Declines in habitat and wildlife in semiarid African savannas are widely reported and commonly attributed to agropastoral population growth, livestock impacts, and subsistence cultivation. However, extreme annual and shorter-term variability of rainfall, primary production, vegetation, and populations of grazers make directional trends and causal chains hard to establish in these ecosystems. Here two decades of changes in land cover and wildebeest in the Serengeti-Mara region of East Africa are analyzed in terms of potential drivers (rainfall, human and livestock population growth, socio-economic trends, land tenure, agricultural policies, and markets). The natural experiment research design controls for confounding variables, and our conceptual model and statistical approach integrate natural and social sciences data. The Kenyan part of the ecosystem shows rapid land-cover change and drastic decline for a wide range of wildlife species, but these changes are absent on the Tanzanian side. Temporal climate trends, human population density and growth rates, uptake of small-holder agriculture, and livestock population trends do not differ between the Kenyan and Tanzanian parts of the ecosystem and cannot account for observed changes. Differences in private versus state͞communal land tenure, agricultural policy, and market conditions suggest, and spatial correlations confirm, that the major changes in land cover and dominant grazer species numbers are driven primarily by private landowners responding to market opportunities for mechanized agriculture, less by agropastoral population growth, cattle numbers, or small-holder land use.T he extent to which conservation areas can successfully coexist with local users in developing countries is hotly debated, as are the conditions for environmental, social, and economic sustainability of any such coexistence (refs. 1-5 and 44). In East African savannas, habitat loss and wildlife decline are widely perceived and generally attributed to rapid population growth and the spread of subsistence cultivation. Directional trends and causal chains are hard to establish in semiarid lands, however, because rainfall, primary production, grazer populations, and vegetation formations show major unpredictable fluctuations between seasons and years. The 100,000-km 2 Serengeti-Mara Ecosystem (SME) serves as a natural experiment allowing analysis of the long-term outcomes of different policies for conservation on the one hand and community development on the other. The SME comprises contrasting land-use zones with different tenure arrangements, ranging from state-controlled ''fortress'' conservation areas to private and nonprivate tracts with multiple land uses, some with community-based conservation initiatives, superimposed on a rangeland where ecological, microeconomic, and ethnic continuities make it possible to control for many confounding variables. The SME is bisected by the Kenya͞Tanzania border, allowing comparative analysis of the implications of contrasting economic, political, and...

HighlightsMulti-method review of challenges introducing HPV vaccine in developing countries.HPV vaccine delivery methods can overcome inadequate health systems.Political will is essential for successful HPV vaccine roll-out.

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Unsafe abortion is a significant but preventable cause of global maternal mortality and morbidity. Zambia has among the most liberal abortion laws in sub-Saharan Africa, however this alone does not guarantee access to safe abortion, and 30% of maternal mortality is attributable to unsafe procedures. Too little is known about the pathways women take to reach abortion services in such resource-poor settings, or what informs care-seeking behaviours, barriers and delays. In-depth qualitative interviews were conducted in 2013 with 112 women who accessed abortion-related care in a Lusaka tertiary government hospital at some point in their pathway. The sample included women seeking safe abortion and also those receiving hospital care following unsafe abortion. We identified a typology of three care-seeking trajectories that ended in the use of hospital services: clinical abortion induced in hospital; clinical abortion initiated elsewhere, with post-abortion care in hospital; and non-clinical abortion initiated elsewhere, with post-abortion care in hospital. Framework analyses of 70 transcripts showed that trajectories to a termination of an unwanted pregnancy can be complex and iterative. Individuals may navigate private and public formal healthcare systems and consult unqualified providers, often trying multiple strategies. We found four major influences on which trajectory a woman followed, as well as the complexity and timing of her trajectory: i) the advice of trusted others ii) perceptions of risk iii) delays in care-seeking and receipt of services and iv) economic cost. Even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies. Levels of awareness about the legality of abortion and its provision remain low even in urban Zambia, especially among adolescents. Unofficial payments required by some providers can be a major barrier to safe care. Timely access to safe abortion services depends on chance rather than informed exercise of entitlement.

We present a new conceptual framework for studying trajectories to obtaining abortion-related care. It assembles for the first time all of the known factors influencing a trajectory and encourages readers to consider the ways these macro- and micro-level factors operate in multiple and sometimes conflicting ways. Based on presentation to and feedback from abortion experts (researchers, providers, funders, policymakers and advisors, advocates) (n = 325) between 03/06/2014 and 22/08/2015, and a systematic mapping of peer-reviewed literature (n = 424) published between 01/01/2011 and 30/10/2017, our framework synthesises the factors shaping abortion trajectories, grouped into three domains: abortion-specific experiences, individual contexts, and (inter)national and sub-national contexts. Our framework includes time-dependent processes involved in an individual trajectory, starting with timing of pregnancy awareness. This framework can be used to guide testable hypotheses about enabling and inhibiting influences on care-seeking behaviour and consideration about how abortion trajectories might be influenced by policy or practice. Research based on understanding of trajectories has the potential to improve women's experiences and outcomes of abortion-related care.

Objectives This study presents a scoping review of evidence relating to knowledge and experiences of puberty and menstruation among females aged 10–14 years in low- and middle-income countries. Methods Forty-four items from 12 countries were identified from a systematic scoping review and screening of 8083 items. Included studies were quality assessed. Results A majority (40/44) of studies used school-based samples, and fifteen studies reported on interventions. Girls had inadequate knowledge about menstruation; menarche as a trigger for girls learning about menstruation was common. Adolescents struggled with menstrual hygiene. Negative emotions were associated with menarche and menstrual management. A minority of studies dealt explicitly with puberty. Most girls obtained information about menstruation and/or puberty from their mothers, although mothers were not necessarily girls’ preferred source for learning about these topics. Conclusions Young adolescent girls are under-prepared for puberty and menstruation. Predominantly school-based studies mean we know little about young out-of-school adolescents. The evidence base lags behind the rise in interest from practitioners as well as the development (and evaluation) of puberty and/or menstruation interventions. Electronic supplementary material The online version of this article (10.1007/s00038-019-01209-0) contains supplementary material, which is available to authorized users.

ObjectivesFertility desires require new understanding in a context of expanding access to antiretroviral therapy for people living with HIV/AIDS in Sub-Saharan Africa. This paper studies the fertility desires and their rationales, of slum-dwelling Kenyan men and women living with HIV/AIDS who know their serostatus, but have different antiretroviral therapy treatment statuses. It addresses two research questions: How do people living with HIV/AIDS consider their future fertility? What factors contribute to an explanation of fertility desires among people living with HIV/AIDS.MethodsA mixed methods study (survey [n = 513] and in-depth interviews [n = 41]) with adults living with HIV/AIDS living in Nairobi slums was conducted in 2010. Regression analyses assess independent relationships between fertility desires and socio-demographic factors. Analyses of in-depth interviews are used to interpret the statistical analyses of fertility desires.ResultsOur analyses show that fertility desires are complex and ambivalent, reflecting tensions between familial and societal pressures to have children versus pressures for HIV (re-)infection prevention. More than a third (34%) of men and women living with HIV expressed future fertility desires; however, this is significantly lower than in the general population. Factors independently associated with desiring a child among people living with HIV/AIDS were age, sex, number of surviving children, social support and household wealth of the respondent.DiscussionIncreasing access to ART is changing the context of future childbearing for people living with HIV/AIDS. Prevailing values mean that, for many people living with HIV/AIDS, having children is seen as necessary for a “normal” and healthy adult life. However, the social rewards of childbearing conflict with moral imperatives of HIV prevention, presenting dilemmas about the “proper” reproductive behaviour of people living with HIV/AIDS. The health policy and service delivery implications of these findings are explored.

We analyse the use of the concept of household in sample surveys, with evidence drawn from a review of survey definitions, a series of in-depth interviews with data producers and users, and a systematic study of recent literature. We consider the place of the concept within the discipline of demography, and demonstrate how its definition and use interact with cultural values and core concepts integral to the discipline. Focusing on Tanzania as a case study, we examine the diversity of factors that influence the construction of household-level data from cross-sectional household surveys. Throughout the survey process, contrasting interpretations of the meaning of household and different motivations for using specific definitions of the term interact. This generates data and outputs with potential for undercounting, bias, and misrepresentations, with adverse effects on the quality of data used for monitoring development indicators. Some ways of improving data collection on households are proposed.