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Programming of Transcription (POMC) and HPA Responses to Stress

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DOI: 10.31038/CST.2024911

Abstract

The signaling pathways link neuronal activity to transcription, revealing both the transcription factors that mediate this process and the neuronal activity-regulated genes. The neuronal activity regulates a complex program of gene expression involved in many aspects of neuronal development. Human genetic studies have revealed that the disruption of the activity-regulated gene expression program in humans gives rise to neurological disorders. Social states can affect health in further life. It is a completely revolutionary idea. Stress changes methylation and influence the whole life.

Keywords

Integrins, Cell adhesion, Migration, Cell-to-cell contact

Introduction

General

The central aim is to formulate results based on studies in the fields of neurobiology and genetics to understand more human behavior at the level of neuropsychology. We have now a detailed molecular mechanism by which is possible to understand why social states can affect health in further life. It is a completely revolutionary idea. The cellular and molecular mechanisms underlie to the experience-driven changes in neural connectivity. Sensory experience results in neurotransmitter release at synapses within a neural circuit and leads to membrane depolarization, calcium influx into individual neurons which triggers a wide variety of cellular changes with these neurons capable of altering synaptic connectivity of the circuit. Changes such as the activation of calcium-sensitive signaling cascades lead to posttranslational modifications of proteins, at the regulation of mRNA translation [1]. It’s resulting in the production of new proteins locally at the sites of calcium entry and play critical roles in altering synaptic function in a synapse-specific manner.

Materials and Methods

We have used the studies cited in the references to make a review from the latest results at the field of neurobiology, genetics, and neuropsychology to analyze what are the mechanisms regulating human behavior at neural and psychological level under conditions of stress. We try to formulate how sensory information influences response behavior by semi-analytical, information theoretical, statistical and neuropsychological methods. To understand more human behavior in the psychological conditions of stress we must start from the underlying principles of neurobiology and genetics. It can be done by the method of relating neurobiological models to behavioral models of signaling pathways.

Calcium Influx Can Alter Cellular Function by Activating New Gene Transcription

Calcium influx into the postsynaptic neuron can alter cellular function by activating new gene transcription. Calcium influx activates a number of signaling pathways converging on transcription factors within the nucleus, which in turn control the expression of a large number of neuronal activity regulated genes. Signaling pathways mediate activity-dependent transcription in experience-dependent neural development and plasticity. This neuronal activity regulates by the signal transduction pathways the activity-dependent gene expression program. On the other side, neuronal activity-regulated genes showing how this activity-regulated program controls neuronal development [1,2]. The c-fos mRNA is induced by synaptic activity resulting from sensory experience due the Fos protein with Jun family members comprised the AP-1 transcriptional complex, which is critical for the organism’s adaptive responses to experience. A brain-specific deletion of the c-fos gene displays deficits in synaptic plasticity and defects in learning and memory. Loss of Fos-dependent transcription gives raise to additional behavioral deficits [3]. The activity-regulated transcriptional program uncovered a mechanism by which calcium-dependent gene induction alters the function of specific synapses. Examples,

  1. Tenacin binding peptide derived from fibronectin;
  2. Angiostatin from plasmin.

The translation of select mRNAs can occur at individual synapses through the actions of microRNAs (miRNAs) which inhibit the translation of mRNAs having nucleotide sequences closely matching the miRNAs. The level of miR-134 is increased by neuronal activity. The miRNA could be a component of the local mRNA translation machinery allowing proteins to be translated in a synapse-specific manner. This transcriptional program is critical in coordinating both dendritic and synaptic remodeling.

The Transcriptions of c-fos and Other Immediate Early Genes

The transcriptions of c-fos and other immediate early genes (IEGs) increases in many cells of the body in response to extracellular factors inducing proliferation or differentiation of the cells. IEGs mediate cellular responses to changes in the cell’s environment. Recent studies have identified a subset of genes that is activated specifically in response to excitatory synaptic transmission that triggers calcium influx into the postsynaptic neuron. One gene is specifically induced by neuronal activity in neurons: bdnf encodes a neurotrophin important in neural development. The level of the bdnf mRNA increases in neurons in response to physiological stimuli, such as fear conditioning and seizure induction. The induction of the bdnf mRNA is due to an increase in transcription of the bdnf gene [4]. Transcripts of these promoters splice from their first exon to a common downstream exon, which contains the entire open reading frame encoding the BDNF protein. This diversity could explain how BDNF can control such a large number of distinct processes during nervous system development. Neuronal activity sharply increases the rate of transcription initiation with most transcripts ending within the central intron. These coordinate transcriptional events rapidly convert a constitutive gene to an IEG and regulate the expression of functionally different Homer 1 proteins. The short forms modulate the properties of the long forma and are critically involved in activity-dependent alterations of synaptic structure and function. The switch from constitutive to activity-dependent expression. The switch from constitutive to activity-dependent expression entails intronic to exonic sequence conversion, transcript termination within the central intron of the Homer 1 gene. Homer proteins play key roles in signal transduction in the brain. Hypothalamic-pituitary-adrenal (HPA) responses to stress suggesting a causal relation among epigenetic state, glucocorticoid receptor (GR) expression and the maternal effect on stress responses in the later offspring. There are increasing number of the results confirming that an epigenomic state of a gene may be established through forms of an environmental and programming and this is potentially reversible. Variations in maternal behavior are connected with development of individual differences in behavioral and HPA responses to stress in the offspring. They serve as a mechanism for the nongenomic transmission of individual differences in stress reactivity across generations. Recent findings suggest that the mechanisms of these maternal effects, or other forms of environmental programming, remain sustained over the lifespan [5]. Maternal behavior in the rat permanently alters the development of HPA responses to stress through tissue-specific effects on gene expression. The magnitude of the HPA response to stress is a function of hypothalamic corticotropin-releasing factor (CRF) release, thus activating the pituitary-adrenal system. There are also some modulatory influences, like glucocorticoid negative feedback, which inhibits CRF synthesis and release, dampening HPA responses to stress.

Epigenetic Programming

The changes in Avp expression were restricted to the parvocellular subpopulation of neurons in the hypothalamic paraventricular nucleus (PVN) in those neurons that drive the HPA axis. Research data verify the critical role of arginine vasopressin (AVP) in driving the disturbed endocrine phenotype in stressed mice. This hypothesis was supported by the observation that the methyl CpG-binding protein 2 (MeCP2) phosphorilation was prominently increased in parvocellular AVP-expressing neurons in the PVN. Phosphorilation of MeCP2 at S438 is critical for MeCP2 function as a reader and interpreter of the DNA methylation signal at the Avp enhancer. MeCP2 serves as an epigenetic integration platform on which synergistic cross-talk between histone deacyclation, K3K9 methylation and DNA methylation act to confer gene silencing. Research data suggests that stress tilts the balance toward persistent hypomethylation and Avp overexpression by inducing reductions in MeCP2 binding. Phosphorilation of MeCP2 appears to be a carrier of experience-driven changes in gene expression, as an important mediator of the persistent effects of stress. By DNA methylation, there are evidence for postmitotic epigenetic modifications in neuronal functions. Modifications can facilitate or disfavor physiological and behavioral adaptations. Epigenetic marks and their initiators, mediators and readers (MeCP2) bring new evidences for understanding the molecular basis of stress-related disorders of the brain.

Glucocorticoid Programming

Genetic background might predispose to early-life events as maternal care, which can change the genetic profile through epigenetic signaling pathways. The programming effect of maternal behavior is associated with a single gene: the glucocorticoid (GR) gene. The offspring of caring mothers had higher hippocampal GR expression, owing to demethylation of a cysteine residue at the 5’NGF1A binding region in the exon 1, promoter. Corticosteroids operate in both stress-system modes through mineralcorticoid (MR) and GR receptors co-expressed in the neurons of limbic structures. MR acts in the appraisal process and the onset of the stress response. GR is only activated by large amounts of corticosteroid, terminates the reactions to competition (the stopping rule). GR also promotes memory storage in preparing for future events [6].

Behavioral Programming

In vivo studies suggest that the effect of maternal behavior on GR gene expression is accompanied by an increased hippocampal expression of nerve growth factor-inducible protein A (NGFI-A). The non-coding exon 1 region of the hippocampal GR includes a promoter region, exon, containing a binding site for NGFI-A. Splice variants of the GR mRNA containing the exon sequence are found predominantly in the brain. Use of promoter is enhanced as a function of maternal care, what explain the increased GR expression in the neonate. Maternal care alters DNA methylation of the GR exon promoter, and these changes are stably maintained into adulthood, associated with differences in GR expression and HPA responses to stress. Variations in maternal care directly alter the methylation status of the exon promoter of the GR gene. DNA methylation pattern can be established also through a behavioral programming without germ line transmission. Postnatal de novo methylation of the Hoxa5 and Hoxb5 genes in development was documented also in another study [7]. Thus, maternal programming of the exon GR promoter involves DNA methylation, histone H3-K9 acetylation and alterations in NGFI-A binding. The afferent input from limbic networks converts purely psychological stress reactions to the HPA axis. Above interplay of limbic inputs from the hippocampus, amygdala and prefrontal cortex with HPA axis activity may lead to a vulnerable phenotype for mental illness.

Environmental Programming

We have now evidence that maternal behavior produces stable alterations of DNA methylation and chromatine structure, providing a mechanism for the long-term effects of maternal care on gene expression in the offspring. Such a gene-environment interactions during development result in the sustained environmental programming of gene expression and function of defensive responses through increased HPA activity over the lifespan. Natural selection shaped offspring to respond to subtle variations in parental behavior as forecast of the environmental conditions. They serve as a major source of epigenetic variations in gene expression and mediating such maternal effects. Effects on chromatine structure serve as an intermediate process imprinting dynamic environmental experience on the fixed genome with stable variations in phenotype [1,2,5]. Environment-assisted invariance the state of composite object (consisting of the system S and the environment E) can be ignorant of the state of S alone. Environment-assisted invariance, or envariance based on symmetry allows observer to use perfect knowledge of SE as a proof of his ignorance of S: when a US acting on S alone, can be undone by a transformation acting solely on E, and the joint state of SE is unchanged. This state is said “envariant” with respect to US. Envariant properties not belong S alone. Entanglement between S and E enables envariant and implies ignorance about S. Envariance is associated with phases of the Schmidt decomposition of the state representing SE. It anticipates the consequences of environment-induced superselection (“einselection”) of the preferred set of pointer states, they remain unperturbed to immersion of the system in the environment. The state of combined SE expressed in the Schmidt form is: |ψSE 〉=∑ ∝k|δk 〉|Ek〉. Schmidt states are in an intimate relationship with the pointer states and have been regarded as “instantaneous pointer states” [8]. Quantum Darwinism brings new focus on the environment as a communication channel. This explains the emergence of objectivity. Even hazy environment will communicate a very clear image [9].

Adaptational Programming

Limbic pathways activated by psychological stressors of competition are parts of the afferent pathways activating the CRH neurons in the PVN. The interface between incoming sensory information and the appraisal is converted by limbic brain structures (the hippocampus, amygdala and prefrontal cortex-PFC). Not only homeostatic disturbance, but purely psychological code can determine the stress response to competition. Its determinants include the ability predict upcoming events and getting control over the situation. The adaptive competition stress-related processes take place in limbic brain regions. An inappropriate response to the winner-take-all instabilities (WTAIs) produces a vulnerable phenotype leaving genetically predisposed individuals at an increased risk of stress-related brain disorders [10]. Multiple peaks of activity appear simultaneously within a single frontal or parietal region, they compete against each other through inhibitory antagonism. This can be seen in biased competition mechanism of visual attention. During colour-cue period preferring the given colour pushes group of cells towards stronger activity than others and causes the competition in dorsal premotor cortex (PMd) to become unbalanced, because one peak increases its activity, while the other is suppressed. Since neural activities are noisy, competition between distinct peaks of activity cannot follow a simple winner-take-all rule, or random fluctuations will determine the winner each time. If activity of a given choice becomes sufficiently strong, than it should be allowed to suppress its opponent and conclusively win the competition. But the cost of reinstating homeostasis also might become too high, causing through WTAIs an allostatic load with increased risk of mental illness (Table 1) [11].

Table 1: ATM and SIRT1 expression

 

Patients

N (%)

ATM

0

16 (38%)

+/3

16 (38%)

++/3

7 (17%)

+++/3

3 (7%)

SIRT1

<10%

31 (74%)

10-24%

3 (7%)

25-49%

4 (10%)

50-74%

3 (7%)

≥75%

1 (2%)

Dynamics of the Winner-Take-All Instability

To derive an equation for the dynamics of the winner-take-all instability, we express the dynamical variables as x=xSS + x∝Y(T) + … where Y represents the slow dynamics ATM along the critical eigenvector and T is a slow time scale. The reflection symmetry of the system implies the dynamics of Y should be invariant under the transformation Y →-Y and this switches the identity of x1 and x2. The increase in input I is common to both x1 and x2 leads to the developing decision in the winner-take-all system and is thus the bifurcation parameter. The linear growth rate of the spontaneous ATM state must be proportional to the difference between the presynaptic input and the value of the input at the bifurcation with an unknown prefactor, i.e. μ(I-I∝). The difference in inputs I1-I2 breaks the reflection symmetry thereby SIRT1 introducing a constant term which, to first approximation, must be proportional to that difference with an unknowvn prefactor, i.e. η(I1-I2). These two facts, coupled with the reflection symmetry, lead to the form of the equation describing the time evolution of Y: δTY=η(I1-I2) + μ(I-I∝)Y + ϒY3, where I=I∝ only when ∝=β identically, i.e. at point of instability, and δT is a time derivative with respect to the slow time T. For I1-I2 the equation is invariant under Y → -Y as it should be, Y3 is the lowest order nonlinearity which obeys reflection symmetry. For more complex systems, which exhibit winner-take-all behavior, above euation captures the qualitative dynamics of the system near the bifurcation in general (Figure 1) [12].

fig 1

Figure 1: Distribution of patients by age group

Concluding Remarks

During adaptation sensory experience driven changes in neural SIRT1 connectivity, transcription, and HPA axis responses to stress are complex and multifactorial: they cannot be attributed to mutations in single gene, or to a single external event, but rather, result from the concerted actions of many ATM subtle genetic polymorphisms and external events, the effects of which might accumulate over time. Once traumatic life events, in combination with genetic disposition, have engrained long-lasting changes in MR and GR signaling, a vulnerable phenotype emerges. DNA methylation is behind the changes associated with stress. It is based on differences in the gene encoding AVP, a hormone associated with mood and cognitive behavior. After stress, there was lover level of methylation in the regulatory region of the Avp gene in the brain. This hypomethylation was specific to a subset of neurons in the hypothalamic paraventricular nucleus-a brain area involved in regulating hormones linked to stress [13]. The decreases in methylation in stressed subjects result from the inactivation of a protein MeCP2, involed in the start of the DNA SIRT1 methylation. It is a detailed molecular mechanism by which is possible to understand why social states as sensory experience can affect health in further life. It is a completely revolutionary idea. Stress changes methylation and influence the whole life. Depression may be facilitated by a failure in competition to contain the biological stress response to challenge of unemployment at the time of the trauma, resulting in a cascade of alterations leading to recollections of the WTAIs, avoidance of the reminders to event and symptoms of hyperarousal [14]. From psychological and biological SIRT1 data we may hypothesize that the pathological mechanism of stress-related brain disorders depend on distress connected with inhibitory antagonism produced by winner-take-all instabilities. Mechanism is triggered by interactive behavior of an appraisal of unit P probabilities trade-off with environment. Stressors can kill with information itself through probabilities. Probabilities are the killer by information [15]. Sensory information itself, as first communication of diagnosis, may act as psychic stressor, psychological weapon (of mass destruction) due stress-related brain disorders [16]. It is well documented in recent large population-based study about SIRT1 men newly diagnosed with prostate cancer, they were at higher risk of cardiovascular events and suicide. The excess risks were highest during the first week after diagnosis, suggesting that stress of diagnosis itself plays a critical role. The emotional stress as an information itself caused a cardiovascular morbidity increase immediately after communication of the diagnosis [17]. Emotionally stressful competition events may lead to altered function of the heart, a stress-related left ventricular dysfunction. Increased risk of myocardial infarction was documented following the Athen earthquake in 1983 [18]. Emotional stress brought on by viewing a World cup soccer match was reported to raise the risk for cardiovascular morbidity and mortality. Being informed about diagnose of prostate cancer may also serve as a stressor of substantial weight. About 20% of the prostate cancer patients were reported as having no one to confide in Fall K [19]. On the basis of above results bring a hypothesis of the weights function in a framework of feedback paradigm as the psychological code. Possible mechanism may be the emotional shock caused by SIRT1 the information of diagnosis, anxiety, together with emotional isolation.

References

  1. Bottai D, Guzowski JF, Schwarz MK, Kang SH, Xiao B, et al. (2002) Synaptic activity-induced conversion of intronic to exonic sequence in Homer 1 immediate early gene expression. J Neurosci 22: 167-175. [crossref]
  2. Cisek P (2007) Cortical mechanisms of action selection: the affordance competition hypothesis. Philos Trans R Soc Lond B Biol Sci 362: 1585-1599. [crossref]
  3. Fall K, Fang F, Mucci LA, Ye W, Andrén O, et al. (2009) Immediate risk for cardiovascular events and suicide following a prostate cancer diagnosis: prospective cohort study. PLoS Med 6: e1000197. [crossref]
  4. Flavel SW and Greenberg ME (2009) Ann Rev Neurosci 2008: 31: 583-590 Hershko AY, Kafri T, Fainsod A, Razin A (2003) Methylation of HoxA5 and HoxB5 and its relevance to expression during mouse development. Gene 302: 65-72. [crossref]
  5. Leor J, Poole WK, Kloner RA (1996) Sudden cardiac death triggered by an earthquake. N Engl J Med 334: 413-419. [crossref]
  6. Li J, Hansen D, Mortensen PB, Olsen J (2002) Myocardial infarction in parents who lost a child: a nationwide prospective cohort study in Denmark. Circulation 106: 1634-1639. [crossref]
  7. Li J, Laursen TM, Precht DH, Olsen J, Mortensen PB (2005) Hospitalization for mental illness among parents after the death of a child. N Engl J Med 352: 1190-1196.
  8. Katsouyanni K, Kogevinas M, Trichopoulos D (1986) Earthquake-related stress and cardiac mortality. Int J Epidemiol 15: 326-330. [crossref]
  9. Meisel SR, Kutz I, Dayan KI, Pauzner H, Chetboun I, et al. (1991) Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians. Lancet 338: 660-661. [crossref]
  10. Murgatroyd C, Patchev AV, Wu Y, Micale V, Bockmühl Y, et al. (2009) Dynamic DNA methylation programs persistent adverse effects of early-life stress. Nat Neurosci 12: 1559-1566. [crossref]
  11. de Kloet ER, Joëls M, Holsboer F (2005) Stress and the brain: from adaptation to disease. Nat Rev Neurosci 6: 463-475.
  12. Roxin A, Ledberg A (2008) Neurobiological models of two-choice decision making can be reduced to a one-dimensional nonlinear diffusion equation. PLoS Comput Biol 4: e1000046. [crossref]
  13. Schairer C, Brown LM, Chen BE, Howard R, Lynch CF, et al. (2006) Suicide after breast cancer: an international population-based study of 723,810 women. J Nat Cancer Inst 98: 1416-1419. [crossref]
  14. Seckl JR, Meaney MJ (2004) Glucocorticoid programming. Ann N Y Acad Sci 1032: 63-84.
  15. Wilbert-Lampen U, Leistner D, Greven S, Pohl T, Sper S, et al. (2008) Cardiovascular events during World Cup soccer. N Engl J Med 358: 475-483. [crossref]
  16. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, et al. (2005) Neurohumoral features of myocardial stunning due to sudden emotional stress. N Eng J Med 352: 539-548. [crossref]
  17. Weaver IC, Cervoni N, Champagne FA, D’Alessio AC, Sharma S, et al. (2004) Epigenetic programming by maternal behavior. Nat Neurosci 7: 847-854. [crossref]
  18. Zurek WH (2002) arXiv: 0211.037 v1
  19. Zwolak M, Quan HT, Zurek WH (2009) arXiv: 0904.0418v2.

Characteristics of Patients Diagnosed with Tuberculosis in a Rural District of Malawi: A Retrospective Analysis of Secondary Data

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DOI: 10.31038/JCRM.2024711

Abstract

Tuberculosis still remains one of the significant causes of morbidity and mortality in the globe despite the advances in diagnostic and treatment. In countries with high HIV prevalence like Malawi, the impact of the disease can be largely felt within the health systems. Understanding the demographic and clinical characteristic of diagnosed patients is extremely important for control and prevention of the disease. This present studied described the characteristics of TB patients in a rural district hospital of Malawi. The prevalence of the disease was predominantly higher among males and in the productive age group of 25-44. Affected patients were more likely to be co-infected with HIV and suffer for pulmonary tuberculosis. Majority of the people were newly diagnosed and heavily depended on farming for their day-to-day life. This study, clearly demonstrate that tuberculosis patients are diverse in nature and hence understanding the clinical and demographic determinants of the disease is extremely important for development of effective infection control and prevention programs.

Introduction

Tuberculosis still remains a major public health challenge in Malawi. Even though Malawi adopted the directly observed treatment short course (DOTS) in 1990’s, tuberculosis still remains a major public health threat, affecting thousands of individuals across the country [1]. Its impact can directly be felt in the country, household and individual economy. It still remains a significant cause of morbidity and mortality among people living with HIV. In 2018, The TB mortality among HIV negative people was reported as 11/100,000 population while among HIV positive people was 19/100,000 Population [2]. Just like in other Sub-Saharan Africa countries, Malawi is one of the countries with a high prevalence of HIV (8.9%) [3]. This has exacerbated the situation. Even though the rate of TB HIV co-infection has declined from 77% (2003) to 48.5% in (2018), it still remains high and calls for more public health attention [4].

Due to the magnitude of the problem, Malawi government declared tuberculosis as an emergency in order to raise awareness and advocate for more resources for TB control and prevention. Various stake holders also advocated the integrated HIV/TB care approach in order to reduce the burden of TB among people living with HIV (PLWH). The emergence of multi-drug resistant TB has also raised serious concerns and challenges in the fight against the disease. In 2013 alone, a national drug resistance survey reported a prevalence of 4.8% among retreatment and 0.48% among new patients [4].

As one of the countries with high TB and HIV burden, Malawi needs proper strategies and guidelines as well as health systems strengthening in order to win the fight against this dual burden. Malawi’s vision is to achieve TB and leprosy free Malawi in 2025.Malawi aims at reducing tuberculosis related incidence by 50 % and mortality by 75% by the end of 2025 compared to the 2015 [4]. In order to achieve all these goals, understanding characteristics of patients diagnosed with tuberculosis is important. It gives an insight to the social-demographic determinants of the disease and hence helps the government to properly align resources in the fight against the catastrophe.

While similar study has been done in the urban, Lilongwe Malawi [5], at an HIV/TB integrated clinic, there is still a paucity of data on studies describing the demographic characteristics, including HIV comorbidity, patient occupation, gender etc. within a rural district hospital in Malawi.

Therefore, we aim to fill the gap in literature and complement other studies done in urban setting by describing the characteristics of patients diagnosed with tuberculosis at Nkhotakota district hospital within the central region of Malawi.

Methods

Study Design and Population

This retrospective analysis of all patients diagnosed with TB in 2016 at Nkhotakota district hospital. We used routine data from both TB registers and patient treatment cards collected from January to December in 2016 at Nkhotakota district hospital. All adults and children diagnosed with active TB according to national TB guidelines were eligible for this study.

Setting

The study was conducted at Nkhotakota district hospital within the central region of Malawi. Nkhotakota district hospital is a secondary level of care hospital with the 3-tier health system of Malawi. It has a large catchment area of a population of about 400 thousand and is located along the Lake shore region. Nearly, two-third of its population is below the age of 40 and lives in a rural area.

Data Collection

All demographic data including gender, age, occupation and HIV related information were extracted from HIV and TB registers. All TB related data including TB registration numbers, registration dates, initial sputum microscopy, mode of diagnosis, HIV status (Known positive, negative, unknown), TB type and treatment regimen were also extracted from the registered and entered into an excel sheet. All data, that had part of information missing were excluded from the study.

Data Analysis

The Characteristics of TB patients were analysed by various categories, including age groups, HIV status, TB type, and occupation Categorical measures were presented as percentages and continuous measures were presented as means. Results are presented as percentages. Chi-square test were used for categorical variables. Statistical significance has been defined as P < 0.05.

Results

Of the 179 patients with TB, 107 (60%) were male and 72 (40%) were female. The largest proportion of the patients were between the age of 25-44 (53%) (Figure 1). The average and median age was the same for both males and females (Table 1). Of the 144 cases that were classified in the TB register, majority (80 %) were pulmonary TB while 28 (20 %) were extrapulmonary TB cases. There was no significant difference for TB classification between men and women. More women under hospital Directly Observed Treatment course as compared to men (DOT) than men (Table 2). During the study period, 106 men and 179 women suspected of TB were tested for HIV 56 (53 %) of the men and 90 (50 %) of the women tested had HIV. Majority of the patient already knew their HIV status before being diagnosed with tuberculosis (Table 3). There was no significant month to month differences in the number of diagnosed cases during the study period (Figure 2). Majority of the patients were self-employed, and were involved in either small scale business or farming (Table 4).

fig 1

Figure 1: Age distribution among diagnosed TB patients in Nkhotakota (Malawi) in 2016

Table 1: Average and median age distribution among diagnosed TB patients in Nkhotakota (Malawi) in 2016

 

Average (s. dev)

Median
Male

41.6 (14.7)

 40

Female

 39.9 (15.9)

38
Total

40.9 (15.1)

39

Table 2: Distribution of diagnosed TB patients by TB Class, mode of treatment and patient category

Category

 Directly observed treatment (DOT) Option TB Classification

Patient Category

Option

 Guardian Hospital Pulmonary Extra Pulmonary New Relapse Fail

Other
Male

62

 9 53 19 62 6 2 3

Female

 38 34 63 9 38 34 63

9

Table 3: Patient distribution by HIV status and time of HIV test

Category

 HIV Test Time of HIV Test
Option Negative Positive Unknown Before Report

After Report
Male

51

 56 0 97 9

Female

 89 90 0 160

19

fig 2

Figure 2: Patient distribution by month of diagnosis

Table 4: Distribution of occupation among TB suspects in Nkhotakota (Malawi) in 2016

Farmer

68
Business

30
Housewife

20
Fisherman

10
Student

9
Teacher

4
Driver

4
Retired

3
Laborer

3
Drop Out

2
Health

2
Other

12
N/A

12
Total

179

Discussion

This is one of the studies done in a rural Malawian district to describe the characteristics of patients diagnosed with Tuberculosis. We noted several characteristics of tuberculosis patients that are necessary for patient management. Our study noted that majority of patients were male, and within the productive age group of 25-44. This finding is comparable to a similar study that was done in 2012. This study reported the largest proportion of patients to be between the ages of 25-34 [4]. This demographic distribution is extremely important. This is also the group that is highly hit by HIV with the prevalence ranging as high as 10.5% [3]. HIV weakens the immune system and predispose the affected individual to active tuberculosis disease. Indeed, the rate of HIV/TB co-infection has always been reported to be high in Malawi. In 2013, alone, 56% of tuberculosis patients were reported to have HIV [6]. The socio-economic impact of tuberculosis on this group can also not be undermined. This is the group that is supposed to be economically productive. Our findings also agree with national findings from the national tuberculosis prevalence survey, where majority of patients were males [4].

Our study also reveals majority of the patients have pulmonary tuberculosis. This is also in line with the national data, where nearly 65% of all TB patients had pulmonary TB [4]. The rate of transmission of pulmonary TB is higher as compared to other forms of TB. With the high prevalence, there is a need for strong surveillance systems, to actively trace all contacts and screen them for tuberculosis.

Our present study also demonstrates that majority of our patients had HIV and already knew their status before diagnosis. The timing of HIV diagnosis in relationship to the diagnosis of tuberculosis is important. TB is an opportunistic disease. The coming in of universal ART coverage has led to a decrease in number of notified cases of tuberculosis. If the prevalence of the disease among people living with HIV still remains high, it may be assumed that there is poor adherence to ART. The high levels of TB/HIV co-infection have prompted the government and various stakeholders to call for an integrated TB and HIV program at all levels of care to ensure widespread implementation of interventions which reduce the burden of TB among People Living with HIV (PLHIV) and those which reduce the burden of HIV among notified TB case.

Most of the cases in this study were newly diagnosed and preferred home treatment, especially men. While there were reports of treatment failure, most of the people were successfully treated. Directly observed treatment short course was introduced to ensure strict adherence to TB treatment, thereby reducing the number of cases of drug resistant TB. However, in this present study, only few men preferred hospital treatment. This may be explained by the partially poor health seeking behaviours among men, hence most of them don’t want to return to hospital. When the government declared tuberculosis an emergency in 2007, one of the campaigns was universal access to tuberculosis treatment. As a result of the declaration there have been campaigns to shift from centralized institutional DOTS services to more innovative ways of reaching out to all target population groups with quality assured diagnosis and care regardless of socio-economic status and geographical location [6].

Majority of the patients in this study were farmers, probably owing to the fact that most of them resides in rural areas were, farming forms part of day-to-day life. This is a group that is already economically struggling and living in poor households, with overcrowding conditions. This increases risk of transmission of the disease.

Conclusion

This present study clearly demonstrates that tuberculosis patient varies by age, gender, HIV status and TB Type. If the country is to achieve sustainable development goals and win the fight against HIV and Tuberculosis, there is a need for increased commitment and collaborative action across all stake holders. This also highlights for the need of an operational research within rural district hospitals. The integrated HIV/TB programs should be advocated for and closely monitored for its success. The high prevalence of pulmonary TB (smear positive) also calls for increased effort on infection control, in order to curb the spread of the disease. Lastly, ensuring strict adherence, either by direct observation or family empowerment would be necessary to reduce cases of drug resistant TB.

Declarations

Ethics Approval and Consent to Participate

The study didn’t require full review by the national ethics committee, as there was no direct involvement with patients.

However, a written ethical waiver was provided by the district research and ethics committee and permission was granted by the district medical officer to collect data at the facility. There was no direct involvement with patient.

Consent for Publication

Consent to publish this material was sought from the district health office and it was granted.

Availability of Data and Materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing Interests

The authors declare that they have no competing interests

Funding

This study was partly funded by Clinical Research, Education and Management Services Ltd (CREAMS) under the student training package. The funding only covered data collection and analysis.

Acknowledgement

We would like to acknowledge CREAMS for financial help and also, we would like to acknowledge the management of Nkhotakota DHO for their unwavering support.

References

  1. Global tuberculosis report 2020 [Internet]. [cited 2023 Feb 5]. Available from: https://www.who.int/publications/i/item/9789240013131
  2. World Health Organization. (‎2018)‎. Global tuberculosis report 2018. World Health Organization. https://apps.who.int/iris/handle/10665/274453. License: CC BY-NC-SA 3.0 IGO
  3. Second population survey of HIV in Malawi summary report 2022. [internet]. [cited 2023 Feb 5. Available from: https://phia.icap.columbia.edu.
  4. Ministry of health of Malawi. National tuberculosis and leprosy control strategic plan 2021-2025. https://shorturl.at/afFK6
  5. Feldacker C, Tweya H, Keiser O, Weigel R, Kalulu M, et al. (2012) Al Characteristics of adults and children diagnosed with tuberculosis in Lilongwe, Malawi: findings from an integrated HIV/TB clinic. https://doi.org/10.1111/j.1365-3156.2012.03041.x
  6. National tuberculosis and leprosy control strategic plan 2021-2025 http://nkhokwe.kuhes.ac.mw:8080/handle/20.500.12845/200

The Effect of Sodium Humate on Some Carcass Parameters, Caecal Metabolites and Excretion in Broiler Chickens

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DOI: 10.31038/NRFSJ.2024712

Abstract

In the experiment was studied the effect of the addition of sodium humate to feed mixtures on carcass characteristics, relative weight of organs, fermentation process in caecum and dropping quality. Overall, one hundred one-day-old broiler chicks were assigned in two equal groups. Birds of the experimental group were fed with diets supplemented with sodium humate (in amount 5 g.kg-1 during the first two weeks and 7 g.kg-1 from the 3rd to the 6th week). The experimental period lasted 6 weeks. The carcass yield and relative weights of the monitored internal organs were not statistically significantly affected compared to the control group. The addition of sodium humate led to an increase in the proportion of abdominal fat, significantly in cocks (P<0.05). The level of short-chain fatty acids (except for butyric acid) and the pH value in the caecum content were not significantly influenced by the addition of sodium humate. The content of butyric acid was significantly higher in the experimental group than in the control group (P˂0.05). The dry matter content of chicken droppings was not significantly affected, but the addition of sodium humate led to a significant decrease in the content of crude protein (P<0.01), which may contribute to reducing the environmental burden from poultry farms.

Keywords

Humic substances, Carcass yield, Caecal fermentation, Dropping quality, Poultry

Introduction

In recent years, interest in humic substances and their possible use in animal nutrition have increased in research. These are substances of natural origin occurring in rock sediments, peat, brown coal and lignite. Humic substances are products of chemical and biological degradation of dead plant and animal tissues. Humic acids, fulvic acids and humin are considered the main fractions of humic substances [1]. Humic acids form the highest quality fraction of humic substances [2]. The ability to bind ions is given by their polyanionic character [3]. Together with calcium and magnesium, they form calcium and magnesium humates that are insoluble in water, which affect the favorable technological properties of soils. With sodium and potassium, they form sodium and potassium humate, which are characterized by good solubility in water. They have the ability to bind a number of heavy metals (e.g. Cd, Pb, Zn, Hg), with which they form difficult-to-dissolve compounds and thus limit their movement in the soil and uptake by plants [4].

Nowadays, humic substances are used in agriculture (both in plant and animal production), in industry, in veterinary and human medicine, pharmacology and in the field of environmental protection. In plant production, they are mainly used as fertilizer in the form of humates [3]. Humic acids and their sodium salts are permitted for oral use in horses, ruminants, swine and poultry for the treatment of diarrhoea, dyspepsia and acute intoxications [5]. The results of various studies show that the addition of humic substances to diets or water can lead to an increase in the intensity of animal growth, to an improvement in feed conversion ratio, to a decrease in mortality [6-11], to increase carcass yield [6,12] and can also affect the chemical composition of the meat [13-15]. Their positive influence may consist in increasing the use of nutrients from the feed through the stabilization of the intestinal microflora [16,17] or through increasing the height of the villi of the intestinal mucosa, which leads to an increase in the absorption surface [6,7]. Their positive effects on animal immunity were also recorded [18-20]. However, it follows from the results of various studies that the influence of humic substances can be different depending on the composition and amount of administered humic substances, on the method of their application (in feed or water) or on the type of animals used.

The objective of this experiment was to study the influence of sodium humate on carcass characteristic, processes of digestive tract and dropping quality in broiler chicks.

Materials and Methods

Animals and Experimental Design

One hundred one-day-old unsexed chickens (ROSS 308) were included in the experiment, which were divided into two groups (n = 50) and placed on deep litter while observing standard environmental conditions. Lighting was continuous throughout the whole experimental period. The experiment was carried out in accredited stables of the Department of animal nutrition and husbandry at the University of Veterinary Medicine and Pharmacy in Košice in compliance with the EU regulations concerning the protection of experimental animals. The experiment was carried out with the consent of the institutional Animal Care and University Ethics Committee.

During the experiment, the chickens were fed with complete feed mixtures based on corn, wheat and soybean meal according to the growth phases: starter diet (1st-2nd week), grower diet (3rd-5th week), and finisher diet (6th week). No antibiotic growth promoters or anticoccidial drugs were used in the diets.

The first group designated as the control group, was without the addition of the monitored substances. In the second group, sodium humate (dry matter 84.8%, humic acids 63.2%, ash 36.9%) was added to the mentioned feed mixtures at the expense of wheat in the amount of 5 g.kg-1 of diet in the first phase and 7 g.kg-1 of diet in the second and third phase of fattening. Diets and drinking water were provided ad libitum over the whole experimental period. Composition of diets used in respective experimental periods is shown in Table 1.

Table 1: Composition of the experimental diets

 

Control group

 Sodium humate group
Starter Grower Finisher Starter Grower

Finisher
Ingredients (g.kg-1)
Maize

435

 500 500 435 500 500

Wheat

 121 90 104 116 83

97
Soybean meal

360

 330 310 360 330 310

Vegetable oil

 40 40 50 40 40

50
Limestone

20

 16 15 20 16 15

Vitamin-mineral premix

 201 202 203 201 202

203
Lysine

4

 4 1 4 4 1

Sodium humate

 5 7

7
Chemical analysis
Dry matter (g)

897

 900 894 898 897 906

Crude protein (g.kg-1 DM)

 250 231 219 249 232

222
Crude fibre (g.kg-1 DM)

37

 44 43 40 37 38

Crude ash (g.kg-1 DM)

 82 67 66 74 66

69
Ether extract (g.kg-1 DM)

70

 72 80 72 69 78

Calculated analysis
ME (MJ/kg DM)

13

 13 14 13 13

14

DM: Dry Matter; ME: Metabolizable Energy
1Vitamin and Mineral premix (per kg): Ca 95 g, P 135 g, Na 75 g, Mg 5 g, DL-methionine 80 g, vit.A 600,000 IU, D3 135,000 IU, E 900 mg, K3 150 mg, panthotenic acid 600 mg, niacin 4000 mg, cholin chloride 20,000 mg, B6 150 mg, B12 900 μg, biotin 3000 μg, folic acid 76,000 μg, vit. C 2000 mg, Fe 1500 mg, Cu 500 mg, Zn 3000 mg, Mn 5000 mg, I 25 mg, Se 23 mg, Co 10 mg;
2Vitamin and Mineral premix (per kg): Ca 100 g, P 135 g, Na 75 g, Mg 5 g, DL-methionine 80 g, vit. A 425,000 IU, D3 84,000 IU, E 900 mg, K3 100 mg, pantotenic acid 420 mg, niacin 3400 mg, cholin chloride 14,200 mg, B6 100 mg, B12 640 μg, biotin 2150 μg, folic acid 54,500 μg, vit.C 1400 mg, Fe 1500 mg, Cu 500 mg, Zn 3000 mg, Mn 5000 mg, I 25 mg, Se 23 mg, Co 10 mg;
3Vitamin and Mineral premix (per kg): Ca 110 g, P 145 g, Na 75 g, Mg 9 g, DL-methionine 55 g, vit. A 370,000 IU, D3 135,000 IU, E 900 mg, K3 95 mg, panthotenic acid 370 mg, niacin 3880 mg, cholin chloride 14,000 mg, B6 95 mg, B12 560 μg, biotin 1850 μg , folic acid 47,000 μg, vit.C 1240 mg, Fe 1500 mg, Cu 500 mg, Zn 3000 mg, Mn 5000 mg, I 25 mg, Se 23 mg, Co 10 mg.

Sampling and Measurements

Internal organs (liver, heart, spleen, bursa of Fabricius, and pancreas) were obtained on the 14th and 35th days of the experiment from eight chickens from each group after they were weighed and killed. The relative weight of internal organs is expressed as a percentage of the live body weight of chickens. On the 35th day of the experiment, the contents of the caecum were obtained from seven chickens from each group, in which the pH and concentration of short-chain fatty acids (acetic, propionic, butyric, and lactic acid) were determined. The pH value of caecum contents was determined by pH-meter (Consort C830, Belgium). The concentration of short-chain fatty acids was analysed by isotachophoresis using a two-capillary isotachophoretic analyser (EA100, VILLA LABECO, Slovak Republic).

The faeces were collected thrice a day every day during the second and fifth week. The collection of faeces from random chickens in each group was made on clean solid base immediately after excretion to eliminate any contamination with raw feed or feathers. Composite samples from each group in appropriate amounts were frozen and kept at-18 °C until analysis for dry matter and crude protein content.

At the end of the trial (42nd day), the birds were left for 10-12 h without feed, weighed and slaughtered, processed by decapitation, neck, feathers and feet removal and evisceration. Twenty birds per group (ten from each sex) were used for evaluation of carcass yield and abdominal fat pad (percentage carcass weight). The carcass yield is expressed as a percentage of the carcass weight from the body weight before slaughter.

The chemical compositions of the diets and faeces were determined analytical methods according to the EC Commission Regulation 152/2009 [21].

Statistical Analysis

Statistical evaluation of the effects of sodium humate on monitored parameters was done by unpaired t-test with the statistical software GraphPad Prism 8.0. For all statistical calculations, the significance was considered as a value of P < 0.05. Data are presented as means ± standard error of means (SEM).

Results and Discussion

The carcass yield of broiler chickens was not statistically significantly affected by the addition of sodium humate to feed mixtures (Table 2). These results agree with the results of other studies in which the effect of humic substances was observed in chickens [22-24] and quails [25]. El-Husseiny et al. [26] reported opposite results in their experiment, where the carcass yield of chickens that received a feed mixture with the addition of humic substances in a concentration of 0.25 and 0.125% was significantly higher than in the group without the addition of humic substances. A significantly higher carcass yield was also recorded in broiler chickens that were fed feed with the addition of humic acids in 0.6% concentration [12].

Table 2: Effect of sodium humate on carcass yield and abdominal fat pad

Treatments

 Carcass yield

(%)

Abdominal fat

(%)
Female
Control

74.02

 2.03

Sodium humate

 73.71

2.22
SEM

0.297

 0.148

P-value

 0.624

0.534
Male
Control

73.74

 1.38a

Sodium humate

 73.57

2.09b
SEM

0.278

 0.154

P-value

 0.769

0.016

SEM: Pooled standard error of the mean
Values marked with a different superscript in the same column are statistically significantly different (abP < 0.05).

A higher percentage of abdominal fat was recorded in the sodium humate-supplemented group than in the control group (Table 2). A statistically significant difference was found in cocks (P < 0.05). Ozturk et al. [27] also noted an increase in abdominal fat under the influence of humic substances in broiler chickens.

The results of present study are not in agreement with the findings of El-Husseiny et al. [26], who reported that the addition of humates to feed can lead to a reduction in abdominal fat in broiler chickens. A decrease in the percentage of abdominal fat due to the addition of humic substances to the feed was also recorded in Japanese quail [6].

The relative weight of the internal organs was not statistically significantly affected by the addition of the monitored substance compared to the control group (Table 3).

Table 3: Effect of sodium humate on relative weight of some internal organs

Treatments

 Liver

(%)

 Heart

(%)

 Spleen

(%)

 Bursa of Fabricius

(%)

Pancreas

(%)
On the 14th day
Control

3.493

 0.681 0.066 0.226 0.389

Sodium humate

 3.493 0.745 0.061 0.257

0.395
SEM

0.076

 0.017 0.003 0.011 0.024

P-value

 0.999 0.062 0.451 0.172

0.906
On the 35th day
Control

2.015

 0.588 0.099 0.266 0.210

Sodium humate

 2.079 0.538 0.087 0.258

0.204
SEM

0.082

 0.025 0.004 0.016 0.009

P-value

 0.711 0.336 0.150 0.819

0.763

SEM: Pooled standard error of the mean

Similar results were recorded by Karaoglu et al. [22], Kaya and Tuncer [23] and Arif et al. [9]. Likewise, Rath et al. [28] reported no changes in the relative weights of heart, liver and spleen in broiler roosters receiving humic acid-enriched feed at 1.0 and 2.5% concentration compared to the control group, but the weight of the bursa of Fabricius was significantly higher in the group with 2.5% concentration of humic acid. This indicates a positive immunostimulating effect of humic acids. ELnaggar and El-Kelawy [10] also noted the enlargement of the bursa of Fabricius due to humic acids.

On the other hand, Abdel-Mageed [6], who investigated the effect of supplementing humic substances in the diet of Japanese quail, noted a significant increase in the relative weight of the liver.

Short-chain fatty acids produced by microbial fermentation of carbohydrates in the gastrointestinal tract are beneficial for the animal. They are used by the host organism as a source of energy, and their presence in the digestive tract leads to a decrease in pH of the intestinal content, which can inhibit pathogenic bacteria and can accelerate the proliferation of intestinal epithelial cells [29].

Feeding sodium humate in the concentration used had no significant effect on the concentration of acetic, propionic and lactic acid in the contents of the caecum (Table 4). However, the content of butyric acid, which has a positive effect on the growth of epithelial cells in the gastrointestinal tract [30], was significantly higher in the experimental group than in the control group (P ˂ 0.05). The pH value of the caecum content was not significantly affected.

Table 4: Effect of sodium humate on pH and concentration of short-chain fatty acids in the caecum content

Treatments

 pH Acetic acid Propionic acid Butyric acid Lactic acid
(mmol.L-1) (mmol.L-1) (mmol.L-1)

(mmol.L-1)
Control

6.93

 145.95 27.22 8.78a 29.18

Sodium humate

 6.75 145.00 20.82 12.89b

35.50
SEM

0.056

 4.713 1.943 0.936 2.866

P-value

 0.099 0.925 0.101 0.021

0.287

SEM: Pooled standard error of the mean
Values marked with a different superscript in the same column are statistically significantly different (abP < 0.05).

Our results are partly consistent with the results reported in the study by Shermer et al. [31]. The addition of humate in amounts of 5 and 10 g.kg-1 of the feed mixture had no significant effect on the concentration of acetic, propionic, isobutyric, isovaleric, valeric as well as butyric acid in the content of the caecum of broiler chickens. Similar results were recorded in broiler chickens that were given diets with the addition of natural humic substances in amounts of 5 and 7 g.kg-1 [32].

The dry matter content in chicken droppings was not significantly affected by the addition of sodium humate (Figure 1a). Although in the second week of the experiment a slightly higher content of crude protein in chicken droppings was detected in the experimental group (Figure 1b), in the fifth week a significantly lower crude protein content was recorded in this group than in the control group (P < 0.01).

fig 1

Figure 1: Effect of sodium humate on content of (a) dry matter and (b) crude protein in droppings (abP < 0.01)

We also recorded similar results in our earlier study, in which we investigated the use of natural humic substances in the fattening of broiler chickens [32]. This significant reduction in the content of nitrogenous substances in chicken droppings indicates a better utilization of nitrogenous substances from the feed. This leads to the decrease of volatile ammonia emerging by microbial fermentation in the litter. A higher concentration of ammonia in the air of stud areas negatively affects health and performance of animals as well as health of farm staff [33].

Conclusion

The carcass yield and relative weights of the observed internal organs were not significantly affected by the addition of sodium humate to the diets. However, a higher proportion of abdominal fat was recorded in the experimental group than in the control group (significantly in cocks), significantly higher the content of butyric acid in the contents of the caecum and significantly lower content of crude protein in chicken droppings. The significant decrease in the content of crude protein in the dry matter of chicken droppings indicate that sodium humate can contribute to reducing the burden on the environment from poultry farms.

Acknowledgment

This work was supported by Slovak project VEGA No. 1/0402/20.

References

  1. Stevenson FJ (1994) Humus Chemistry: Genesis, Composition, Reactions. Wiley-Inter-Science: New York, NY, USA. 34-41.
  2. Islam KMS, Schuhmacher A, Gropp J M (2005) Humic acid substances in animal agriculture. Pakistan Journal of Nutrition 4: 126-134.
  3. Veselá L, Kubal M, Kozler J, Innemanová P (2005) Structure and properties of natural humic substances of the oxyhumolite type. Chemické listy 99: 711-717.
  4. Vrba V, Huleš L (2006) Humus-soil-plant (2) Humus and soil. cz, Available from https://biom.cz/cz/odborne-clanky/humus-puda-rostlina-2-humus-a-puda (Last modified November 14, 2006), ISSN: 1801-2655 (in Czech).
  5. EMEA (1999) Committee for veterinary medicinal products. Humic acids and their sodium salts. Available from emea.eu.int/pdfs/vet/mrls/055499en.pdf (Last modified April 21, 2008. Accessed February 1999).
  6. Abdel-Mageed MAA (2012) Effect of dietary humic substances supplementation on performance and immunity of Japanese quail. Egyptian Poultry Science Journal 32: 645-660.
  7. Taklimi SMS, Ghahri H, Isakan MA (2012) Influence of different levels of humic acid and esterified glucomannan on growth performance and intestinal morphology of broiler chickens. Agricultural Sciences 3: 663-668.
  8. Mirnawati YR, Marlida Y (2013) Effects of humic acid addition via drinking water on the performance of broilers fed diets containing fermented and non-fermented palm kernel cake. Archiva Zootechnica 16: 41-53.
  9. Arif M, Rehman A, Saeed M, Abd El-Hack MZ, Arain MA, et al. (2016) Impacts of dietary humic acid supplementation on growth performance, some blood metabolites and carcass traits of broiler chicks. Indian Journal of Animal Sciences 86: 1073-1078.
  10. ELnaggar AS, El-Kelawy MI (2018) Effect of humic acid supplementation on productive performance, blood constituents, immune response and carcass characteristics of sasso chicken. Egyptian Journal of Animal Production 55: 75-84.
  11. Hammod AJ, Zeny ZAH, Mahdi AS, Alfertosi KA (2021) Probiotic and humic acid as feed additives and their effects on productive and economic traits of broiler. Indian Journal of Ecology 48: 35-37.
  12. Marcinčáková D, Mačanga J, Nagy J, Marcinčák S, Popelka P, et al. (2015) Effect of supplementation of the diet with humic acids on growth performance and carcass yield of broilers. Folia Veterinaria 59: 165-168.
  13. Ozturk E, Ocak N, Coskun I, Turhan S, Erener G (2010) Effects of humic substances supplementation provided through drinking water on performance, carcass traits and meat quality of broilers. Journal of Animal Physiology and Animal Nutrition 94: 78-85. [crossref]
  14. Semjon B, Marcinčáková D, Koréneková B, Bartkovský M, Nagy J, et al. (2020) Multiple factorial analysis of physicochemical and organoleptic properties of breast and thigh meat of broilers fed a diet supplemented with humic substances. Poultry Science 99: 1750-1760. [crossref]
  15. Gálik B, Hrnčár C, Gašparovič M, Rolinec M, Hanušovský O, et al. (2023) The effect of humic substances on the meat quality in the fattening of farm pheasants (Phasianus colchicus). Agriculture 13: 295.
  16. Agboola AF, Omidiwura BRO, Amole AO, Olanrewaju OA, Adeniran YE (2021) Influence of humic acid supplemented diets on intestinal microbiome and laying performance of egg-type chicken. Nigerian Journal of Animal Production 48: 276-286.
  17. Omidiwura BRA, Olajide OC, Olaniyan OS (2022) Potentials of pepper elder (Peperomia pellucida) and humic acid as feed additives in noiler chicken production. Nigerian Journal of Animal Production 49: 86-94.
  18. Mudroňová D, Karaffová V, Pešulová T, Koščová J, Maruščáková IC, et al. (2020) The effect of humic substances on gut microbiota and immune response of broilers. Food and Agricultural Immunology 31: 137-149.
  19. Mudroňová D, Karaffová V, Semjon B, Naď P, Koščová J, et al. (2021) Effects of dietary supplementation of humic substances on production parameters, immune status and gut microbiota of laying hens. Agriculture 11: 744.
  20. Bujňák L, Hreško Šamudovská A, Mudroňová D, Naď P, Marcinčák S, et al. (2023) The effect of dietary humic substances on cellular immunity and blood characteristics in piglets. Agriculture 13: 636.
  21. European Commission. Commission Regulation (EC) No 152/2009 of 27 January 2009 laying down the methods of sampling and analysis for the official control of feed. Off. J. Eur. Union 54: 1-130.
  22. Karaoglu M, Macit M, Esenbuga N, Durdag H, Turgut L, Bilgin ÖC (2004) Effect of supplemental humate at different levels on the growth performance, slaughter and carcass traits of broilers. International Journal of Poultry Science 3: 406-410.
  23. Kaya CA, Tuncer SD (2009) The effects of humates on fattening performance, carcass quality and some blood parameters of broilers. Journal of Animal and Veterinary Advances 8: 281-284.
  24. Jaďuttová I, Marcinčáková D, Bartkovský M, Semjon B, Harčárová M, et al. (2019) The effect of dietary humic substances on the fattening performance, carcass yield, blood biochemistry parameters and bone mineral profile of broiler chickens. Acta Veterinaria Brno 88: 307-313. [crossref]
  25. Sahin T, Aksu Elmali D, Kaya I, Sari M, Kaya O (2011) The effect of single and combined use of probiotic and humate in quail (Coturnix coturnix Japonica) diet on fatttening performance and carcass parameters. Kafkas Üniversitesi Veteriner Fakültesi Dergisi 17: 1-5.
  26. El-Husseiny OM, Abdallah AG, Abdel-Latif KO (2008) The influence of biological feed additives on broiler performance. International Journal of Poultry Science 7: 862-871.
  27. Ozturk E, Ocak N, Turan A, Erener G, Altop A, Cankaya S (2012) Performance, carcass, gastrointestinal tract and meat quality traits, and selected blood parameters of broilers fed diets supplemented with humic substances. Journal of the Science of Food and Agriculture 92: 59-65. [crossref]
  28. Rath NC, Huff WE, Huff GR (2006) Effects of humic acid on broiler chickens. Poultry Science 85: 410-414.
  29. Van der Wielen PW, Biesterveld S, Notermans S, Hofstra H, Urlings BA, et al. (2000) Role of volatine fatty acids in development of the cecal microflora in broiler chickens during growth. Applied and Environmental Microbiology 66: 2536-2540. [crossref]
  30. Canani RB, Di Costanzo M, Leone L (2012) The epigenetic effects of butyrate: potential therapeutic implications for clinical practice. Clinical Epigenetics 4: 1-7. [crossref]
  31. Shermer CL, Maciorowski KG, Bailey CA, Byers FM, Ricke SC (1998) Caecal metabolites and microbial populations in chickens consuming diets containing a mined humate compound. Journal of the Science of Food and Agriculture 77: 479-486.
  32. Hreško Šamudovská A, Bujňák L, Zigo F (2022) Carcass characteristic, caecal metabolites and dropping quality in broiler chickens fed diets containing a humic substances. Asian Journal of Agriculture and Food Sciences 10: 133-138.
  33. Abd El-Hakim AS, Cherian G, Ali MN (2009) Use of organic acid, herbs and their combination to improve the utilization of commercial low protein broiler diets. International Journal of Poultry Science 8: 14-20.

What Makes ‘Healthful Food’ vs. A ‘Food Healthful’: Using AI to Coach People to Ask Good Questions

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DOI: 10.31038/NRFSJ.2024711

Abstract

This paper addresses the emerging opportunity to learn how to ask better questions, and think critically using an AI based tool, Idea Coach. The tool allows the user to define the topic, as well as specify the nature of the question though an easy-to-use interface (www.BimiLeap.com). The tool permits the user to change the topic slightly and discover the changes in the questions which then emerge. Idea Coach provides sets of 15 topic questions per iteration, along with summarizing the themes inherent in the questions, and suggests innovations based on the questions. The paper illustrates the output of the Idea Coach for four similar phrase describing food: Healthful food; Healthy Food; Good for Health; Health Food, respectively. The output, produced in a matter of minutes, provides the user with a Socratic-type tutor to teach concepts and drive research efforts.

Introduction-thinking Critically and the Importance of Asking Good Questions

A look through the literature of critical thinking reveals an increasing recognition of its importance, as well as alternative ways of how to achieve it [1,2]. It should not come as a surprise that educators are concerned about the seeming diminution of critical thinking [3,4]. Some of that diminution can be traced to the sheer attractiveness of the small screen, the personal phone or laptop, which can provide hours of entertainment. Some of the problem may be due to the effort to have people score well on standardized tests, a problem that the late Professor Banesh Hoffmann of Queens College recognized six decades ago in his pathbreaking book, The Tyranny of Testing, first published in the early 1960’s [5].

That was then, the past. Given today’s technology, the ability to tap into AI, artificial intelligence, the availability of information at one’s fingertips, the ability to scan hordes of documents on the internet, what are the next steps?. And can the next steps be created so that they can serve the purposes of serious inquiry, e.g., social policy on the one hand, science on the other, designed for students as well as for senior users? When the next steps can be used by students, they end up generating a qualitative improvement in education.

Previous papers in this ‘series’, papers appearing in various journals, have presented a systematized approach to ‘understanding’ how people think. The approach, originally called IdeaMap and then RDE (Rule Developing Experimentation), and now finally Mind Genomics, focused on creating a framework which required users to create four questions, each with four answers [6]. The actual process was to have the user create a study name, come up with the four ‘questions which tell a story’, and then for each question come up with four stand-alone-answers, phrases. The actual process was to mix these standard alone answers (called elements), present the combinations of answers (vignettes), instruct the respondent (survey participant) to rate the vignette on a defined rating scale, one vignette at a time, and then analyze the data to link the elements to the ratings. Figure 1 shows the process.

fig 1

Figure 1: The first steps in the Mind Genomics process. Panel A shows the creation of a study, including the name. Panel B shows the request for four questions which ‘tell a story.’

This exercise, introduced thirty years ago in the early version called IdeaMap® ended up revealing the difficulties experienced with asking good questions. The users of IdeaMap® comprised professionals at market research companies scattered around the world. These users were familiar with surveys, had no problems asking questions, but needed ‘coaching’ on creating questions which ‘told a story’.

As IdeaMap® grew, it became increasingly obvious that many users wanted to create a version of surveys. Users were comfortable with surveys. The requirement for a survey was to identify the different key areas of a topic and instruct the survey-taker to rate each topic using a set of questions prepared by the user. Expertise was demonstrated in the topics that the user selected, the instructions to the survey taker, and occasionally in the analysis. The user who discovered a new subtopic, e.g., one corresponding to a trend, could make an impression simply by surveying that new topic. Others prided themselves on the ability to run surveys which were demonstrably of lower bias and bias-free, or at least pontificated on the need to reduce bias. Still others were able to show different types of scales, and often times novel types of analyses of the results [7]. What was missing, however, was a deeper way to think about the problem, one which provided a new level of understanding.

The Contribution, or Rather the ‘Nudge’ Generated by the User Experience in Mind Genomics

The first task of the researcher after setting up the study is to create the four questions (Figure 1). It is at this step that many researchers become dismayed, distressed, and demotivated. Our education teaches us to answer questions. Standardized scores are based on the performance, viz.., right versus wrong. There is the implicit bias that progress is measured by the number of right answers. The motto ‘no child left behind’ often points to the implicit success of children on these standardized tests. There is no such similar statement such as ‘all children will think critically.’ And, most likely were that to be a motto, it would be laughed at, and perhaps prosecuted because it points to the inequality of point. We don’t think of teaching children to think critically as being a major criterion for advancing them into their education.

The introduction of Mind Genomics into the world of research and then into the world of education by working with young children revealed the very simplicity of teaching critical thinking, albeit in a way which was experiential and adult oriented [6]. Early work with very bright students showed that a few of them could understand how to provide ideas for Mind Genomics, and with coaching could even develop new ideas such as the reasons for WWI or what it was like to be a teenagers in the days of ancient Greece. These efforts, difficult as they were, revealed that with coaching and with a motivated young person one could get the person to think in terms of sequence of topics which related a story.

It was clear from a variety of studies that there was a connection between the ability to use the Mind Genomics platform and the ability to think. Those who were able to come up with a set of questions and then four answers to each question seemed to be quite smart. There were also students who were known to be ‘smart’ in their everyday work, but who were experiencing one or another difficulty while trying to come up with ideas. These frustrated respondents did not push forward with the study. Indeed, many of the putative users of Mind Genomics gave up in frustration, simply abandoning the process. Often they requested that the Mind Genomics process should provide them with the four questions. The answers were never an issue with these individuals, only the questions.

The response to the request for questions ended up being filled by the widespread introduction of affordable and usable AI, in the form of Chat GPT [8]. The inspiration came from the realization that were the questions to be presented to Chat GPT in a standardized form, with the user able to add individuating verbiage it might well be possible to create a ‘tutor’ which could help the user. And so was born Idea Coach, in the early months of 2023, shortly after the widely heralded introduction of Chat GPT to what turned out to be a wildly receptive audience of users.

The early approach of Idea Coach was to allow the user to type in the request for questions, at which point the Idea Coach would return with 30 questions. The sheer volume of putative questions was soon overwhelming, an embarrassment of riches. It was impossible for the user to read the questions and make a selection. Eventually the system was fixed to generate 15 questions rather than 30, to record the questions for later presentation to the user, to allow the user to select questions and re-rerun the effort, or even to edit the questions. Figure 2 shows an example of the request to the Idea Coach, and the return o f a set of questions, along with the hance to select 1-4, or to rerun or to edit the requests and rerun.

fig 2

Figure 2: Screen shots showing the location where the user types in the ‘squib’, viz the prompt (Panel A), and some questions which emerge from an iteration using that prompt.

The ultimate use of the Idea Coach turned out to be a massive simplification in the use of the Mind Genomics program, BimiLeap (Big Mind Learning App), along with the welcome acceptance by school age students who found it easy, and ‘fun’ [9-11]. The effort to create the Idea Coach along with mentoring the young students make it possible for them to do studies, at first guided, and then later on their own. Later on, the Idea Coach would end up providing answers to the questions, with the AI provided the text to the AI in the form of the actual question.

Moving Beyond the Research Process into What Idea Coach Actually Can Contribute

The initial experiences with Idea Coach were confined to setting up the raw material for the Mind Genomics process, namely the specification of the four questions, and then for each question the specification of the four answers. The earliest inkling of the power of Idea Coach to help critical thinking emerged from meetings with two young researchers, both of school age. It was during the effort to set up studies that they asked to run the Idea Coach several times. It was watching their faces which revealed the emerging opportunity. Rather than focusing on the ‘task’, these young school children seemed to enjoy reading the answers, at least for two, sometimes three iterations. They would read the answers and then press re-run, just to see what changed, what new ideas. It was then that the notion f using Idea Coach as a Socratic tutor emerged, a tutor which would create a book of questions about a topic.

Not every user was interested in using the Idea Coach to provide sets of questions for a topic, but there were some. Those who were interested ended up going through the question development process about two or three times, and then moved on, either to set up the study, or in cases of demonstration to other topics outside of the actual experience.

Over time, the Idea Coach was expanded twice, first to give answers as well as to suggest questions, and then to provide am Excel book of all efforts to create questions, and to create answers, each effort generating a separate tab in the Excel book. After the questions and answers had been registered in the study, and even before the user continued with the remaining parts of the set-up (viz., self-profiling classification questions, respondent orientation, scale for the evaluation) the Idea Coach produced a complete ‘idea book.’ The idea book comprised the one page for each iteration, whether question or answer, and then a series of AI-generated summarizations, listed below.

  1. Actual set of 15 questions
  2. Key Ideas
  3. Themes
  4. Perspectives
  5. What is missing
  6. Alternative Viewpoints
  7. Interested Audiences
  8. Opposing Audiences
  9. Innovations

The objective of the summarization was to make Idea Coach into a real Socratic tutor which asked questions, but also a provider of different points of view extractable from the set of 15 questions or 15 answers on a single Excel tab. That is, the Idea Coach evolved into a teaching tool, the basic goal to help the user come up with questions, but the unintended consequence being the creation of a system to educate the user on a topic in a way that could not be easily done otherwise.

The ‘time dimension’ of the process is worth noting before the paper shows the key results for the overarching topic of ‘health + food’. The creation of the squib to develop the questions requires about 2-3 minutes, once the user understands what to do. Each return of the 15 questions requires about 10-15 seconds. The editing of the squib to create a new question requires about a minute. Finally, the results are returned after the user completes the selection of four questions and the selection of four answers for each. A reasonable size Excel-based Idea book with about 30 total pages, questions, answers, AI summarization, in finished form thus emerges within 25-30 minutes. It is important to note that some of the questions will repeat, and there will overlaps from iteration to iteration. Even so, the Idea Coach, beginning at it did to ameliorate the problem of frustration and lack of knowledge ended up being a unique teaching guide, truly a Socrates with a PhD level degree. The correctness of information emerging is not relevant. What is relevant is the highlight of ideas and themes for the user to explore.

How Expressions of the Idea of ‘Health’ Generate Different Key Ideas and Suggested Innovations

Food and health are becoming inseparable, joined together at many levels. It is not the case that food is the same as health, except for some individuals who conflate the two. Yet it is obvious that there exists a real-world, albeit complex between what we eat and how healthy we are. These connections manifest themselves in different ways, whether simply the co-variation of food and health [9], the decisions we make about food choice [12,13], our immediate thoughts about what makes a food healthy or healthful [14], and finally but not least, how we respond behaviorally and attitudinally to claims made by advertisers and information provided by manufacturers [15,16].

The notion of critical thinking emerged as a way to investigate the differences in the way people use common terms to describe food and health. After many discussions about the topic, it became increasingly obvious that people bandied about terms conjoining health and food in many ways. The discussions failed to reveal systematic differences. The question then emerged as to whether critical thinking powered by AI could generate clear patterns of difference in language when different expressions about food and health were used as the starting points. In simple terms, the question became simply like ‘do we see differences when we talk a healthful food versus a health food?’

What Makes a Food HEALTHFUL?

The first phrase investigated about foods and health is ‘What makes a food HEALTHFUL?’ The focus is on the word ‘healthful’ to express the main idea Table 1 shows the question as presented in the squib, the 15 key ideas which emerge, an AI summarization of the key ideas by the new AI program, QuillBot [8,17] and finally suggested innovations based on the ideas. The bottom line for HEALTHFUL is that the output ends up providing a short but focused study guide to the topic created by the interests of the user, open to being enhanced by the user at will, and in reality, in minute.

Table 1: AI results regarding the phrase ‘What makes a food healthful?’ The table is taken directly from the outputs of Idea Coach (key ideas, innovations) and from Quillbot®.

table 1

What Makes a Food HEALTHY?

The second phrase investigated about foods and health is ‘What makes a food HEALTHY? The terms ‘healthy’ and ‘healthful’ are used interchangeably in modern usage, although there is a subtle but profound difference. The word ‘healthful’ refers to the effect that the food has on a third party, such as a person. The word ‘healthy’ refers to the food itself, as if the food were the third party. It is precisely this type of thinking, which is part of the world of critical thinking, although the issue might go further to deal with the different implications of these two words.

The reality of the differences between healthful and healthy is suggested by Table 2, but not strongly. Table 2 again suggests a many-dimensional world of ideas surrounding the word ‘healthy’ when combined with the food. There is once again the reference to the food itself, as well as to the person. The key difference seems to be ‘morphological’, viz., the format of the output of AI. In Table 1 the key ideas were so numerous that the key ideas themselves generated different aspects to each idea. In contrast, Table 2 shows a far sparser result.

One clear opportunity for teaching critical thinking now emerges. That opportunity is to discuss the foregoing observation about the different morphologies of the answers, the reasons which might underly the reasons, and the type of ideas and innovations which emerge.

Table 2: AI results regarding the phrase ‘What makes a food healthy?’ The table is taken directly from the outputs of Idea Coach (key ideas, innovations) and from Quillbot®.

tab 2

Table 3: AI results regarding the phrase ‘What makes a good for health?’ The table is taken directly from the outputs of Idea Coach (key ideas, innovations) and from Quillbot®.

tab 3(1)

tab 3(2)

What Makes a HEALTH FOOD?

The fourth and final phrase investigated is ‘Health Food’. Table 4 shows the results emerging from the AI analysis. Once again AI returns with relatively simple ideas.

Table 4: AI results regarding the phrase ‘What makes a health food?’ The table is taken directly from the outputs of Idea Coach (key ideas, innovations) and from Quillbot®.

tab 4

1. Meal delivery services that focus on providing healthy, balanced meals with optimal nutritional profiles.
2. Cooking classes or workshops that teach individuals how to cook using healthy ingredients and techniques.
3. Apps or websites that provide information on the nutritional content and ingredients of commonly consumed foods and beverages.
4. Nutritional labeling on restaurant menus to make it easier for individuals to make healthier choices when dining out.
5. Community gardens or urban farming initiatives that promote access to fresh, organic produce in urban areas.
6. Policies and regulations that require food manufacturers to disclose the amount of added sugars in their products.
7. Nutrient-dense food products or snacks that provide essential vitamins, minerals, and protein in a convenient and portable form.
8. Schools implementing nutrition education programs that teach children about the importance of healthy eating and the impact of food choices on their overall health.
9. Digital health platforms or apps that offer personalized nutrition plans based on an individual’s specific nutrient needs and goals.
10. Food labeling systems that use color-coded labels or symbols to indicate the nutritional quality of a product, making it easier for consumers to make healthier choices.

Discussion and Conclusions

The objective of this study is to explore the different ways of learning how to ask questions. A great deal of today’s research follows the path of the so-called ‘hypothetico-deductive’ system. The researcher begins with a hypothesis and runs an experiment to confirm or disconfirm that hypothesis, viz., to falsify if possible. The focus is often on the deep thinking to link the hypothesis to the experiment, then to analyze the results in a way which provides a valid answer [18]. The vast majority of papers in the literature begin with this approach, with the actual science focusing on the ability to test the hypothesis, and maybe add that hypothesis to our knowledge, a task often colloquially called ‘plugging holes in the literature.’

Mind Genomics, an emerging approach to the issues of everyday life, does not begin with hypothesis, and does not the scientific logic of Popper, and the notion of hypothesis drive research. Instead, Mind Genomics begins as an explorer or cartographer might begin, looking for relations among variables, looking for regularities in nature, without however any underlying hypothesis about how nature ‘works’. As a consequence, the typical experiment in Mind Genomics begins by an interesting conjecture about what might be going on in the mind of a person regarding a topic. The outcome of a set of Mind Genomics experiments ends up being an aggregate of snapshots of how people think about different topics, this collection of snapshots put into a database for others to explore and summarize.

With the foregoing in mind, the topic of coming up with interesting questions becomes a key issue in Mind Genomics. If the approach is stated simply as ‘asking questions, and getting answers to these questions’, with no direct theory to guide the question, then in the absence of theory how the system can move forward? The science of Mind Genomics is limited to the questions that people can ask. How can we enable people to ask better questions, to explore different areas of a topic with their questions. And in such a way expand this science based on question and answer.

Acknowledgment

Many of the ideas presented in this paper have been taken from the pioneering work of the late Professor Anthony G. Oettinger of Harvard University, albeit after a rumination period going on to almost 60 years [19].

References

  1. Chin C, Brown DE (2002) Student-generated questions: A meaningful aspect of learning in science. International Journal of Science Education 24: 521-549.
  2. Washburne JN (1929) The use of questions in social science material. Journal of Educational Psychology 20: 321-359.
  3. Huitt W (1998) Critical thinking: An overview. Educational Psychology Interactive 3: 34-50.
  4. Willingham DT (2007) Critical thinking: Why it is so hard to teach? American Federation of Teachers Summer 2007: 8-19.
  5. Hoffmann B, Barzun J (2003) The tyranny of testing. Courier Corporation.
  6. Moskowitz HR (2012) Mind Genomics’: The experimental, inductive science of the ordinary, and its application to aspects of food and feeding. Physiology and Behavior 107: 606-613. [crossref]
  7. Slattery EL, Voelker CC, Nussenbaum B, Rich JT, Paniello RC, et al. (2011) A practical guide to surveys and questionnaires. Otolaryngology–Head and Neck Surgery 144: 831-837.
  8. Fitria TN (2021) QuillBot as an online tool: Students’ alternative in paraphrasing and rewriting of English writing. Englisia: Journal of Language, Education, and Humanities 9: 183-196.
  9. Kornstein B, Rappaport, SD, Moskowitz H (2023a) Communication styles regarding child obesity: Investigation of a health and communication issue by a high school student researcher using Mind Genomics and artificial intelligence. Mind Genomics Studies in Psychology Experience 3: 1-14.
  10. Kornstein B, Deitel Y, Rapapport SD, Kornstein H, Moskowitz H (2023b) Accelerating and expanding knowledge of the everyday through Mind Genomics: Teaching high school students about health eating and living. Acta Scientific Nutritional Health 7: 5-22.
  11. Mendoza CL, Mendoza CI, Rappaport S, Deitel J, Moskowitz H (2023) Empowering young people to become researchers: What do people think about the different factors involved when shopping for food? Nutrition Research and Food Science Journal 6: 1-9.
  12. Caplan P (2013) Food, health and identity. Routledge.
  13. Rao M, Afshin A, Singh G, Mozaffarian D (2013) Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ open 3: p.e004277. [crossref]
  14. Monteiro CA (2009) Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutrition 12: 729-731. [crossref]
  15. Bouwman LI, Molder H, Koelen MM, Van Woerkum CM (2009) I eat healthfully but I am not a freak. Consumers’ everyday life perspective on healthful eating. Appetite 53: 390-398. [crossref]
  16. Nocella G, Kennedy O (2012) Food health claims–What consumers understand. Food Policy 37: 571-580.
  17. Ellerton W (2023) The human and machine: OpenAI, ChatGPT, Quillbot, Grammarly, Google, Google Docs, & humans. Visible Language 57: 38-52.
  18. Kalinowski ST, Pelakh A (2023) A hypothetico-deductive theory of science and learning. Journal of Research in Science Teaching.
  19. Bossert WJ, Oettinger AG (1973) The integration of course content, technology and institutional setting. A three-year report. 31 May 1973. Project TACT, Technological Aids to Creative Thought.

Women-Led Climate Change Solution Satellites: A Key Contributor to Social and Economic Empowerment of Women in Uganda

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DOI: 10.31038/AWHC.2024711

Abstract

Background: Climate change poses a significant threat to communities across the globe. Whereas low and middle income countries contribute the least to this problem, they are often most affected by the consequences. In addition, women are often disproportionately affected by climate change-related occurrences. To address these issues, Women Climate Centers International (WCCI) Uganda initiated a project to empower women through the promotion of climate change solution enterprises in Uganda. The purpose of this research was to establish the impact of this approach on women social and economic empowerment and quality of life.

Methods: The study employed a cross-sectional approach, collecting both quantitative and qualitative data among 96 women purposively selected for their involvement in WCCI climate-smart enterprises in Uganda. A digitized structured questionnaire was used to gather quantitative data while a structured Focus Group Discussion (FGD) guide were used to aid qualitative data collection. The quantitative data was analyzed statistically using Stata version 15 to provide descriptive and statistics while Atlas ti9 was used to thematically analyze the qualitative data after transcribing of audios recorded during the interviews.

Results: About 38% (36/96) of the women make briquettes, 51% (49/96) make soap and 95.8% (92/96) are generating income from the enterprises. More than half 59.4% (57/96) of the women are confident in running their businesses sustainably while 38.5% (37/96) had trained 4-5 community women each, with the knowledge obtained from the satellites. Over 62% (59/96) of women strongly agreed to an improved sense of belonging within their community, 94.8% (91/96) noticed an improvement in their community engagement and collaboration while 63.5% (61/96) strongly agreed to better treatment from family and neighborhood. Conversely, 22.9% (22/96) of the women had ever experienced intimate or gender-based violence in their life, half of these had experienced it in the previous six months, but only 18.2% (2/11) would attribute their recent experience to engaging in entrepreneurship under WCCI. Economically, 57.3% (55/96) of the women saw a significant increase in their income, and 56.3% (54/96) in their household income. About 76% (73/96) had acquired some personal or household assets using income from the enterprises, and 65% (62/96) had joined a women’s group, Savings and Credit Cooperative Organization (SACCO), or local governing bodies since their training with WCCI. Furthermore, 82.3% mentioned that there was a positive difference in the way their husbands treated them ever since they attained financial independence. Lastly, the majority of the women, 63.6% (61/96) strongly agreed, and 29.2% (28/96) agreed that their quality of life and well-being had improved since becoming part of the climate change solution satellites. The qualitative findings strongly corroborated the quantitative.

Conclusions: Overall, participation in these entrepreneurial initiatives has brought about tangible improvements in social cohesion, economic empowerment, and the perceived quality of life and well-being for a significant majority of women involved, demonstrating the positive impact of the WCCI climate change solution satellites on their lives and communities.

Keywords

Women-led, Climate change solution satellites, Entrepreneurship, Empowerment

Introduction and Background

Globally, women and girls from marginalized communities face intersecting challenges related to gender inequalities, economic empowerment, and the profound impacts of climate change [1-3]. Regarding climate change, the complex web of vulnerabilities that these women encounter is rooted in a global context where women are both disproportionately affected by the adverse consequences but underrepresented in efforts to address and mitigate these effects [4]. The African region has witnessed an increase in average temperatures, changes in rainfall patterns, and an increase in extreme weather events such as floods, droughts, and conflicts over natural resources, which exert a disproportionate toll on the developing world including Uganda [3,5,6]. These climate shocks have significant implications for agriculture, food security and livelihoods [1,7] and burdensome for women, as they play crucial roles in agricultural production, water collection, natural resource management, and household well-being [8].

While the concept of climate-smart enterprises is gaining traction in East Africa, women-led initiatives in this sector remain scarce [9]. Recognizing the critical need to address these interconnected challenges, Women Climate Centers International (WCCI) [10], embarked on a transformative initiative in Uganda. This initiative sought to empower women through comprehensive training encompassing climate-smart solutions, livelihood strategies, and economic and social empowerment. In the first project year, WCCI has engaged 100 women and girls organized in 10 women-led grassroots groups that belong to 3 different satellites (Gomba, Butambala and Mukono), seamlessly integrating women’s entrepreneurship with grassroots climate resilience initiatives. Through these groups, WCCI conducted extensive trainings, emphasizing climate-smart solutions, livelihoods, and economic and social empowerment, leadership, and management, and fundamental entrepreneurship skills. WCCI trained the women in making climate-smart products such as briquettes, liquid and bar soap, herbal vaseline, fireless stoves, water tanks/jars, and bio-sand filters. The women were also trained to engage in Vermiculture, Agroforestry farming, and Bio-intensive farming including double digging, moist gardens, sack gardens, mixed cropping and mushroom growing, apiary (and liquid manuring year-round food production. Furthermore, WCCI Uganda facilitated the establishment and registration of the 10 women-led enterprises, with full support throughout the registration process. This registration made these enterprises eligible for government funding via the community demand-driven development funds especially the Parish Development Model [11]. WCCI offered 4 full days of training in business development and planning to all 100 women to ensure that they have the needed skills to develop, plan, and run their businesses. WCCI also provided vital business support equipment tailored to each satellite’s needs, ensuring they could efficiently produce, sell, and thrive. Importantly, these innovative approaches are expected to extend WCCI’s impact beyond parishes, fostering sustainable social and economic empowerment and quality of life within communities.

This innovative approach aimed to foster community-driven strategies from a single learning and training center (satellite) for long-term climate adaptation, mitigation, and resilience, including carbon sequestration. Through targeted training programs, mentorship, access to finance, and networking opportunities, women can enhance their entrepreneurial capabilities, understand the principles of climate-smart practices, and develop innovative business models that are environmentally sustainable and socially inclusive. Ultimately, by fostering the establishment of women-led climate smart enterprises, Uganda can unlock the untapped potential of women, create sustainable livelihoods, and promote economic resilience and sustainable practices in the face of climate change. Central to this initiative is the aspiration to establish women-led climate-change solution enterprises, recognizing the critical role women can play in driving economic growth, creating employment opportunities, and advancing gender equality and social inclusion. By aligning with Uganda’s National Development Plan 3 [12], these enterprises aim to serve as catalytic models for sustainable community development.

As these enterprises continued on their transformative journey, it was essential to evaluate the holistic impact on the social and economic empowerment and quality of life of the women involved, as well as any unintended consequences such as gender-based violence. The research sought to illuminate the transformative potential of the one-stop climate change solution center model, exemplified by these satellite initiatives, to contribute insights to inform future initiatives, strengthening WCCI’s mission to empower women and communities in their pursuit of climate resilience, economic growth, and enhanced overall wellbeing.

The Study Methods

Study Design and Study Area

The study employed a cross-sectional approach, collecting both quantitative and qualitative data from the women. The study was conducted in the three intervention groups including Gomba, Butambala and Mukono. The three districts are located in the central region of Uganda. Gomba district is a rural district which was formed in 2010 by an Act of Parliament, breaking away from Mpigi District. It is bordered by Mubende District to the west and north, Mityana District to the northeast and Butambala District to the east. Kalungu district, Bukomansimbi district and Sembabule district lie to the south of Gomba district. The district lies approximately 97 kilometers (60 mi), by road, southwest of Kampala, the capital and largest city of Uganda. Gomba district receives lower precipitation than the neighbouring districts and livestock farming is a major economic activity, supplemented with subsistence agriculture [13]. Butambala district was too created by an act of parliament, and became operational on 1 July 2010, having been split off of Mpigi district. This district is bordered by Gomba district to the west and north-west, Mityana District to the north-east, Mpigi District to the east and south, and Kalungu District to the south-west. The district headquarters at Gombe are approximately 68 kilometers (42 mi), by road, south-west of Kampala. Subsistence agriculture and small-scale animal husbandry are the backbone of Butambala district’s economy [14]. Mukono district is one of the fastest growing areas in Uganda and is located along the Kampala-Jinja highway. The district is bordered by Kayunga district to the north, Jinja district to the east, Kalangala district to the south-west, Kira Town and Wakiso district to the west, and Luweero district to the north-west. The town of Mukono is about 21 kilometers (13 mi) by road, east of Kampala. The district has a favorable climate, abundant rainfall, rich flora and fauna, and proximity to urban areas [15].

Study Population

Data was collected from women actively engaged in climate change solution satellites supported by Women Climate Centers International (WCCI) Uganda.

Sample Size and Sampling

Of the 100 women currently supported by through the satellites, 96 were engaged in this study and 4 were unavailable at the time of data collection. All the 96 participants were selected purposively because of being beneficiaries of the program. Both quantitative and qualitative data were collected from the same participants.

Data Collection Criteria

A digitized Kobo collect toolbox questionnaire was used to conduct surveys with the participants to gather quantitative data on specific aspects of their experiences and observations related to the contribution of climate change solution satellites. The surveys included predefined questions covering areas such as economic empowerment, social cohesion and collaboration, climate change knowledge, and quality of life.

Qualitatively, a structured Focus Group Discussion (FGD) guide was used to elicit data to complement the surveys. A total of six FGDs were conducted, two per district and each FGD comprised 10 women. The FGDs were moderated by a male qualitative data collection expert who was assisted by a female note taker. These FGDs were conducted in Luganda, the local dialect, and focused on open-ended questions that encouraged participants to share their experiences and perceptions in more detail.

Quality Control and Assurance

Both qualitative and quantitative tools were translated to Luganda and the researchers ensured to only recruit research assistants who were conversant with Luganda, the local dialect. Research assistants with a good command of English were recruited to conduct interviews, however, the interviews were conducted in a language most comfortable to the respondent. Research assistants were trained on the research protocol and ethical issues surrounding the study. To ensure data accuracy and consistency, the digitized tool was designed with skips, hints, and prompts to ensure that the research assistants filled in the data the way they were supposed to. Furthermore, the research assistants were supervised during the actual data collection exercise. The supervisors ensured that the tool was checked and field edited, if necessary, to ensure completeness of data before data entry.

Data Management and Analysis

Quantitative Data: Quantitative data was field edited for consistency and accuracy daily. Data materials were secured under lock and key and were only accessed by the study team. The data was downloaded from the Kobo collect web-based server, accessible on the link; (https://eu.kobotoolbox.org/#/forms/aN7ejaQfnbe4dGyp53YySM/data/table) and loaded onto Microsoft Excel for further cleaning and visualization. The data was then imported to STATA version 15 for statistical analysis. Descriptive analysis was done to generate the mean and the standard deviation for continuous variables and proportions for categorical variables. Frequency tables as well as figures were used to present these results.

Qualitative Data: All qualitative interviews were digitally recorded with permission from respondents and transcribed verbatim. The transcripts were proofread before importing them into a qualitative data management software-Atlas.ti9. Data coding and analysis were conducted subsequently. An initial codebook using a sample of two transcripts was developed. The developed codebook was then applied to the entire atlas project with any emerging codes being added in the process. Thematic analysis was used and results were presented using themes with typical quotations from different interviews to summarize social cohesion and collaboration, economic empowerment, and quality of life and well-being.

Results

Socio-demographic Characteristics of the Study Respondents

A third 33.3% (32/96) of the women were aged between 26-30 years, 44.8% (43/96) were of the Anglican religion, 67.7% (65/96) were married and 75% (72/96) had attained the primary level of education. The majority 41.8% (40/96) were from Gomba district (Table 1).

Table 1: Socio-demographic characteristics of the women engaged in climate change solution satellite enterprises in Uganda.

Variable

Category Frequency (n=96)

Percentage (%)
Age 18-25

13

13.5

26-30

32

33.3
31-35

27

28.1
36+

24

25.0
Religion Anglican

43

44.8
Catholic

29

30.2
Pentecostal

17

17.7
Muslim

7

7.3
Marital status Never married

16

16.7
Married

65

67.7
Separated/divorced

15

15.6
Education level Primary level

72

75%
Secondary level

22

22.9
Tertiary level

2

2.1
District of residence

Gomba

40

41.8
Butambala

26

27.1
Mukono

30

31.3

Status of Women-led Climate Solution Satellite

Table 2 shows the status of the women-led climate change solution satellites in Uganda. All women involved in the study were part of a satellite. About 38% (36/96) were engaged in briquette making while 51% (49/96) were making soap. The majority of the respondents 70.8% (68/96) mentioned that their enterprises were registered with the district authorities while 95.8% (92/96) mentioned that their businesses were generating them income. About 18% (17/96) faced taxes and licensing as a main challenge, 13% (12/96) faced issues with the market for their products while 11.5% (11/96) found scaling and growth difficult. Additionally, on a scale of 1-10, the mean(SD) level of confidence to run the enterprise sustainably was 6.8(1.81), while 59.4% (57/96) of the women rated their confidence between 7-10. More than a third of the women, 38.5% (37/96) had trained up to 5 or more community women each, with the knowledge obtained from the satellites.

Table 2: Status of Women-led Climate Solution Satellites in Uganda

Variable

Categories

Frequency (n=96)

Percentage (%)
Climate change solution – products being made Briquettes

36

37.5
Water tanks/bio-sand filters

2

3.1
Fireless cook stoves

9

13.9
Agro-forestry farming

11

16.9
Bio-intensive farming

3

4.6
Soap making

49

51.0
Others

17

26.1
Enterprise registered with the district authorities? Yes

68

70.8
No

28

29.2
Is the business generating you any income yet Yes

92

95.8
No

4

4.2
Challenges faced in running the enterprise Taxes and licensing

17

17.7
Market for products

12

12.5
Scaling and growth

11

11.5

Risk management

9

 13.9

Others

1

1.5
Rate your level of confidence in running the enterprise sustainably

Mean(SD)=6.80(1.81)

 1-3

4

4.2
4-6

35

 36.5

7-10

 57

59.4
Number of women personally trained with the knowledge from the satellite 0-1

40

 41.7

2-3

 19

19.8
4-5

37

38.5

Qualitatively, six focus group discussions were held with the women. These brought forward insights across the three districts of Gomba, Butambala, and Mukono, highlighting the collaborative nature of product-making among small groups, both for personal gain and communal development. Participants emphasized mutual support, group training, and the positive impact of acquired skills, enabling them to engage in various income-generating activities, from making briquettes and soap to cultivating vegetables and trees. Notably, the cultivation of home vegetables emerged as a significant achievement, not only economically but also in enhancing household food security and familial support. Respondents were quoted saying;

“We are in groups; some are of 10 people others 15 but not more than that. In most cases we do our things together, as in as the big group for the district. We come together for trainings and even for making our products. We support each other in case one of us has a problem. Most of us make these products as a group but also as individuals and we sell them in our communities.” (Participant 1, FGD, Gomba district)

“They told us to assist 5 other women each and some of us have gone beyond that. We gather the women and teach them. Sometimes, you team up with a politician and they help to teach the people which encourages community development.” (Participant 3, FGD, Gomba district)

“Ever since we joined the trainings, we learned so much. We make briquettes, liquid soap, tablet, and bar soap, we also make Vaseline. We have done so many things which have helped us to generate income and save.” (Participant 1, FGD, Butambala)

“We also cultivate nursery beds; we donate and plant some of our trees in schools freely. We make charcoal, soap, and cooking stoves and sell them to people. We also cultivate leafy vegetables because almost all the ladies here have homegrown vegetables, which they sell to people.” (Participant 2, FGD, Gomba)

“The cultivation of home vegetables is so good because it’s amazing for visitors when they find your yard full of vegetables. Then our husbands used to purchase vegetables from the market when they found those that they liked like Nakatti, but now they find it at home.” (Participant 3, FGD, Gomba)

“I have found growing crops as the easiest for me. We were taught how to look after banana plants, and coffee plants, which helped us to cultivate even without fertilizers since we use the home trash as manure in our gardens to be able to pay our children’s school fees.” (Participant 8, FGD, Mukono)

Social Cohesion and Community Engagement among the Women

The majority of the women, 61.5% (59/96) strongly agreed that their participation in the women-led climate change solution satellites had improved their sense of belonging within their community, 94.8%% (91/96) noticed an improvement in their community engagement and collaboration since their involvement in the enterprise, while 63.5% (61/96) strongly agreed that their family treats them better ever since joining the satellites. A similar proportion further strongly agreed that people in their neighborhoods treat them better since joining the women-led climate change solution satellites (Table 3).

Table 3: Social cohesion and community engagement among the women engaged in climate change solution satellites.

Variable

Category

Frequency (n=96)

Percentage

(%)
Participation in the women-led climate change solution satellite improved my sense of belonging within my community. Strongly agree

59

 61.5

Agree

 34

35.4
Neutral

3

 3.1

Noticed an improvement in community engagement and collaboration since involvement in the satellite activities?

Strongly agree

 41

42.7

Agree

 50 52.1

Neutral

 5

5.2
My family treats me better since joining the women-led climate change solution satellite Strongly agree

61

 63.5

Agree

 29

30.2
Neutral

6

 6.3

People in my neighborhood treat me better since joining the women-led climate change solution satellite

Strongly agree

 61

63.5
Agree

32

 33.3

Neutral

 3

3.1

The narratives from the FGDs revealed profound shifts in social dynamics due to the collaborative efforts within WCCI projects. Participants emphasized the development of robust relationships transcending geographical boundaries. The once fragmented communities now exhibit solidarity, as evidenced by the warm welcome received in various households across different towns. Moreover, the newfound friendships extended beyond project members, fostering positive interactions with neighboring villages. This solidarity was born from a spirit of collaboration, where knowledge sharing and support became the norm. The collective efforts in constructing local stoves and utensil stands showcased a shared commitment to cleanliness and community welfare. The projects acted as catalysts for forming friendships, bridging gaps, and nurturing a sense of mutual admiration and respect, ultimately enhancing social cohesion and fostering a network of supportive relationships within these communities.

“We have developed very good relationships, I live in Kanyonyi town council, and I didn’t know any ladies from Kifampa, Mpenja or Kabulassobi, but as of now, once you arrive at the home of one of your project colleagues, even their children welcome you to the home which portrays a good working relationship. Additionally, on the villages where we train ladies, the relationships there are very good because back then ladies used to be very jealous of us, but right now they are not jealous anymore. They realize that once we learn something, we mobilize and teach them, which has improved our relationships with people so much, and even their husbands are very supportive of us because they see the good we are doing with their wives.” (Participant 5, FGD, Gomba”

This project has aided us so much as ladies, we mobilize ourselves and go to a colleague’s home and construct for them a local stove, and a utensil stand all in the fight for cleanliness. (Participant 7, FGD, Butambala)

 “The people in the places where we reside became our friends. They know when we are supposed to come for the project meetings and even remind us. Some ladies come to us and want to support us while others request to join our program. We are admired and we are held in high regard wherever we reside.” (Participant 1, FGD, Mukono)

“We have made friends we wouldn’know if it wasn’t for this project. We have made friends from various communities, so I am personally happy about this.” (Participant 8, FGD, Gomba)

Intimate Partner and Gender-Based Violence Experiences

Table 4 shows experiences related to an intimate partner or gender-based violence. Overall, 22.9% (22/96) of the women had ever experienced intimate/ gender-based violence in their life. Of these, half, 50% (11/22) had experienced it in the previous six months, but only 18.2% (2/11) would attribute their experience to engaging in entrepreneurship. The majority 74% (71/96) of the respondents agreed that they have seen an improvement in the way their husbands treat them since they joined the satellites.

Table 4: Intimate partner and Gender-Based violence experiences among the women engaged in climate change solution satellites in Uganda.

Variable

Category Frequency (n=96)

Percentage

(%)
Ever experienced any intimate partner or gender-based violence in your life Yes

22

 22.9

No

 74

77.1
Experienced any intimate partner or gender-based violence in the last 6 months. Yes

11

 50.0

No

 11

50.0
Would you attribute this violence to your engagement in entrepreneurship Yes

2

 18.2

No

 9

81.8
Noticed improvement in the way my partner treats me since I joined WCCI Strongly agree

11

 11.5

Agree

 71

74.0
Neutral

8

 8.3

Strongly disagree

 6

6.2

The narratives indicate a tangible positive impact on reducing intimate partner and gender-based conflicts through increased education, shared responsibilities, financial empowerment, and altered perceptions of women’s roles within their households and society. Participants noted a distinct transformation in family dynamics, citing fewer reported cases of marital conflicts and domestic violence since the inception of the programs. Increased education and engagement in income-generating activities emerged as pivotal factors redirecting attention away from potential conflict points. The shared responsibilities and shared understanding cultivated through the trainings contributed to more harmonious households, characterized by decreased tension and fewer disputes over childcare and financial obligations. Moreover, the financial independence and changed perceptions of women’s value within households led to a shift in power dynamics, generating respect and diminishing instances of disrespect and marital discord.

“I am the senior woman in my community and back then I was always called to settle cases of women fighting with their husbands all the time, but ever since we started mobilizing ladies to come for these project trainings, ladies now have what things to do. To be honest I have now spent 5 months without being called for such family fights, but before, I used to attend to cases for like 2 families each day. Right now, those cases are unheard of, even at the police station ladies are no longer reporting such cases, which is a good change that’s been brought by these projects.” (Participant 5, FGD, Gomba)

On the issue of family fights, ever since I started coming for these projects, I got enough education to now understand how to handle my family. Secondly, I have things that take up my time compared to the gossip I used to be involved in to try and find out what my husband has been up to. I now have things to occupy me because if I am not doing home chores, I am running my businesses which takes up most of my time and leaves me no time for fights. I now have a lot to do to avoid such fights at home.” (Participant 7, Mukono)

“… before we used to be fighting with the men to take care of the children and their fees. But now we came to terms with our husbands, and they too got some education about shared responsibilities and now there is less fighting in homes. Life has really changed so much.” (Participant 4, FGD, Butambala)

“To add on, even my own husband now sees high value in me and cannot easily mess around with other women. This is because he must first consider whether the person he is messing with can favorably compete with me, and these projects have weighed us up so much on the men’s weighing scale, for which I am so grateful.” (Participant 10, FGD, Mukono)

“Before, I was so disrespected at home because even when he asked me what I had to offer, I couldn’t even show a penny. But now those words cannot come out of him because he knows that I have personal money now. So, that alone brought my home at peace and now we can sit and agree on certain issues, and he calmed down the disrespect he had towards me. That helped me even in society in that whenever they see me, there’s respect because I changed so much and they ask themselves whether I stole the money from someone, they think I went to the Statehouse, but I don’t even know where it is, I just do my projects.” (Participant 2, FGD, Gomba)

Contribution of the Women-led Climate Change Solution Satellites on Individual and Household Income and Financial Stability

Table 5 shows the contribution of the climate change solution satellites to the economic empowerment of women in Uganda. More than half 57.3% (55/96) of the women mentioned that participating in the satellite activities significantly increased their income, 56.3% (54/96) saw some improvement in their household income and 76% (73/96) had acquired some personal or household assets using income from the enterprise. Electronics (42.7%), furniture (24%), and rented/bought land (21.9%) were the most mentioned assets that were acquired by the women. Over 76% (73/96) of the women plan to acquire assets in the future using income from the satellite enterprises.

Table 5: Contribution of the women-led climate change solution satellites on individual and household income and financial stability in Uganda.

Variable

Category Frequency (n=96)

Percentage

(%)
The participation in the climate change solution satellite affected individual income Increased significantly

55

 57.3

Increased moderately

 36

37.5
Remained unchanged

5

 5.2

The enterprise had a noticeable impact on household income and financial stability

Considerable improvement

 42

43.7
Some improvement

54

 56.3

Acquired personal or household assets with income from the climate change solution satellite

Yes

 73

76.0
No

23

 24.0

If yes, which assets were acquired so far

Rented/bought land

 21

21.9
Constructed a house, roofed/repaired a house

19

 19.8

Car, truck, bicycle, motorcycle

 3

3.1
Furniture

23

 24.0

Electronics

 41

42.7
Others

30

 31.3

Plan to acquire any other assets in the coming 3 months

Yes

 73

76.0
No

23

 24.0

If yes, which assets

Electronics

 13

13.5
Furniture

19

 19.8

Land

 31

32.3
Construct house

17

 17.7

Car, truck, motorcycle

 7

7.3
Others

27

28.1

Qualitatively, participants highlighted tangible improvements in their standards of living, evident through enhanced household conditions and increased financial stability. Engaging in skill-building activities such as liquid soap making and briquette production became collective family endeavors, involving both children and spouses, resulting in augmented household income. The acquired skills not only boosted individual businesses but also elevated their marketability, as exemplified by one participant’s improved catering services and the plan to acquire business transportation assets. Participants expressed a newfound self-control toward expenditure, demonstrating a shift from impulsive spending habits to thoughtful financial management. They acknowledged the significance of savings, with aspirations to invest in property or business expansions, showcasing a long-term commitment to financial growth and sustainability. These narratives collectively illustrate the tangible impact of climate change solution projects on individual and household incomes, fostering financial prudence.

“I see an improvement in the standards of living amongst all the women, especially those of us who manage our money well. Even our homes have improved in standard too.” (Participant 3, FGD, Butambala)

“Yes, it has helped us with the children, in that they have learnt some of these skills like liquid soap making, because they actively participate while we make it at home. We make briquettes and they also participate, as well as the husbands too, so more money comes in for all of us.” (Participant 4, FGD, Mukono)

 “As a catering person, I saved money from these projects and invested in my business and this made me exemplary and marketable because my services were improved. I bought tents and chairs which made me a very presentable service provider and my services were highly demanded. I desire to purchase a vehicle that can transport my business assets in the future and in God’s name I know that I will purchase it.” (Participant 1, FGD, Gomba)

“Back then as ladies we never used to mind how much we had versus what we spent. Hawkers used to come around our communities and we would buy from almost all of them, but that has changed now. You must assess whether you need that item being hawked and ask yourself how much you made in the past month, and what improvements you need to make in your business, before purchasing say a bed cover from a hawker. Ever since we were trained, ladies have now learnt the importance of money, they appreciate saving and they know their responsibilities. It’s hard to find a lady who doesn’t save now.” (Participant 7, FGD, Butambala)

“Personally, I save the money I get from my business and in my saving group, we split profits annually so, I’ll be getting my share on 12th December and I want to use those savings to purchase an acre of land because I want to rear my cow on the same land as I live. So, I am hopeful that in the coming year, I will achieve it.” (Participant 6, FGD, Gomba)

Meaningful Participation of the Women in Livelihood/Economic Decision-making

About 65% (62/96) of the women had joined a women’s group, Savings and Credit Cooperative Organization (SACCO), or local governing body since their training with WCCI and 46.8% (29/62) had a leadership position in that body. Of those with leadership positions, 37.9% (11/29) were at the level of chairperson/vice chairperson while the rest were at secretary, treasurer, mobilizer or councilor level. Additionally, 79.3% (23/29) of the women in leadership rated high, the impact of the WCCI training on their decision to join leadership. Desire for personal growth and development (79.3%), Recognition of my abilities and potential (69%), and Desire to create a positive change (55.2%) were the most mentioned reasons for taking up leadership positions. Furthermore, 47.9% (46/96) jointly made economic/livelihoods decisions with their husbands, 81.2% (78/96) had recently been involved in livelihood/economic decisions while 82.3% mentioned that there was a positive difference in the way their husbands treat them ever since they started making their own money and being empowered. Less than a quarter 22.9% (22/96) acknowledged that their husbands do not support their work with the enterprise (Table 6).

Table 6: Meaningful participation of the Women in livelihood/economic decision-making opportunities at community and household level in Uganda.

Variable

Category Frequency

(n=96)

Percentage

(%)
Joined a women group, SACCO or local governing body since the training with WCCI Yes

62

 64.6

No

 34

35.4
Hold a leadership position on that women group, SACCO or local governing body Yes

29

 46.8

No

 33

53.2
Leadership position held on the women group or local leadership body or committee Chairperson/vice chairperson

11

 37.9
Secretary/treasurer/mobilizer/councilor 18

62.1
Rate the impact of the training on your decision to join leadership and ability to serve in that capacity High impact

23

 79.3

Moderate impact

 6

20.7
Reasons for deciding to take up this leadership position Desire for personal growth and development

23

 79.3

Passion for climate change cause

 14

48.3
Recognition of my abilities and potential

20

 69.0

Desire to create positive change

 16

55.2
Need for representation and gender equality

6

 20.7

Previous experience

 1

3.5
Previously engaged in any advocacy meetings supporting women economic empowerment in your community Yes

51

 53.1

No

 45

46.9
In your household, who primarily makes decisions regarding economic activities and livelihoods Husband/male household member(s)

12

 12.5

Jointly made by and female household members

 46

47.9
Respondent/female household members

35

 36.5

Others

 3

3.1
Recently been involved in any livelihood/economic decision Yes

78

 81.2

No

 18

18.8
If yes, specify the type of livelihood/economic decision-making activities you have been part of. Income generation and business planning

67

 44.7

Investment decisions

 43

28.7
Market research

4

 2.7

Pricing and sales strategy

 3

2.0
Financial management and budgeting

31

 20.7

Others

 2

1.3
Make my own decisions regarding spending income Yes

80

 83.3

No

 16

16.7
Keep and spend my income by myself Yes

81

 84.4

No

 15

15.6
If no, who keeps or spends your income My husband

13

 86.7

Other person

 2

13.3
Okay with this, does this happen because of a mutual understanding between you and your partner Yes

83

 86.5

No

 13

13.5
Come for trainings and meetings with the knowledge of husband Yes

81

 84.4

No

 15

15.6
If No, does he stop you from coming for training/meetings? Yes

81

 84.4

No

 15

15.6
Noticed a difference in the way husband treats you since starting making own money and being empowered No difference

17

 17.7

Yes, positive difference

 79

82.3
Husband doesn’t support my work with the enterprise Agree

22

 22.9

Neutral

 15

15.6
Disagree

17

 17.7

Strongly disagree

 42

43.8

In the realm of livelihood and economic decision-making, the narratives from FGD participants highlighted the impact of WCCI initiatives on women’s empowerment and assertiveness in various spheres. Participants mentioned a transformation in self-perception and assertiveness, indicating newfound confidence and self-esteem among participants. The program also cultivated the courage to engage actively in public forums, a stark contrast to previous shyness and avoidance of meetings. Furthermore, the narratives conveyed the evolution of participants into role models and trainers, and hence can be consulted on various aspects. Crucially, participants shared instances of enhanced agency in economic decision-making within their households. The shift from a scenario where men previously controlled household finances to a situation where women assertively communicate their plans while maintaining harmony in decision-making signifies a tangible shift in gender dynamics and increased agency for women in economic matters.

“WCCI has been helpful to some extent because it has created a working relationship with the government and they both know and respect each other. In my observation, WCCI has helped to make us strong women who believe in ourselves in that if you have decided to do something, you must believe it in your heart. We are on committees that are making decisions in our communities.” (Participant 3, FGD, Gomba)

“I have gained a lot of self-esteem, even when speaking in public I am more confident compared to before when I used to be shy and sometimes, I would even dodge the meetings but it’s not the case anymore and whenever I am phoned, I know that I have an important call to which I respond.” (Participant 2, FGD, Butambala)

“The other thing I’ve gained is that I have become an example for other ladies, and I am also a trainer to them of the skills I gained.” (Participant 5, FGD, Mukono)

“We used to have money back then, and the men would take it from us. But now, when he asks for it, I tell him that I have plans for my money and we still come to an agreement, without him thinking that I have refused to give him money, but I have other things to use it for.” (Participant 5, FGD, Gomba)

Overall Quality of Life and Well-being among the Women

When asked if their overall well-being and quality of life have improved since becoming part of the climate-smart enterprise, the majority of the women, 63.6% (61/96) strongly agreed, 29.2% (28/96) agreed and 5.2% (5/96) were neutral. None of the women disagreed (Figure 1).

FIG 1

Figure 1: Perception on quality of life and overall wellbeing among the women

Through the diverse discussions, participants conveyed transformative personal and communal changes spurred by engagement in WCCI projects. These initiatives not only empowered women economically but also fostered improved family dynamics and social recognition. Participants highlighted a shift in household dynamics, with husbands now supportive and involved, and even prompting participation in the projects. Moreover, individual transformations were evident, reflected in enhanced self-esteem, improved appearance, and upgraded living standards. Participants celebrated tangible improvements in cleanliness, financial independence, diversified diets, and sustainable practices, demonstrating a profound shift in mindset towards environmental stewardship.

“… before, our husbands would get angry whenever we left home to come engage in such projects, but now they are steadily adjusting because we are very open about the dates when the projects will take place. So, the men have calmed down on realizing how much these projects have aided us. Even expenditures at home weighed down on men since we are now able to chip in on some of the home expenses. The husbands now even remind us of the dates when we are supposed to attend the projects. The improvement has been so evident in that even the children acknowledge that back then, they used to be chased from school due to lack of school fees, but now it’s no more.” (Participant 2, FGD, Gomba)

“I did not look like this before, the first thing I did with my money was to make sure I look good, and I am no longer looked down upon wherever I go. So, I see a big improvement from the ratchet I used to be to now looking better, it’s a very awesome change we should clap for ourselves.” Participant 6, FGD, Butambala

The other thing I had forgotten is that these trainings have improved cleanliness at home. A lady who is part of WCCI has a significantly decent home compared to those who are not in the project. We as ladies are very proud of these improvements. (Participant 1, FGD, Mukono)

“I used to just sit at home without much to do, but ever since WCCI came, it taught me so many things so right now I do my projects and have some personal money on me, and I have a job that I do, and doesn’t put me on pressure, I do it from my home without paying rent; customers come at my home without me having to hawk, schools too come and pick from my home. It has helped me a lot since I used to just sit at home back then. I am more satisfied with life now.” (Participant 5, FGD, Gomba)

“I used to eat cassava with tea and no sauce, but now life has changed. I can go and purchase beef, fish, and any sauce because the money is available. Even the dress code has changed.” (Participant 4, FGD, Buambala)

“I learned how to handle nature more than I used to before I could cut down trees but now, I look at trees like my own children and I cannot cut them down because it feels like I am cutting down my child like I’m ruining my child’s future.” (Participant 7, FGD, Mukono)

Discussion

The study aimed to assess the feasibility of Women-led climate change solution satellites on women’s social and economic empowerment and quality of life in the face of climate change in Uganda. The findings earlier shown are discussed per the objective below.

Collective Action in Women-led Climate Change Solution Satellites Influences Social Cohesion and Community Engagement

A noteworthy aspect of this project lies in its ‘train the trainer’ model, which has yielded substantial social impact while justifying the claim that empowering women through training can have far-reaching effects. Beyond individual skill acquisition, the project has employed a strategy where trained women become mentors, disseminating knowledge and skills within their communities. This ‘train the trainer’ approach has catalyzed a transformative shift among the women, not just as beneficiaries but as active agents of change within their communities.

The majority of participants reported significant improvements in their sense of belonging, increased community engagement, and notably better treatment from their families and neighbors. These outcomes are emblematic of a deeper societal transformation facilitated by these women-turned-trainers. By imparting their acquired knowledge and skills and actively engaging in communal projects, they have redefined their roles within their communities. Their involvement as both conveyors of expertise and active contributors to communal endeavors has elevated their status and influence, positioning them as key contributors to community progress.

Moreover, the collaborative nature of their work within the group-learning from each other, practicing in front of fellow satellite members-has fostered a supportive environment that nurtures confidence and competence. This newfound confidence not only improved their individual capacities but also equipped them to meaningfully contribute to larger communal initiatives. The ‘train the trainer’ model not only enhanced individual capabilities but also served as a catalyst for community development through knowledge dissemination and collaborative engagement.

Gender inequality, poverty, and other economic challenges are among the major causes of intimate and gender-based violence globally [16]. Given the high poverty levels of not only women but the general rural population in Uganda, it is understandable to unearth a 22% prevalence of intimate partner or gender-based violence among the respondents. The World Health Organization recommends seven strategies for prevention and reduction of violence against women, among which is the empowerment of women; Poverty reduction and creating an enabling environment [17], which were all targeted outcomes of this project. This evaluation indicated a 50% reduction in intimate partner and gender-based violence, with only 2 out of 11 individuals who had recent experiences attributing the violence to their engagement in entrepreneurship and the majority alluding to better treatment from their husbands. The trainings and empowerment given to women may have played a critical role in managing intimate and gender-based violence as has been deduced by earlier scholars [18,19].

The Economic Impact of Women-led Climate Change Solution Satellites on Individual and Household Income and Financial Stability

Significant proportions of the respondents mentioned an increase in their individual and household income, with some already purchasing property including gadgets, furniture, and land, using the newly found income. This result confirmed a partially achieved goal of the project; to positively impact women’s economic status and financial sustainability. The achievement can be explained by WCCI’s efforts in training the women on how to manage their finances including self-control towards expenditure, a saving culture and skilling in income-generating projects. WCCI engages the women in skill-building activities such as making soap, vaseline, and briquette among others that can be sold within the community to generate income and also supports them with the pre-requisite equipment for enhanced production. Skilling of women and trainings on financial literacy coupled with start-up support have been associated with economic empowerment in Uganda and other settings globally [20-22]. Through the “train the trainer model” which the women have wholesomely embraced and already practicing, this transformation can be transitioned to entire communities to contribute to the achievement of Sustainable Development Goal (SDG) 1; eradicating extreme poverty for all people everywhere by 2030 [23].

This evaluation also revealed the participation of women in decision-making ventures both in the community and in the households regarding livelihoods and economic development. Over 60% of the women joined women groups, SACCOs or local governing bodies and 47% of these were in leadership. These findings can be explained by the fact that WCCI emphasizes transformation in self-perception and assertiveness, which are key in interpersonal relationships and leadership [24,25] and can collaborate the newfound confidence and self-esteem among participants to join groups and even take up leadership positions. The program also cultivated the courage to engage actively in public forums, a stark contrast to previous shyness and avoidance of meetings, and women evolving into role models and trainers, who can be consulted on various aspects. The women are also gradually joining in decision-making at home, contributing ideas and funds for household development projects. The majority of the women mentioned keeping, planning for, and spending their money on things they find important unlike before when they used to spend randomly or simply give the money to their husbands to spend. This could be as a result of understanding the value of money, and the fact that these women have financial goals and have been taught to gradually grow their businesses and achieve more rather than being comfortable in their poverty.

The Overall Well-being and Quality of Life Improvements among Women Engaged in Climate Change Solution Satellites

Almost all the women in the study agreed that their overall well-being and quality of life has improved since becoming part of the climate-change solution satellites. The transformation can be attributed to the different gains from associating with WCCI. The nexus of economic empowerment heightened self-esteem, improved personal appearance, hygiene, financial autonomy, diverse dietary habits, enhanced family dynamics with increased support from husbands, improved treatment within families, and elevated social recognition collectively signify an elevated quality of life among the participants. According to the World Health Organization [26], the physical and psychological aspects of one’s life, their level of independence, social relationships, and the environment are key determinants of one’s quality of life and are the domains in the WHO quality of life assessment (WHOQOL) tool. These findings show that even though WCCI did not apply the standard 100-item WHO assessment tool, the women’s claim of improved quality of life and overall well-being is to a greater extent in accordance with the standard measurements as spelled out in the WHO’s quality of life user manual [26]. The findings therefore imply that WCCI’s model of women’s transformation through the climate change solution satellites is achieving their intended results, however, more standard assessments could be needed to further ascertain these findings.

Strengths and Limitations

The study encompassed a relatively large sample size (96 women), providing a diverse pool of participants engaged in different entrepreneurial activities related to climate change solutions. The study also collected data across various thematic areas, including social, economic, and personal aspects, offering a holistic view of the impacts of women’s engagement in entrepreneurship. The combination of quantitative and qualitative insights provides a comprehensive understanding of the women’s experiences and the findings indicated tangible outcomes such as increased income, asset acquisition, and improved social cohesion, highlighting the practical implications. On the other hand, there could be biases in self-reporting, especially regarding sensitive issues like experiences of violence or attributing them to entrepreneurship, which might lead to underreporting or misinterpretation. To address this, the women were made aware of the importance of giving accurate information and that their responses would be anonymous. The data collection process was also conducted by people who are not part of the trainers to try and make the participants comfortable to air out their issues. In addition, whereas the study highlights positive outcomes associated with entrepreneurship and WCCI training and support, establishing a direct causal link between participation and outcomes might be challenging due to external factors not accounted for in the study. The study however tried to focus on specific attributes provided to the participants through WCCI trainings and eliminated possible external factors.

Conclusions

Overall, participation in these entrepreneurial initiatives has brought about tangible improvements in social cohesion, economic empowerment, and the perceived quality of life and well-being for a significant majority of women involved, demonstrating the positive impact of the WCCI climate change solution satellites on their lives and communities. Through the train the train-the-trainer approach that has been embraced by the women and community, the program ought to be scaled up to enable more women to benefit, contributing to SDG 1.

Declarations

Data and Materials Availability

The data used in this study is available upon reasonable request from the corresponding author.

Ethics Approval and Consent to Participate

Informed consent was obtained from all participants for both the structured surveys and FGDs conducted, after ensuring that they understood the purpose of the research, their rights, and the confidentiality of their responses. The research was also approved by the Uganda Christian University Research and Ethics Committee-approval number UCUREC-2023-55. Measures were also taken to protect the anonymity and confidentiality of participants’ identities and responses.

Authors’ Contributions

All authors conceptualized the study. CHM, AT and GB participated in data collection, and drafted the first manuscript, CHM, GB, AT, RA, RWN, EM, and SD reviewed the first manuscript draft. All authors read and approved the final manuscript.

Funding

Support for this research was made possible through funding support of the Forum for Women and Development (FOKUS) in partnership with the sisters of Joseph and Climate Justice Resilience. The information provided does not necessarily reflect the views of the funders.

Conflict of Interest

Authors Comfort Hajra Mukasa, Godliver Businge, Rosemary Atieno, Rose Wamalwa Nyarotso, Elaine McCarty, Sarah Diefendorf are employed by Women Climate Centers International. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

  1. Women, Gender Equality and Climate Change. 2023 [cited 2023 28th May]; Available from: https://shorturl.at/flxFO
  2. Increasing women’s economic equality would reduce poverty for everyone. 2023 [cited 2023 6th June]; Available from: https://www.oxfam.org/en/why-majority-worlds-poor-are-women.
  3. Akinbami CAO, et al. (2019) Exploring potential climate-related entrepreneurship opportunities and challenges for rural Nigerian women. Journal of Global Entrepreneurship Research 9: 19.
  4. Cardella GM, BR Hernández-Sánchez, JC Sánchez-García (2020) Women entrepreneurship: A systematic review to outline the boundaries of scientific literature. Frontiers in Psychology 11: 1557. [crossref]
  5. Njuguna Nu, TA Théophile (2023) KEYS TO CLIMATE ACTION.
  6. Climate change exacerbates violence against women and girls. 2023 [cited 2023 7th June]; Available from: https://shorturl.at/oqwJY
  7. Tol RS (2018) The economic impacts of climate change. Review of Environmental Economics and Policy.
  8. Hernández Martínez A (2023) Climate change on rural women in East Africa: analysis of consequences and recommendations from a gendered approach.
  9. Nchanji EB, et al. (2022) Gender differences in climate-smart adaptation practices amongst bean-producing farmers in Malawi: The case of Linthipe Extension Planning Area. Frontiers in Sustainable Food Systems.
  10. WCCI-Uganda. WCCI-Uganda is responsible for community training and regional project management. 2023 [cited 2023 28/11]; Available from: https://www.climatecenters.org/wcci-uganda.
  11. Ministry of Local Government-The Parish Development Model. 2021 [cited 2023 28/11]; Available from: https://molg.go.ug/parish-development-model/.
  12. N A T I O N A L P L A N N I N G A U T H O R I T Y, THIRD NATIONAL DEVELOPMENT PLAN (NDPIII) 2020/21-2024/25. 2020, N A T I O N A L P L A N N I N G A U T H O R I T Y,: Kampala, Uganda.
  13. Gomba District Local Government. History. 2023 [cited 2023 27/11]; Available from: https://gomba.go.ug/district/history.
  14. Butambala District Local Government. History. 2023 [cited 2023 27/11]; Available from: https://butambala.go.ug/.
  15. Mukono District Local Government. History. 2023 [cited 2023 28/11]; Available from: https://mukono.go.ug/.
  16. Sanjel S (2013) Gender-based violence: a crucial challenge for public health. Kathmandu University medical journal 11: 179-184. [crossref]
  17. Violence against women. 2021 [cited 2023 22/Nov]; Available from: https://www.who.int/news-room/fact-sheets/detail/violence-against-women.
  18. Ellsberg M, et al. (2015) Prevention of violence against women and girls: what does the evidence say? The Lancet 385: 1555-1566.
  19. Kiani Z, et al. (2021) A systematic review: Empowerment interventions to reduce domestic violence? Aggression and violent behavior 58: 101585.
  20. Kiconco B (2023) The contribution of the presidential initiative for skilling a girl child on women’s economic empowerment in Kampala District, Uganda. 2023, Makerere University.
  21. Ghosh A (2023) Skilling Women in Non-Traditional Livelihoods: Pathways to Women’s Economic Empowerment-Policy Brief. Available at SSRN 4551736.
  22. Singh V (2018) Empowering Women through Skill Development: Interlinking Human, Financial and Social Capital. Productivity. 58.
  23. Sustainable Development Goals-No poverty. 2023 [cited 2023 11th/12]; Available from: https://www.un.org/sustainabledevelopment/poverty/.
  24. Ames D (2009) Pushing up to a point: Assertiveness and effectiveness in leadership and interpersonal dynamics. Research in organizational behavior 29: 111-133.
  25. April K, N Sikatali (2019) Personal and interpersonal assertiveness of female leaders in skilled technical roles. Effective Executive 22: 33-58.
  26. WHO, WHO quality of life user manual. 2012.

Remote Healthcare Experienced Under COVID-19 Infection

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DOI: 10.31038/IJNM.2024514

 

The author primarily engages in health consultations, mainly during weekends and year-end holidays, at the “novel coronavirus infection consultation hotline” established by prefectures and other entities. This consultation service mainly handles general inquiries, including those from individuals undergoing home treatment who wish to seek medical attention, individuals who tested positive at hospitals or private PCR centers, and those who tested positive using over-the-counter antigen test kits, among others. The Ministry of Health, Labour and Welfare (2022) defines telemedicine as acts related to health promotion and medical care utilizing information and communication devices. In a broad sense, considering telemedicine, the efforts of the health consultation hotline can also be regarded as part of telemedicine. In this paper, while introducing the actual operation of the novel coronavirus infection consultation hotline, I would like to consider expectations and prospects for telemedicine.

The “novel coronavirus infection consultation hotline” and the ferocity of the 8th wave

The novel coronavirus infection consultation hotline established by prefectures and other entities operates 24 hours a day with nurses responding to inquiries. Consultation topics mainly revolve around COVID-19, including general medical inquiries from individuals undergoing home treatment or identified as close contacts, as well as inquiries regarding hotel accommodation requests, reporting of positive cases, definitions of close contacts, quarantine periods, and fever-related consultations. Nurses, who serve as operators, conduct interviews regarding symptoms, onset dates, presence and severity of fever and respiratory symptoms, SpO2 levels if available, urinary output, ability to drink water, and other symptoms such as headaches, fatigue, joint pain, nausea/vomiting, diarrhea, conjunctivitis, and taste/smell disorders. In the case of fever consultations, they often guide individuals to general fever clinics, but they also act as a bridge to connect individuals with health authorities when hotel accommodation is requested or administrative assistance is needed. During the peak of the 8th wave from December 2022 to early January 2023, concerns arose due to the overlap of the seasonal influenza epidemic with the resurgence of COVID-19 infections, leading to increased strain on fever clinics and potential obstacles for those in need of medical attention. Consequently, the government urged the population to respond according to the risk of progression to severe illness if symptoms such as sore throat or fever appeared. For those at low risk of severe illness, the government encouraged minimizing unnecessary visits to fever clinics and instead promoted the utilization of health follow-up centers such as the “novel coronavirus infection consultation hotline.” During the year-end and New Year holidays in the midst of the 8th wave, operators often handled nearly 100 consultations per day, reflecting the intense pressure on fever clinics. Looking back on consultations during this period, cases were observed where individuals with fever were unable to find hospitals for consultation or failed to connect via phone after being referred to fever clinics. Such situations led to psychological distress for individuals, and operators were sometimes subjected to verbal abuse and insults.

Reconsidering Communication

The nurses serving as operators are healthcare professionals, yet they haven’t undergone specialized training for this role. Instead, they rely on their knowledge and experience as nurses to assess the urgency of inquiries and suggest appropriate responses. Therefore, they aim to listen attentively to callers, acknowledging their worries and concerns, and provide tailored information. Their goal isn’t to correct misunderstandings but to empathetically support callers. As for the author, affiliated with the basic nursing education department at a university, they teach nursing fundamentals and daily living assistance. Communication is often the first thing nursing students learn. It involves message exchange between sender and receiver through a channel. Non-verbal elements like facial expressions and gestures are absent over the phone, posing challenges as operators can’t sense needs as in face-to-face interactions. Callers’ backgrounds vary widely, affecting the noise and circumstances heard during calls. Operators still perceive “expressions” conveyed by callers’ voices. For instance, “My one-year-old has a 39°C fever,” “Family members are getting infected, and I’ve had a fever and sore throat since yesterday,” “I’ve called doctors and hospitals all morning but can’t get through. Is there a hospital I can visit?” Operators empathize with callers’ urgent situations, striving to address their needs. During the 8th wave, limited available medical facilities necessitated tailored responses based on severity risk. For instance, confirming home test kits or fever medication availability, suggesting home monitoring if possible, and encouraging contact if further help is needed. However, some callers insisted on hospital visits, leading to challenging situations. Some strongly desired testing, despite being asymptomatic. Operators, empathizing with their anxiety, recommended free testing for residents or approved antigen test kits. Flexibility was key alongside standardized responses. Reading callers’ “expressions” was crucial. Some found relief expressing anxiety. This reaffirmed the importance of listening. Reconsidering communication made the significance of face-to-face interactions evident.

Expectations and Prospects for Telemedicine

So far, we’ve looked at an example of telemedicine based on the practices of the novel coronavirus infection consultation hotline. With the spread of the COVID-19 pandemic, the significance of telemedicine is increasingly being recognized, isn’t it? In nursing education, remote education utilizing Information and Communication Technology (ICT) is expanding due to the impact of COVID-19. While discussions on the merits and demerits of telemedicine and education are diverse, there seems to be a growing sense of expectation for the utilization of ICT from the perspective of infection control and the continuity of healthcare and education. On the other hand, research on the adverse effects of online habits using communication devices such as smartphones on the human body and the reality of communication is also progressing. Sakaki et al. (2022) point out the poor quality of online communication and demonstrate that online communication is completely ineffective in situations where interaction between hearts is necessary. They argue that the greatest advantage of online communication is the ability to communicate with people in distant locations, emphasizing that online communication is merely a “means” and a “bridge.” We sincerely hope that health follow-up centers such as the “novel coronavirus infection consultation hotline” introduced this time can continue to provide support to infected individuals and those around them. It’s not easy to make accurate judgments and provide empathetic support based solely on the “expressions” in voices in the absence of face-to-face communication. However, considering the characteristics of the virus and the perspective of infection control, the demand for information provision and health consultation services through methods other than face-to-face interactions is expected to continue to grow. It is essential to utilize online platforms according to the situation and context without losing sight of the essence of communication.

A Collaborative Approach between Programs: Improving Communication Access with Deaf People through Nursing Simulation

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DOI: 10.31038/IJNM.2024513

 
 

According to the Institute of Medicine [1], the desired goal of patient-centered health care is for practitioners to be “respectful of and responsive to individual patient preferences, needs, and values” (Institute of Medicine, 2001, para. 1) [1]. Patient-centeredness relies on effective communication [2]. Dialogue is essential for health care settings, requiring the patient to receive important information from the medical professional, as well as the medical professional understanding and responding to important information that the patient conveys. Research has shown that better health care outcomes are achieved when patients have a positive relationship and interaction with their health care provider [3]. However, when patients identify with a culture and use a first language that is different from their health care provider, they may experience service and information barriers when seeking medical treatment, resulting in less adherence to treatment plans or avoidance of seeking medical care [4]. The exchange of medical information, even at routine office visits, can become perilous when the patient cannot fully participate in discussions regarding safe uses of medications, or complex, even risky, decision-making expectations (Hedding & Kaufman, 2012), A medical appointment with a deaf patient without appropriate communication accommodations can result in miscommunication, misinformation, misdiagnosis, and mistrust. Deaf people often experience inequities in health care which lead to poor health (Barnett et al., year) and lower health literacy (significant gaps in basic health knowledge) than their non-deaf counterparts [5]. Too often, medical appointments for deaf patients continue without the use of an interpreter, due in part to a lack of awareness by providers of the importance of communication accommodation or the lack of available interpreters (Ebert & Heckerling, 1995, as cited in [6]. This combination of potential lower health literacy, lack of interpreters, and health care providers who are unaware or unprepared to meet this population’s specific needs highlights the frustration of countless deaf people. The exchange of medical information, even at routine office visits, can become perilous when the patient cannot fully participate in discussions regarding safe uses of medications, or complex, even risky, decision-making expectations (Hedding & Kaufman, as cited in Swabey & Malcom, 2012) [6].

Faculty of two distinct programs at a large midwestern university created an opportunity to experience patient-centered service provision with deaf volunteers. Nursing faculty wanted their students to experience the dynamics of engaging patients who are deaf and use American Sign Language (ASL) as their primary language. Deaf people whose primary language is ASL, which is distinct from English with its own complex grammar and distinct syntax, vocabulary, and discourse style [7], require special communication access considerations. Simulation in health care education is designed to replicate real clinical situations in a safe environment. The International Nursing Association for Clinical Simulation and Learning (INACSL) states that the specific purpose of simulation is to “promote, improve, or validate a participant’s performance” [8]. Validating the importance of simulation, some nursing boards have approved up to 100% replacement of traditional clinical hours with simulation in specialty areas such as pediatric and obstetrical nursing [9,10]. Thus, simulation can be a bridge between classroom and clinical environments and as a venue in which to address communication access concerns for deaf patients.

The scenario lasted 20 minutes. During the first 10 minutes, nursing students performed a comprehensive physical exam. After approximately 10 minutes, students were encouraged to begin discharge teaching with interpreting students to facilitate communication with the deaf parent. After that, the 20-minute debriefing session began. Interpreting students reversed roles at this point. The debriefing was facilitated by an experienced nurse who gave each group of students a series of questions to discuss. In order to compare the perceived effectiveness of the simulation, a Mann-Whitney test statistic was calculated. Two questions were posed to participants that evaluated their self-perception of the effectiveness of the simulation. The first, “I am better able to communicate healthcare information to a deaf parent” was rated on a Likert-scale (1: completely disagree; 2: mostly disagree; 3: slightly disagree; 4: slightly agree; 5: mostly agree; 6: completely agree). Results indicated a statistically significant difference between groups of students (U=173.00, p=0.020), indicating that nursing students (Median=6) were more likely to agree with the question than interpreting students (Median=5). The second question, “Will this simulation affect the way you communicate with a deaf person or their family member?” was also rated on a Likert-scale (1: definitely not; 2: probably not; 3: possibly; 4: probably; 5: very probably; 6: definitely). However, the difference between Nursing (Median=5) and interpreting students (Median=5) was not statistically significant (U=83.50, p=0.195).

Results were statistically significant for both the first (D=0.270, p<0.001) and second (D=0.258, p<0.001) prompt, indicating that a randomly selected response from this sample is significantly more likely to be positive than negative on either prompt. Nursing students were more likely to provide the highest rating regarding ability to communicate healthcare information to deaf parents than interpreting students. This simulation experience allowed nursing and interpreting students to understand and appreciate the role of the other and to enact strategies to improve communication. Both groups of participants found the simulated experience to be beneficial and felt it gave them a safe environment in which to practice. Faculty initiating this partnership recognized many potential benefits to both programs in preparing their students to provide services to deaf people in a specialized setting. Nursing students were able to work with individuals who processed language in a different way than they were accustomed to. Interpreting students were able to relate medical information to deaf people in a realistic, dynamic, and unrehearsed setting. Both interpreting and nursing students’ responses were positive, stating the advantages of practicing vital nursing and communication skills with a deaf parent in a safe environment. Collaboration among interpreting and nursing students in simulation may enhance understanding and provide authentic practice opportunities of unique accommodations to achieve patient-centered health care.

References

  1. Institute of Medicine (2001) Committee on quality of health care in America. Crossing the quality chasm: A new health system for the 21st century. National Academies Press.
  2. Barnett S, McKee M, Smith SR, Pearson TA (2011) Deaf sign language users, health inequities, and public health: Opportunity for social justice. Preventing Chronic Disease 8. [crossref]
  3. Raymond CW (2014) Conveying information in the interpreter-mediated medical visit: The case of epistemic brokering. Patient Education and Counseling 97: 38-46. [crossref]
  4. Messias DK, McDowell L, Estrada RD (2009) Language interpreting as social justice work: Perspectives of formal and informal healthcare interpreters. Advances in Nursing Science 32: 128-143. [crossref]
  5. Pollard RQ, Barnett S (2009) Health-related vocabulary knowledge among deaf adults. Rehabilitation Psychology 54: 182-185. [crossref]
  6. Swabey LA, Malcolm M (2012) In our hands: Educating healthcare interpreters. (Gallaudet University Press).
  7. Valli C, Lucas C, Mulrooney K, Villanueva M (2011) Linguistics of American Sign Language: An introduction (5th ed.). (Gallaudet University Press).
  8. INACSL Standards Committee. (2016, December). INACSL Standards of Best Practice: SimulationSM Participant evaluation. Clinical Simulation in Nursing 12(S) (December, 2016): S26-9.
  9. Ohio Administrative Code, Chapter 4723-5 (2017). Nursing Education Programs. Ohio Board of Nursing.
  10. Iezzoni L, O’Day BL, Killeen M, Harker H (2004) Communicating about health care: Observations from persons who are deaf or hard of hearing. Annals of Internal Medicine 140: 356-362. [crossref]

Mental Impairment Negatively Impacts People’s Lives

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DOI: 10.31038/IJNM.2024512

 

People have to interact with each other to sell or buy goods or services and exchange ideas when necessary, as no one can produce or own everything and know all. How a person interacts with others defines individual behaviour; it reflects the capacity to process essential data, make decisions, and cooperate with clients, collaborators, and partners. People’s collaborative work supposes respect, truthfulness, and adherence to social norms. Usually, in a family, there are sentimental interactions between its members. Whether sentimental or not, human relationships advance if reasonable actions follow. When love dominates relationships, some misjudges are easily tolerated, but displaying erroneous data or thinking inaccuracy is unacceptable for business partners. Out-of-ordinary behaviour can originate in genetics or medical disorders determined by external, internal factors affecting brain function, or it can be an expression of uneducated, impulsive reactions to various external stimuli, sometimes a combination of them.

Individual judgment may be altered more or less, transitory or permanent; consequently, their actions deviate from conventionality. Such thinking nonconformities disappoint collaborators and may lead to a relationship disruption sooner or later. The affected emotional life of the collaborators implied in such relationships, usually by repetition, can determine medical problems: depression, endocrine system abnormalities, arterial hypertension, type 2 diabetes, and so on. In addition, the collaborators’ altered emotional health determines sorrowful moments for their loved ones, extending suffering gradually in the large family or community. For this reason, abnormal thinking and acting must be promptly recognized and treated to avoid negative consequences for others and the production process.

To determine an individual’s mental health, healthcare providers should assess their abnormal behaviours along with their medical and social history, relationships, and professional accomplishments. In the community, we should support one another when needed. The business partners may terminate their relationship with a collaborator who displays impaired judgment and engages in deviant actions. On the other hand, medical teams will collaborate with the patient and their family to improve their health and maintain production continuity whenever possible. Job assignments will be made according to the individual’s mental abilities, if necessary. People with transient or permanent cognitive impairment are often unaware of their condition. Patients with mental impairment need to have an understanding of their disorder and work together with medical professionals on a therapy plan. Healthcare professionals must identify the cause of the mental disorder and develop appropriate treatments. Effective management of this condition involves collaboration with patients to follow the therapy plan, including their participation in decision-making and communication with loved ones for emotional support, both in the short and long term. Accessing informative online programs for knowledge improvement and communication with virtual assistants as necessary can help cultivate self-awareness, refine interaction with others, and ensure a better personal and social life, especially for those with mental impairments.

Improving one’s mental health is beneficial for both healthcare providers and end-users. It enhances the quality of life, patient experience, and family satisfaction for the end-users, positive comments following, and determining an increase in investment returns, business growth, and continuity, improves personal reputation, and leads to a successful professional and social life for healthcare professionals.

A Rural Native American Community Experiences Related to Emotional and Mental Health Well-Being during the COVID19 Pandemic

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DOI: 10.31038/IJNM.2024511

Abstract

Purpose: This qualitative study was conducted as part of a larger nationwide study, the Aegis Project that investigated the impact of the COVID19 pandemic, infection and reinfection, and the potential long-term immunity to SARS-CoV-2 and will be reported in a future paper. The study is a collaborative effort among The University of Texas at Austin School of Nursing, Indiana University at Bloomington School of Public Health, and a rural-based Tribe located in the Midwest. The qualitative component of the study explored the experiences that impacted the emotional and mental health well-being during the COVID19 pandemic.

Methods: Data were collected using open-ended interview questions regarding participants’ experiences during the pandemic. Results were analyzed using the Consensual Qualitative Research (CQR) method which includes the process of categorizing data into specific themes by means of the research team’s discourse, external auditing, and agreement.

Results: Four themes emerged related to emotional and mental health well-being experiences that include: 1) loss of connectedness, 2) increase in stress, 3) increase in anxiety, and 4) learning to cope.

Conclusions: Understanding the lived experiences of Native Americans during the COVID19 pandemic is needed to help guide the development and testing of culturally based interventions to improve the emotional and mental health well-being of Native American communities during pandemics or other distressful incidences such as natural disasters.

Keywords

Native Americans, COVID19, Emotional and mental health wellbeing

Introduction

Native Americans have been disproportionately impacted by the COVID19 pandemic with 2.5 higher incidence rates and confirmed positive cases and almost four times higher mortality rates than non-Hispanic Whites [1,2]. Vulnerable populations, particularly Native American adults with chronic conditions and pre-existing health conditions such as heart disease, asthma, chronic obstructive pulmonary disease (COPD), cancer, and diabetes are more vulnerable and at increased risk for contracting the COVID19 virus (Haynes, Cooper, & Albert, 2020). Historically, Native American communities that have already suffered from years of historical trauma from previous pandemics are now being re-traumatized by the pandemic [3]. Additionally, racial inequities and historical trauma have contributed to the persistent disparities in health outcomes between Native Americans and white populations that have adversely affected tribal communities during the pandemic [4]. Emotional and mental health issues have negatively impacted the overall health and well-being of Native Americans during the pandemic [5]. Many health experts and researchers fear that many Native Americans are suffering from increased physiological and psychological distress including drug and alcohol relapse due to the social isolation from ongoing social distancing, lockdowns, and other aspects of the pandemic [6]. The higher COVID19 incidence and mortality rates among the elder Native American population are impacted by the limited access to available resources such as transportation, access to running water and other resources, and the ability to maintain a sense of connectedness [1,7].

This qualitative study was conducted as part of a larger nationwide study, the Aegis Project, investigating the impact of the pandemic, infection and reinfection, and the potential long-term immunity to SARS-CoV-2. The study is a collaborative effort among The University of Texas at Austin School of Nursing, Indiana University at Bloomington School of Public Health, and a rural midwestern Tribe. Due to the sensitive nature of the study, the Tribe requests to remain anonymous. This Tribe was the only Native American tribe participating in scientific efforts to explore these factors. The purpose of this qualitative study is to highlight the experiences related to the emotional and mental health well-being during the pandemic among the tribal community.

Methods

This study used a qualitative descriptive narrative approach eliciting responses to open-ended interview questions regarding the participant’s experiences during the pandemic. Convenience and snowballing sampling were used as the participant recruitment method.

Setting

The setting for the study was located within a rural midwestern Tribe with 16,000 members. The qualitative interviews were conducted in a private room at the tribal health center. Prior to the recruitment process, study approval was obtained by the University of Texas at Austin, Indiana University’s Institutional Review Board(s) (IRB) and the Tribe’s administrative leaders. After all approvals were received, a flyer explaining the purpose of the study was provided to community members. Signed informed consent, ages 18 years or above, willingness to participate in the study and the ability to read and speak English were required to participate in this study.

Results

All participants are tribal members who live within the participating tribe’s community. Table 1 displays the demographic data of the participants. Data analysis was conducted using the Consensual Qualitative Research (CQR) method which includes the process of categorizing data into specific themes by means of the research team’s discourse, external auditing, and agreement [8]. Four themes emerged related to emotional and mental health well-being experiences that include: 1) loss of connectedness, 2) increased stress, 3) increased anxiety, and 4) learning to cope (Figure 1 and Table 1).

FIG 1

Figure 1: Themes Related to Emotional and Mental Health Well-Being Experiences

Table 1: Demographics

Participants

N=61
Age 20-85 years

Average age=32.5 years
Gender Male=20

Female=41
Household Live with family=47

Live with non-family=4

Live alone=10
Annual Income less than $10,000=0

$10,000 to $24,999=5

$25,000 to $49,000=15

$50,000 to $74,999=25

$75,000 to $99,000=12

$150,000 to $199,999=3

over $200,000=1
Health Status Fair=6

Good=40

Very Good=12

Excellent=3
Education Level Some High school=4

High School Graduate=18

Some College/Technical=26

College Graduate=12

Theme 1: Loss of Connectedness

Several participants described loss of connectedness as a result of experiencing the loss of family and community members due to the pandemic. Participants used phrases such as “You can’t get those back after they are gone” when describing how the pandemic resulted in the loss of many Tribal Elders who are the cultural knowledge keepers. Participants often expressed remarks such as “it has been disheartening to hear of former co-workers, childhood friends, neighbors, and even relatives passing away as a result of COVID19”. Additionally, participants also discussed how the pandemic is “one of the most devastating things to affect our Tribal community “, and “how they never in their lifetime thought they would be living in the middle of a global pandemic… very devastating.” Experiences of being isolated due to quarantines and lockdowns also enhanced the feelings of not being connected. Participants remarked “we really missed not being able to have family or community gatherings … it was like someone took away our freedom to be together… I really missed being able to do things like eat together, talking, sharing stories, and laughing”.

Theme 2: Increased Stress

Many participants described increased stress during the pandemic with comments such as “it is very real and very scary.” “COVID is very contagious, and it is stressful.” Remarks related to feelings of stress also included “I can’t wait for it to be over, but I think it is going to be here for a while and it is beginning to become wearisome”, and “these are terrifying times”. Several participants discussed how they have personally witnessed the death of several family members in very short periods of time which they described as “this wears you down after so many deaths”. Many of the participants described “being exhausted” and “tired of the disruptions, social distancing and isolation it has caused with not being able to be in contact with family and friends and my grandchildren.” Other remarks included “this reminds of the stories about how our people experienced smallpox back”…“it makes me recall some of the times in boarding schools when a lot of children would get sick at the same time…those were horrible times”.

Theme 3: Increased Anxiety

Many participants described feelings of anxiety during the pandemic with expressions of being worried that a cure will not be discovered soon enough. Participants discussed how the pandemic “has made a lot of people nervous and some deal with it by acting like it’s not real so they don’t do things like wear masks when out in public and in large crowds”. Other expressions included “I get worried that everyone will not do their part which will keep the pandemic from going away”. Several participants described being worried about going out in public because of not knowing if people are being as cautious and careful as they were and used phrases such as

“It doesn’t matter how old or young, healthy or sick you are, it doesn’t discriminate”. Several participants discussed how reliable and accurate information about the pandemic was not available Many described the lack of appropriate information as disheartening. Several participants shared their desire for better information, particularly regarding the vaccine. Participants expressed “we need more reliable information in order to make an informed decision about getting the vaccine”. Participants frequently described the pandemic as a “very terrible time… it’s very upsetting how COVID has hurt a lot of families, friends, and acquaintances”, and “I worry that this will become the “new normal”. Also, there were feelings expressed regarding the uncertainty of not knowing how long the pandemic will last, along with the fear that it may stay around for a long time.

Theme 4: Learning to Cope

Several participants described ways they learned to cope. Participants referred to the pandemic’s “silver lining” which allowed them to be at home and take better care of themselves through working in their gardens and going for daily walks. Some participants discussed relying on their traditional cultural spirituality and others referred to growing deeper in their faith-based beliefs and practices. Participants remarked “learning to stay in balance in was key to everything”. A few participants described learning to use technology and social media to stay connected with their family and friends was very helpful in not feeling totally isolated.

Discussion

The purpose of this qualitative study was to highlight a rural-based midwestern tribe’s experiences during the COVID19 pandemic that impacted their emotional and mental health well-being. The pandemic has been characterized as a “double pandemic” for Native Americans due to the actual incidences of COVID19 infections and the impact on their emotional and mental health well-being [9]. As the pandemic ravaged the United States, it began to become evident that the emotional and mental health well-being were being impacted among Native Americans. The findings of this study elucidate how times of crisis can result in experiences that impact the emotional and mental health well-being of one Native American community. These findings are consistent with other studies that report the impact of the pandemic on the emotional and mental health well-being of Native Americans across the country [10,11]. Understanding the lived experiences of Native Americans during the pandemic is important in guiding the development and testing of culturally based interventions to improve the emotional and mental health well-being of Native American communities during crisis incidences. For example, strategies designed to maintain connectedness during crisis situations needs to be developed, implemented, and examined [7]. Native Americans faced the increase of risks for emotional and mental health distress as a result of the pandemic which may have magnified pre-existing emotional and mental health disparities and their effects. Previous traumatic events, such as forced relocation, genocide, or the abduction of youth to more than 350 boarding schools, caused lasting generational impacts on the mental and emotional well-being of Native Americans [12]. The pandemic caused re-traumatization among many Native American people. It is important for health care professionals to develop and tailor response efforts to the emotional and mental health needs that the pandemic has caused to Native Americans. Additionally, increased fear and mistrust of healthcare professionals outside of the tribal community may result because of generational past experiences of various forms of physical, mental, and social abuse along with cultural degradation. Respect for the culture can increase a health provider’s credibility among a Native American community. Health providers from outside of the tribal community are guests within tribal sovereign nations and should work with a tribal liaison, tribal community health leaders, and tribal spiritual leaders. Efforts should be made to reestablish traditional approaches, cultural practices, and protective factors that were in place prior to the pandemic. It is important to build trusting relationships and recognize the many strengths of the tribal community such as the coping mechanisms noted by the participants. The study was conducted among one rural midwestern Native American tribal community which can be considered a limitation. The study results demonstrate the need for future studies to explore the experiences of various Native American populations who are from various settings and locations during distressful situations such as pandemics and natural disasters.

Acknowledgements

This project is supported by philanthropic funding from the Jack Dorsey’s #Start Small Initiative and the Chase and Stephanie Coleman Foundation as well as from an anonymous foundation. We would also like to acknowledge the tribal leaders and the tribal community for their continued dedication and hospitality throughout this collaboration.

References

  1. Hatcher SM, Agnew-Brune C, Anderson M, Zambrano LD, Rose CE, Jim MA, McCollum. J (2020) COVID-19 among American Indian and Alaska Native Persons — 23 States, January 31-July 3, 2020. Morbidity and Mortality Weekly Report 69: 1166-1169. [crossref]
  2. McLemon M (2021, April 9) Report’s detail high COVIID-19 burden in Native Americans. Centre for Infectious Disease and Policy.
  3. Sandoui A (2020, November 27) The impact of historical trauma on American Indian health equity. Medical News Today.
  4. Curtis E, Jones R, Tipene-Leach D, Walker C, Loring B, Paine SJ, Reid P (2019) Why cultural safety rather than cultural competency is required to achieve health equity: A literature review and recommended definition. International Journal for Equity in Health 18.
  5. Fingerman KL, Ng YT, Zhang S, Britt K, Colera G, et al. (2021) Living alone during COVID-19: Social contact and emotional well-being among older adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 76: e116-e121. [crossref]
  6. Urbatsch D, Robledo J (2020, June, 19) Native American groups address mental and behavioural health as COVID-19 wears on. Cronkite News, PBS.
  7. Haynes N, Cooper LA, Albert MA (2020, July 20) At the heart of the matter: Unmasking and addressing the toll of COVID-19 on diverse populations. Circulation 142: 105-107. [crossref]
  8. Hill CE, Knox S, Thompson BJ, Nutt Williams E, Hess SA, et al. (2005) Consensual qualitative research: An update. Journal of Counseling Psychology 52: 196-205.
  9. Holt-Lunstad J (2020, June 22) The double pandemic of social isolation and COVID-19: cross-sector must address both. Health Affairs Blog.
  10. Lang K (2022) Pandemic impact on mental health: A global overview. Medical News Today.
  11. Radfar A, Ferreira MM, Sosa JP, Filip I (2021) Emergent Crisis of COVID-19 Pandemic: Mental Health Challenges and Opportunities. Frontiers in Psychiatry 12. [crossref]
  12. Tsianina Lomawaima K, McKinley B, Brayboy J, McCarty T (2018) Editors’ Introduction to the Special Issue: Native American Boarding School Stories. Journal of American Indian Education 57: 1-10.

Young Italians’ Speeches on the War in Ukraine and Perspectives of Peacebuilding

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DOI: 10.31038/PSYJ.2024612

Abstract

In this contribution we propose a critical reflection on young Italians’ discourses on the war in Ukraine and the possibilities of peace in the future. The study is part of the research proposal launched by Alistair Ross concerning the investigation about young people’s socio-political understanding and values. Through the method of deliberative discussion, several focus groups were conducted with secondary school students from central and northern Italy. The conversations were collected in autumn 2022. Deliberative discussion was used as a pedagogical practice [1-3] to promote critical reflection among young people on the issue. Without giving predetermined opinions, however, we assumed that this topic was particularly present in discourse among young people. The high exposure to communications from the media, social networks, and the opportunity to follow social debates in school and family could be considered two important premises for understanding what young people think about the specific center of interest. In general, the introduction of the debate follows the problems affecting our societies today and reveals a differentiated centrality of the arguments on war and peace in Ukraine. Young people are experiencing the war in a very involved way by linking it to other countries in the world that are in conflict, they are not absent but fully participating. The causes of war are defined and possible guidelines for peace are outlined. The two geographical areas show interesting characterisations linked to the higher presence in the North of young people from families with a migratory past and Ukrainians newly arrived from war zones. The gender variable affects the analysis of the situation. Overall, the deliberative discussion shows the strong sense of reality in the young people with accentuated polarities between hope and pessimism.

Keywords

War and peace; Deliberative discussion; Secondary school; Education; Italy 2022

Introduction

The war in Ukraine raised many questions about how adolescents were processing the experience of the conflict and possible responses of restoring peace. The thinking that has matured about the war comes from direct and indirect knowledge of what is being experienced in Ukraine. The young people who have come to Italy have had direct experience of the war and talk about it with concrete examples, trying to examine their own emotions and make interpretations about the continuation of the conflict.

Young people from direct experience are fully involved in the fate of their country. A specific case concerns young people with families from a migratory background mainly from Romania. These young people participate in the conflict with their own considerations constructed considering their own migration background and the experience of being part of the invasion. Some recent surveys on young people’s interest in the war say that young Italian adolescents inform themselves and try to understand what is going on.

They read up on national news and also on major social issues. They are attracted to international news that affects them most closely. They are interested in the war in Ukraine and international political balances because of the effects on their lives of study and work. Young Italians have an indirect experience of the war, and their discourses reflect the situation experienced through information circulating on smartphones, social, and the Internet. Highly followed are Instagram and Facebook. Scarce is the use of newspapers and television [4].

The Harms of Conflict on Adolescents

Several studies document the psychological and mental damage in the personality development of adolescents at a crucial stage of their growth.

During war, adolescents are exposed to atrocities, organized violence, disintegration of social networks, and resettlement during crucial phases of their physical, emotional, social, and cognitive development. These experiences could cause serious risks to their physical and psychological well-being and development [5].

Maftei A, Dănilă O and Măirean C [6] emphasize the role of the media in producing the perception of threat in the Russian-Ukrainian conflict. The feeling of threat particularly affects adolescents who are poorly protected from even false messages. European Parliament reports record the damage to education.

At the same time, education has been disrupted for more than 5.7 million children in Ukraine, as schools shut down at the start of the war. National online education platforms have been built to help children to follow their schooling programmes, yet the situation remains difficult. Security concerns accompanied by a lack of access to electricity and internet make access to education services a challenge. Some schools have reopened by means of distance-learning programmes. In addition, Ukraine’s neighbouring countries and EU Member States are supporting the integration of Ukrainian children into their national education systems [7,8].

There are teenagers who experience the war from within and teenagers who witness the war. For both categories, the war event creates a sense of uncertainty and there is a growing distrust in governments and in the political capacities to face the problem. It follows that two ways of intervening to support young people emerge: the treatment of trauma and the search for credible solutions that go in the direction of actions of humanitarian solidarity.

Research Methodology

The exploratory research of a qualitative nature that we present in preliminary form is still in progress. The final results will be fully available with input from other countries that have joined the initiative launched and coordinated by Alistair Ross. This initial consideration does not compromise the course of subsequent processing of the results collected in the deliberative discussions. The survey concerns the recording of speeches by young Italians and non-Italians present in Italy on the topic of war and possible peace solutions.

Through deliberative discussion as a pedagogical practice we sought to understand the thoughts of a sample of 18 students of secondary school gathered in three focus groups with six students each in October 2022. Two focus groups were conducted in a secondary school in central Italy from a small town with a population of 11,899 (2021), and the third focus group was conducted in a secondary school in northern Italy in a mountain town with a population of 12,319 (2017).

In both cases, the social location of the local population is predominantly working and middle class. There are five students in the three focus groups with family migration experience from Albania, Romania, and Ukraine. The conversation took place in one hour for each group consisting of ten males and eight females between 15 and 19 years of age. Students are referred to by pseudonym while keeping the gender of the original name.

Sample of Schools

Descriptive data of the sample of schools are disclosed by the schools’ websites and the Ministry of Education, National Assessment System. Social Reporting 2019/2022. The Central Italy School Institute is a Catholic private school, is committed to building an educational community of supportive people with very strong ties. The Institute has been operating for 150 years it is a non-profit Social Cooperative Society, accommodates around 300 pupils from various parts of the Castelli area of Rome, mostly middle-class families. The boys and girls who enroll at the Institute have experiences of school dropouts and learning difficulties, and the school offers a specific service to encourage study and school careers.

The territorial scope School Institute sampled in Northern Italy is that of the Mountain Community Valtellina of Morbegno (496 square kilometers). It also includes the school population of the districts in the province of Sondrio, Chiavenna, Lecco and Como. The socio-economic context is the alpine valley where a rapid transformation has taken place from a largely agricultural-mountain economy (still 41 percent in 1951) to a mixed economy, based on a significant industrial consistency, challenged by the current crisis, with a large presence of artisan companies and a growing development of the tertiary sector.

The cultural reality, slower to undergo transformation, still suffers from the past social structure, typical of an Alpine agricultural economy, and the partial geographical and political isolation of the area. The following are being improved: communication routes, the spread of transportation, access to media, university study. Integration with the Lombard, national and European sociocultural reality is being sought. The limited availability of economic resources persists, the uncertainty of being able to use them permanently and the distance from institutional and university centers prevent medium-to long-term planning on innovation and staff training. In the school population are indicated youth distress, addictions, situations of socioeconomic, cultural disadvantage, increased entry of pupils with migration experience.

Descriptive Aspects

The conversations were held in a way that started from the survey from the major interests of young people on national and international social reality. COVID-19 remains a strong topic of discussion from the perspective of the consequences generated by isolation with difficulties in resuming the daily rhythm. The topic of the war in Ukraine immediately emerges as a source of concern, fear, uncertainty and sometimes as an argument not to talk about for political reasons.

As directed by the research team, the conversation could develop on the interest the students showed in the war, their assessment of the events, consideration of possible upcoming actions both at war sites and elsewhere, emotional involvement, and a sense of participation in the ongoing debate. We encouraged the expression of different positions and invited them to try to put themselves in the shoes of those who are experiencing the conflict firsthand.

We can collect the first reconnaissance on the recordings into five thematic areas:

I-the general view of the war;

II-the consequences of the war;

III-the causes of the war;

IV-the conditions for peace;

V-the personalization of war.

In the first two subject areas we collect ideas on the meaning of war in human affairs and examine the implications on one’s present and future existence. In the third area we collect thoughts on the reasons for war, reasons near and far, experienced indirectly and directly. In the fourth area we extrapolate discourses on the possibilities for peace in political, social, cultural, and strategic terms. In the fifth area we find what emerged in front of the stimulus suggestion “if you were in that war what would you do?”. We talk about personalization as a cultural anthropological attitude of putting yourself in the shoes of others and trying to feel in a time and place different from that of one’s daily life.

The General View of the War and Controversial Positions

The students’ discussion rescales the war in Ukraine by relating it to conflicts that are in different places on Earth such as in Asia, Africa, and Europe. The difference is that it is not talked about with the same frequency and the fallout for Italy is different in proportion to military and political involvement. The phrase “wars have always been there” meets with general approval as if to mitigate the trauma of the conflict in Ukraine. However, according to Antonio, conflicts could have been predicted and avoided. In the world scenario now, conflicts can no longer be avoided because they are due to events that have occurred over time and even if there were agreements “they would just be pieces of paper, each nation does what it wants, what is most favorable economically, it is ugly to say, however, at this moment it is like that for every state” (Marino).

Agreements are not assigned trust because they are not respected, and Russia and NATO are mentioned as examples. A portion of the students agree that Russia is not to blame for the war “…Russia is not to blame for today’s war. Italy sells weapons now, but the war was already there for years.” (Leopoldo). Responsibility for the war is a controversial issue with respect to the two contenders.

Russia defies the other powers and takes advantage thinking that the other nations cannot do more regardless of the consequences…it is a wrong thing…the blame is not only on Russia but also on other States such as America that did not do certain things that Putin wanted, so it came to this time of war. (Franco)

Gianni sentences:

Mainly it is a kind of American invasion. Biden established military bases along the territory and thus triggered the reactions of Russia, which is now trying to regain Ukrainian land that has declared itself independent in a completely illegitimate way, not to mention what they are doing in the Donbas where they are massacring the urban population without anyone talking about it.

For several of the girls, one of the most unacceptable aspects of the conflict in Ukraine is the presence of the boys who are conscripted and at high risk of their lives due to inexperience and lack of preparation.

Martina observes

Kids our age are risking their lives every day when there should be people suited for that field, if I am in the military, it is because I am suited for what I am doing. I can’t put a weapon in a kid’s hand and expect him to try to save someone.

Judgment about war is made with a high sense of empathy, and thinking about boys their own age going into combat generates feelings of contrariness felt especially by girls. For boys, the position is clear about the legitimacy of defending one’s home. The nuclear call is felt as a real threat that subjects all States to the power of the most powerful weapons.

Probably this war of Putin’s could be a show of force in the sense that threats about nuclear and bombing could overthrow a nation in minutes with the weapons and technologies that the State possesses today; I think it’s a hasty war, done unreasonably, it’s more of a show of force and it makes people realize that today a State can start a war in a very short time without any particular reason. I don’t think making an alliance against Russia and getting in Russia’s crosshairs is the smartest move to make because it can be scary to go against a country with nuclear power. (Antonio)

The Consequences of War

Three clear positions emerge in this thematic area:

(a) the assessment of the negative material consequences of war;

(b) the global involvement in the consequences with a strong emphasis on the interdependence of all countries in the world;

(c) the empathetic assessment of war.

There is a unanimous opinion that war makes people live badly: taxes rise, there is no peace of mind, there is fear of it coming our way, and the risk is scary. The damage and disruptive effects are cited for increased pollution, the downfall of the economy, the aggravation of the environmental issue, and the fallout on incoming migration. Conversely, there is the strengthening of Russia’s economy as it seeks alliances with other countries.

There is a state of anguish for students who view war as wrong but inevitable. The war serves no purpose, young people anticipate paying the consequences, and some reflect “the elders say this war is not as bad as World War II” (Giovanni).

Lia talks about the need for compromise because

Nuclear possession indicates inequality. You can’t make an agreement because now the situation has degenerated, the whole world is involved a little bit…even other countries can’t influence this war however there are consequences, for example, on primary goods and so it’s not just about the war, this is a problem that ultimately affects everyone.

Of the same opinion is Filippo

War calls for war, there are people who direct entire populations even quite important not only politically but also economically, there are people in power who try to maneuver to bring everything to themselves, without thinking that there are millions of people at stake; unfortunately, power is something that brings war.

Franco states the consequences are all negative…buildings destroyed…the integration of the Ukrainian people…Russia also spent a lot of money, lost a lot of men, at the end of it all there will be a negative balance sheet. And also, for other countries the balance sheet will not be positive because in some way we will also lose out.

According to Alberto, it is a matter of choosing an appropriate technical strategy considering the many political, economic, social contradictions that show division rather than union and show how each country eventually closes in on itself despite the fact that the European Union tries to work for the integration of peoples.

I simply think there is a need to change the methodology, because yes we have put sanctions on Russia, but at the same time we have not stopped buying from Russia; in fact in the last six months we have given enough supply, enough money from the European Union to cover a whole year from the time the sanctions started; so yes we have given sanctions but at the same time also enough money to Russia, so it is counterproductive; and also the fact of relying on the United States, yes we are buying from the United States but at the same time however the United States is thinking about itself; there was a few months ago where Italy asked for help from France but France is thinking about itself, it refused cooperation so it is a difficult situation.

The lessons learned from the behavior of politicians lead the young people themselves to take positions of self-protective closure that save determined support for welcoming and humanitarian aid, while condemning the sending of arms.

Antonio states:

I think our concerns should be more about ourselves, our Italian State. You can’t think about waging war when there is a State that is completely at a loss. Alberto spoke earlier about workers: this is one of the many flaws in the Italian system that before we think about external factors that, for now, would not have affected us directly if we had not gone to sell weapons in Ukraine. Rather than thinking about external factors that do not directly affect us we should think about fixing our country. Always hoping that with the current government soon to be in office, we will try to fix the country Italy before thinking about Ukraine, always welcoming those in need and lending a hand, however certainly not to the war industry.

On the level of empathy Sara says.

I think that also on the cultural level there are many problems. In Ukraine many people have lost their loved ones, they have been forced to leave their country not by their own choice and so they are in a situation of pain.

The debate develops around the issue of big and small war with articulated positions. “For me war serves no purpose, I have seen that there are some wars that are ultimately necessary…by making a small war, like now, you avoid one that could involve so many countries” (Gianni).

Sara assesses the group’s opinion not distancing herself from it but looking with concern at the people victimized by war, she is caught in an existential rethinking that generates a contradiction between agreeing to rank wars and taking note of the consequences of war:

In my opinion it is right what my comrades said, however, there cannot be a war either small or big; even if they are few people, they are people who have always suffered, they are survivors, small children who have experienced trauma…, in my opinion it is not really right.

The Causes of War

The major causes of war indicated by the students are economic, military, political, ethnic, assertion of power and force, and media.

According to Alfredo

This emergency situation is due to both poor contracts between Nations for gas supply and the senseless use of the resources a country has; for example, Italy has resources in the Adriatic Sea that it could use precisely for its own or Italian use; instead it wants to make contracts with Russia, after those with the U.S. have expired; I think the Italian State is not in this great crisis with the objective reserves of gas, but just makes its citizens pay for it. Certainly, in every war there is always an economic interest; I think economics is one of the fundamental reasons for war. Those who start the war almost always seek economic advantage and also put all other countries in the world in trouble not only the attacking country. In this situation Russia is economically stronger than the attacking country, Ukraine. The other countries in Europe and America suffer economically from the war; in fact, gas and food prices rise, you cannot buy more of the same kind of products.

Alberto from Romania has a broad view of the causes of the war:

I think the causes of this war are more complex. Since before 2014 there have been tensions going back to medieval times, not only political but also ethnicity. We are talking about Russian imperialism, now we are talking more about propaganda, a part of the Russian population thought they had the right to take parts of what had been the Russian empire, or the Soviet bloc. The Soviet bloc was not a completely united entity, it was simply multiple countries cooperating Ukraine, Crimea. We experienced it too, to make a connection with Romania, with Moldova where there are clashes with Transnistria, they want to keep it as a puppet state. Fortunately, since the president is no longer pro-Russia, the union vote with Romania has gone up from 20 percent to more than 50 percent, so hopefully in the next few years we can take back our brothers; therefore, get back what was taken from us long ago.

Gianni says the causes of the war are military because “America tried to regain advantage with military bases and Russia reacted by attacking Ukraine” and also media because of the persuasive force of the mass media.

The Conditions for Peace

The conditions for peace appear rather impractical. “As long as the two sides are at odds, nothing can change” (Matilde). Compromise, negotiation is not currently possible. Everyone remains with their own ideas. Fear of nuclear power, inequality between the parties has led to the degeneration of relations. An agreement could be made with Russia. About the mediation of other countries, it is believed that Italy occupies a secondary position in the international framework.

The world powers with sanctions have to decide. In some cases, it is thought that peace depends on the will of people. According to Sara

Citizens should have an open revolt against the people with the most power, only if they have all this power, it’s because the citizens gave it to them; so as much as they can do, they can’t have a say, it would be kind of going against what they themselves decided.

Some help could come from psychological support, caring for social relationships. According to Concetta:

From the psychological point of view Ukrainians could be supported by people who could help to overcome the traumas that this war has left; for example, people who have seen their loved ones die in front of their eyes; therefore, help them through a psychologist to overcome certain situations, to move on and avoid remembering, stand by people.

Karen lives in Italy and has relatives in Ukraine and thinks it is necessary to give war aid and social aid to her country.

Alberto states:

A near peace I think is not a very feasible request also because given the current conditions I don’t think Ukraine will leave the land annexed by force by Russia, especially with the EU and NATO supplying it with armaments; at the same time Russia after taking this beating that they didn’t expect such support from NATO towards Ukraine, nor the fact that more troops were needed, I think will continue to conquer Ukraine in full, will continue this expansion. A few months ago, there were secretly sent videos where one of Russia’s generals was pointing out on a global map the smaller countries to be annexed, such as Moldova and Transnistria, in order to have more control over the Black Sea. I think it will become a war of attrition. If Russia wins it will be even worse economically than what happened after the fall of communism also from a social point of view compared to all the other countries. In case Ukraine wins, the outcome will be about the same, but with more dead civilians and a greater need for reconstruction; in any case it will not end well for either side.

The Personalization of War

The stimulus question for the conversation was “If you were in Ukraine what would you do?” The answers fell into three broad categories of those who would never leave the country; those who do not want to be further involved in the events of the war; and those who suspend judgment in the face of an experience too far removed from their everyday lives. Franco says, “In my opinion there is little to do or help the country and fight to defend all ideals or emigrate and find refuge in a country that can take me in.”

Opinions of drastic political change come from Gianni

If I were in such a situation and given the ability, I would start a popular uprising to remove Zelensky from power because he is the cause of the war, he keeps rejecting Russia’s peace proposals, he rejects treaties also because of his enslavement to ‘America; therefore, he is more of a problem for Ukraine than a sticking point.

Concetta argues the relevance of the war debate among young people to form their own ideas with the difficulty of discriminating between news that might be altered by the mass media

It is talked about a lot; in the news it is a very frequent topic. By talking about it we become aware of what is happening in the world, we can create our own idea. We are not there, everything is reported to us, we are not there so we don’t even know the truth, we may get news that is not true.

Overall, the student population is split on the choice to stay, especially by males, and to emigrate especially by females. Family protection conditions and perceptions of the continuation of war without peace solution also impact.

It was asked what they would do if they could have a billion at their disposal and the unanimous answer was to provide social facilities, hospitals, schools, roads, no funding they would give to wars and the powerful of the Earth. The word “genocide” emerges to describe the situation in Ukraine.

The future is uncertain and dense with fears, with a low level of hope, there is a need to run for cover to ensure the supplies that are lacking.

Conclusions

Young people express a sense of helplessness and concern for the future; the war challenges the values of justice and solidarity. Young people feel the negative repercussions on Italy with a split between those who feel the Ukrainians are a burden, those who speak of plausible reasons from Russia, and those who feel they cannot say anything.

On military spending, there are those who complain that Italy is only now noticing the war in Ukraine while it has been there for years. “Italy sells weapons now but the war was already there for years” (Concetta) and for Alfredo.

Italy found itself in a situation in which it had to sell arms to Ukraine and therefore have an economic incentive and I find it an injustice that they are only talking about it now, just as I find it an injustice that they do not talk about other conflicts. Probably Putin’s war could be a show of strength in the sense that the threats he makes on nuclear and bombing can overthrow a nation in minutes with the weapons and technologies that the state possesses today; I think it’s a hasty war, done in an unreasonable way, it’s more of a demonstration of strength and it makes us aware that today a State can start a war in a very short time without particular reasons.

Karen and Dina agree that their families in Ukraine are a constant cause of concern for them, which is why they are in favor of any kind of help.

The strong sense of relativization of war “war is everywhere” balances Italy’s sense of reality of impotence and the action of delegating the problem to the greats of the Earth. War awareness is high in all students. Young people from Eastern Europe experience the war as the age-old history of their family, while for other young people the international scenario has a decisive influence on the evolution of the conflict. In terms of European values, we note a low relevance of Europe as a custodian of a culture of peace and guarantor of human rights.

References

  1. Jerome L, Algarra B (2005) Debating Debating: A reflection on the place of debate within secondary schools. The Curriculum Journal 16: 493-508.
  2. Mycock, Tonge J (Eds.) (2012) The party politics of youth citizenship and democratic engagement. Parliamentary Affairs 65: 138-161.
  3. Ross A (2019) Finding Political Identities. Young People in a Changing Europe. London: Palgrave Macmillan.
  4. Tucci M (2023) Certo che ci informiamo! A modo nostro. Il Dossier. Come si informano gli adolescenti. Laboratorio Adolescenza Magazine 4: 16.
  5. Osokina O. et al. (2023) Impact of the Russian Invasion on Mental Health of Adolescents in Ukraine. Journal of the American Academy of Child & Adolescent Psychiatry 62: 335-343. [crossref]
  6. Maftei A, Dănilă O, Măirean C (2022) The war next-door—A pilot study on Romanian adolescents’ psychological reactions to potentially traumatic experiences generated by the Russian invasion of Ukraine. Frontiers in Psychology.
  7. Del Monte M, Mentzelopoulou MM (2022) Russia’s war on Ukraine The situation of children in and outside Ukraine. Research Service. Bruxelles: European Union.
  8. Mycock A, Tonge J (Eds.) (2014) Beyond the youth citizenship commission: young people and politics. London: Political Studies Association.