SummaryBackgroundPost-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.MethodsIn this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.FindingsBetween March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus ...

In Uganda, potato is primarily grown as a cash crop and smallholder farmers sell majority of their produce immediately after harvest. Only a few farmers store ware potato for later sale using various traditional storage methods. Main reasons are farmers’ immediate need for cash, the low volumes of potato harvested, fear of loss during storage due to pests and diseases, and a lack of adequate storage facilities. In order to exploit the seasonal market price fluctuations and increase the economic return of potato farming, improved individual and collective ambient ware potato storage units were introduced. Unlike traditional storage facilities that maintain the marketability of stored potato up to five weeks only, improved ambient stores can maintain their marketability up to nine weeks. This article uses cost-benefit analysis methods to compare the economic performance of improved ambient stores with traditional storage facilities. Results indicate that few of the traditional and improved collective storage units generated profit, an aspect that was attributed to management challenges. The improved individual stores performed overall well, generating higher profit margins than improved collective stores. Improved individual stores had an average payback period of three to four years that could even be reduced to less than one year if used at full capacity. Due to their characteristics, improved individual ambient ware potato stores thus seem to be particularly suitable to substantially increase the income of potato farming households.

Potato is a key food and cash crop in Uganda, mainly produced by smallholder farmers in the eastern and southwestern highlands of the country. This study assessed different factors influencing the choice of storage technologies by Ugandan potato farmers. Data were collected from 240 potato farmers using structured questionnaires in key potato producing districts in eastern and southwestern Uganda. Data were analysed using descriptive statistics and the multinomial probit regression model. Results indicate that potato farmers have limited access to credit and adequate extension services. Furthermore, most of the potato production is sold immediately after harvest. Although significant quantities of potato are stored as food for the household and seed for the next season, very few farmers store ware potato for later sale at a higher price. The farmer households generally use light storage technologies designed for seed storage, while dark stores required for proper ware potato storage are rarely used. Results for factors influencing the choice of storage technologies were mixed, and the extent and direction of influence varied with technology. The predominant factors that positively influenced the choice of dark storage technologies or a combination of different storage technologies included monthly income from sources other than potato sales, access to storage management advice and access to credit. This study recommends enhancing farmers’ access to adequate extension services and credit to promote good ware potato storage conditions.