Rural Livelihoods, HIV/AIDS and Women’s Activism: The Struggle for Gender Equality in Primary Education in Uganda

In Uganda, various stake holders including the government, NGOs, and women activists have undeniably played important roles in the combat for gender equality in primary education. However, there is evidence that success has not yet been realized. This article is based on research conducted to discover why gender inequalities in Uganda’s Universal Primary Education persist despite deliberate measures to eradicate them. Two questions are addressed, namely: does HIV/AIDS contribute to the persistence of gender inequality in rural areas? What is the importance of linking theory and practice in women’s activism in such a context? The findings reveal that HIV/AIDS affects household access to essential livelihood assets prompting responses and pathways incompatible with girls’ schooling. These included girls’ involvement in sex for economic gains, which obviously exposed them to the risk of contracting HIV. A vicious cycle of HIV/AIDS and gender inequality therefore exists despite women’s protracted engagement in activism even in the era of HIV/AIDS. I argue that there is a need to refocus women’s activism towards more practical rather than theoretical engagement. Apparently, there has been too much theorizing about the need to perceive the achievement of gender equality as a social justice issue. Such a perception must be accompanied by corresponding practice rather than just rhetoric. For example, the vicious cycle of HIV/AIDS and inequality could possibly be broken by a radical feminist movement capable of, not only advocating for, but also instituting practical measures to eradicate gendered discrimination at the household level to begin with. In addition, there is a need for the provision of better HIV/AIDS medical care and children’s school requirements particularly in rural areas. Thereafter, we shall comfortably count the achievements of women activism for educational gender equity in Uganda and Africa at large

ADOPTION OF SOIL CONSERVATION THROUGH COLLECTIVE ACTIONS IN SOUTHWESTERN UGANDA

In developing countries, access to and use of renewable natural resources are essential for rural livelihoods to thrive. Hence, cooperation in the management of natural resources is increasingly an important strategy that can enhance long-term socio-ecological resilience. In most cases, collective actions have widely been recognised as an alternative institutional arrangement to centralised governance for the management of natural resources, but their success largely depends on factors that are specific to localities where they are implemented. In this study, factors that influence adoption and extent of adoption of natural resource conservation activities were identified using two case studies: Bubaare and Bufundi Innovation Platforms in Uganda. The drivers of adoption of community natural resource management strategies are analysed using an Ordered Logit Model while extent of adoption is analysed using a truncated regression model. The education level of a household head, membership in collective action group, and perception of plot slope and relevance of bye-laws were factors associated with likelihood of adoption. Value of livestock, membership in collective action group, access to credit and off-farm income were found to positively influence the level of investment. Thus, collective action increases opportunities for adoption; hence farmers should be supported to work collectively.Dans les pays en voie de d\ue9veloppement, l\u2019acc\ue8s et l\u2019utilisation des ressources naturelles sont essentiels pour la suivie en mileu rural et pour y prosp\ue9rer. Ainsi, la coop\ue9ration dans la gestion des ressources naturelles est de plus en plus une strat\ue9gie importante qui peut am\ue9liorer \ue0 long terme la coh\ue9sion socio-\ue9cologique. Dans beaucoup de cas; les actions collectives ont \ue9t\ue9 largement reconnues comme une alternative d\u2019organisation institutionnelle pour centraliser la gouvernance de la gestion des ressources naturelles, mais leur succ\ue8s d\ue9pend largement des facteurs qui sont sp\ue9cifiques aux milieux o\uf9 elles sont mise en oeuvre. Dans cette \ue9tude, les facteus qui influencent l\u2019adoption et le degr\ue9 d\u2019adoption des activit\ue9s de conservation des ressources naturelles \ue9taient identifi\ue9s en utilisant deux cas d\u2019\ue9tude: Les Plate-formes d\u2019Innovation de Bubaare et Bufundi en Ouganda. Les forces motrices d\u2019adoption des strategies de gestion des ressources naturelles communautaires sont analys\ue9es en utilsant un mod\ue8le Logit Ordonn\ue9 tandis que le degr\ue9 d\u2019adoption est analys\ue9 en utilisant un mod\ue8le de r\ue9gression tronqu\ue9. Le niveau d\u2019\ue9ducation du chef de m\ue9nage, l\u2019appartenance au groupe d\u2019action collective, et la perception de la pente de la parcelle et limportance des arr\ueat\ue9s \ue9taient les facteurs associ\ue9s au taux d\u2019adoption. La value du b\ue9tail, l\u2019appartenance au groupe d\u2019action collective, l\u2019acc\ue8s au cr\ue9dit et le revenu non- agricole \ue9taient les facteurs qui influencent positivement le niveau d\u2019investissement. Donc, les actions collectives augmentent les opportunit\ue9s pour l\u2019adoption; ainsi les producteurs devraient \ueatre encourag\ue9s \ue0 travailler de fa\ue7con collective

Predicting Optimal Dihydroartemisinin-Piperaquine Regimens to Prevent Malaria During Pregnancy for Human Immunodeficiency Virus-Infected Women Receiving Efavirenz

Background. A monthly treatment course of dihydroartemisinin-piperaquine (DHA-PQ) effectively prevents malaria during pregnancy. However, a drug-drug interaction pharmacokinetic (PK) study found that pregnant human immunodeficiency virus (HIV)-infected women receiving efavirenz-based antiretroviral therapy (ART) had markedly reduced piperaquine (PQ) exposure. This suggests the need for alternative DHA-PQ chemoprevention regimens in this population. Methods. Eighty-three HIV-infected pregnant women who received monthly DHA-PQ and efavirenz contributed longitudinal PK and corrected QT interval (QTc) (n = 25) data. Population PK and PK-QTc models for PQ were developed to consider the benefits (protective PQ coverage) and risks (QTc prolongation) of alternative DHA-PQ chemoprevention regimens. Protective PQ coverage was defined as maintaining a concentration > 10 ng/mL for > 95% of the chemoprevention period. Results. PQ clearance was 4540 L/day. With monthly DHA-PQ (2880 mg PQ), lt 1% of women achieved defined protective PQ coverage. Weekly (960 mg PQ) or low-dose daily (320 or 160 mg PQ) regimens achieved protective PQ coverage for 34% and > 96% of women, respectively. All regimens were safe, with lt = 2% of women predicted to have >= 30 msec QTc increase. Conclusions. For HIV-infected pregnant women receiving efavirenz, low daily DHA-PQ dosing was predicted to improve protection against parasitemia and reduce risk of toxicity compared to monthly dosing

Modeling Prevention of Malaria and Selection of Drug Resistance with Different Dosing Schedules of Dihydroartemisinin-Piperaquine Preventive Therapy during Pregnancy in Uganda.

Dihydroartemisinin-piperaquine (DHA-PQ) is under study for intermittent preventive treatment during pregnancy (IPTp), but it may accelerate selection for drug resistance. Understanding the relationships between piperaquine concentration, prevention of parasitemia, and selection for decreased drug sensitivity can inform control policies and optimization of DHA-PQ dosing. Piperaquine concentrations, measures of parasitemia, and Plasmodium falciparum genotypes associated with decreased aminoquinoline sensitivity in Africa (pfmdr1 86Y, pfcrt 76T) were obtained from pregnant Ugandan women randomized to IPTp with sulfadoxine-pyrimethamine (SP) or DHA-PQ. Joint pharmacokinetic/pharmacodynamic models described relationships between piperaquine concentration and the probability of genotypes of interest using nonlinear mixed effects modeling. An increase in the piperaquine plasma concentration was associated with a log-linear decrease in risk of parasitemia. Our models predicted that higher median piperaquine concentrations would be required to provide 99% protection against mutant infections than against wild-type infections (pfmdr1: N86, 9.6 ng/ml; 86Y, 19.6 ng/ml; pfcrt: K76, 6.5 ng/ml; 76T, 19.6 ng/ml). Comparing monthly, weekly, and daily dosing, daily low-dose DHA-PQ was predicted to result in the fewest infections and the fewest mutant infections per 1,000 pregnancies (predicted mutant infections for pfmdr1 86Y: SP monthly, 607; DHA-PQ monthly, 198; DHA-PQ daily, 1; for pfcrt 76T: SP monthly, 1,564; DHA-PQ monthly, 283; DHA-PQ daily, 1). Our models predict that higher piperaquine concentrations are needed to prevent infections with the pfmdr1/pfcrt mutant compared to those with wild-type parasites and that, despite selection for mutants by DHA-PQ, the overall burden of mutant infections is lower for IPTp with DHA-PQ than for IPTp with SP. (This study has been registered at ClinicalTrials.gov under identifier NCT02282293.)

Overall, anti-malarial, and non-malarial effect of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine on birthweight: a mediation analysis.

BACKGROUND: Trials of intermittent preventive treatment (IPTp) of malaria in pregnant women that compared dihydroartemisinin-piperaquine with the standard of care, sulfadoxine-pyrimethamine, showed dihydroartemisinin-piperaquine was superior at preventing malaria infection, but not at improving birthweight. We aimed to assess whether sulfadoxine-pyrimethamine shows greater non-malarial benefits for birth outcomes than does dihydroartemisinin-piperaquine, and whether dihydroartemisinin-piperaquine shows greater antimalarial benefits for birth outcomes than does sulfadoxine-pyrimethamine. METHODS: We defined treatment as random assignment to sulfadoxine-pyrimethamine or dihydroartemisinin-piperaquine before pooling individual participant-level data from 1617 HIV-uninfected pregnant women in Kenya (one trial; n=806) and Uganda (two trials; n=811). We quantified the relative effect of treatment on birthweight (primary outcome) attributed to preventing placental malaria infection (mediator). We estimated antimalarial (indirect) and non-malarial (direct) effects of IPTp on birth outcomes using causal mediation analyses, accounting for confounders. We used two-stage individual participant data meta-analyses to calculate pooled-effect sizes. FINDINGS: Overall, birthweight was higher among neonates of women randomly assigned to sulfadoxine-pyrimethamine compared with women assigned to dihydroartemisinin-piperaquine (mean difference 69 g, 95% CI 26 to 112), despite placental malaria infection being lower in the dihydroartemisinin-piperaquine group (relative risk [RR] 0·64, 95% CI 0·39 to 1·04). Mediation analyses showed sulfadoxine-pyrimethamine conferred a greater non-malarial effect than did dihydroartemisinin-piperaquine (mean difference 87 g, 95% CI 43 to 131), whereas dihydroartemisinin-piperaquine conferred a slightly larger antimalarial effect than did sulfadoxine-pyrimethamine (8 g, -9 to 26), although more frequent dosing increased the antimalarial effect (31 g, 3 to 60). INTERPRETATION: IPTp with sulfadoxine-pyrimethamine appears to have potent non-malarial effects on birthweight. Further research is needed to evaluate monthly dihydroartemisinin-piperaquine with sulfadoxine-pyrimethamine (or another compound with non-malarial effects) to achieve greater protection against malarial and non-malarial causes of low birthweight. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bill & Melinda Gates Foundation, and Worldwide Antimalarial Resistance Network

Isolation of non-tuberculous mycobacteria from pastoral ecosystems of Uganda: Public Health significance

<p>Abstract</p> <p>Background</p> <p>The importance of non-tuberculous mycobacteria (NTM) infections in humans and animals in sub-Saharan Africa at the human-environment-livestock-wildlife interface has recently received increased attention. NTM are environmental opportunistic pathogens of humans and animals. Recent studies in pastoral ecosystems of Uganda detected NTM in humans with cervical lymphadenitis and cattle with lesions compatible with bovine tuberculosis. However, little is known about the source of these mycobacteria in Uganda. The aim of this study was to isolate and identify NTM in the environment of pastoral communities in Uganda, as well as assess the potential risk factors and the public health significance of NTM in these ecosystems.</p> <p>Method</p> <p>A total of 310 samples (soil, water and faecal from cattle and pigs) were examined for mycobacteria. Isolates were identified by the INNO-Lipa test and by 16S rDNA sequencing. Additionally, a questionnaire survey involving 231 pastoralists was conducted during sample collection. Data were analysed using descriptive statistics followed by a multivariable logistic regression analysis.</p> <p>Results</p> <p>Forty-eight isolates of NTM were detected; 25.3% of soil samples, 11.8% of water and 9.1% from animal faecal samples contained mycobacteria. Soils around water sources were the most contaminated with NTM (29.8%). Of these samples, <it>M. fortuitum-peregrinum </it>complex, <it>M. avium </it>complex, <it>M. gordonae</it>, and <it>M. nonchromogenicum </it>were the most frequently detected mycobacteria. Drinking untreated compared to treated water (OR = 33), use of valley dam versus stream water for drinking and other domestic use (OR = 20), sharing of water sources with wild primates compared to antelopes (OR = 4.6), sharing of water sources with domestic animals (OR = 5.3), and close contact with cattle or other domestic animals (OR = 13.8) were the most plausible risk factors for humans to come in contact with NTM in the environment.</p> <p>Conclusions</p> <p>The study detected a wide range of potentially pathogenic NTM from the environment around the pastoral communities in Uganda. Drinking untreated water and living in close contact with cattle or other domestic animals may be risk factors associated with the possibility of humans and animals acquiring NTM infections from these ecosystems.</p

Gravidity influences distinct transcriptional profiles of maternal and fetal placental macrophages at term

IntroductionMaternal intervillous monocytes (MIMs) and fetal Hofbauer cells (HBCs) are myeloid-derived immune cells at the maternal-fetal interface. Maternal reproductive history is associated with differential risk of pregnancy complications. The molecular phenotypes and roles of these distinct monocyte/macrophage populations and the influence of gravidity on these phenotypes has not been systematically investigated.MethodsHere, we used RNA sequencing to study the transcriptional profiles of MIMs and HBCs in normal term pregnancies.ResultsOur analyses revealed distinct transcriptomes of MIMs and HBCs. Genes involved in differentiation and cell organization pathways were more highly expressed in MIMs vs. HBCs. In contrast, HBCs had higher expression of genes involved in inflammatory responses and cell surface receptor signaling. Maternal gravidity influenced monocyte programming, as expression of pro-inflammatory molecules was significantly higher in MIMs from multigravidae compared to primigravidae. In HBCs, multigravidae displayed enrichment of gene pathways involved in cell-cell signaling and differentiation.DiscussionOur results demonstrated that MIMs and HBCs have highly divergent transcriptional signatures, reflecting their distinct origins, locations, functions, and roles in inflammatory responses. Furthermore, maternal gravidity influences the gene signatures of MIMs and HBCs, potentially modulating the interplay between tolerance and trained immunity. The phenomenon of reproductive immune memory may play a novel role in the differential susceptibility of primigravidae to pregnancy complications