Eating for honour: A cultural-ecological analysis of food behaviours among adolescent girls in the southern plains of Nepal

Access to adequate and nutritious food is important for the current and future health of adolescent girls. Interventions often focus on the individual as responsible for their own health ignoring the complex structural issues that underlie optimal nutrition. In South Asia gender inequalities have been noted as an important determinant of poor nutrition among women and their young children, but analysis of adolescent girls' diets and what influences these are rarely undertaken. Therefore, we sought to analyse the factors affecting what and where girls' eat and what affects their behaviour in the plains of Nepal, using a cultural-ecological approach. We analysed a secondary qualitative dataset of focus group discussions with adolescent girls aged 12-19 years old, young mothers, mothers-in-law, and older female key informants. Eating was heavily influenced by patriarchal norms. Boys had preferential access to food, money, and freedom of movement to appreciate their future role in providing for the family. Food was an investment, and boys were perceived to have more nutritional need than girls. Girls were not perceived to be a good return on investment of food, and eating practices sought to prepare them for life as a subservient daughter-in-law and wife. Obedience and sacrifice were valued in girls, and they were expected to eat less and do more housework than boys. Girls' eating and behaviour was constrained to maintain self and family honour. Interventions should acknowledge cultural influences on eating and engage multiple actors in addressing harmful gender norms which limit eating and prevent girls from reaching their potential

The actress and the look of the other

This thesis, titled The Actress and the Look of the Other, comprises a novella and a dissertation. The thesis consists of a work of fiction and a critically-based literary dissertation, with the two complementing each other. That is, this is not a practice-based exegesis where an analysis of a creative component is undertaken. The dissertation analyses two novelistic representations of actresses—Regina in Simone de Beauvoir’s All Men Are Mortal (1946) and Sibyl Vane in Oscar Wilde’s The Picture of Dorian Gray (1891)—through relevant aspects of Existentialism. The application of de Beauvoir’s ideas about female “transcendence” and acting in The Second Sex, and Jean-Paul Sartre’s existentialist philosophy of the other’s look, draws out and illuminates themes of objectivation and alienation in the novels, in relation to these hitherto neglected characters. The thesis addresses the previous neglect of these two figures in literary analyses and illustrates their relevance to the often inexplicit use of Existentialism in celebrity studies. It answers the research question: to what extent does Existentialism inform the actress characters in All Men Are Mortal and The Picture of Dorian Gray? Further, to what extent has Existentialism informed interpretations of the actor in celebrity studies? The research question also informs the creative component of the thesis, which is titled As Though Floating. Engaging with de Beauvoir’s ideas about acting, “transcendence”, gender and fame, and Sartre’s ideas about self-estrangement in the other’s look, the novella explores how these existentialist themes relate to mortality, insignificance, fame and the acting craft. The novella explores a female actor’s unhappy pursuit of fame and her realisation that fulfilment may lie elsewhere. Fen is dissatisfied in her career as an understudy in London’s West End theatres, and is so preoccupied with recognition and success that she forgets her love of acting itself. When she returns home to Perth for a former lover’s funeral, Fen works through her memories and grief. In doing so, she reconciles with family and friends, and with her past treatment of the former lover whose celebrity and death play a key role in the novel

Validating an Agency-based Tool for Measuring Women's Empowerment in a Complex Public Health Trial in Rural Nepal.

Despite the rising popularity of indicators of women's empowerment in global development programmes, little work has been done on the validity of existing measures of such a complex concept. We present a mixed methods validation of the use of the Relative Autonomy Index for measuring Amartya Sen's notion of agency freedom in rural Nepal. Analysis of think-aloud interviews (n = 7) indicated adequate respondent understanding of questionnaire items, but multiple problems of interpretation including difficulties with the four-point Likert scale, questionnaire item ambiguity and difficulties with translation. Exploratory Factor Analysis of a calibration sample (n = 511) suggested two positively correlated factors (r = 0.64) loading on internally and externally motivated behaviour. Both factors increased with decreasing education and decision-making power on large expenditures and food preparation. Confirmatory Factor Analysis on a validation sample (n = 509) revealed good fit (Root Mean Square Error of Approximation 0.05-0.08, Comparative Fit Index 0.91-0.99). In conclusion, we caution against uncritical use of agency-based quantification of women's empowerment. While qualitative and quantitative analysis revealed overall satisfactory construct and content validity, the positive correlation between external and internal motivations suggests the existence of adaptive preferences. High scores on internally motivated behaviour may reflect internalized oppression rather than agency freedom

Understanding multilevel barriers to childhood vaccination uptake among Internally Displaced Populations (IDPs) in Mogadishu, Somalia: a qualitative study

BACKGROUND: Disparities in vaccination coverage exist in Somalia with Internally Displaced Persons (IDPs) being among the groups with the lowest coverage. We implemented an adapted Participatory Learning and Action (PLA) intervention, which focused on routine vaccinations among displaced populations living in Mogadishu IDP camps. The intervention was successful in improving maternal knowledge and vaccination coverage but unsuccessful in improving timely vaccination. We conducted a qualitative study to understand this result and analyze the multi-level barriers to routine childhood immunization uptake. METHOD: In this qualitative study we used observation data from 40 PLA group discussions with female caregivers and purposively sampled nine vaccination service providers and six policy makers for interview. We also reviewed national-level vaccine policy documents and assessed the quality of health facilities in the study area. We used the socioecological framework to structure our analysis and analyzed the data in NVivo. RESULTS: The barriers to childhood vaccination among IDPs at the individual level were fear due to lack of knowledge, mistrust of vaccines, concerns about side effects and misinformation; opportunity costs; and costs of transportation. At the interpersonal level, family members played an important role as did the extent of decision-making autonomy. Community factors such as cultural practices, gender roles, and household evictions influenced vaccination. Organizational issues at health facilities such as waiting times, vaccine stock-outs, distance to the facility, language differences, and hesitancy of health workers to open multi-dose vials affected vaccination. At the policy level, confusion about the eligible age for routine vaccination and age restrictions for catch-up vaccination and certain antigens such as BCG were important barriers. CONCLUSION: Complex and interrelated factors affect childhood vaccination uptake among IDPs in Somalia. Interventions that address multiple barriers simultaneously will have the greatest impact given the complex nature of vulnerabilities in this population. There is a need to strengthen the health system and connect it with existing community structures to increase demand for services. Our research highlights the importance of formative research before implementing interventions. Further research on the integration of health service strengthening with PLA to improve childhood vaccination among IDPs is recommended. TRIAL REGISTRATION NUMBER: ISRCTN-83,172,390. Date of registration: 03/08/2021

Experts react: EU progress reports 2014

On 8 October, the European Commission released its annual reports on the progress achieved by EU candidate and potential candidate countries. Experts on the seven countries for which reports were issued give their responses below to the key points raised for each state. James Ker-Lindsay on Serbia: “It’s time to start building a new state” Krenar Gashi on Kosovo: “Same alarms, no surprises” Will Bartlett on Bosnia and Herzegovina: “Deep frustration at political stalemate” Kenneth Morrison on Montenegro: “The road to the EU may take longer than expected” Cvete Koneska on Macedonia: “The report’s criticism is unlikely to be taken seriously by the government” Joanna Hanson on Albania: “Moderate progress, but strong criticism of the parliament persists” Didem Buhari-Gulmez on Turkey: “Substantial problems with human rights, rule of law, corruption and governance” Can Karahasan on Turkey: “Economic development is hampered by political tensions

Trypanosomosis in The Gambia: prevalence in working horses and donkeys detected by whole genome amplification and PCR, and evidence for interactions between trypanosome species

<p>Abstract</p> <p>Background</p> <p>The Gambia has an increasing population of <it>equidae </it>largely used for agriculture and transportation. A review of cases at The Gambian Horse and Donkey Trust (GHDT) indicated that a common reason for presentation is a poorly defined medical condition often attributed to trypanosomosis. There are few reports describing the prevalence or the range of clinical signs associated with infection with different species of trypanosomes in horses and donkeys, but given the importance of these animals, the role of trypanosomosis requires investigation.</p> <p>Results</p> <p>In total 241 animals from the Central River Division in The Gambia (183 horses and 58 donkeys) were screened using Whole Genome Amplification (WGA) followed by trypanosome species identification using polymerase chain reaction (PCR). The results indicated overall trypanosome prevalence of 91%; with an infection rate of 31% for <it>Trypanosoma congolense </it>Savannah, 87% for <it>Trypanosoma vivax </it>and 18% for <it>Trypanosoma brucei </it>sp. Multiple species were present in 43% of infections. Microscopy had a good specificity (100%) and positive predictive value (100%) for trypanosome detection, but the sensitivity (20%) and negative predictive value (10.5%) were low relative to PCR-based diagnosis.</p> <p>Infection with <it>T congolense </it>showed the greatest negative effect on packed cell volume (PCV), while infection with <it>T. brucei </it>sp also had a significant, although lesser, negative effect on PCV. In addition, cases positive by microscopy were associated with significantly lower PCV. However, concurrent infection with <it>T. vivax </it>appeared to cause less effect on PCV, compared to animals infected with <it>T. congolense </it>alone.</p> <p>Conclusion</p> <p>The prevalence of Trypanosomosis was high in both horses and donkeys. Infection with <it>T. congolense </it>appeared to have the greatest clinical significance, while <it>T. vivax </it>infection may be of limited clinical significance in this population. Indeed, there is evidence of <it>T. vivax </it>co-infection ameliorating the pathology caused by <it>T. congolense</it>. WGA and PCR allowed a more comprehensive analysis of field infections with the detection of infections below the threshold of microscopy, and provided indications of interactions between parasite species that would otherwise remain undetected. The study raises important questions about the epidemiology of trypanosome infection in relation to disease that require a full scale longitudinal analysis.</p

Potential recruitment into a clinical trial of vascular secondary prevention medications in cerebral small vessel disease, based on concomitant medication use

This research has been conducted using the UK Biobank resource. The authors are grateful to UK Biobank participants. UK Biobank was established by the Wellcome Trust medical charity, Medical Research Council, Department of Health, Scottish Government, and the Northwest Regional Development Agency. It has also had funding from the Welsh Assembly Government and the British Heart Foundation.Peer reviewedPublisher PD

Behaviour change in perinatal care practices among rural women exposed to a women's group intervention in Nepal [ISRCTN31137309]

BACKGROUND: A randomised controlled trial of participatory women's groups in rural Nepal previously showed reductions in maternal and newborn mortality. In addition to the outcome data we also collected previously unreported information from the subgroup of women who had been pregnant prior to study commencement and conceived during the trial period. To determine the mechanisms via which the intervention worked we here examine the changes in perinatal care of these women. In particular we use the information to study factors affecting positive behaviour change in pregnancy, childbirth and newborn care. METHODS: Women's groups focusing on perinatal care were introduced into 12 of 24 study clusters (average cluster population 7000). A total of 5400 women of reproductive age enrolled in the trial had previously been pregnant and conceived during the trial period. For each of four outcomes (attendance at antenatal care; use of a boiled blade to cut the cord; appropriate dressing of the cord; not discarding colostrum) each of these women was classified as BETTER, GOOD, BAD or WORSE to describe whether and how she changed her pre-trial practice. Multilevel multinomial models were used to identify women most responsive to intervention. RESULTS: Among those not initially following good practice, women in intervention areas were significantly more likely to do so later for all four outcomes (OR 1.92 to 3.13). Within intervention clusters, women who attended groups were more likely to show a positive change than non-group members with regard to antenatal care utilisation and not discarding colostrum, but non-group members also benefited. CONCLUSION: Women's groups promoted significant behaviour change for perinatal care amongst women not previously following good practice. Positive changes attributable to intervention were not restricted to specific demographic subgroups