Controlled Human Malaria Infection in Semi-Immune Kenyan Adults (CHMI-SIKA): a study protocol to investigate in vivo Plasmodium falciparum malaria parasite growth in the context of pre-existing immunity [version 2; peer review: 2 approved]

Malaria remains a major public health burden despite approval for implementation of a partially effective pre-erythrocytic malaria vaccine. There is an urgent need to accelerate development of a more effective multi-stage vaccine. Adults in malaria endemic areas may have substantial immunity provided by responses to the blood stages of malaria parasites, but field trials conducted on several blood-stage vaccines have not shown high levels of efficacy. We will use the controlled human malaria infection (CHMI) models with malaria-exposed volunteers to identify correlations between immune responses and parasite growth rates in vivo. Immune responses more strongly associated with control of parasite growth should be prioritized to accelerate malaria vaccine development. We aim to recruit up to 200 healthy adult volunteers from areas of differing malaria transmission in Kenya, and after confirming their health status through clinical examination and routine haematology and biochemistry, we will comprehensively characterize immunity to malaria using >100 blood-stage antigens. We will administer 3,200 aseptic, purified, cryopreserved Plasmodium falciparum sporozoites (PfSPZ Challenge) by direct venous inoculation. Serial quantitative polymerase chain reaction to measure parasite growth rate in vivo will be undertaken. Clinical and laboratory monitoring will be undertaken to ensure volunteer safety. In addition, we will also explore the perceptions and experiences of volunteers and other stakeholders in participating in a malaria volunteer infection study. Serum, plasma, peripheral blood mononuclear cells and whole blood will be stored to allow a comprehensive assessment of adaptive and innate host immunity. We will use CHMI in semi-immune adult volunteers to relate parasite growth outcomes with antibody responses and other markers of host immunity. / Registration: ClinicalTrials.gov identifier NCT02739763

Towards Customary Legal Empowerment

Rule of Law and Development: Formation, Implementation and Improvement of Law and Governance in Developing Countrie

'Issues of equity are also issues of rights': Lessons from experiences in Southern Africa

BACKGROUND: Human rights approaches to health have been criticized as antithetical to equity, principally because they are seen to prioritise rights of individuals at the expense of the interests of groups, a core tenet of public health. The objective of this study was to identify how human rights approaches can promote health equity. METHODS: The Network on Equity in Health in Southern Africa undertook an exploration of three regional case studies – antiretroviral access, patient rights charters and civic organization for health. A combination of archival reviews and stakeholder interviews were complemented with a literature review to provide a theoretical framework for the empirical evidence. RESULTS: Critical success factors for equity are the importance of rights approaches addressing the full spectrum from civil and political, through to socio-economic rights, as well as the need to locate rights in a group context. Human rights approaches succeed in achieving health equity when coupled with community engagement in ways that reinforce community capacity, particularly when strengthening the collective agency of its most vulnerable groups. Additionally, human rights approaches provide opportunities for mobilising resources outside the health sector, and must aim to address the public-private divide at local, national and international levels. CONCLUSION: Where it is clear that rights approaches are predicated upon understanding the need to prioritize vulnerable groups and where the way rights are operationalised recognizes the role of agency on the part of those most affected in realising their socio-economic rights, human rights approaches appear to offer powerful tools to support social justice and health equity

The Changing Relationships of Co-wives Over Time in Rural Southern Uganda

Co-wives are often portrayed both as being rivals for their husband's affections and resources as well as collaborators in managing the family. I explore a further dimension: historical time. The life trajectories of individual women in rural Uganda show how co-wife relationships are established, change, endure or end. In addition to ageing, which plays a part in women's changing conjugal arrangements, political upheavals and HIV and AIDS have also had a profound impact on their lives, affecting not only their relationship and attitude towards their husbands but also towards their children, as well as each other. © 2012 Taylor and Francis Group, LLC

On-Line Project-Based Learning on Healthcare Technologies Against Epidemic Diseases: A COVID-19 Case Study

Quality technical education on healthcare technologies is still inaccessible to young adults in low-resource settings due to high costs, low-tech environments, and gaps in learning materials. The online and open-source collaborative Project-Based Learning (PBL) methodology intends to introduce early-career engineers into the development of healthcare technologies by allowing students from all around the world, regardless of background or place of origin, to engage in collaborative design methods, the use of open-source resources and learning experiences from experts in the field. This paper discusses a case study in which the aforementioned methodology was implemented, the "COVID-19 Innovation Competition and Design Bootcamp 2020", which brought together 105 participants from 22 countries, mostly in Africa, to conceptualize the design of 10 medical devices in two weeks for an integral management of the COVID-19 pandemic that is applicable to other infectious disease outbreaks. The presented experience demonstrates that highly formative virtual PBL experiences can be carried out, in a cost-effective way and in connection with real societal needs, for which remarkable solutions can be found, by virtue of multidisciplinary and international cooperation. Our findings demonstrate that even if it is difficult to reach the degree of project completion achievable with longer-term and on-site design-build experiences, on-line PBL has been shown to promote students' professional skills in an effective way