Premature adult mortality in urban Zambia: a repeated population-based cross-sectional study.

OBJECTIVES: To measure the sex-specific and community-specific mortality rates for adults in Lusaka, Zambia, and to identify potential individual-level, household-level and community-level correlates of premature mortality. We conducted 12 survey rounds of a population-based cross-sectional study between 2004 and 2011, and collected data via a structured interview with a household head. SETTING: Households in Lusaka District, Zambia, 2004-2011. PARTICIPANTS: 43,064 household heads (88% female) who enumerated 123,807 adult household members aged between 15 and 60 years. PRIMARY OUTCOME: Premature adult mortality. RESULTS: The overall mortality rate was 16.2/1000 person-years for men and 12.3/1000 person-years for women. The conditional probability of dying between age 15 and 60 (45q15) was 0.626 for men and 0.537 for women. The top three causes of death for men and women were infectious in origin (ie, tuberculosis, HIV and malaria). We observed an over twofold variation of mortality rates between communities. The mortality rate was 1.98 times higher (95% CI 1.57 to 2.51) in households where a family member required nursing care, 1.44 times higher (95% CI 1.22 to 1.71) during the cool dry season, and 1.28 times higher (95% CI 1.06 to 1.54) in communities with low-cost housing. CONCLUSIONS: To meet Zambia's development goals, further investigation is needed into the factors associated with adult mortality. Mortality can potentially be reduced through focus on high-need households and communities, and improved infectious disease prevention and treatment services

Language policy and orthographic harmonization across linguistic, ethnic and national boundaries in Southern Africa

Drawing on online and daily newspapers, speakers' language and writing practices, official government documents and prescribed spelling systems in Southern Africa, the paper explores the challenges and possibilities of orthographic reforms allowing for mobility across language clusters, ethnicity, regional and national borders. I argue that this entails a different theorisation of language, and for orthographies that account for the translocations and diasporic nature of late modern African identities and lifestyles. I suggest an ideological shift from prescriptivism to practice-orientated approaches to harmonisation in which orthographies are based on descriptions of observable writing practices in the mobile linguistic universe. The argument for orthographic reforms is counterbalanced with an expose on current language policies which appear designed for an increasing rare monoglot 'standard' speaker, who speaks only a 'tribal' language. The implications of the philosophical challenges this poses for linguists, language planners and policy makers are thereafter discussed.IS

Position Statement of the Max Planck Institute for Innovation and Competition of 25 May 2022 on the Commission's Proposal of 23 February 2022 for a Regulation on Harmonised Rules on Fair Access to and Use of Data (Data Act)

On 23 February 2022, the European Commission issued a Proposal for a Regulation on harmonised rules on fair access to and use of data (Data Act). The overarching objective of the Proposal is to ‘ensure fairness in the digital environment, stimulate a competitive data market, open opportunities for data-driven innovation and make data available for all’. The Institute hereby presents its Position Statement that features a comprehensive analysis of whether and to what extent the proposed rules might reach the envisaged objectives. It comments on all parts of the Proposal, including the new IoT data access and use right. Finally, the Institute offers a set of recommendations as to how the proposed provisions should be amended in the legislative process to align them better with the objectives of the Data Act

Analysis of adoption of conservation agriculture practices in southern Africa: mixed-methods approach

Open Access Journal; Published online: 27 Apr 2023In southern Africa, conservation agriculture (CA) has been promoted to address low agricultural productivity, food insecurity, and land degradation. However, despite significant experimental evidence on the agronomic and economic benefits of CA and large scale investments by the donor community and national governments, adoption rates among smallholders remain below expectation. The main objective of this research project was thus to investigate why previous efforts and investments to scale CA technologies and practices in southern Africa have not led to widespread adoption. The paper applies a multivariate probit model and other methods to survey data from 4,373 households and 278 focus groups to identify the drivers and barriers of CA adoption in Malawi, Zambia, and Zimbabwe. The results show that declining soil fertility is a major constraint to maize production in Zambia and Malawi, and drought/heat is more pronounced in Zimbabwe. We also find gaps between (a) awareness and adoption, (b) training and adoption, and (c) demonstration and adoption rates of CA practices in all three countries. The gaps are much bigger between awareness and adoption and much smaller between hosting demonstration and adoption, suggesting that much of the awareness of CA practices has not translated to greater adoption. Training and demonstrations are better conduits to enhance adoption than mere awareness creation. Therefore, demonstrating the applications and benefits of CA practices is critical for promoting CA practices in all countries. Besides, greater adoption of CA practices requires enhancing farmers’ access to inputs, addressing drudgery associated with CA implementation, enhancing farmers’ technical know-how, and enacting and enforcing community bylaws regarding livestock grazing and wildfires. The paper concludes by discussing the implications for policy and investments in CA promotion

Genetic determinants of the pharmacokinetic variability of rifampin in Malawian adults with pulmonary tuberculosis

D.J.S. was supported by a Wellcome Trust Clinical PhD Fellowship (086757/Z/08/A to D.J.S.). A.D.M. was supported by a National Institute for Health Research Integrated Clinical Academic Training Fellowship and a Wellcome Trust Clinical PhD Fellowship (105/392/B/14/Z). The Malawi Liverpool Wellcome Trust Clinical Research Programme is supported by a strategic award from the Wellcome Trust.Variable exposure to antituberculosis (TB) drugs, partially driven by genetic factors, may be associated with poor clinical outcomes. Previous studies have suggested an influence of the SLCO1B1 locus on the plasma area under the concentration-time curve (AUC) of rifampin. We evaluated the contribution of single nucleotide polymorphisms (SNPs) in SLCO1B1 and other candidate genes (AADAC and CES-1) to interindividual pharmacokinetic variability in Malawi. A total of 174 adults with pulmonary TB underwent sampling of plasma rifampin concentrations at 2 and 6 h postdose. Data from a prior cohort of 47 intensively sampled, similar patients from the same setting were available to support population pharmacokinetic model development in NONMEM v7.2, using a two-stage strategy to improve information during the absorption phase. In contrast to recent studies in South Africa and Uganda, SNPs in SLCO1B1 did not explain variability in AUC0-∞ of rifampin. No pharmacokinetic associations were identified with AADAC or CES-1 SNPs, which were rare in the Malawian population. Pharmacogenetic determinants of rifampin exposure may vary between African populations. SLCO1B1 and other novel candidate genes, as well as nongenetic sources of interindividual variability, should be further explored in geographically diverse, adequately powered cohorts.Publisher PDFPeer reviewe

The Magnitude, Clinical Presentation and Consequences of Patients with Burn Injuries Admitted to Tertiary Care Hospital, Kurunegala, Sri Lanka: A Prospective Analysis

This prospective analysis is based on clinical forensic examinations and clinical case records of the victims who sustained burns and were admitted during a one-year period since 2017. Of the 90 patients (34 children and 56 adults), 54 % were male with ages ranging from 1 month to 80 years. Males below the age of 20 years (48 %) were highly vulnerable. Education status revealed that most of the patients have an education level below O/L representing 52 % (Ordinary Level/ O/L is similar to the General Certificate of Secondary Education/ GCSE in Cambridge Education System in United Kingdom) and the majority were married (52%). Scalds were seen in 52 %, while flame burns in 28 % cases. Most of the incidents had taken place at home (92%). Burn injuries were most frequently observed on upper extremities (47 %) and the majority were of first degree in nature. Furthermore, this study revealed that 57 % recovered without any complications, while 34 % resulted in scarring or disfigurement. It was highlighted that children are the most vulnerable to in sustaining burns, especially with hot water in domestic settings. The study recommends increasing awareness among parents/guardians regarding safe handling of hot water to minimize such incidents

The burden and natural history of cardiac pathology at TB diagnosis in a high-HIV prevalence district in Zambia: protocol for the TB-Heart study.

BACKGROUND: Tuberculosis (TB) continues to be a major cause of death across sub-Saharan Africa (SSA). In parallel, non-communicable disease and especially cardiovascular disease (CVD) burden has increased substantially in the region. Cardiac manifestations of TB are well-recognised but the extent to which they co-exist with pulmonary TB (PTB) has not been systematically evaluated. The aim of this study is to improve understanding of the burden of cardiac pathology in PTB in those living with and without HIV in a high-burden setting. METHODS: This is a cross-sectional and natural history study to evaluate the burden and natural history of cardiac pathology in participants with PTB in Lusaka, Zambia, a high burden setting for TB and HIV. Participants with PTB, with and without HIV will be consecutively recruited alongside age- and sex-matched TB-uninfected comparators on a 2:1 basis. Participants will undergo baseline assessments to collect clinical, socio-demographic, functional, laboratory and TB disease impact data followed by point-of-care and standard echocardiography. Participants with PTB will undergo further repeat clinical and functional examination at two- and six months follow-up. Those with cardiac pathology at baseline will undergo repeat echocardiography at six months. DISCUSSION: The outcomes of the study are to a) determine the burden of cardiac pathology at TB diagnosis, b) describe its association with patient-defining risk factors and biochemical markers of cardiac injury and stretch and c) describe the natural history of cardiac pathology during the course of TB treatment

"Poof! a'm heppily saving the Lord...": multimodality and evaluative discourses in male toilet graffiti at the University of the Western Cape

This paper explores the use of punctuation, capitalisation, linguistic forms and images in the construction of evaluative discourses in male toilet graffiti at the University of the Western Cape. Of particular interest is how male students use these devises in the discursive construction of the appraisal resource of Attitude, Graduation and Evaluation. Using over 150 tokens of graffiti, the paper uses a multimodal approach employing notions of resemiotisation and remediation to show how taboo language, font size, images and sketches are repurposed to aid the evaluation of the 'self' and the 'other' in toilet graffiti. The paper shows that through utilising multimodal texts, graffiti writers are able to reformulate and situate novel meanings in contexts; and in terms of appraisal, the verbal and non-verbal semiotic material are strategically combined to engender novel evaluations

Drinking water quality from rural handpump-boreholes in Africa

Groundwater provides a vital source of drinking water for rural communities in many parts of Africa, particularly in the dry season when there are few safe alternative sources. This paper summarises results from a study (n = 428) assessing dry season water quality, both microbiological and inorganic chemistry, in handpump equipped boreholes (HPBs) across the Ethiopia Highlands (n = 142), Malawi (n = 162) and Uganda (n = 124) using a stratified, randomised sampling design. This study seeks to examine general water quality by randomly sampling rural groundwater supplies across larger areas with different geology and climate. The majority, 72%, of HPBs surveyed provide good quality dry season drinking water as defined by WHO drinking water quality criteria. Within this overall picture, the most notable constraints were from thermotolerant coliforms (TTCs), which exceeded the WHO drinking water guideline of zero colony forming units (cfu/100 ml) in 21% of sites (range 0–626 cfu/100 ml). TTC contamination was found to have a significant and positive correlation with annual average rainfall (ρ = 0.2, p = 0.00003). Across all three countries, WHO health based chemical drinking water quality values were exceeded at 9% of sites and were found for manganese (4%), fluoride (2.6%) and nitrate (2.5%); arsenic concentrations were below the guideline value of 10 μg l−1 (range 400 μg l−1) found in drinking water sources in Uganda challenges the decision by WHO not to formalise a health-based guideline for Mn. While the overall level of microbiological contamination from HPBs is low, results from this study strongly suggest that at a national and regional level, microbiological contamination rather than chemical contamination will provide a greater barrier to achieving targets set for improved drinking water quality under the UN-SDG 6. Efforts should be made to ensure that boreholes are properly sited and constructed effectively to reduce pathogen contamination