Severe malaria in Burkina Faso: urban and rural environment

The age distribution and the clinical patterns of severe malaria (SM) were compared in patients from urban areas characterized by relatively low transmission, and from rural areas where the mean inoculation rates are at least twenty fold higher. The mean age of the urban and rural patients was 4.8 +/- 3.0 and 2.2 +/- 1.9 respectively (p < 0.000). The prevalence of coma was higher in the urban subsample (53.6 vs 28.9%, p < 0.000) while that of severe anemia (hemoglobin < 5 g/dl) was higher in rural patients (47.4 vs 14.8%, p < 0.000). Our data, in line with previous results obtained comparing rural areas characterized by different inoculation rates, show that the epidemiological context influences the clinical presentation of SM.     

Tick control practices in Burkina Faso and acaricide resistance survey in Rhipicephalus (Boophilus) geigyi (Acari: Ixodidae)

Traditional systems account for 95 % of the livestock produced in Burkina Faso. Tick infestation hampers livestock productivity in this area. However, little information exists on tick-control practices used by livestock farmers. We interviewed 60 stockbreeders working in traditional farming systems to obtain the first data on tick-control practices. Sixteen farmers (27 %) did not use conventional practices: seven removed ticks by hand or plastered cattle with dung or engine oil; nine farmers treated cattle with crop pesticides. Forty-four farmers (73 %) used mainly synthetic pyrethroids (SP; either alphacypermethrin or deltamethrin in 20 and 18 farms, respectively) and occasionally amitraz (N = 6). Intervals between treatments varied significantly depending on the chemical used: most farmers using crop pesticides (100 %), amitraz (100 %) or alphacypermethrin (80 %) adjusted tick-control to tick-burden, whereas farmers using deltamethrin tended more to follow a tick-control schedule. Perception of tick-control effectiveness significantly varied among practices: tick-control failures were more frequently reported by farmers using alphacypermethrin (55 %) than by those using either other conventional acaricides (17 %) or crop pesticides (0 %). We investigated whether this could indicate actual development of SP-resistance in cattle ticks. First, using the larval packet test technique, we confirmed that the computation of LC₅₀ and LC₉₀ was repeatable and remained stable across generations of the Rhipicephalus (Boophilus) geigyi Houndé laboratory strain. We then collected from the field fully-engorged female R. geigyi to evaluate the SP-resistance relative to the Houndé reference strain. We did not detect any case of SP-resistance in the field-derived R. geigyi ticks.     

Process and effects of a community intervention on malaria in rural Burkina Faso: randomized controlled trial

Background

In the rural areas of sub-Saharan Africa, the majority of young children affected by malaria have no access to formal health services. Home treatment through mothers of febrile children supported by mother groups and local health workers has the potential to reduce malaria morbidity and mortality.

Methods

A cluster-randomized controlled effectiveness trial was implemented from 2002–2004 in a malaria endemic area of rural Burkina Faso. Six and seven villages were randomly assigned to the intervention and control arms respectively. Febrile children from intervention villages were treated with chloroquine (CQ) by their mothers, supported by local women group leaders. CQ was regularly supplied through a revolving fund from local health centres. The trial was evaluated through two cross-sectional surveys at baseline and after two years of intervention. The primary endpoint of the study was the proportion of moderate to severe anaemia in children aged 6–59 months. For assessment of the development of drug efficacy over time, an in vivo CQ efficacy study was nested into the trial. The study is registered under http://www.controlled-trials.com (ISRCTN 34104704).

Results

The intervention was shown to be feasible under program conditions and a total of 1.076 children and 999 children were evaluated at baseline and follow-up time points respectively. Self-reported CQ treatment of fever episodes at home as well as referrals to health centres increased over the study period. At follow-up, CQ was detected in the blood of high proportions of intervention and control children. Compared to baseline findings, the prevalence of anaemia (29% vs 16%, p < 0.0001) and malaria parameters such as prevalence of P. falciparum parasitaemia, fever and palpable spleens was lower at follow-up but there were no differences between the intervention and control group. CQ efficacy decreased over the study period but this was not associated with the intervention.

Discussion

The decreasing prevalence of malaria morbidity including anaemia over the study period can be explained by an overall increase of malaria prevention and treatment activities in the study area. The lack of effectiveness of the intervention was likely caused by contamination, pre-existing differences in the coverage of malaria treatment in both study groups and an unexpectedly rapid increase of resistance against CQ, the first-line treatment drug at the time of the study.

     

Determinants of infant and young child feeding practices by mothers in two rural districts of Sindh,Pakistan: a cross-sectional survey

Background

Infant and young child feeding (IYCF) practices during the first two years of life are important for the growth and development of a child. The aim of this study was to assess IYCF practices and its associated factors in two rural districts of Pakistan.

Methods

A cross-sectional study was conducted in two rural districts of Sindh province, Pakistan as part of a stunting prevention project between May and August 2014. A standard questionnaire on IYCF practices recommended by World Health Organization was used to collect information from 2013 mothers who had a child aged between 0 and 23 months.

Results

Only 49% of mothers initiated breastfeeding within one hour of birth. Thirty-seven percent of mothers exclusively breastfed their infants for six months. Seventy-percent mothers introduced complementary feeding at 6–8 months of age. Eighty-two percent of mothers continued breastfeeding for at least one year and 75% for at least two years of age. IYCF practices were not significantly different for boys and girls in the study area. Being an employed mother (AOR 2.14; 95% CI 1.02, 4.51) was positively associated with the early initiation of breastfeeding. Children who were born at a health facility (AOR 0.65; 95% CI 0.50, 0.84) and were aged six to eleven months (AOR 0.70; 95% CI 0.54, 0.90) were less likely to be have an early initiation of breastfeeding. Mothers aged 25 to 29 years (AOR 1.83; 95% CI 1.05, 3.18), being literate (AOR 1.79; 95% CI 1.15, 2.78), and higher income (AOR 10.6; 95% CI 4.40, 25.30) were more likely to have an improved dietary diversity. Being an employed mother (AOR 2.18; 95% CI 1.77, 4.03) and higher income were more likely to have minimum acceptable diet (AOR 9.7; 95% CI 4.33, 21.71).

Conclusion

IYCF practices were below the acceptable level and associated with maternal age, maternal illiteracy, unemployment, and poor household wealth status. Emphasis should be given to improve maternal literacy and reduction in poverty to improve IYCF practices.

     

Utilization of permethrin-impregnated curtains by the inhabitants of a rural community in Burkina Faso]

The degree of utilisation of permethrin-impregnated curtains was assessed in a rural community near Ouagadougou, Burkina Faso. Results showed that in the first half of the night, until 11-11.30 p.m., curtains were only partially used by the community. Indeed by this time around 50% of houses had doors well protected by curtains and, over 35% of the community, children and adults, were staying outside. A very marked pattern of this behavior was found, wrong utilisation of curtains being higher in the warm season and lower in the cold season. On the one hand, this situation decreased the potential action of curtains as a barrier to avoid mosquito-man contact and, on the other hand, facilitated the exposure of community to the risk of outdoor infection. These findings may explain the variable level of efficacy showed by curtains in the prevention of malaria morbidity, which seems to be higher in the period between January and February, the winter season in Burkina Faso. The possible application of impregnated curtains as a community-based vector control method is discussed.     

Distribution systems of insecticide-treated bed nets for malaria control in rural Burkina Faso: cluster-randomized controlled trial

Background

Insecticide-impregnated bed nets (ITNs) have been shown to be a highly effective tool against malaria in the endemic regions of sub-Saharan Africa (SSA). There are however different opinions about the role of ITN social marketing and ITN free distribution in the roll-out of ITN programmes. The objective of this study was to evaluate the effects of free ITN distribution through antenatal care services in addition to an ITN social marketing programme in an area typical for rural SSA.

Methods

A cluster-randomised controlled ITN trial took place in the whole Kossi Province in north-western Burkina Faso, an area highly endemic for malaria. Twelve clusters were assigned to long-term ITN (Serena brand) social marketing plus free ITN (Serena brand) distribution to all pregnant women attending governmental antenatal care services (group A), and 13 clusters to ITN social marketing only (group B). The intervention took place during the rainy season of 2006 and thereafter. The trial was evaluated through a representative household survey at baseline and after one year. Serena ITN household ownership was the primary outcome measure.

Findings

A total of 1052 households were visited at baseline in February 2006 and 1050 at follow-up in February 2007. Overall Serena ITN household ownership increased from 16% to 28% over the study period, with a significantly higher increase in group A (13% to 35%) than in group B (18% to 23%) (p<0.001).

Interpretation

The free distribution of ITNs to pregnant women through governmental antenatal care services in addition to ITN social marketing substantially improved ITN household ownership in rural Burkina Faso.

Trial registration

Controlled-Trials.com ISRCTN07985309     

Prenatal fortified balanced energy-protein supplementation and birth outcomes in rural Burkina Faso: A randomized controlled efficacy trial

BackgroundProviding balanced energy–protein (BEP) supplements is a promising intervention to improve birth outcomes in low- and middle-income countries (LMICs); however, evidence is limited. We aimed to assess the efficacy of fortified BEP supplementation during pregnancy to improve birth outcomes, as compared to iron–folic acid (IFA) tablets, the standard of care.Methods and findingsWe conducted an individually randomized controlled efficacy trial (MIcronutriments pour la SAnté de la Mère et de l’Enfant [MISAME]-III) in 6 health center catchment areas in rural Burkina Faso. Pregnant women, aged 15 to 40 years with gestational age (GA) <21 completed weeks, were randomly assigned to receive either fortified BEP supplements and IFA (intervention) or IFA (control). Supplements were provided during home visits, and intake was supervised on a daily basis by trained village-based project workers. The primary outcome was prevalence of small-for-gestational age (SGA) and secondary outcomes included large-for-gestational age (LGA), low birth weight (LBW), preterm birth (PTB), gestational duration, birth weight, birth length, Rohrer’s ponderal index, head circumference, thoracic circumference, arm circumference, fetal loss, and stillbirth. Statistical analyses followed the intention-to-treat (ITT) principle. From October 2019 to December 2020, 1,897 pregnant women were randomized (960 control and 937 intervention). The last child was born in August 2021, and birth anthropometry was analyzed from 1,708 pregnancies (872 control and 836 intervention). A total of 22 women were lost to follow-up in the control group and 27 women in the intervention group. BEP supplementation led to a mean 3.1 percentage points (pp) reduction in SGA with a 95% confidence interval (CI) of −7.39 to 1.16 (P = 0.151), indicating a wide range of plausible true treatment efficacy. Adjusting for prognostic factors of SGA, and conducting complete cases (1,659/1,708, 97%) and per-protocol analysis among women with an observed BEP adherence ≥75% (1,481/1,708, 87%), did not change the results. The intervention significantly improved the duration of gestation (+0.20 weeks, 95% CI 0.05 to 0.36, P = 0.010), birth weight (50.1 g, 8.11 to 92.0, P = 0.019), birth length (0.20 cm, 0.01 to 0.40, P = 0.044), thoracic circumference (0.20 cm, 0.04 to 0.37, P = 0.016), arm circumference (0.86 mm, 0.11 to 1.62, P = 0.025), and decreased LBW prevalence (−3.95 pp, −6.83 to −1.06, P = 0.007) as secondary outcomes measures. No differences in serious adverse events [SAEs; fetal loss (21 control and 26 intervention) and stillbirth (16 control and 17 intervention)] between the study groups were found. Key limitations are the nonblinded administration of supplements and the lack of information on other prognostic factors (e.g., infection, inflammation, stress, and physical activity) to determine to which extent these might have influenced the effect on nutrient availability and birth outcomes.ConclusionsThe MISAME-III trial did not provide evidence that fortified BEP supplementation is efficacious in reducing SGA prevalence. However, the intervention had a small positive effect on other birth outcomes. Additional maternal and biochemical outcomes need to be investigated to provide further evidence on the overall clinical relevance of BEP supplementation.Trial registrationClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT03533712","term_id":"NCT03533712"}}NCT03533712.

Brenda de Kok and colleagues investigate the efficacy of fortified BEP supplementation during pregnancy to improve birth outcomes, as compared to iron-folic acid (IFA) tablets, among pregnant women in rural Burkina Faso.     

Woody vegetation spatial patterns in a semi-arid savanna of Burkina Faso,West Africa

Spatial patterns of woody individuals were studied in a semi-arid savanna of West Africa located in Burkina Faso at and around 14° 12 N and 2° 27 W. The study was based upon a 10.24 ha plot within which individuals were mapped. Spatial pattern analysis was carried out using second order characteristics of point processes as K functions and pair correlations. The overall density amounted to 298 individuals ha^-1. The most abundant species were Combretum micranthum G. Don., Grewia bicolor Juss. and Pterocarpus lucens Lepr. Anogeissus leiocarpus (D.C.) G. et Perr. was also an important constituant of this vegetation type, owing to its taller stature. Clumped spatial distributions were identified for all species except for two, for which complete spatial randomness (CSR) was found (including P. lucens, a dominant woody plant). No regular pattern was found even when tall individuals were considered alone. Aggregation dominates interspecific relationships, resulting in multispecific clumps and patches. The overall aggregation pattern was constituted by two different structures. A coarse-grain pattern of ca. 30–40 m was based on edaphic features, and expresses the contrast between sparse stands on petroferric outcrops and denser patches on less shallow soils. A finer-grain pattern made of clumps ca. 5–10 m wide, with no obvious relation to pre-existing soil heterogeneity. There was no overall pattern for saplings (between 0.5 m and 1.5 m in height) irrespective of species, and thus no obvious common facilitation factor. For species with a high recruitment level there was no significant relationship between mature adult and saplings. The only case of clumped saplings with randomly distributed adults was found in P. lucens. However, this cannot be unequivocally interpreted as density dependent regulation since the existence of such a process was not consistent with the spatial distribution of dead P. lucens individuals (victims of the last drought). The mean density around dead P. lucens was lower than around surviving ones, indicating that the last drought tended to reinforce clumping rather than promote a regular pattern of trees. Spatial pattern analysis yielded no evidence supporting a hypothesis of stand density regulation through competition between individuals. Other processes, as surface sealing of bare soils or insufficient recruitment, may play a more important role in preventing a savanna-like vegetation from turning into denser woodlands or thickets.     

Intermittent preventive treatment of malaria in children: a qualitative study of community perceptions and recommendations in Burkina Faso and Mali

Background

Intermittent preventive treatment of malaria in children (IPTc) is a highly efficacious method of malaria control where malaria transmission is highly seasonal. However, no studies published to date have examined community perceptions of IPTc.

Methods

A qualitative study was undertaken in parallel with a double-blind, placebo-controlled, randomized trial of IPTc conducted in Mali and Burkina Faso in 2008–2009 to assess community perceptions of and recommendations for IPTc. Caregivers and community health workers (CHWs) were purposively sampled. Seventy-two in-depth individual interviews and 23 focus group discussions were conducted.

Findings

Widespread perceptions of health benefits for children led to enthusiasm for the trial and for IPTc specifically. Trust in and respect for those providing the tablets and a sense of obligation to the community to participate in sanctioned activities favoured initial adoption. IPTc fits in well with existing understandings of childhood illness. Participants did not express concerns about the specific drugs used for IPTc or about providing tablets to children without symptoms of malaria. There was no evidence that IPTc was perceived as a substitute for bed net usage, nor did it inhibit care seeking. Participants recommended that distribution be “closer to the population”, but expressed concern over caregivers'' ability to administer tablets at home.

Conclusions

The trial context mediated perceptions of IPTc. Nonetheless, the results indicate that community perceptions of IPTc in the settings studied were largely favourable and that the delivery strategy rather than the tablets themselves presented the main areas of concern for caregivers and CHWs. The study identifies a number of key questions to consider in planning an IPTc distribution strategy. Single-dose formulations could increase the success of IPTc implementation, as could integration of IPTc within a package of activities, such as bed net distribution and free curative care, for which demand is already high.     

Widespread distribution of insecticide-impregnated curtains reduces child mortality, prevalence and intensity of malaria infection, and malaria transmission in rural Burkina Faso

The results of the first two years of implementation of a large scale trial of insecticide-treated curtains in Burkina Faso are summarised in this presentation. The trial was conducted in a highly malarious area and involved a population of slightly less than 100,000, distributed in 158 villages over an area of almost 1000 km2. A remarkable impact on entomological parameters (Anopheles density, sporozoite rate, entomological inoculation rate) was accompanied by a relatively modest reduction of parasitological indices (prevalence and density of Plasmodium falciparum). All-cause mortality in children 0.5 to 5 year old showed over two years a 15% decline. The authors believe that the wide surface of the protected zone and the almost total coverage achieved in the intervention villages were the major determinants of the observed reduction of transmission. A conclusive interpretation of the mortality results requires a further follow-up of the study population.     

Smoking among young rural to urban migrant women in China: a cross-sectional survey

Background

Rural-to-urban migrant women may be vulnerable to smoking initiation as they are newly exposed to risk factors in the urban environment. We sought to identify correlates of smoking among rural-to-urban migrant women in China.

Methods/Principal Findings

A cross-sectional survey of rural-to-urban migrant women working in restaurants and hotels (RHW) and those working as commercial sex workers (CSW) was conducted in ten provincial capital cities in China. Multiple logistic regression was conducted to identify correlates of smoking. We enrolled 2229 rural-to-urban migrant women (1697 RHWs aged 18–24 years and 532 CSWs aged 18–30 years). Of these, 18.4% RHWs and 58.3% CSWs reported ever tried smoking and 3.2% RHWs and 41.9% CSWs reported current smoking. Participants who first tried smoking after moving to the city were more likely to be current smokers compared to participants who first tried smoking before moving to the city (25.3% vs. 13.8% among RHWs, p = 0.02; 83.6% vs. 58.6% among CSWs, p = <0.01). Adjusting for other factors, “tried female cigarette brands” had the strongest association with current smoking (OR 5.69, 95%CI 3.44 to 9.41) among participants who had ever tried smoking.

Conclusions/Significance

Exposure to female cigarette brands may increase the susceptibility to smoking among rural-to-urban migrant women. Smoke-free policies and increased taxes may be effective in preventing rural-to-urban migrant women from smoking initiation.     

Insecticide treated curtains and allelic polymorphism of Plasmodium falciparum genes in a rural area of Burkina Faso (west Africa)

To assess the possible impact of insecticide treated curtains (ITC) on the composition of a Plasmodium falciparum population in a rural area of Burkina Faso, blood samples were collected during the rainy season of 1997 from 226 children aged 3-6 years, from 4 villages equipped with ITC and 2 control villages without ITC. The analysis of fragment lengths of 3 highly polymorphic P. falciparum genes (msp-1, msp-2 and glurp) revealed a maximum number of 3 alleles per infected person for each gene. The mean number of clones per infected person was similar in villages with and without ITC.     

Further observations on chemoprophylaxis and prevalence of malaria using questionnaire data in urban and rural areas of Burkina Faso

A cross-sectional study of malaria prevalence (98.6% Plasmodium falciparum) was carried out in Ouagadougou (Burkina Faso) and in 3 neighbouring villages on 2117 children, zero to five years old. Data on antimalarial prophylaxis and treatment were obtained from the child's parent using an interviewer-administered questionnaire. Regular weekly chloroquine consumption lowered the parasite rate but a significant increase with respect to parasite density was recorded in protected children from the rural area. No significant differences related to previous antimalarial treatments were observed in parasite rate or density. Antimalarial treatments were less frequent in children under chemoprophylaxis. Information about dosage and date of therapy was not recalled by most of the interviewed parents. Problems and suggestions for questionnaire data are briefly discussed.     

Adverse childhood experiences,adult depression,and suicidal ideation in rural Uganda: A cross-sectional,population-based study

BackgroundDepression is recognized globally as a leading cause of disability. Early-life adverse childhood experiences (ACEs) have been shown to have robust associations with poor mental health during adulthood. These effects may be cumulative, whereby a greater number of ACEs are progressively associated with worse outcomes. This study aimed to estimate the associations between ACEs and adult depression and suicidal ideation in a cross-sectional, population-based study of adults in Uganda.Methods and findingsBetween 2016 and 2018, research assistants visited the homes of 1,626 adult residents of Nyakabare Parish, a rural area in southwestern Uganda. ACEs were assessed using a modified version of the Adverse Childhood Experiences-International Questionnaire, and depression symptom severity and suicidal ideation were assessed using the Hopkins Symptom Checklist for Depression (HSCL-D). We applied a validated algorithm to determine major depressive disorder diagnoses. Overall, 1,458 participants (90%) had experienced at least one ACE, 159 participants (10%) met criteria for major depressive disorder, and 28 participants (1.7%) reported suicidal ideation. We fitted regression models to estimate the associations between cumulative number of ACEs and depression symptom severity (linear regression model) and major depressive disorder and suicidal ideation (Poisson regression models). In multivariable regression models adjusted for age, sex, primary school completion, marital status, self-reported HIV status, and household asset wealth, the cumulative number of ACEs was associated with greater depression symptom severity (b = 0.050; 95% confidence interval [CI], 0.039–0.061, p < 0.001) and increased risk for major depressive disorder (adjusted relative risk [ARR] = 1.190; 95% CI, 1.109–1.276; p < 0.001) and suicidal ideation (ARR = 1.146; 95% CI, 1.001–1.311; p = 0.048). We assessed the robustness of our findings by probing for nonlinearities and conducting analyses stratified by age. The limitations of the study include the reliance on retrospective self-report as well as the focus on ACEs that occurred within the household.ConclusionsIn this whole-population, cross-sectional study of adults in rural Uganda, the cumulative number of ACEs had statistically significant associations with depression symptom severity, major depressive disorder, and suicidal ideation. These findings highlight the importance of developing and implementing policies and programs that safeguard children, promote mental health, and prevent trajectories toward psychosocial disability.

In a cross-sectional, population based study of adults in rural Uganda, Emily Satinsky and colleagues investigate adverse childhood experiences and associations with depression and suicidal ideation.     

Neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan: a cross-sectional study

Background

During the past two decades there has been a sustained decline in child and infant mortality, however neonatal mortality has remained relatively unchanged. Almost all neonatal deaths (99%) occur in developing countries, where the majority are delivered at homes. Evidence suggests that these deaths could be prevented by simple, inexpensive practices and interventions during the pregnancy, delivery and postnatal period. In Pakistan over the last decade extensive efforts have been made by the international donors and government to implement these practices. However, limited attempts have been made to explore if these efforts have made a difference at the grass root level. This study assessed the burden of neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan.

Methodology/Principal Findings

A community based cross-sectional study was performed. A pre-tested structured questionnaire was administered to 565 women who had recently delivered. Information was collected on neonatal morbidity, mortality and practices of women regarding care during pregnancy, child birth and for newborn, till 28th day of birth. Although 70% of women mentioned receiving antenatal care by a skilled provider, only 54.5% had four or more visits. Tetanus toxoid was received by 79% of women while only 56% delivered at a health care facility by a skilled attendant. Newborn care practices like bathing the baby immediately after birth (56%), giving pre-lacteals (79.5%), late initiation of breast feeding (80.3%), application of substances on umbilical cord (58%) and body massage (89%) were common. Most neonates (81.1%) received BCG injection and polio drops after birth. Neonatal mortality rate was 27/1000 live births with the majority of deaths occurring during the first three days of life.

Conclusion

Even after years of efforts by government and nongovernmental sector to reduce newborn morbidity and mortality, inadequate antenatal care, home deliveries and unhealthy newborn care practices are highly prevalent. This leads us to important questions of why practices and behaviors have not changed. Who is responsible and what strategies are needed to bring this change?     

Perceptions, use and availability of woody plants among the Gourounsi in Burkina Faso

The present study was conducted in five villages around the Nazinga Game Ranch, Burkina Faso. Fifty informants of the Gourounsi ethnic group were used. Eighty-one useful woody species were identified, out of a total of 110 woody species in the area. Woody plant use was quantified as: edible fruits (28 species), vegetable sauce (22 species), firewood (33 species), construction (29 species) and medicine (64 species and 167 remedies). Further, species accumulation curves were used to estimate that more than 650 remedies for medicine are used in the area. The community's knowledge of plants was analysed in relation to age, gender, village of residence and amount of intercultural visits. The knowledge pattern was remarkably uniform, with only two variations: (1) men generally identified more edible fruit trees than women, and (2) one village reported more firewood species than the other four villages. The informants had a variety of opinions concerning the availability of useful plants, but the majority found the availability to be fine and 47% of the informants searched for useable products in the savanna on a daily basis. No correlation was found between an informant's impression of useful products availability and his/her frequency of visits into the savanna. The results show that the Gourounsi people live in intimate relation with the savanna surrounding their villages. They are aware of the environment and are willing to learn and adopt new conservation practices.