Why I write

Reflections on the author's literary writings on war and civil conflict

Writing in Englishes: taking control of the technology of power through literary aesthetics: a keynote speech to the African Studies Association Conference, 2021

As language increasingly becomes uncoupled from the nation state, transnational writers, transnational African writers, and African writers are using language to serve their own purposes and creating new literary aesthetics. This essay, first given as a keynote speech to the 2021 African Studies Association Annual Conference, examines some debates about the relationship between language and power and argues that these are being upended by writers who do not fit conventional categories, including transnational African writers. These writers are exploring the range of options presented by their own multilingualism and making unapologetic aesthetic claims upon the English language

Comparison of machine learning methods for estimating case fatality ratios: an Ebola outbreak simulation study

Background Machine learning (ML) algorithms are now increasingly used in infectious disease epidemiology. Epidemiologists should understand how ML algorithms behave within the context of outbreak data where missingness of data is almost ubiquitous. Methods Using simulated data, we use a ML algorithmic framework to evaluate data imputation performance and the resulting case fatality ratio (CFR) estimates, focusing on the scale and type of data missingness (i.e., missing completely at random—MCAR, missing at random—MAR, or missing not at random—MNAR). Results Across ML methods, dataset sizes and proportions of training data used, the area under the receiver operating characteristic curve decreased by 7% (median, range: 1%–16%) when missingness was increased from 10% to 40%. Overall reduction in CFR bias for MAR across methods, proportion of missingness, outbreak size and proportion of training data was 0.5% (median, range: 0%–11%). Conclusion ML methods could reduce bias and increase the precision in CFR estimates at low levels of missingness. However, no method is robust to high percentages of missingness. Thus, a datacentric approach is recommended in outbreak settings—patient survival outcome data should be prioritised for collection and random-sample follow-ups should be implemented to ascertain missing outcomes

Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April–May, 2018: an epidemiological study

Background On May 8, 2018, the Government of the Democratic Republic of the Congo reported an outbreak of Ebola virus disease in Équateur Province in the northwest of the country. The remoteness of most affected communities and the involvement of an urban centre connected to the capital city and neighbouring countries makes this outbreak the most complex and high risk ever experienced by the Democratic Republic of the Congo. We provide early epidemiological information arising from the ongoing investigation of this outbreak. Methods We classified cases as suspected, probable, or confirmed using national case definitions of the Democratic Republic of the Congo Ministère de la Santé Publique. We investigated all cases to obtain demographic characteristics, determine possible exposures, describe signs and symptoms, and identify contacts to be followed up for 21 days. We also estimated the reproduction number and projected number of cases for the 4-week period from May 25, to June 21, 2018. Findings As of May 30, 2018, 50 cases (37 confirmed, 13 probable) of Zaire ebolavirus were reported in the Democratic Republic of the Congo. 21 (42%) were reported in Bikoro, 25 (50%) in Iboko, and four (8%) in Wangata health zones. Wangata is part of Mbandaka, the urban capital of Équateur Province, which is connected to major national and international transport routes. By May 30, 2018, 25 deaths from Ebola virus disease had been reported, with a case fatality ratio of 56% (95% CI 39–72) after adjustment for censoring. This case fatality ratio is consistent with estimates for the 2014–16 west African Ebola virus disease epidemic (p=0·427). The median age of people with confirmed or probable infection was 40 years (range 8–80) and 30 (60%) were male. The most commonly reported signs and symptoms in people with confirmed or probable Ebola virus disease were fever (40 [95%] of 42 cases), intense general fatigue (37 [90%] of 41 cases), and loss of appetite (37 [90%] of 41 cases). Gastrointestinal symptoms were frequently reported, and 14 (33%) of 43 people reported haemorrhagic signs. Time from illness onset and hospitalisation to sample testing decreased over time. By May 30, 2018, 1458 contacts had been identified, of which 746 (51%) remained under active follow-up. The estimated reproduction number was 1·03 (95% credible interval 0·83–1·37) and the cumulative case incidence for the outbreak by June 21, 2018, is projected to be 78 confirmed cases (37–281), assuming heterogeneous transmissibility. Interpretation The ongoing Ebola virus outbreak in the Democratic Republic of the Congo has similar epidemiological features to previous Ebola virus disease outbreaks. Early detection, rapid patient isolation, contact tracing, and the ongoing vaccination programme should sufficiently control the outbreak. The forecast of the number of cases does not exceed the current capacity to respond if the epidemiological situation does not change. The information presented, although preliminary, has been essential in guiding the ongoing investigation and response to this outbreak

'On the Wet Side of the Womb’:The construction of mothers in anti-abortion activism in England and Wales

Across the UK, there has been an increase in anti-abortion activism outside abortion clinics. The activism deployed includes explicitly religious activities such as ‘prayerful witnessing’ and ‘pavement counselling’, which aim to discourage women from entering clinics. This article stems from a wider ethnographic study of public activism over abortion to determine what claims about motherhood are being made within these debates. Two arguments are presented. First, how women’s role as mothers is central and essentialised in anti-abortion discourses, with the body of the mother often disappearing as activists seek to erode the distinction between a foetus and a baby by constructing pregnancy as a foetal environment. Motherhood is constructed as ‘natural’ and sacred, therefore abortion must be damaging because it destroys women’s ‘natural’ position. Second, the article argues that although the activists’ arguments are always religiously framed, their activism takes place in a largely secular context, meaning that they have to find ways of appealing to secular audiences. This leads to a complex interrelationship between secular and religious discourses, where theological viewpoints sit alongside ‘scientific’ claims to buttress activists’ views. This article explores how the presence and absence of mothers within activists’ narratives is due to the tensions between religiously based understandings of motherhood, and the need to appeal to a secular audience

Negotiating sacred roles:a sociological exploration of priests who are mothers

In 1992, in a historic move, the Church of England voted to allow women's ordination to priesthood and in 1994 the first women priests started to be ordained. Despite much research interest, the experiences of priests who are mothers to dependent children have been minimally investigated. Based on in-depth interviews with seventeen mothers ordained in the Church, this paper will focus on how the sacred-profane boundary is managed. Priests who are mothers have a particular insight into the Church hierarchy as they symbolically straddle the competing discourses of sacred and profane. However, instead of reifying these binaries, the experiences of these women show how such dualisms are challenged and managed in everyday life. Indeed, in terms of experience, ritual, ministry and preaching, priests who are mothers are resisting, recasting and renegotiating sacred terrain in subtle and nuanced ways. Mothers thus not only negotiate the practical and sacramental demands placed on priests, but also illuminate how the sacred domain is regulated and constructed

Antiretroviral treatment reverses HIV-associated anemia in rural Tanzania

<p>Abstract</p> <p>Background</p> <p>HIV-associated anemia is common and associated with poor prognosis. However, its response to antiretroviral treatment (ART) in rural Africa is poorly understood.</p> <p>Methods</p> <p>HIV-infected adults (≥15 years) who enrolled in HIV care at Haydom Lutheran Hospital in northern Tanzania were included in the study. The effect of ART (zidovudine/stavudine + lamivudine + efavirenz/nevirapine) on HIV-associated anemia was studied in a subset of patients who were anemic at the time they started ART and had a follow-up hemoglobin measurement 12 months later. Pregnant women were excluded from the study, as were women who had given birth within the past 6 weeks. Anemia was defined as hemoglobin <12 g/dL in women and <13 g/dL in men. We applied paired sample T-tests to compare hemoglobin levels before and one year after ART initiation, and logistic regression models to identify predictors of persistent anemia.</p> <p>Results</p> <p>At enrollment, mean hemoglobin was 10.3 g/dL, and 649 of 838 patients (77.4%) were anemic. Of the anemic patients, 254 (39.1%) had microcytosis and hypochromia. Among 102 patients who were anemic at ART initiation and had a follow-up hemoglobin measurement after 12 months, the mean hemoglobin increased by 2.5 g/dL (<it>P </it>< 0.001); however, 39 patients (38.2%) were still anemic after 12 months of ART. Independent predictors of persistent anemia were mean cell volume in the lower quartile (<76.0 fL; Odds Ratio [OR] 4.34; 95% confidence interval [CI] 1.22-15.5) and a zidovudine-containing initial regimen (OR 2.91; 95% CI 1.03-8.19).</p> <p>Conclusions</p> <p>Most patients had anemia at enrollment, of whom nearly 40% had microcytosis and hypochromia suggestive of iron deficiency. The mean hemoglobin increased significantly in patients who received ART, but one third were still anemic 12 months after ART initiation indicating that additional interventions to treat HIV-associated anemia in rural Africa might be warranted, particularly in patients with microcytosis and those treated with zidovudine.</p

Success with antiretroviral treatment for children in Kigali, Rwanda: Experience with health center/nurse-based care

BACKGROUND: Although a number of studies have shown good results in treating children with antiretroviral drugs (ARVs) in hospital settings, there is limited published information on results in pediatric programs that are nurse-centered and based in health centers, in particular on the psychosocial aspects of care. METHODS: Program treatment and outcome data were reported from two government-run health centers that were supported by Médecins Sans Frontières (MSF) in Kigali, Rwanda between October 2003 and June 2007. Interviews were held with health center staff and MSF program records were reviewed to describe the organization of the program. Important aspects included adequate training and supervision of nurses to manage ARV treatment. The program also emphasized family-centered care addressing the psychosocial needs of both caregivers and children to encourage early diagnosis, good adherence and follow-up. RESULTS: A total of 315 children (< 15 years) were started on ARVs, at a median age of 7.2 years (range: 0.7-14.9). Sixty percent were in WHO clinical stage I/II, with a median CD4% of 14%. Eighty-nine percent (n = 281) started a stavudine-containing regimen, mainly using the adult fixed-dose combination. The median follow-up time after ARV initiation was 2 years (interquartile range 1.2-2.6). Eighty-four percent (n = 265) of children were still on treatment in the program. Thirty (9.5%) were transferred out, eight (2.6%) died and 12 (3.8%) were lost to follow-up. An important feature of the study was that viral loads were done at a median time period of 18 months after starting ARVs and were available for 87% of the children. Of the 174 samples, VL was < 400 copies/ml in 82.8% (n = 144). Two children were started on second-line ARVs. Treatment was changed due to toxicity for 26 children (8.3%), mainly related to nevirapine. CONCLUSION: This report suggests that providing ARVs to children in a health center/nurse-based program is both feasible and very effective. Adequate numbers and training of nursing staff and an emphasis on the psychosocial needs of caregivers and children have been key elements for the successful scaling-up of ARVs at this level of the health system