Contextual Challenges for Application of the Minimum Standards in Education for Emergencies

Education in emergencies is a necessity that can be both life sustaining and life saving To this end, the development of the Minimum Standards in Education for Emergencies, Chronic Crisis and Early Reconstruction (MSEE) is an expression of commitment by major stakeholders that all individuals in crisis situations deserve quality education. While development of the MSEE is a commendable effort towards addressing issues of access, quality and accountability in program implementation, achievement of the standards is contingent on factors that are far more complex and beyond the capacity and control of agencies. This analytic study questions the fundamental assumptions that guided the development of the minimum standards and asserts that the adoption of a one-size-fits-all strategy ignominiously ignores contextual differences and complexities in the field. The study cites factors such as the dynamics and specificities of each crisis, differences in the demand and availability of resources and the existence of multiple institutional players as major challenges. Drawing on evidence from the field and the author\u27s experience implementing and coordinating emergency education projects with UNICEF in Sierra Leone, this study highlights some of the challenges that are likely to hinder operationalization of the MSEE as a quasipolicy instrument. It concludes that while the MSEE may be relevant and indeed a desirable goal, it is prescriptive and far too ambitious and unrealistic. Thus the achievement of the 19 minimum standards and 109 indicators may not be practicable and attainable in most contexts given the already fragile nature of institutions and systems in such countries and the resource limitations. Finally, the author proposes actions to operationalize the MSEE at the field level, including increased advocacy for recognition of emergency education as a legitimate humanitarian activity for increased donor funding. The study also recommends the establishment of country-level and project level mechanisms and support for capacity building of government institutions to lead. These actions are critical for an improvement in education delivery in general and more specifically if the MSEE should serve its purpose of contributing to an improvement in learning outcomes at the classroom level

Monitoring anti-tuberculosis treatment response using analysis of whole blood Mycobacterium tuberculosis specific T cell activation and functional markers

Background: Blood-based biomarkers have been proposed as an alternative to current sputum-based treatment monitoring methods in active tuberculosis (ATB). The aim of this study was to validate previously described phenotypic, activation, and cytokine markers of treatment response in a West African cohort. Methods: Whole blood immune responses to Mycobacterium tuberculosis ESAT-6/CFP-10 (EC) and purified protein derivative (PPD) were measured in twenty adults at baseline and after 2 months of standard TB treatment. Patients were classified as fast or slow responders based on a negative or positive sputum culture result at 2 months, respectively. Cellular expression of activation markers (CD38, HLA-DR), memory markers (CD27), and functional intracellular cytokine and proliferation (IFN-γ, Ki-67, TNF-α) markers were measured using multi-color flow cytometry. Results: There was a significant increase in the proportion of CD4+CD27+ cells expressing CD38 and HLA-DR following EC stimulation at 2 months compared to baseline (p = 0.0328 and p = 0.0400, respectively). Following PPD stimulation, slow treatment responders had a significantly higher proportion of CD8+CD27–IFN-γ+ (p = 0.0105) and CD4+CD27+HLA-DR+CD38+ (p = 0.0077) T cells than fast responders at baseline. Receiver operating curve analysis of these subsets resulted in 80% sensitivity and 70 and 100% specificity, respectively (AUC of 0.82, p = 0.0156 and 0.84, p = 0.0102). Conclusion: Our pilot data show reductions in expression of T cell activation markers were seen with treatment, but this was not associated with fast or slow sputum conversion at 2 months. However, baseline proportions of activated T cell subsets are potentially predictive of the subsequent speed of response to treatment

The violence of peace and the role of education: insights from Sierra Leone

Research on peacebuilding has mushroomed over the last decade and there is a growing interest in the role of education in supporting peacebuilding processes. This paper engages with these debates, UN peacebuilding activities and the location of education initiatives therein, through a case study of Sierra Leone. In the first part, we explore the complex and multi-dimensional nature of violence in post-conflict Sierra Leone. In the second, we critically address the role of education in the conflict and post-conflict period, highlighting education’s centrality as a catalyst to conflict, and then reflect on the failure of the post-conflict reconstruction process to adequately transform the education system into one that could support a process of sustainable peacebuilding. Finally, we conclude by exploring the ways that greater investment and focus, both financial and human, in the education sector might, in the long term, better contribute to a sustainable and socially just peace

Resistance to antiretroviral drugs in treated and drug-naive patients in the Democratic Republic of Congo

Background: We studied virological outcome and drug resistance in patients on antiretroviral therapy (ART) in health care centers in the Democratic Republic of Congo and looked for the presence of drug resistance in antiretroviral-naive patients attending the same clinics. Methods: In 2008, we conducted a cross-sectional survey among patients on ART for >= 12 months in 4 major cities [Kinshasa (n = 289), Matadi (n = 198), Lubumbashi (n = 77), and Mbuji-Mayi (n = 103)]. Genotypic drug resistance tests were done with an in-house assay on samples with viral load > 1000 copies/mL. ART-naive patients (n = 283) were also consecutively enrolled in the same clinics. Results: Of the 667 patients on ART, > 98% received Lamivudine + Stavudine/azidothymidine + Nevirapine/Efavirenz as first-line regimen and 74.4% were women. Median time on ART was 25 months [interquartile ratio (IQR), 19-32] in Kinshasa, 26 months (IQR, 19-32) in Matadi, 27 months (IQR, 19-44) in Lubumbashi, and 19 months (IQR, 16-24) in Mbuji-Mayi. A total of 97 patients (14.6%) had viral load > 1000 copies/mL, and among the 93 successfully sequenced samples, 78 (83.9%) were resistant to at least 1 drug of their ART regimen: 68 harbored resistance mutations to nucleoside reverse transcriptase inhibitor (NRTI) and nonnucleoside reverse transcriptase inhibitor (NNRTI), 2 to NRTI only, 7 to NNRTI only, and 1 to NRTI + NNRTI + protease inhibitor. The majority of patients, 70/78 (89.7%), were resistant to at least 2 of the 3 drugs from their treatment. The use of next-generation NNRTI, etravirine was already compromised for 19.2% (15/78) of the patients and 7 patients had the K65R mutation compromising the use of tenofovir in second-line regimens. The proportion of antiretroviral-resistant patients increased over time from 8.4% to 18.6% for patients on ART for 12-23 months or > 35 months (P = 0.013), respectively. Virological failure and rates of drug resistance were significantly higher among men than women, 19.9% versus 8.8%, respectively (P = 0.0001). Among the 253 recently diagnosed patients, 20 (7.9%) harbored resistance mutations. Conclusions: The accumulation of drug resistance mutations with time on ART needs further attention, and surveillance should be reinforced in ART programs in sub-Saharan Africa

Use of the FilmArray System for Detection of Zaire ebolavirus in a Small Hospital in Bo, Sierra Leone

Laboratories associated with small hospitals often have limited expertise, personnel, and equipment to rapidly identify rare and emerging infectious diseases. We describe the successful use of the FilmArray system for rapid detection of Ebola virus directly from clinical samples in 6 out of 83 tested subjects in a small health care center in Sierra Leone