Qualitative research toolkit to explore child marriage dynamics and how to fast-track prevention

Accelerating progress towards eliminating child marriage and empowering married girls requires not just more research, but different tools. Tools that are designed with action and inclusion in mind. GAGE’s new child marriage toolkit builds on existent tools, including those we used in our formative and baseline work (see GAGE baseline qualitative research tools), and hones in on how to prevent child marriage – for girls and boys – and mitigate its impacts on adolescent girls, including those who are separated and divorced. Our new tools focus on marriage decision-making and ask marriage decision-makers what might encourage them to make different decisions. They also trace the threats and opportunities that girls (and boys) face at various steps along the child marriage pathway (engagement to divorce) and explore how a range of services might improve outcomes. Most importantly, our new child marriage toolkit is built around the decision-making underpinning child marriage and the experiences of married adolescents, rather than indirectly through an exploration of adolescence more broadly. Our tools are directly aimed at two questions: how can we prevent child marriage and how can we make married girls’ (and boys’) lives better

Adolescent sexual and reproductive health in Ethiopia and Rwanda: a qualitative exploration of the role of social norms

This article seeks to address the dearth of evidence on early adolescent understandings and experiences of sexual and reproductive health (SRH) in Ethiopia and Rwanda, drawing on a multisite qualitative research study with 10- to 12-year-old and 14- to 15-year-old male and female adolescents and a range of adult participants. The article is informed by a conceptual framework that draws on Amartya Sen’s capability approach, which calls for investments in a broad set of assets that expand individuals’ capacity to “be” and to “do.” Using SRH as a focal lens, the article considers the role played by gendered social norms in adolescents’ experiences of SRH-related understandings and experiences. Three key interrelated gender themes emerge from our thematic analyses of qualitative evidence generated by our multimethods approach: puberty transitions, sexuality, and victim blaming. In our analyses, we pay attention to diversity (e.g., age, gender, place of residence) among adolescents within and across the two focal countries and consider how discriminatory gendered social norms play a role in hindering the effective uptake of expanding health services. We conclude by emphasizing the need for program designers and implementers to address the role of underlying social norms in a more strategic and context-specific way to help young people navigate their sexual and reproductive lives

MERS coronaviruses from camels in Africa exhibit region-dependent genetic diversity

International audienceMiddle East respiratory syndrome coronavirus (MERS-CoV) causes a zoonotic respiratory disease of global public health concern, and dromedary camels are the only proven source of zoonotic infection. Although MERS-CoV infection is ubiquitous in dromedaries across Africa as well as in the Arabian Peninsula, zoonotic disease appears confined to the Arabian Peninsula. MERS-CoVs from Africa have hitherto been poorly studied. We genetically and phenotypically characterized MERS-CoV from dromedaries sampled in Morocco, Burkina Faso, Nigeria, and Ethiopia. Viruses from Africa (clade C) are phylogenetically distinct from contemporary viruses from the Arabian Peninsula (clades A and B) but remain antigenically similar in microneutralization tests. Viruses from West (Nigeria, Burkina Faso) and North (Morocco) Africa form a subclade, C1, that shares clade-defining genetic signatures including deletions in the accessory gene ORF4b. Compared with human and camel MERS-CoV from Saudi Arabia, virus isolates from Burkina Faso (BF785) and Nigeria (Nig1657) had lower virus replication competence in Calu-3 cells and in ex vivo cultures of human bronchus and lung. BF785 replicated to lower titer in lungs of human DPP4-transduced mice. A reverse genetics-derived recombinant MERS-CoV (EMC) lacking ORF4b elicited higher type I and III IFN responses than the isogenic EMC virus in Calu-3 cells. However, ORF4b deletions may not be the major determinant of the reduced replication competence of BF785 and Nig1657. Genetic and phenotypic differences in West African viruses may be relevant to zoonotic potential. There is an urgent need for studies of MERS-CoV at the animal-human interface

Presentation of MPO-ANCA positive microscopic polyangiitis with usual interstitial pneumonia.

Microscopic polyangiitis (MPA), commonly associated with the myeloperoxidase (MPO) subtype, is a pauci-immune vasculitis of small vessels. Common manifestations include renal impairment, rash, mononeuritis multiplex, polyarticular arthritis, and diffuse alveolar hemorrhage. The incidence of interstitial lung disease (ILD) in MPO-anti-neutrophilic cytoplasmic antibody (ANCA) vasculitis is reported from 2.7% to 43%. We share a rare case of Usual Interstitial Pneumonia (UIP) preceding development of extra-pulmonary manifestations of MPA to emphasize the need for surveillance of extrapulmonary rheumatologic manifestations in patients with UIP radiologic pattern and positive autoantibodies. Case:A 75 year old female from Mexico, never smoker, was referred to pulmonology for a 6 week history of cough, 23 pound weight loss and interstitial infiltrates on chest x-ray. She denied dyspnea, Raynaud, joint pain or swelling, or rash. Pulmonary evaluation was remarkable for lack of hypoxia, presence of bibasilar crackles, normal forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and FEV1/FVC, and diffusion capacity (DLCO) 56% of predicted. Serology exposed an antinuclear antibody (ANA) 1:640 (speckled), rheumatoid factor 1230 with negative cyclic citrullinated peptide (CCP). High resolution CT showed peripheral reticulation and honeycombing (definite UIP pattern). The patient deferred rheumatologic evaluation. She presented 8 months later with livedo reticularis and bilateral foot numbness. DLCO decreased to 37% predicted. Perinuclear (P-) ANCA was positive, confirmed with MPO. Repeat CT chest exhibited areas of superimposed consolidation. Bronchoscopy revealed chronic inflammation consistent with focal organizing pneumonia without evidence of infection.EMG showed axonal sensorimotor peripheral neuropathy with muscle denervation. Sural nerve biopsy exhibited vasculitic neuropathy. The patient was diagnosed with MPA, MPO-ANCA subtype with vasculitic polyneuropathy and UIP. She was treated with systemic steroids and cyclophosphamide with improvement in her symptoms and stabilization of DLCO. Discussion:The incidence of rheumatologic disease developing in patients initially diagnosed with idiopathic pulmonary fibrosis (IPF) is up to 15.5% at 10 years. The addition of ANCA to the screening serology panel of ANA, CCP and rheumatoid factor, in patients with suspected IPF, has been suggested to identify patients with vasculitis. Early diagnosis may lead t0 closer monitoring and earlier treatment. Proposed mechanisms of development of ILD in MPA include 1) recurrent subclinical alveolar hemorrhage causing fibrosis and 2) oxidative stress caused by MPO-ANCA stimulating myeloperoxidase and producing hypochlorous acid damaging lung tissue. Response to treatment is variable in MPA with UIP, though prognosis and treatment response is better than in patients with IPF

“Girls and Boys Have Become the Toys of Everyone”: Interrogating the Drivers and Experiences of Adolescent Migration in Ethiopia.

The recently adopted Global Compact for Migration (GCM) has a strong focus on the rights of migrants. While the GCM is non-legally binding and its adoption has been heatedly contested, this is an important historical moment to reflect on the status of some of the most vulnerable migrants – adolescent girls and boys – and the efforts that will be needed to fast-track social change and ensure that they benefit from the ambitious targets of the GCM and the 2030 Sustainable Development Agenda. This article explores these issues through a case study on Ethiopia, where migration—especially of young people—is already accelerating and is poised for explosive growth in the coming years. Drawing on qualitative data collected by the Gender and Adolescence: Global Evidence (GAGE) international research programme, this article focuses on the ways in which adolescent girls’ and boys’ multi-dimensional capabilities drive and are shaped by migration. Our findings highlight that in many cases Ethiopian adolescents are “choosing” to migrate because they perceive no other viable options. Simultaneously pushed and pulled into undertaking risky endeavours with limited information, they often find themselves vulnerable to a range of risks with very little support. To help mitigate those risks, and help adolescents use migration to improve, rather than restrict, their access to their human rights, our conclusions discuss a number of key policy and programming entry points

Prevalence of brucellosis and associated risk factors in dairy cattle in Maekel and Debub Regions, Eritrea

IntroductionBrucellosis is a zoonotic disease with worldwide distribution. It is considered endemic in Eritrea, however, the current prevalence status and related risk factors in animals are unknown. The objective of this study was to determine the prevalence of and risk factors for brucellosis in dairy cattle in Maekel and Debub regions, Eritrea.MethodsA cross sectional study was conducted between August 2021 and February 2022. A total of 2,740 dairy cattle from 214 herds in 10 sub-regions of Eritrea were selected for blood and data collection. Blood samples were tested using Rose Bengal Plate Test (RBPT) and positive samples were confirmed using competitive (c-ELISA). Data on risk factors was collected using questionnaire and analyzed using logistic regression.ResultsIn total, 34/2740 animals tested positive by RBPT. Of these, 29 were confirmed positive by c-ELISA, giving an apparent and estimated true individual-level prevalence of 1.1% (95% CI: 0.7, 1.5%) and 1.3% (95% CI: 0.9, 1.8%), respectively. Sixteen herds (7.5%) tested positive by RBPT and of these 15 herds (7.0%) were confirmed positive by c-ELISA, giving an estimated true herd-level prevalence of 7.0% (95% CI: 4.0, 10.7). Animal and herd-level apparent prevalence was 1.6 and 9.2% in Maekel, while in Debub it was 0.6 and 5.5%, respectively. Multivariable regression analysis indicated that non-pregnant lactating cows (adjusted odds ratio [aOR] = 3.35; p = 0.042) were more likely to be Brucella sero-positive. History of abortion on the farm (aOR = 5.71; p = 0.026) and larger number of cows in the herd (aOR = 1.14; p &amp;lt; 0.001) were associated with brucellosis sero-positivity in herds.ConclusionBrucellosis prevalence was low in the study areas. Nonetheless, this low prevalence may increase if the disease is not controlled. Therefore, testing animals before movement, good farming practices, sanitary measures, and an awareness raising program on brucellosis are recommended.</jats:sec

Prevalence of Brucellosis in livestock owners in Northern Red Sea Region, Eritrea: community knowledge, attitude and practice.

Background: Brucellosis is an infectious zoonotic disease broadly spread worldwide. Brucellosis is endemic in Eritrea, however the prevalence rate, knowledge and practice of brucellosis among the livestock owners in the study area is unknown. The objective of this study was to determine the prevalence of brucellosis in livestock owners and evaluate the level of knowledge and practice of the community in Northern Red Sea region, Eritrea. Methods: Community based cross sectional study was conducted from October 2020 to February 2021, where a total of 637 livestock owners from 29 villages were sampled for blood and data collection. Blood samples were tested using RBPT and positive samples further confirmed using c-ELISA. Data were collected using structured questionnaires. Results: A total of 637 respondents were enrolled in the study. Study participants were dominated by males (74.9%), Tigre ethnic (73%) and farmers (70.5%). The overall sero-prevalence of brucellosis in the study area was 2.4% (95% CI:1.3 - 3.6) with the highest rate in Ghindae (3.9%). The comprehensive knowledge and practice was 58.4% and 10.5%, respectively. Comprehensive knowledge showed significant association with sub-region and age, while good practice indicated significant association with age (P=0.000). Sub-region Ghindae indicated odds (OR)of 3.27 (P=0.001) for comprehensive knowledge and odds of 3.12 (P=0.000) for good practice. Age group of ≥60 years revealed odds of 4.40 (P=0.000) for comprehensive knowledge. Conclusion: The overall sero-prevalence of brucellosis in livestock owners in the study area was low, but considerable higher in some spot areas. The participants showed good level of knowledge but poor practice. Study sub-region and age were important factors associated with comprehensive knowledge and good practice of the participants. Respondents from Sub-region Ghindae showed relatively higher level of prevalence rate, comprehensive knowledge and good practice to wards brucellosis. The study recommends urgent educational campaign to increase the community knowledge and improve their good practice habit on brucellosis. Conduct regular testing of animals and implement feasible control measures against brucellosis

Genetic diversity and molecular epidemiology of Middle East Respiratory Syndrome Coronavirus in dromedaries in Ethiopia, 2017–2020

ABSTRACTMiddle East respiratory syndrome coronavirus (MERS-CoV) is enzootic in dromedary camels and causes zoonotic infection and disease in humans. Although over 80% of the global population of infected dromedary camels are found in Africa, zoonotic disease had only been reported in the Arabia Peninsula and travel-associated disease has been reported elsewhere. In this study, genetic diversity and molecular epidemiology of MERS-CoV in dromedary camels in Ethiopia were investigated during 2017–2020. Of 1766 nasal swab samples collected, 61 (3.5%) were detected positive for MERS-CoV RNA. Of 484 turbinate swab samples collected, 10 (2.1%) were detected positive for MERS-CoV RNA. Twenty-five whole genome sequences were obtained from these MERS-CoV positive samples. Phylogenetically, these Ethiopian camel-originated MERS-CoV belonged to clade C2, clustering with other East African camel strains. Virus sequences from camel herds clustered geographically while in an abattoir, two distinct phylogenetic clusters of MERS-CoVs were observed in two sequential sampling collections, which indicates the greater genetic diversity of MERS-CoV in abattoirs. In contrast to clade A and B viruses from the Arabian Peninsula, clade C camel-originated MERS-CoV from Ethiopia had various nucleotide insertions and deletions in non-structural gene nsp3, accessory genes ORF3 and ORF5 and structural gene N. This study demonstrates the genetic instability of MERS-CoV in dromedaries in East Africa, which indicates that the virus is still actively adapting to its camel host. The impact of the observed nucleotide insertions and deletions on virus evolution, viral fitness, and zoonotic potential deserves further study