Knowledge Management for Development Journal
Vol 11, No 2 (2015)
http://journal.km4dev.org/journal/index.php/km4dj/index

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Papers
Data sharing and use of ICTs in agriculture: working with small farmer groups in Colombia
Fanny Cecile Howland, Luis Armando Muñoz, Simone Staiger, James Cock, Sophie Alvarez
Abstract
This article describes the experience of analyzing groups of Colombian fruit farmers’ capacity to collect information and their interest and ability to take advantage of the opportunities offered by information and communication technologies (ICTs). Three cycles were designed to understand the attitudes, skills, and current practices of fruit growers and to define the necessary conditions for effective information sharing. The three cycles involved individual farmers, farmer groups meeting face to face, and virtual meeting with farmer groups. The results contribute to the design of strategies for farmer engagement in the knowledge-sharing online platform of the AES-CE (Acronym in Spanish for Sharing Experiences for Site Specific Agriculture) project, designed to assist growers in improved decision making through sharing of multiple types of information from multiple sources. We find that farmers understand the usefulness of record keeping, but data collection is often imposed externally, and records are not generally used to better manage production. Farmers, overall, were positive towards information sharing and understand the benefits of using information from a wider environment, shared through an ICT platform, but shortage of skills in using these technologies is a serious limiting factor to expansion to a broader scale. We discuss future strategies that can be used to the design and implement ICT platforms which farmers can use to share information and improve their management.

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Papers
Mainstreaming as a knowledge process: new lessons from mainstreaming gender, disability and sexual diversity
Saskia C. van Veen, Petra Staal, Rob van Poelje
Abstract
Mainstreaming is a strategy to enhance citizen participation of marginalised groups. In development practice, various mainstreaming issues have caught the attention of development organisations that shows their commitment to initiate inclusive development practice. However, influencing societal change by inclusive practices is difficult and requires a knowledge process to co-create socially robust knowledge. This paper brings together the knowledge and experiences from existing literature and from three cases on mainstreaming, namely from gender, disability inclusions and sexual diversity. We show how capacity development and knowledge co-creation at non-governmental organisations (NGOs) can be a lever for the inclusion of marginalised groups in society. The lessons learned may help development practitioners to reinforce and strengthen their emancipating work.

The Lancet
Jan 30, 2016 Volume 387 Number 10017 p403-504
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
Ebola’s legacy: UK deficits and their global lessons
The Lancet
Summary
A devastating report on the UK’s lessons from Ebola was published this week by the House of Commons Science and Technology Committee. Much of the blame for the world’s lacklustre response to Ebola has been laid at the door of WHO. But the committee also found surprising weaknesses in the UK’s application of science to global health emergencies. It makes important recommendations for corrective action. Although targeted towards the UK, the committee’s findings will also likely apply to other high-income countries involved in the response to Ebola.

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Articles
Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group
Leontine Alkema, Doris Chou, Daniel Hogan, Sanqian Zhang, Ann-Beth Moller, Alison Gemmill, Doris Ma Fat, Ties Boerma, Marleen Temmerman, Colin Mathers, Lale Say, United Nations Maternal Mortality Estimation Inter-Agency Group collaborators, technical advisory group
Summary
Background
Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100 000 livebirths globally by 2030.
Methods
We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources.
Results
We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100 000 livebirths (80% UI 359–427) in 1990, to 216 (207–249) in 2015, corresponding to a relative decline of 43·9% (34·0–48·7), with 303 000 (291 000–349 000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0–3·1) in the Caribbean to 5·0% (4·0–6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100 000 livebirths (11–14) for high-income regions to 546 (511–652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%.
Interpretation
Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths.
Funding
National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

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Series
Breastfeeding
Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect
Cesar G Victora, Rajiv Bahl, Aluísio J D Barros, Giovanny V A França, Susan Horton, Julia Krasevec, Simon Murch, Mari Jeeva Sankar, Neff Walker, Nigel C Rollins, The Lancet Breastfeeding Series Group

Breastfeeding
Why invest, and what it will take to improve breastfeeding practices?
Nigel C Rollins, Nita Bhandari, Nemat Hajeebhoy, Susan Horton, Chessa K Lutter, Jose C Martines, Ellen G Piwoz, Linda M Richter, Cesar G Victora, The Lancet Breastfeeding Series Group

New England Journal of Medicine
January 28, 2016 Vol. 374 No. 4
http://www.nejm.org/toc/nejm/medical-journal

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Editorial
Sharing Clinical Trial Data — A Proposal from the International Committee of Medical Journal Editors
Darren B. Taichman, M.D., Ph.D., Joyce Backus, M.S.L.S., Christopher Baethge, M.D., Howard Bauchner, M.D., Peter W. de Leeuw, M.D., Jeffrey M. Drazen, M.D., John Fletcher, M.B., B.Chir., M.P.H., Frank A. Frizelle, M.B., Ch.B., F.R.A.C.S., Trish Groves, M.B., B.S., M.R.C.Psych., Abraham Haileamlak, M.D., Astrid James, M.B., B.S., Christine Laine, M.D., M.P.H., Larry Peiperl, M.D., Anja Pinborg, M.D., Peush Sahni, M.B., B.S., M.S., Ph.D., and Sinan Wu, M.D.
N Engl J Med 2016; 374:384-386
January 28, 2016
DOI: 10.1056/NEJMe1515172

The International Committee of Medical Journal Editors (ICMJE) believes that there is an ethical obligation to responsibly share data generated by interventional clinical trials because participants have put themselves at risk. In a growing consensus, many funders around the world — foundations, government agencies, and industry — now mandate data sharing. Here we outline the ICMJE’s proposed requirements to help meet this obligation. We encourage feedback on the proposed requirements. Anyone can provide feedback at http://www.icmje.org by 18 April 2016.

The ICMJE defines a clinical trial as any research project that prospectively assigns people or a group of people to an intervention, with or without concurrent comparison or control groups, to study the cause-and-effect relationship between a health-related intervention and a health outcome. Further details may be found in the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals at http://www.icmje.org.

As a condition of consideration for publication of a clinical trial report in our member journals, the ICMJE proposes to require authors to share with others the deidentified individual-patient data (IPD) underlying the results presented in the article (including tables, figures, and appendices or supplementary material) no later than 6 months after publication. The data underlying the results are defined as the IPD required to reproduce the article’s findings, including necessary metadata. This requirement will go into effect for clinical trials that begin to enroll participants beginning 1 year after the ICMJE adopts its data-sharing requirements. (The ICMJE plans to adopt data-sharing requirements after considering feedback received to the proposals made here.)

Enabling responsible data sharing is a major endeavor that will affect the fabric of how clinical trials are planned and conducted and how their data are used. By changing the requirements of the manuscripts we will consider for publication in our journals, editors can help foster this endeavor. As editors, our direct influence is logically, and practically, limited to those data underpinning the results and analyses we publish in our journals.

The ICMJE also proposes to require that authors include a plan for data sharing as a component of clinical trial registration. This plan must include where the researchers will house the data and, if not in a public repository, the mechanism by which they will provide others access to the data, as well as other data-sharing plan elements outlined in the 2015 Institute of Medicine Report (e.g., whether data will be freely available to anyone upon request or only after application to and approval by a learned intermediary, whether a data use agreement will be required).1 ClinicalTrials.gov has added an element to its registration platform to collect data-sharing plans. We encourage other trial registries to similarly incorporate mechanisms for the registration of data-sharing plans. Trialists who want to publish in ICMJE member journals (or nonmember journals that choose to follow these recommendations) should choose a registry that includes a data-sharing plan element as a specified registry item or allows for its entry as a free-text statement in a miscellaneous registry field. As a condition of consideration for publication in our member journals, authors will be required to include a description of the data-sharing plan in the submitted manuscript. Authors may choose to share the deidentified IPD underlying the results presented in the article under less restrictive, but not more restrictive, conditions than were indicated in the registered data-sharing plan.

The ICMJE already requires the prospective registration of all clinical trials prior to enrollment of the first participant. This requirement aims, in part, to prevent selective publication and selective reporting of research outcomes, and to prevent unnecessary duplication of research effort. Including a commitment to a data-sharing plan is a logical addition to trial registration that will further each of these goals. Prospective trial registration currently includes documenting the planned primary and major secondary end points to be assessed, which enables identification of incomplete reporting as well as post hoc analyses. Declaring the plan for sharing data prior to their collection will further enhance transparency in the conduct and reporting of clinical trials by exposing when data availability following trial completion differs from prior commitments.

Sharing clinical trial data, including deidentified IPD, requires planning to ensure appropriate ethics committee or institutional review board approval and the informed consent of study participants. Accordingly, we will defer these requirements for 1 year to allow investigators, trial sponsors, and regulatory bodies time to plan for their implementation.

Just as the confidentiality of trial participants must be protected (through the deidentification of IPD), and the needs of those reasonably requesting data met (through the provision of useable data), the reasonable rights of investigators and trial sponsors must also be protected. The ICMJE proposes the following to safeguard these rights. First, ICMJE editors will not consider the deposition of data in a registry to constitute prior publication. Second, authors of secondary analyses using these shared data must attest that their use was in accordance with the terms (if any) agreed to upon their receipt. Third, they must reference the source of the data using a unique identifier of a clinical trial’s data set to provide appropriate credit to those who generated it and allow searching for the studies it has supported. Fourth, authors of secondary analyses must explain completely how theirs differ from previous analyses. In addition, those who generate and then share clinical trial data sets deserve substantial credit for their efforts. Those using data collected by others should seek collaboration with those who collected the data. However, because collaboration will not always be possible, practical, or desired, an alternative means of providing appropriate credit needs to be developed and recognized in the academic community. We welcome ideas about how to provide such credit.

Data sharing is a shared responsibility. Editors of individual journals can help foster data sharing by changing the requirements of the manuscripts they will consider for publication in their journals. Funders and sponsors of clinical trials are in a position to support and ensure adherence to IPD-sharing obligations. If journal editors become aware that IPD-sharing obligations are not being met, they may choose to request additional information; to publish an expression of concern; to notify the sponsors, funders, or institutions; or in certain cases, to retract the publication.

In the rare situation in which compliance with these requirements is impossible, editors may consider authors’ requests for exceptions. If an exception is made, the reason(s) must be explained in the publication.

Sharing data will increase confidence and trust in the conclusions drawn from clinical trials. It will enable the independent confirmation of results, an essential tenet of the scientific process. It will foster the development and testing of new hypotheses. Done well, sharing clinical trial data should also make progress more efficient by making the most of what may be learned from each trial and by avoiding unwarranted repetition. It will help to fulfill our moral obligation to study participants, and we believe it will benefit patients, investigators, sponsors, and society.

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 30 January 2016]

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Evacuation During Hurricane Sandy: Data from a Rapid Community Assessment
January 29, 2016 · Research Article
Introduction: In anticipation of Hurricane Sandy in 2012 New York City officials issued mandatory evacuation orders for evacuation Zone A. However, only a small proportion of residents complied. Failure to comply with evacuation warnings can result in severe consequences including injury and death. To better ascertain why individuals failed to heed pre¬-emptive evacuation warnings for Hurricane Sandy we assessed factors that may have affected evacuation among residents in neighborhoods severely affected by the storm.
Methods: Data from a mental health needs assessment survey conducted among adult residents in South Brooklyn, the Rockaways, and Staten Island from December 13-¬18, 2012 was assessed. Several disasters related questions were evaluated, and prevalence estimates of evacuation and evacuation timing by potential factors that may influence evacuation were estimated. Measures of association were assessed using chi-¬square and t-¬test.
Results: Our sample consisted of 420 residents of which, only 49% evacuated at any time for Sandy. Evacuation was higher among those who witnessed trauma to others related to the World Trade Center attacks (66% vs. 40%, p=0.024). Those who reported extensive household damage after Sandy, had a higher rate of evacuation than those with minimal damage (83% vs. 30%, p<0.001). Among those who evacuated, evacuation before the storm was lower among residents living on higher floors (56% vs. 22%, p=0.022).
Discussion: Given that warnings to evacuate were issued before Sandy made landfall, evacuation among residents in South Brooklyn, the Rockaways and Staten Island, while higher than the overall Zone A evacuation rate, was less than optimal. Continued research on evacuation behaviors is needed, particularly on how timing affects evacuation. A better understanding may help to reduce barriers, and improve evacuation compliance.

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Immediate Needs and Concerns among Pregnant Women During and after Typhoon Haiyan (Yolanda)
January 25, 2016 · Research Article
Introduction: Pregnant and postpartum women are especially vulnerable to natural disasters. These women suffer from increased risk of physical and mental issues including pregnant related problems. Typhoon Haiyan (Yolanda), which hit the Philippines affected a large number of people and caused devastating damages. During and after the typhoon, pregnant women were forced to live in particularly difficult circumstances. The purpose of this study was to determine concerns and problems regarding public health needs and coping mechanisms among pregnant women during and shortly after the typhoon.
Methods: This study employed a cross-sectional design utilizing focus group discussions (FGDs). Participants were 53 women (mean age: 26.6 years old; 42 had children) from four affected communities who were pregnant at the time of the typhoon. FGDs were conducted 4 months after the typhoon, from March 19 to 28, 2014, using semi-structured interviews. Data were analyzed using the qualitative content analysis.
Result: Three themes were identified regarding problems and concerns during and after the typhoon: 1) having no ideas what is going to happen during the evacuation, 2) lacking essentials to survive, and 3) being unsure of how to deal with health concerns. Two themes were identified as means of solving issues: 1) finding food for survival and 2) avoiding diseases to save my family. As the pregnant women already had several typhoon experiences without any major problems, they underestimated the catastrophic nature of this typhoon. During the typhoon, the women could not ensure their safety and did not have a strong sense of crisis management. They suffered from hunger, food shortage, and poor sanitation. Moreover, though the women had fear and anxiety regarding their pregnancy, they had no way to resolve these concerns. Pregnant women and their families also suffered from common health problems for which they would usually seek medical services. Under such conditions, the pregnant woman cooperated with others for survival and used their knowledge of disease prevention.
Discussion: Pregnant women experienced difficulties with evacuation, a lack of minimum survival needs, and attending to their own health issues. Pregnant women were also concerned about needs and health issues of their families, particular, when they had small children. Collecting accurate information regarding the disaster and conducting self-sustainable preparation prior to the disaster among pregnant women will help them to protect their pregnancy status, thereby improving their families’ chance of survival during and after disasters

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 30 January 2016)

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Historical Parallels, Ebola Virus Disease and Cholera: Understanding Community Distrust and Social Violence with Epidemics
January 26, 2016 · Discussion
In the three West African countries most affected by the recent Ebola virus disease (EVD) outbreak, resistance to public health measures contributed to the startling speed and persistence of this epidemic in the region. But how do we explain this resistance, and how have people in these communities understood their actions? By comparing these recent events to historical precedents during Cholera outbreaks in Europe in the 19th century we show that these events have not been new to history or unique to Africa. Community resistance must be analysed in context and go beyond simple single-variable determinants. Knowledge and respect of the cultures and beliefs of the afflicted is essential for dealing with threatening disease outbreaks and their potential social violence.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 30 January 2016)

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Editorial
Can Data Sharing Become the Path of Least Resistance?
The PLOS Medicine Editors
Published: January 26, 2016
DOI: 10.1371/journal.pmed.1001949
Initial text
The year 2016 could be the year when medical research converges on data sharing as a universal standard, if recent events, reflected in several PLOS Medicine articles this month, are a good indication. Attaining that standard, however, may take a little longer…

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Strategies to Prevent Cholera Introduction during International Personnel Deployments: A Computational Modeling Analysis Based on the 2010 Haiti Outbreak
Joseph A. Lewnard, Marina Antillón, Gregg Gonsalves, Alice M. Miller, Albert I. Ko, Virginia E. Pitzer
Research Article | published 26 Jan 2016 | PLOS Medicine
10.1371/journal.pmed.1001947
Abstract
Background
Introduction of Vibrio cholerae to Haiti during the deployment of United Nations (UN) peacekeepers in 2010 resulted in one of the largest cholera epidemics of the modern era. Following the outbreak, a UN-commissioned independent panel recommended three pre-deployment intervention strategies to minimize the risk of cholera introduction in future peacekeeping operations: screening for V. cholerae carriage, administering prophylactic antimicrobial chemotherapies, or immunizing with oral cholera vaccines. However, uncertainty regarding the effectiveness of these approaches has forestalled their implementation by the UN. We assessed how the interventions would have impacted the likelihood of the Haiti cholera epidemic.
Methods and Findings
We developed a stochastic model for cholera importation and transmission, fitted to reported cases during the first weeks of the 2010 outbreak in Haiti. Using this model, we estimated that diagnostic screening reduces the probability of cases occurring by 82% (95% credible interval: 75%, 85%); however, false-positive test outcomes may hamper this approach. Antimicrobial chemoprophylaxis at time of departure and oral cholera vaccination reduce the probability of cases by 50% (41%, 57%) and by up to 61% (58%, 63%), respectively. Chemoprophylaxis beginning 1 wk before departure confers a 91% (78%, 96%) reduction independently, and up to a 98% reduction (94%, 99%) if coupled with vaccination. These results are not sensitive to assumptions about the background cholera incidence rate in the endemic troop-sending country. Further research is needed to (1) validate the sensitivity and specificity of rapid test approaches for detecting asymptomatic carriage, (2) compare prophylactic efficacy across antimicrobial regimens, and (3) quantify the impact of oral cholera vaccine on transmission from asymptomatic carriers.
Conclusions
Screening, chemoprophylaxis, and vaccination are all effective strategies to prevent cholera introduction during large-scale personnel deployments such as that precipitating the 2010 Haiti outbreak. Antimicrobial chemoprophylaxis was estimated to provide the greatest protection at the lowest cost among the approaches recently evaluated by the UN.

PLoS One
http://www.plosone.org/
[Accessed 30 January 2016]

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Assessing Progress towards Public Health, Human Rights, and International Development Goals Using Frontier Analysis
Jeanne Luh, Ryan Cronk, Jamie Bartram
Research Article | published 26 Jan 2016 | PLOS ONE
10.1371/journal.pone.0147663
71/journal.pone.0145548
Abstract
Indicators to measure progress towards achieving public health, human rights, and international development targets, such as 100% access to improved drinking water or zero maternal mortality ratio, generally focus on status (i.e., level of attainment or coverage) or trends in status (i.e., rates of change). However, these indicators do not account for different levels of development that countries experience, thus making it difficult to compare progress between countries. We describe a recently developed new use of frontier analysis and apply this method to calculate country performance indices in three areas: maternal mortality ratio, poverty headcount ratio, and primary school completion rate. Frontier analysis is used to identify the maximum achievable rates of change, defined by the historically best-performing countries, as a function of coverage level. Performance indices are calculated by comparing a country’s rate of change against the maximum achievable rate at the same coverage level. A country’s performance can be positive or negative, corresponding to progression or regression, respectively. The calculated performance indices allow countries to be compared against each other regardless of whether they have only begun to make progress or whether they have almost achieved the target. This paper is the first to use frontier analysis to determine the maximum achievable rates as a function of coverage level and to calculate performance indices for public health, human rights, and international development indicators. The method can be applied to multiple fields and settings, for example health targets such as cessation in smoking or specific vaccine immunizations, and offers both a new approach to analyze existing data and a new data source for consideration when assessing progress achieved.

Science
29 January 2016 Vol 351, Issue 6272
http://www.sciencemag.org/current.dtl

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EDITORIAL
Global science engagement
Geraldine Richmond
Summary
In rural Laos, more than 50% of newborns will be stunted by age 2 due to chronic malnourishment. Worldwide, 161 million children under the age of 5, many of them in Africa and Asia, suffered irreversible stunting as of 2013. The developed world is not immune. As recently as 2010, stunting affected 8 to 9% of babies enrolled in U.S. federal food-subsidy programs. Next week in Washington, DC, the American Association for the Advancement of Science (AAAS is the publisher of Science) will convene its annual meeting (11 to 15 February), where world leaders will discuss food security and other major challenges that lie ahead in both the science and international policy arenas.

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Policy Forum
Conservation Ecology
How can higher-yield farming help to spare nature?
Ben Phalan1,*, Rhys E. Green1,2, Lynn V. Dicks1, Graziela Dotta3, Claire Feniuk1, Anthony Lamb1, Bernardo B. N. Strassburg4,5, David R. Williams1, Erasmus K. H. J. zu Ermgassen1,
Andrew Balmford1
Summary
Expansion of land area used for agriculture is a leading cause of biodiversity loss and greenhouse gas emissions, particularly in the tropics. One potential way to reduce these impacts is to increase food production per unit area (yield) on existing farmland, so as to minimize farmland area and to spare land for habitat conservation or restoration. There is now widespread evidence that such a strategy could benefit a large proportion of wild species, provided that spared land is conserved as natural habitat (1). However, the scope for yield growth to spare land by lowering food prices and, hence, incentives for clearance (“passive” land sparing) can be undermined if lower prices stimulate demand and if higher yields raise profits, encouraging agricultural expansion and increasing the opportunity cost of conservation (2, 3). We offer a first description of four categories of “active” land-sparing mechanisms that could overcome these rebound effects by linking yield increases with habitat protection or restoration (table S1). The effectiveness, limitations, and potential for unintended consequences of these mechanisms have yet to be systematically tested, but in each case, we describe real-world interventions that illustrate how intentional links between yield increases and land sparing might be developed.