COVID-19 and Ubuntu Disruptions: Curbing the violence against Women and Girls with Disabilities through African Women’s Theology of Disability

The COVID-19 restrictions that require the lockdown of public and economic activities heighten the levels of sexual and gender-based violence against women and girls with disabilities. As the COVID-19 pandemic spreads across the globe, particularly in Africa, women and girls with disabilities become vulnerable to sexual and gender-based violence, highlighting that the home is no longer a safe space for the vulnerable. The restrictions have eroded the community structures that are promoted by Ubuntu to protect vulnerable community members from violence and different forms of abuse. This article grapples with the question of African women’s theology of disability and Ubuntu in the context of COVID-19. It seeks to address the vulnerability of women and girls with disabilities to sexual and gender-based violence (SGBV) in private homes. The question, therefore, that this article seeks to answer is how African women’s theology of disability informed by Ubuntu can curb the violence and abuses perpetrated on women and girls with disabilities in the context of COVID-19

Domestic abuse in marriage and self-silencing: Pastoral care in a context of self-silencing

The socialisation of women into self-silencing by religion has complicated pastoral care interventions for the victims of domestic violence, particularly within the context of marriage. This article is written from an intercultural approach to pastoral care and applies the theory on silence. The aim of this article is to explore the way pastoral caregivers can extend caregiving to the victims of marital domestic violence who have silenced the self. The article draws from qualitative data that were collected through autobiographical narratives, in-depth interviews and observations, and analysed through thematic analysis. The findings indicate that women are forced to silence the self in contexts of domestic violence by not speaking about the abuse that takes place in marriage. The self-silencing is justified by those who interpret Biblical texts that address marriage naively; in this case one of the two women who participated in this study confirmed that Proverbs 21:9 is used to justify self-silencing. Thus, the article concludes that pastoral care interventions in such contexts should include a circle of the significant others that women interact with such as the perpetrator and the broader community, including her social networks

‘Disabled motherhood in an African community’: Towards an African women theology of disability

The politics of culture, motherhood and mothering in some African communities highlight the tensions that exist in the broader feminist theology agenda. There are emerging politics between the able and disabled feminist theologians where the binary of ability or disability is ambiguously theologised. Written from a feminist theology of disability, this qualitative study sought to understand and describe the struggles women with visual impairment face to be accepted as being fit for motherhood. Emerging qualitative themes are used to develop towards an African women theology of disability that responds to the plight of women with disabilities. The findings indicate that women with disabilities are constantly challenging and protesting ableism perceptions of motherhood by falling pregnant, giving birth and nurturing their children. They argue that the binary perceptions of ability and disability are informed by patriarchal ideologies and able-bodied women’s fears of being associated with the vulnerability of disability

Vitamin D deficiency in Malawian adults with pulmonary tuberculosis : risk factors and treatment outcomes

The study was supported by a Wellcome Trust (London, UK) Clinical PhD Fellowship awarded to DS (086757/Z/08/A) and the Malawi Liverpool Wellcome Trust (MLW) Core grant from the Wellcome Trust.SETTING: Vitamin D deficiency is common in African adults with tuberculosis (TB), and may be exacerbated by the metabolic effects of anti-tuberculosis drugs and antiretroviral therapy (ART). It is unclear whether vitamin D deficiency influences response to antituberculosis treatment. OBJECTIVES : To describe risk factors for baseline vitamin D deficiency in Malawian adults with pulmonary TB, assess the relationship between serum 25-hydroxy vitamin D (25[OH]D) concentration and treatment response, and evaluate whether the administration of anti-tuberculosis drugs and ART is deleterious to vitamin D status during treatment. DESIGN: A prospective longitudinal cohort study. RESULTS : The median baseline 25(OH)D concentration of the 169 patients (58% human immunodeficiency virus [HIV] infected) recruited was 57 nmol/l; 47 (28%) had vitamin D deficiency (<50 nmol/l). Baseline 25(OH)D concentrations were lower during the cold season (P < 0.001), with food insecurity (P = 0.034) or in patients who consumed alcohol (P = 0.019). No relationship between vitamin D status and anti-tuberculosis treatment response was found. 25(OH)D concentrations increased during anti-tuberculosis treatment, irrespective of HIV status or use of ART. CONCLUSIONS : Vitamin D deficiency is common among TB patients in Malawi, but this does not influence treatment response. Adverse metabolic effects of drug treatment may be compensated by the positive impact of clinical recovery preventing exacerbation of vitamin D deficiency during anti-tuberculosis treatment.Publisher PDFPeer reviewe

The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality : a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa (ETATMBA) project

Background: Maternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe. Perinatal mortality is 12 times higher than maternal mortality accounting for about 7 million neonatal deaths; many of these in sub-Saharan countries. Many of these deaths are preventable. Countries, like Malawi, do not have the resources nor highly trained medical specialists using complex technologies within their healthcare system. Much of the burden falls on healthcare staff other than doctors including non-physician clinicians (NPCs) such as clinical officers, midwives and community health-workers. The aim of this trial is to evaluate a project which is training NPCs as advanced leaders by providing them with skills and knowledge in advanced neonatal and obstetric care. Training that will hopefully be cascaded to their colleagues (other NPCs, midwives, nurses). Methods/design: This is a cluster randomised controlled trial with the unit of randomisation being the 14 districts of central and northern Malawi (one large district was divided into two giving an overall total of 15). Eight districts will be randomly allocated the intervention. Within these eight districts 50 NPCs will be selected and will be enrolled on the training programme (the intervention). Primary outcome will be maternal and perinatal (defined as until discharge from health facility) mortality. Data will be harvested from all facilities in both intervention and control districts for the lifetime of the project (3–4 years) and comparisons made. In addition a process evaluation using both quantitative and qualitative (e.g. interviews) will be undertaken to evaluate the intervention implementation. Discussion: Education and training of NPCs is a key to improving healthcare for mothers and babies in countries like Malawi. Some of the challenges faced are discussed as are the potential limitations. It is hoped that the findings from this trial will lead to a sustainable improvement in healthcare and workforce development and training. Trial registration: ISRCTN6329415

Prevalence, distribution and antimicrobial susceptibility pattern of bacterial isolates from a tertiary Hospital in Malawi

Background: Bacterial infections are a significant cause of sickness and death in sub-Saharan Africa. This study aimed at establishing the prevalence, distribution and antimicrobial susceptibility pattern of major bacterial isolates from patients accessing medical care at a tertiary hospital in Malawi. Methods: We retrospectively reviewed bacteria culture and antimicrobial susceptibility records for 4617 patients from 2002 to 2014 at Mzuzu Central Hospital (MCH). No inclusion and exclusion criteria were followed. Data was analysed using excel (Microsoft office, USA) and GraphPad prism 7 software programs. Results: The most prevalent isolates were S. aureus (34.7%, n = 783), Klebsiella species (17.4%, n = 393) and Proteus species (11.4%, n = 256). Most microorganisms were isolated from adults (88.3%, n = 3889) and pus was the main source (69.3%, n = 1224). S. pneumoniae was predominantly isolated from cerebrospinal fluid (60.3%, n = 44) largely collected from children (88.2%, n = 64). Overall, most bacteria exhibited high resistance to all regularly used antimicrobials excluding ciprofloxacin. Conclusions: Our report demonstrates an increase in bacterial infection burden in sites other than blood stream and subsequent increase in prevalence of antimicrobial resistance for all major isolates. Creating an epidemiological survey unit at MCH will be essential to help inform better treatment and management options for patients with bacterial infections

Incidence and predictors of hospital readmission in children presenting with severe anaemia in Uganda and Malawi: a secondary analysis of TRACT trial data

Background: Severe anaemia (haemoglobin < 6 g/dL) is a leading cause of recurrent hospitalisation in African children. We investigated predictors of readmission in children hospitalised with severe anaemia in the TRACT trial (ISRCTN84086586) in order to identify potential future interventions. Methods: Secondary analyses of the trial examined 3894 children from Uganda and Malawi surviving a hospital episode of severe anaemia. Predictors of all-cause readmission within 180 days of discharge were identified using multivariable regression with death as a competing risk. Groups of children with similar characteristics were identified using hierarchical clustering. Results: Of the 3894 survivors 682 (18%) were readmitted; 403 (10%) had ≥2 re-admissions over 180 days. Three main causes of readmission were identified: severe anaemia (n = 456), malaria (n = 252) and haemoglobinuria/dark urine syndrome (n = 165). Overall, factors increasing risk of readmission included HIV-infection (hazard ratio 2.48 (95% CI 1.63–3.78), p < 0.001); ≥2 hospital admissions in the preceding 12 months (1.44(1.19–1.74), p < 0.001); history of transfusion (1.48(1.13–1.93), p = 0.005); and missing ≥1 trial medication dose (proxy for care quality) (1.43 (1.21–1.69), p < 0.001). Children with uncomplicated severe anaemia (Hb 4-6 g/dL and no severity features), who never received a transfusion (per trial protocol) during the initial admission had a substantially lower risk of readmission (0.67(0.47–0.96), p = 0.04). Malaria (among children with no prior history of transfusion) (0.60(0.47–0.76), p < 0.001); younger-age (1.07 (1.03–1.10) per 1 year younger, p < 0.001) and known sickle cell disease (0.62(0.46–0.82), p = 0.001) also decreased risk of readmission. For anaemia re-admissions, gross splenomegaly and enlarged spleen increased risk by 1.73(1.23–2.44) and 1.46(1.18–1.82) respectively compared to no splenomegaly. Clustering identified four groups of children with readmission rates from 14 to 20%. The cluster with the highest readmission rate was characterised by very low haemoglobin (mean 3.6 g/dL). Sickle Cell Disease (SCD) predominated in two clusters associated with chronic repeated admissions or severe, acute presentations in largely undiagnosed SCD. The final cluster had high rates of malaria (78%), severity signs and very low platelet count, consistent with acute severe malaria. Conclusions: Younger age, HIV infection and history of previous hospital admissions predicted increased risk of readmission. However, no obvious clinical factors for intervention were identified. As missing medication doses was highly predictive, attention to care related factors may be important. Trial registration: ISRCTN ISRCTN84086586. Keywords: Severe anaemia, Readmissio

<i>Ubuntu</i> as care: Deconstructing the gendered <i>Ubuntu</i>

In this article, I explore the concept of Ubuntu in a context of caregiving with the aim of deconstructing the gendering of caregiving in a context of pastoral care. Using a qualitative approach, this article draws from the empirical findings of primeval praxis of Ubuntu from a study conducted on the KwaZulu-Natal chapter of South Africa’s National Research Foundation (NRF) funded ‘Archaeology of Ubuntu’ project. Empirical findings were evaluated through African women theology. Findings of this article highlight that Ubuntu in a context of caregiving is not exclusively feminine because men also display strong tendencies of care in African traditional communities. This suggests that pastoral care in an African context should not be gendered because findings of the article confirm that the Zulu elders from KwaZulu-Natal generally linked Ubuntu to communal care where men and women partnered in extending caregiving to those in need. Intradisciplinary and/or interdisciplinary implications: Although the article is written from a socio-anthropological perspective, it integrates African traditional presumptions of gender and care ethics that are significant in extending pastoral care by reviewing literature from sociology, anthropology, gender, feminist studies, practical theology and systematic theology

Bishop Paul Verryn’s pastoral response towards unaccompanied refugee minors

Bishop Paul Verryn is a South African Methodist Church liberation theologian known for his concern for human rights and human dignity. In this article, I acknowledge his response to children and youth migrants in practical theology, general mission studies and pastoral care. I conceptualise Bishop Verryn’s response towards Unaccompanied Refugee Minors (URMs) and explore how he weaves pastoral care into the mission of the church. The study from which this article draws followed an exploratory design. Data were collected through structured in-depth interviews, informal conversations with Bishop Verryn and observations. Written from a contextual theology perspective, the findings indicate that Bishop Verryn’s pastoral care approach towards URMs is worthy to be developed and recognised as a form of pastoral care and mission work for the broader church’s pastoral ministry towards URMs in Africa and abroad