Improving validity of informed consent for biomedical research in Zambia using a laboratory exposure intervention.

BACKGROUND: Complex biomedical research can lead to disquiet in communities with limited exposure to scientific discussions, leading to rumours or to high drop-out rates. We set out to test an intervention designed to address apprehensions commonly encountered in a community where literacy is uncommon, and where complex biomedical research has been conducted for over a decade. We aimed to determine if it could improve the validity of consent. METHODS: Data were collected using focus group discussions, key informant interviews and observations. We designed an intervention that exposed participants to a detailed demonstration of laboratory processes. Each group was interviewed twice in a day, before and after exposure to the intervention in order to assess changes in their views. RESULTS: Factors that motivated people to participate in invasive biomedical research included a desire to stay healthy because of the screening during the recruitment process, regular advice from doctors, free medical services, and trust in the researchers. Inhibiting factors were limited knowledge about samples taken from their bodies during endoscopic procedures, the impact of endoscopy on the function of internal organs, and concerns about the use of biomedical samples. The belief that blood can be used for Satanic practices also created insecurities about drawing of blood samples. Further inhibiting factors included a fear of being labelled as HIV positive if known to consult heath workers repeatedly, and gender inequality. Concerns about the use and storage of blood and tissue samples were overcome by a laboratory exposure intervention. CONCLUSION: Selecting a group of members from target community and engaging them in a laboratory exposure intervention could be a useful tool for enhancing specific aspects of consent for biomedical research. Further work is needed to determine the extent to which improved understanding permeates beyond the immediate group participating in the intervention

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity

“Going through the Fire with Eyes Wide Open”: African Women’s Perspective on Indigenous Knowledge, Patriarchy, and Sexuality

Activists and scholars have shown through research and scholarship that HIV is a gendered pandemic. Attempts to engage this issue, from a gender justice perspective, however, have seen accusations levelled at African women theologians of using Western models to critique essentially African cultural practices. In response to these accusations the authors of this article, conducted empirical research to see if it was possible to find indigenous knowledge which critiques patriarchal practices from within African culture. While neither the concept of “indigenous knowledge” nor “African culture” is monolithic, we chose to study the proverbs, songs and indigenous healing practices of a Zulu community in rural Inanda as a case study, in the hope that a study of this particular community may help to illuminate a larger dynamic. In this article, we explore the ways in which Zulu songs and proverbs critique patriarchy and the ways in which they promote patriarchy. In conclusion, new models of knowledge for the promotion of life in contexts of HIV are proposed

Limnological variability and pelagic fish abundance (Stolothrissa tanganicae and Lates stappersii) in Lake Tanganyika

The abundance of two main pelagic fish species in Lake Tanganyika (Stolothrissa tanganicae and Lates stappersii) has always been observed to fluctuate considerably at different time scales. The inverse correlation between the abundance of these species has often been interpreted as the consequence of predator-prey relations (avoidance behaviour by the prey). However, currently the two species often appear spatially segregated in the lake, S. tanganicae dominating in the north while L. stappersii is generally abundant in the south where it feeds mostly on shrimps. A fluctuating abundance of the species is nevertheless observed. As these fish species have a major importance for the fisheries, we investigated the limnological variability in relation to the short-term variability of fish catches. The abundance of S. tanganicae was positively correlated to plankton biomass (r = 0.65), while water transparency (r = 0.56), depth of mixed layer (r = -0.70) and oxygenated water appeared important drivers for the abundance of L. stappersii. Alternating "mixing" and "stable" states of the epilimnion related to seasonal and internal waves variability are probably determinant for the short-term variability in abundance of S. tanganicae and L. stappersii. In the framework of this study, remote sensing has shown a potentially interesting application for fisheries research at Lake Tanganyika. We observed a close correspondence between phytoplankton blooms at the time of trade winds changes and increased catches of S. tanganicae in the south. The anti-correlated abundance of S. tanganicae and L. stappersii probably mainly reflects the underlying fluctuating limnological environment. Fisheries studies need to integrate limnological and planktonic monitoring to better understand large and complex ecosystems such as Lake Tanganyika