Wartime children's suffering and quests for therapy in northern Uganda

This book is based on an ethnographic study during an ongoing civil war in northern Uganda. It examines children's suffering as well as their attempts to restore normality. Data shows that there is a high burden of illnesses among the children, both infectious diseases and complaints related to emotional distress. The study describes children's short-term curative approaches to these illnesses, and the ensuing misuse of, and dependencies on, pharmaceuticals. Although children are approached as social actors and their perspectives are privileged, their quests for therapy are shown to be influenced by many other factors as well. The focus therefore lies on children's vulnerability within existing healthcare structures and life conditions. Through this focus, the book critiques the narrow policies regarding healthcare interventions for children above five years, and underscores the importance of addressing wider socio-economic factors in preventive approaches to infectious diseases and emotional suffering.Grace Akello, PhD, is a medical anthropologist trained at the Universities of Amsterdam and Leiden. She is currently employed as senior lecturer at Gulu University, northern Uganda

Wartime children's suffering and quests for therapy in northern Uganda

This ethnographic study investigated what wartime children identified as common illnesses which affected them and how they restored normality. The research findings were aimed at providing baseline information for policies and healthcare interventions consistent with children__s own needs and priorities. Qualitative ethnographic methods suitable for children aged 9-16 years were employed over a one year period in 2004-2005 and through visits to Gulu district in 2006 and 2007. A survey was conducted with 165 children (N=165), in addition to an extensive follow-up of 24 children. Data show that there was a high burden of illnesses among the children. Illnesses were mainly infectious diseases and complaints symptomatic of emotional distress. For infectious illnesses, children used herbal medicines and pharmaceuticals including prescription-only medicines like antibiotics and antimalarials. Coping mechanisms for emotional distress included discouraging open expression of suffering, using tranquilisers, atika plant (Labiate species), and engaging in income generating activities. Findings further highlight epistemological, methodological, theoretical, and policy issues regarding wartime children__s illness experiences and quests for wellbeing. Children readily discussed experiences with infectious illnesses because of their acute onset, primacy, and a priority. Infectious diseases are an immediate need and disorganize a relatively stable condition of emotional distress. Whereas some forms of emotional distress are severe and require immediate redress, there are no simple ways of dealing with them. Although this study underscores the importance of addressing wider socio-economic factors as effective preventive approaches in dealing with infectious diseases and emotional distress, I propose that it is fitting for children to engage in short term curative approaches in illness management, in the context of medical pluralism given the dire context in which they lived.UBL - phd migration 201

Silencing distressed children in the context of war in northern Uganda: An analysis of its dynamics and its health consequences

Children in northern Uganda who are the focus of this article were born and raised in the context of war. The research presented here is based on a one-year ethnographic study (2004-2005) with children aged 9-16 years. Various qualitative and quantitative methods used in this study were geared to this age group. A grounded theory approach was followed to trace the reasons for the silencing of their distress. Throughout the study a child actor perspective was implemented: children were approached as social actors capable of processing social experience and devising ways of coping with life. We found that their lives were characterized by high rates of exposure to extreme events, such as deaths, child abductions, disease epidemics, gender-based violence and poverty. As a consequence, their level of emotional distress was high. However, they did not readily speak about their distress. The article identifies and analyses a complex set of reasons for children's distress and its silencing by the children themselves and other members of society. A distinction is made between the processes of victim blaming, self blaming, mimetic resilience and mirroring resilience. In addition, the consequences of the silencing children are presented. Children expressed their emotional suffering primarily in physical aches and pains and used pharmaceuticals and herbal medicines to minimize their distress. The result was a medicalization of psychological distress. In conclusion, we reflect on the necessity of a multi-pronged approach to address children's distress. (C) 2010 Elsevier Ltd. All rights reserved.Public Health and primary car

Comparison of eleven RNA extraction methods for poliovirus direct molecular detection in stool samples

Direct detection by PCR of poliovirus RNA in stool samples provides a rapid diagnostic and surveillance tool that can replace virus isolation by cell culture in global polio surveillance. The sensitivity of direct detection methods is likely to depend on the choice of RNA extraction method and sample volume. We report a comparative analysis of 11 nucleic acid extraction methods (7 manual and 4 semiautomated) for poliovirus molecular detection using stool samples (n = 59) that had been previously identified as poliovirus positive by cell culture. To assess the effect of RNA recovery methods, extracted RNA using each of the 11 methods was tested with a poliovirus-specific reverse transcription-quantitative PCR (RT-qPCR), a pan-poliovirus RT-PCR (near-whole-genome amplification), a pan-enterovirus RT-PCR (entire capsid region), and a nested VP1 PCR that is the basis of a direct detection method based on nanopore sequencing. We also assessed extracted RNA integrity and quantity. The overall effect of extraction method on poliovirus PCR amplification assays tested in this study was found to be statistically significant (P < 0.001), thus indicating that the choice of RNA extraction method is an important component that needs to be carefully considered for any diagnostic based on nucleic acid amplification. Performance of the methods was generally consistent across the different assays used. Of the 11 extraction methods tested, the MagMAX viral RNA isolation kit used manually or automatically was found to be the preferable method for poliovirus molecular direct detection considering performance, cost, and processing time

The impact of maternal infection with Mycobacterium tuberculosis on the infant response to bacille Calmette-Guérin immunization.

Bacille Calmette-Guérin (BCG) immunization provides variable protection against tuberculosis. Prenatal antigen exposure may have lifelong effects on responses to related antigens and pathogens. We therefore hypothesized that maternal latent Mycobacterium tuberculosis infection (LTBI) influences infant responses to BCG immunization at birth. We measured antibody (n = 53) and cellular (n = 31) responses to M. tuberculosis purified protein derivative (PPD) in infants of mothers with and without LTBI, in cord blood and at one and six weeks after BCG. The concentrations of PPD-specific antibodies declined between birth (median [interquartile range (IQR)]) 5600 ng ml(-1) [3300-11 050] in cord blood) and six weeks (0.00 ng ml(-1) [0-288]). Frequencies of PPD-specific IFN-γ-expressing CD4(+)T cells increased at one week and declined between one and six weeks (p = 0.031). Frequencies of IL-2- and TNF-α-expressing PPD-specific CD4(+)T cells increased between one and six weeks (p = 0.019, p = 0.009, respectively). At one week, the frequency of PPD-specific CD4(+)T cells expressing any of the three cytokines, combined, was lower among infants of mothers with LTBI, in crude analyses (p = 0.002) and after adjusting for confounders (mean difference, 95% CI -0.041% (-0.082, -0.001)). In conclusion, maternal LTBI was associated with lower infant anti-mycobacterial T-cell responses immediately following BCG immunization. These findings are being explored further in a larger study

Characterising demographics, knowledge, practices and clinical care among patients attending sickle cell disease clinics in Eastern Uganda [version 1; peer review: 1 approved, 1 approved with reservations]

Background: In Uganda to date, there are neither established registries nor descriptions of facility-based sickle cell disease (SCD) patient characteristics beyond the central region. Here, we summarize data on the baseline clinical characteristics and routine care available to patients at four clinics in Eastern Uganda as a prelude to a clinical trial. Methods: Between February and August 2018, we conducted a cross-sectional survey of patients attending four SCD clinics in Mbale, Soroti, Atutur and Ngora, all in Eastern Uganda, the planned sites for an upcoming clinical trial (H-PRIME: ISRCTN15724013). Data on socio-demographic characteristics, diagnostic methods, clinic schedules, the use of prophylactic and therapeutic drugs, clinical complications and patient understanding of SCD were collected using a structured questionnaire. Results: Data were collected on 1829 patients. Their ages ranged from 0 to 64 years with a median (IQR) of 6 (3-11) years. 50.9% of participants were male. The majority (1151; 62.9%) reported a positive family history for SCD. Approximately half knew that SCD is inherited from both parents but a substantial proportion did not know how SCD is transmitted and small numbers believed that it is acquired by either transfusion or from other people. Only 118/1819 (6.5%) participants had heard about or were using hydroxyurea while 356/1794 (19.8%) reported stigmatization. Participants reported a median of three (IQR 1-4) hospital admissions during the preceding 12 months; 80.8% had been admitted at least once, while 14.2% had been admitted more than five times. Pain was the most common symptom, while 83.9% of those admitted had received at least one blood transfusion. Conclusion: The majority of patients attending SCD clinics in Eastern Uganda are children and few are currently being treated with hydroxyurea. The data collected through this facility-based survey will provide background data that will be useful in planning for the H-PRIME trial