BackgroundParasitological confirmation is now recommended for all cases of suspected malaria. The roll-out of rapid diagnostic tests (RDTs) is hoped to enable this goal in low resource settings through point of care testing. However, simply making RDTs available has not led to high uptake of the tests or adherence to results by clinicians, with malaria continuing to be overdiagnosed in many settings. We undertook to design an evidence-based intervention package that would be sufficient to support the introduction of RDTs at dispensaries in Tanzania, to be evaluated through the Targeting Artemisinin Combination Therapy (TACT) cluster randomised controlled trial.MethodsWe describe five steps in our intervention design: formative research, review of existing evidence and theory, a workshop to define the intervention approach and content and results of formative research, engagement with behaviour change theory and literature, detailed design of intervention materials and piloting and pretesting of intervention materials. This involved fieldwork with a total of 19 health workers and 212 community members in northeast Tanzania.ResultsThe formative research suggested that RDTs were a potential source of conflict in the health worker-patient interaction, but that health workers used various techniques to resolve this, including provision of antimalarial drugs for RDT-negative patients. Our reviews showed that evidence was mixed regarding the effectiveness of different methods and theories to support change in prescribing practice. Our design process is presented, drawing from this collective evidence. We describe the final TACT intervention package (including interactive small group workshops, feedback text messages, motivational text messages and patient information leaflets and posters) in terms of its programme theory and implementation theory.ConclusionsOur study suggests that evidence-based design of complex interventions is possible. The use of formative research to understand malaria overdiagnosis in context was central to the design of the intervention as well as empirical research to test materials and methods prior to implementation. The TACT interventions may be appropriate for other settings where clinicians face similar challenges with malaria diagnostics.Trial registrationNCT01292707.

A study to assess the direct and indirect drivers and agents of deforestation and forest degradation was carried out in Masito forests in Kigoma Region. Several methodologies were deployed including review of key literature, focused group discussions, household level interviews and review of "smart phones" database of disturbance incidences in the forests. Results revealed that despite forest protection measures taken by the government and other actors for purposes of REDD+ carbon trade, deforestation and forest degradation are problems that are being experienced in the study area. Evidence of deforestation and degradation were provided through change detection data, forest disturbance incidences and community perception on the drivers of deforestation and degradation. The main drivers of deforestation and degradation were characterized to fall into direct drivers and indirect drivers. The demand for land and forests resources was responsible for a number of direct drivers. Indirect drivers were perceived to entail underlying causes of deforestation and degradation forming a complex interaction of socioeconomic, political, cultural and technological variables that cause deforestation and degradation. Characterization of the main agents of deforestation and degradation revealed that human actors in various capacities and functions have served as agents. The assessment of leakage risks revealed that the risk of shifting destructive activities to non-REDD+ project villages was mitigated. In order to address the drivers and sustaining the REDD+, the study recommends the need to address forest tenure; provision of alternatives to the agents of deforestation and degradation, extension support to non-REDD+ villages for capacity building in forest protection; and ensuring that the process of REDD+ piloting is finalized to the level that communities finally sell carbon to get tangible benefits.

This study was designed to assess the consumer’s preference between imported and locally made furniture in Dar es Salaam and Arusha in Tanzania. Primary and secondary data for the study were collected from furniture consumers in the study area. A total of 134 consumers were surveyed. Questionnaires and documentary reviews were used for data collection. Descriptive statistics and binary logistic regression were used in the analysis of data. The result of the study revealed significant differences on the levels of consumers’ preference for furniture products. Imported furniture seems to be far preferred by consumers. It was observed that the major differences in consumers’ preference for furniture were due to quality and design. This study provides valuable implications for local small-scale manufacturers if they want to compete in the globalized market. It is, therefore, recommended that local furniture manufacturers should acquire adequate skills, technology and innovation in order to produce competitive products.

An assessment of staffing and training needs for effective delivery of extension services in mainstreaming sustainable land management (SLM) practices in Kilimanjaro Region was conducted in June/July 2013. Data collection methods included discussions with key informants at the regional and district levels, consultations with village level stakeholders and potential collaborators, review of human resources data both at regional, district and ward levels and collection of individual staff bio-data including capacity deficiencies. The staffing situation at the regional and district levels was considered to be adequate for effective mainstreaming of SLM interventions in the region. Staffing at ward and village levels was very poor and largely inadequate for sustainable execution of extension services. It is optimistically estimated that on average the staffing at ward level needs to be increased by at least 50%. In some districts the deficiency of extension staff at ward level was as high as 80%. Training needs exist at all levels from the region down to community level. At the regional and district levels both long and short term training programs were required. At the community level required training is more practical and purely focused in mainstreaming SLM interventions at individual households and community lands. Potential collaborators with local government were identified in four main categories namely, NGOs/CBOs, private sector, government departments and faith-based organizations. The study recommends a capacity building program on specific knowledge gaps identified at regional, district, ward and village levels. The study further recommends that immediate measures need to be taken by the district authorities to address the staffing problem at ward level including recruitment of volunteers and developing collaboration framework with identified potential partners.