One of a Kind-The Pan African Clinical Trials Registry, a regional registry for Africa

The 2004 Ministerial Summit on Health Research called on the World Health Organization to to establish a registry network with the intention of providing a single access point to identify trials. In 2007 the International Committee of Medical Journal Editors amended their support of this initiative stating that only trials registered prospectively on a member registry of the WHO's Network of Primary Registers would be published. The Pan African Clinical Trials Registry (www.pactr.org), was established in early 2007 as the AIDS, TB and Malaria (ATM) Clinical Trials Registry with the aim of piloting the concept of a registry that would cater to the specific needs of African trialists. In 2009 the ATM Registry expanded its remit to include all diseases for all regions of Africa; The Pan African Clinical Trials Registry became the first and is presently the only African member of the World Health Organization's Network of Primary Registers

Wellbeing on the Edge: The dynamics of Musundian edge- dwelling on the boundaries of protected natural areas in Limpopo, South Africa

This thesis examines the impacts of a protected natural area (Makuya park) on residents of Musunda village in Limpopo, South Africa. The creation of protected natural areas entails the formation of boundaries to limit access and resource use, often under the assumption that the isolation from human activity will allow 'natural' environments/habitats to re-emerge. When humans are not afforded a place in protected spaces, 'edge-dwellers' emerge. This thesis explores how the resulting changes in land use and access can impact the availability, distribution, and quality of strategically important resources, and thus influence a wide range of ecological, epidemiological, and economic processes that directly and indirectly impinge on an individual's wellbeing. Based on over two years of ethnographic fieldwork in the HaMakuya chieftaincy, this thesis aims to explore the tangible and intangible ways in which Makuya park impacts on Musundian edge-dwellers efforts to achieve wellbeing. Specific research questions include: How do edge-dwellers understand, discuss, and enact wellbeing? How and when are natural resources used toward achieving wellbeing? How and when does land access shape land use in terms of wellbeing and in what ways? Have shifts in practices occurred as a result of the formation of protected areas? I address these questions by engaging with current debates in social, medical and environmental anthropology. Using Cohen's (2013) 'ecologies of wellbeing' as a matrix through which to explore local conceptions of health/wellbeing (mutakalo), this thesis engages with a historical 'political ecology of health' (Harper 2002) and conservation to consider health and wellbeing within 'environmental perspectives' (McElroy and Townsend 2009). In focusing on the everyday practices of Musundians, this thesis foregrounds local notions of health (mutakalo) and local perceptions of natural resource limitations imposed by the park as a way to understand edge-dwellers' local ecologies of wellbeing. This thesis provides TshiVenda speakers' (an under-represented group) perspectives; it shows the negative impacts that the park has on resource access, diet, relationships and local healing practices according to edge-dwellers. Questioning how Musundians maintained ambivalence in these challenging circumstances, I discuss how I came to realize that the park is locally understood to offer the promise of 'good things.' Exploring the ways in which hope and the park intersect, I describe how the park has become incorporated into local ecologies of wellbeing. This thesis explores some wellbeing-related experiences of Musunda's edge-dwellers, while considering the park's influence on those dwelling on the boundary of a protected natural area thereby contributing to social anthropology scholarship at the intersection of environmental and medical anthropology. In doing this, this thesis draws on related disciplines in the social sciences, contributing to literatures in human geography, public health and ecology

Supporting registration of child-focused clinical trials in Africa: The Child Strategy Project

Editorial abstract not applicabl

Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence

<p>Abstract</p> <p>Background</p> <p>Current research focuses on three variables in evaluating the impact of stress urinary incontinence (SUI) on daily living: severity of incontinence, distress or bother resulting from incontinence, and effect on health related quality of life (HRQoL). Understanding the impact of these variables is important as they are the driving force behind women seeking surgical treatment. Given the importance of HRQoL in determining need for treatment, as well as evaluating treatment success, this review provides an assessment of the degree to which HRQoL is impaired in women seeking surgical treatment.</p> <p>Methods</p> <p>PubMed searches for the terms "quality of life and distress and urinary incontinence" and "quality of life and bother and urinary incontinence" were performed with limits of English, human and female subjects through May 2008. All studies using validated instruments were included. No time limit was placed on the search.</p> <p>Results</p> <p>Of 178 articles retrieved, 21 met the inclusion criteria, and 17 reported methods of scoring. The studies used the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). Wide ranges of mean and individual levels of severity of symptoms, UDI and IIQ scores were seen among women seeking surgical treatment. Fourteen studies reported baseline and post-surgical treatment distress and QoL data. Statistically significant improvements between baseline and post-surgical UDI and IIQ scores were reported in 12 studies. Reported cure rates ranged from 46% to 97%. Satisfaction with the procedure was reported in 4 studies and ranged from 84% to 91%. A minority of studies reported the relationship between reduction in symptoms and change in HRQoL.</p> <p>Conclusion</p> <p>HRQoL is the main reason women seek surgical treatment for incontinence and surgical treatment leads to a significant improvement in mean HRQoL scores. Assessment of HRQoL has proved less useful in identifying why individual women seek treatment for incontinence. Preliminary work has begun to characterize the interaction between severity of symptoms, distress or bother resulting from these urinary symptoms, impact on HRQoL, and treatment seeking behavior, but further research is needed. Greater standardization in the reporting of results of distress or bother and HRQoL would allow for comparison across studies.</p

Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence

<p>Abstract</p> <p>Background</p> <p>Current research focuses on three variables in evaluating the impact of stress urinary incontinence (SUI) on daily living: severity of incontinence, distress or bother resulting from incontinence, and effect on health related quality of life (HRQoL). Understanding the impact of these variables is important as they are the driving force behind women seeking surgical treatment. Given the importance of HRQoL in determining need for treatment, as well as evaluating treatment success, this review provides an assessment of the degree to which HRQoL is impaired in women seeking surgical treatment.</p> <p>Methods</p> <p>PubMed searches for the terms "quality of life and distress and urinary incontinence" and "quality of life and bother and urinary incontinence" were performed with limits of English, human and female subjects through May 2008. All studies using validated instruments were included. No time limit was placed on the search.</p> <p>Results</p> <p>Of 178 articles retrieved, 21 met the inclusion criteria, and 17 reported methods of scoring. The studies used the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). Wide ranges of mean and individual levels of severity of symptoms, UDI and IIQ scores were seen among women seeking surgical treatment. Fourteen studies reported baseline and post-surgical treatment distress and QoL data. Statistically significant improvements between baseline and post-surgical UDI and IIQ scores were reported in 12 studies. Reported cure rates ranged from 46% to 97%. Satisfaction with the procedure was reported in 4 studies and ranged from 84% to 91%. A minority of studies reported the relationship between reduction in symptoms and change in HRQoL.</p> <p>Conclusion</p> <p>HRQoL is the main reason women seek surgical treatment for incontinence and surgical treatment leads to a significant improvement in mean HRQoL scores. Assessment of HRQoL has proved less useful in identifying why individual women seek treatment for incontinence. Preliminary work has begun to characterize the interaction between severity of symptoms, distress or bother resulting from these urinary symptoms, impact on HRQoL, and treatment seeking behavior, but further research is needed. Greater standardization in the reporting of results of distress or bother and HRQoL would allow for comparison across studies.</p

Water, Sanitation, and Hygiene Vulnerability among Rural Areas and Small Towns in South Africa: Exploring the Role of Climate Change, Marginalization, and Inequality

Access to water, sanitation, and hygiene (WASH)—including drainage-services—is essential for public health and socio-economic development, but access remains inadequate and inequitable in low- to middle-income countries such as South Africa. In South Africa, rural areas and small towns generally depend on a limited and climate-sensitive economic base (e.g., farming), and they have a limited capacity and are located in areas where transport challenges can increase WASH access risks. Climate change shifts hydrological cycles, which can worsen WASH access and increase susceptibility to the interlinked impacts of droughts and flooding in already vulnerable regions. We adopted a transdisciplinary approach to explore the needs, barriers, and vulnerabilities with respect to WASH in rural areas and small towns in South Africa—using two case studies to explore climate risk and vulnerability assessment (CRVA) in one rural village in the northern Limpopo province and a small town in the Western Cape province. This holistic approach considered natural (environment and climate) and socio-economic (economic, social, governance, and political) factors and how they interplay in hampering access to WASH. Extreme weather events characterized by frequent and intense droughts or floods aggravate surface and groundwater availability and damage water infrastructure while threatening agriculture-dependent livelihoods. The lack of reliable transport infrastructure increases risks posed by flooding as roads to vital supplies are prone to damage. High inequality linked to rising unemployment and the Apartheid legacy of a segregated service delivery system result in inequitable access to WASH services. The intertwined ways in which natural elements and historical, social, economic, governance, and policy aspects are changing in South Africa increase WASH vulnerability in rural areas and small towns

Water, Sanitation, and Hygiene Vulnerability among Rural Areas and Small Towns in South Africa: Exploring the Role of Climate Change, Marginalization, and Inequality

Access to water, sanitation, and hygiene (WASH)—including drainage-services—is essential for public health and socio-economic development, but access remains inadequate and inequitable in low- to middle-income countries such as South Africa. In South Africa, rural areas and small towns generally depend on a limited and climate-sensitive economic base (e.g., farming), and they have a limited capacity and are located in areas where transport challenges can increase WASH access risks. Climate change shifts hydrological cycles, which can worsen WASH access and increase susceptibility to the interlinked impacts of droughts and flooding in already vulnerable regions. We adopted a transdisciplinary approach to explore the needs, barriers, and vulnerabilities with respect to WASH in rural areas and small towns in South Africa—using two case studies to explore climate risk and vulnerability assessment (CRVA) in one rural village in the northern Limpopo province and a small town in the Western Cape province. This holistic approach considered natural (environment and climate) and socio-economic (economic, social, governance, and political) factors and how they interplay in hampering access to WASH. Extreme weather events characterized by frequent and intense droughts or floods aggravate surface and groundwater availability and damage water infrastructure while threatening agriculture-dependent livelihoods. The lack of reliable transport infrastructure increases risks posed by flooding as roads to vital supplies are prone to damage. High inequality linked to rising unemployment and the Apartheid legacy of a segregated service delivery system result in inequitable access to WASH services. The intertwined ways in which natural elements and historical, social, economic, governance, and policy aspects are changing in South Africa increase WASH vulnerability in rural areas and small towns

A methodological comparison for WASH-related climate vulnerability assessments

This record includes an extended abstract and MP4 presentation. Presented at the 42nd WEDC International Conference