright © 2010 Royal Meteorological Society

Restoration interventions to combat land degradation are carried out in arid and semi-arid areas to improve vegetation cover and land productivity. Evaluating the success of an intervention over time is challenging due to various constraints (e.g. difficult-to-access areas, lack of long-term records) and the lack of standardised and affordable methodologies. We propose a semi-automatic methodology that uses remote sensing data to provide a rapid, standardised and objective assessment of the biophysical impact, in terms of vegetation cover, of restoration interventions. The Normalised Difference Vegetation Index (NDVI) is used as a proxy for vegetation cover. Recognising that changes in vegetation cover are naturally due to environmental factors such as seasonality and inter-annual climate variability, conclusions about the success of the intervention cannot be drawn by focussing on the intervention area only. We therefore use a comparative method that analyses the temporal variations (before and after the intervention) of the NDVI of the intervention area with respect to multiple control sites that are automatically and randomly selected from a set of candidates that are similar to the intervention area. Similarity is defined in terms of class composition as derived from an ISODATA classification of the imagery before the intervention. The method provides an estimate of the magnitude and significance of the difference in greenness change between the intervention area and control areas. As a case study, the methodology is applied to 15 restoration interventions carried out in Senegal. The impact of the interventions is analysed using 250-m MODIS and 30-m Landsat data. Results show that a significant improvement in vegetation cover was detectable only in one third of the analysed interventions, which is consistent with independent qualitative assessments based on field observations and visual analysis of high resolution imagery. Rural development agencies may potentially use the proposed method for a first screening of restoration interventions.

ABSTRACT Land degradation is a gradual, negative environmental process that is accelerated by human activities. Its gradual nature allows degradation to proceed unnoticed, thus reducing the likelihood of appropriate and timely control action. Presently, there are few practical frameworks to help countries design national strategies and policies for its control. The study presented here developed a framework for the national assessment of land degradation. This framework is envisaged to support governments in formulating policies on land degradation. It uses time‐series remote sensing data to identify the rate and extent of land degradation, local experts to identify prevalent degradation types and drivers of the degradation and field observations to validate the overall assessment. Its simplicity, use of freely downloadable input data and self‐triangulation of the assessment methods make it suitable for rapid assessment of land degradation on a national scale. It was tested in Somalia, where it exhibited accuracy greater than 60 per cent when assessing land degradation. This framework is relevant for designing national strategies and policies that address land degradation and provides an opportunity for accurate identification of areas to target with comprehensive local assessment. Testing of the framework in Somalia showed that about one‐third of the country was degraded because of loss of vegetation cover, topsoil loss and to the decline of soil moisture. Overgrazing, excessive tree cutting and poor agronomic practices in agricultural areas were identified as the primary drivers of the country's land degradation. These drivers are encouraged by the prevailing communal land tenure practices, poor governance and civil war. Copyright © 2011 John Wiley &amp; Sons, Ltd.

Abstract Aim To develop a new modelling approach for spatially autocorrelated non‐normal data, and apply it to a case study of the role that fire–vegetation–soil feedbacks play in maintaining boundaries between fire‐sensitive and fire‐promoted plant communities. Location A mulga ( Acacia aneura ) shrubland–spinifex ( Triodia spp.) grassland mosaic, central Australia. Methods Autoregressive error models were extended to non‐normal data by incorporating neighbourhood values of the response and predictor variables into generalized nonlinear models. These models were used to examine the environmental correlates of three response variables: mulga cover; fire frequency in areas free of mulga; and the presence of mulga banding. Mulga cover and mulga banding were assessed visually by overlaying 4477 × 1 km 2 grid cells on both Landsat 7 ETM+ and very high resolution imagery. Fire frequency was estimated from an existing fire history for central Australia, based on remotely sensed fire scars. Results The autoregressive error models explained 27%, 47% and 57% of the null deviance of mulga cover, fire frequency and mulga banding, respectively, with 12%, 15% and 24% of the null deviance being explained by environmental variables alone. These models accounted for virtually all residual spatial autocorrelation. While there was a clear negative relationship between mulga cover and fire frequency, there was little evidence that mulga was being restricted to parts of the landscape with inherently low fire frequencies. Mulga was most abundant at very low slope angles and on red earths, both of which are likely to reflect high site productivity, while fire frequency was not clearly affected by slope angle and was also relatively high on red earths. Main conclusions The modelling approach we have developed provides a much needed way of analysing spatially autocorrelated non‐normal data and can be easily incorporated into an information‐theoretic modelling framework. Using this approach, we provide evidence that mulga and spinifex have a highly antagonistic relationship. In more productive parts of the landscape, mulga suppresses spinifex and fire, while in less productive parts of the landscape, fire and spinifex suppress mulga, leading to the remarkable abruptness of mulga–spinifex boundaries that are maintained via fire–vegetation–soil feedbacks.

Many females lack access to water, privacy and basic sanitation-felt acutely when menstruating. Water, sanitation and hygiene (WASH) conditions in schools, such as access to latrines, water, and soap, are essential for the comfort, equity, and dignity of menstruating girls. Our study was nested within a cluster randomized controlled pilot feasibility study where nurses provided menstrual items to schoolgirls. We observed the WASH conditions of 30 schools from June 2012⁻October 2013 to see if there were any changes in conditions, to compare differences between study arms and to examine agreement between observed and teacher-reported conditions. Data came from study staff observed, and school head teacher reported, WASH conditions. We developed scores for the condition of school facilities to report any changes in conditions and compare outcomes across study arms. Results demonstrated that soap availability for students increased significantly between baseline and follow-up while there was a significant decrease in the number of "acceptable" latrines. During the study follow-up period, individual WASH indicators supporting menstruating girls, such as locks on latrine doors or water availability in latrines did not significantly improve. Advances in WASH conditions for all students, and menstrual hygiene facilities for schoolgirls, needs further support, a defined budget, and regular monitoring of WASH facilities to maintain standards.

Fascioliasis is a globally distributed, parasitic zoonosis, caused by Fasciola hepatica and F. gigantica. A comprehensive overview of the epidemiology of human fascioliasis in Africa is missing up to now. Therefore, our objective was to conduct a systematic review aiming to summarize recent knowledge on the distribution, prevalence, and risk factors of human fascioliasis in Africa. A key word search was performed in PubMed, Web of Science and Africa Wide, to gather relevant literature, published between the 1st of January 2000 and 31st of December 2020. A total of 472 records were initially retrieved, with 40 full text articles retained for the qualitative synthesis. Human fascioliasis was reported in 12 African countries, namely Algeria, Angola, Cape Verde, Egypt, Ethiopia, Ghana, Morocco, Nigeria, Senegal, South-Africa, Tanzania and Tunisia. The majority of the studies was conducted in Egypt. A total of 28 records were population surveys. Coproscopy was the most commonly used tool for fascioliasis diagnosis in these surveys. Gender (being female), consumption of raw vegetables/seeds, age, owning livestock, and use of unsafe drinking water sources, were identified as risk factors in 7 studies. Furthermore, 43 case reports were retrieved, described in 12 studies. Eosinophilia was present in 39 of these cases, while 11 had positive coproscopy results. Eight cases described having eaten raw wild vegetables. Overall, the low number and quality of records retrieved indicates that human fascioliasis remains a truly neglected disease in Africa, and more epidemiological studies are urgently needed to both establish the actual distribution as well as risk factors on the continent.

OBJECTIVE: To measure prevalence of HIV and syphilis and describe characteristics of sex work among female sex workers (FSWs) in Hargeisa, Somaliland, Somalia. METHODS: A cross-sectional survey recruited 237 FSWs using respondent-driven sampling (RDS). A face-to-face, structured interview using handheld-assisted personal interviewing (HAPI) on personal digital assistants (PDAs) was completed and blood collected for serological testing. RESULTS: FSWs 15-19 years old accounted for 6.9% of the population; 20-24 year-old constituted an additional 18.0%. The majority (86.6%) never attended school. International (59.0%) and interzonal (10.7%) migration was common. Most (95.7%) reported no other source of income; 13.8% had five or more clients in the last 7 days. A minority (38.4%) had heard of STIs, even fewer (6.9%) held no misconceptions about HIV. Only 24% of FSW reported using a condom at last transactional sex, and 4% reported ever been tested for HIV. HIV prevalence was 5.2% and syphilis prevalence was 3.1%. CONCLUSION: Sex work in Hargeisa, Somaliland, Somalia, is characterized by high numbers of sexual acts and extremely low knowledge of HIV. This study illustrates the need for targeted HIV prevention interventions focusing on HIV testing, risk-reduction awareness raising, and review of condom availability and distribution mechanisms among FSWs and males engaging with FSWs.