Building Legitimate and Accountable government in South Sudan Re-thinking inclusive governance in the post CPA-2005

Inclusive governance is significant to the realisation of democracy and peace dividends in states emerging from conflict. In principle, it offers platform for equitable representation of the ethnic majority, minority, marginalised and indigenous groups in public decision making bodies as well as ensuring that these groups benefit equally from development initiatives. In South Sudan, the exercise of inclusivity has been marred with contradictions between constitutional provisions and extant practices, for example, political parties are found to be the foci for rewarding the ‘warlords’ dubbed as freedom fighters at the expense of participatory civilian structures, the nerves of ethnic factionalism over nationalism, exercise of centralised nomination system, all of which breed disaffection and tensions among the citizenry.  Moreover, the observed militarisation of public service, perception of ethnic favouritism in public employment and appointments, the ‘felt’ development marginalisation of regions outside Central Equitoria, and unequal share of national resources comprise practices that violate the foundations of inclusive governance. In effect, these malpractices around inclusivity have fermented call for federalism (return to 23 semi-autonomous colonial districts with federal mandates) as a viable inclusive development platform over the current constitutionally mandated decentralisation (where South Sudan is sub-divided into 10 states). These ills in the exercise of inclusivity compounded with the inability to meet the 25% quota threshold for women & minorities across appointive and elective positions cast doubt on the facets of legitimacy and accountability in post-CPA South Sudan. Thus, achieving consensual and inclusive state in South Sudan must begin with constitutionalism, citizen-accelerated and equitable development and political leadership open to salient arguments on federalism and state stability. Key words: Participation, equality, federalism, marginalise

THE INFLUENCE OF FAMILY FACTORS ON DRUG ABUSE AMONGST PUBLIC PRIMARY PUPILS IN NYAMIRA COUNTY, KENYA

Drug abuse amongst youth and especially those schooling has become a major social problem not only in Kenya, but globally. Drug abuse amongst schooling youth has led to decline in their performance, increased drop out, increased cases of indiscipline and even death. Many studies have offered mixed or inconclusive findings on the causes of drug abuse amongst schooling youth especially those at primary level. The purpose of this was to the influence of family factors on drug abuse amongst public primary pupils in Nyamira County, Kenya. The research was guided by the following objectives: to establish the influence of nature of structure of families on drug abuse, to determine the influence of nature of parenting on the drug abuse to evaluate the influence of family value and culture on the drug abuse among public primary school pupils in Nyamira County. The study employed descriptive research survey. A sample of 220 pupils was selected from a population of 12045 pupils through proportionate stratified sampling together with 20 teachers from the guidance and counseling department who were purposively sampled. A semi-structured questionnaire was used to collect quantitative data from the pupils, while an interview schedule was used to collect qualitative data from the guidance and counseling teachers. For purposes of validity and reliability of the instruments, the questionnaire was piloted in five schools in Borabu Sub-County and their reliability was ascertained using Cronbach’s alpha. The reliability of the questionnaire item was well above 0.75. Quantitative data was analyzed descriptively and inferentially using a Chi-square in SPSS V.23) and the stated hypothesis was rejected at 5% significance level. Qualitative data was transcribed and analyzed thematically. The study established that decline in family nature and structure, coupled with failure by the community to have a united approach in drug abuse has negatively influenced the surge in drug and substance abuse amongst pupils in schools. The study recommends active parental involvement in the schooling and upbringing of their children.  Article visualizations

Fait accompli: legitimizing the illegitimate in elections outcomes Does the legality of the electoral process matter in Kenya?

Credibility of the electoral process across the world is both a means and a necessity to peaceful and stable democracy as credible elections serve to anchor functional legitimate democracy. It also serves as a vehicle that affords citizens an opportunity put in place a people-responsive government that mirrors the people’s will. Elections in most African states, however, have over time tended to validate evidently glaring constitutionally flowed outcomes. This trend is further aggravated by seemingly complicit and dysfunctional constitutional and electoral bodies and institutions. With a focus on the 2013 general elections in Kenya, this paper raises the question of the role of these bodies and institutions tasked with overseeing and ensuring credible electoral outcomes and their ability to live up to their expectations. Key words: Constitutionalism; Elections; Legality of electoral proces

Relationship Between Quality of Teacher-pupil Interaction and Primary School Readiness in Preschool Pupils in Nairobi County, Kenya

A lot of attention and emphasis has lately been placed on the development and education of young children. One of the specific areas of concern is on the quality of experiences that young children are exposed to at the early learning centres. This research paper sought to examine the relationship between the quality of teacher-pupil interaction and primary school readiness in preschool pupils in Nairobi County. The sample comprised 156 preschool pupils and 39 teachers in 39 preschools. The Pearson product-moment correlation statistics was used to examine this relationship. The findings indicate that there is a significant and positive relationship between the quality of positive-relationship dimension of teacher-pupil interaction and primary school readiness. A significant but negative relationship was found between the quality of harshness and detachment dimensions of teacher-pupil interaction and primary school readiness. A weak correlation that is not significant was found between the quality of permissiveness dimension of teacher-pupil interaction and primary school readiness. The researchers recommend that only trained and qualified teachers who are more likely to be aware of the desirable styles of teacher-pupil interaction should be deployed in early learning centres. Those already working should be given in-service training to enable them keep abreast of the best pedagogic practices. Keywords: Teacher-pupil interaction, Primary school readines

How do East African Communities Cope with the Impacts of Prosopis juliflora (Mesquite) Invasion? A Review

Prosopis juliflora is an evergreen invasive plant native to South America, the Caribbean, and Central America. The plant is well adapted to harsh environmental conditions. As a result, it has spread to most arid and semi-arid areas of the world causing both positive and negative impacts. This study reviewed the adaptation/coping strategies adopted by East African communities as a result of the invasion by the plant. The review results showed that East African communities cope by using the plant for human food and animal feed, leasing the infested land, renting land from uninvaded areas, clearing the plant from farming, grazing land, waterways, paths and homesteads, and using it as fuel in form of firewood and charcoal among others. The communities living in the infested areas now almost entirely depend on the plant for livelihood. Some of the employed adaptations/ coping strategies were found to be inadequate and to have negative environmental impacts. In order to enhance the adaptations/ coping strategies, we recommend commercialization of the plant’s seed for animal feed and human food production, sensitization of the communities on the medicinal use of the plant and that programs to manage the plant should take into account the adaptations the communities have developed over time to avoid negative impacts on the communities’ livelihoods. Keywords: Prosopis juliflora; Coping strategies; East Africa; Invasion; Po

A randomized, open-label, comparative efficacy trial of artemether-lumefantrine suspension versus artemether-lumefantrine tablets for treatment of uncomplicated Plasmodium falciparum malaria in children in western Kenya

<p>Abstract</p> <p>Background</p> <p>Artemether/lumefantrine (AL) has been adopted as the treatment of choice for uncomplicated malaria in Kenya and other countries in the region. Six-dose artemether/lumefantrine tablets are highly effective and safe for the treatment of infants and children weighing between five and 25 kg with uncomplicated <it>Plasmodium falciparum </it>malaria. However, oral paediatric formulations are urgently needed, as the tablets are difficult to administer to young children, who cannot swallow whole tablets or tolerate the bitter taste of the crushed tablets.</p> <p>Methods</p> <p>A randomized, controlled, open-label trial was conducted comparing day 28 PCR corrected cure-rates in 245 children aged 6–59 months, treated over three days with either six-dose of artemether/lumefantrine tablets (Coartem^®) or three-dose of artemether/lumefantrine suspension (Co-artesiane^®) for uncomplicated falciparum malaria in western Kenya. The children were followed-up with clinical, parasitological and haematological evaluations over 28 days.</p> <p>Results</p> <p>Ninety three percent (124/133) and 90% (121/134) children in the AL tablets and AL suspension arms respectively completed followed up. A per protocol analysis revealed a PCR-corrected parasitological cure rate of 96.0% at Day 28 in the AL tablets group and 93.4% in the AL suspension group, p = 0.40. Both drugs effectively cleared gametocytes and were well tolerated, with no difference in the overall incidence of adverse events.</p> <p>Conclusion</p> <p>The once daily three-dose of artemether-lumefantrine suspension (Co-artesiane^®) was not superior to six-dose artemether-lumefantrine tablets (Coartem^®) for the treatment of uncomplicated malaria in children below five years of age in western Kenya.</p> <p>Trial registration</p> <p>ClinicalTrials.gov NCT00529867</p

The global diet and activity research (GDAR) network: a global public health partnership to address upstream NCD risk factors in urban low and middle-income contexts.

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of death globally. While upstream approaches to tackle NCD risk factors of poor quality diets and physical inactivity have been trialled in high income countries (HICs), there is little evidence from low and middle-income countries (LMICs) that bear a disproportionate NCD burden. Sub-Saharan Africa and the Caribbean are therefore the focus regions for a novel global health partnership to address upstream determinants of NCDs. PARTNERSHIP: The Global Diet and Activity research Network (GDAR Network) was formed in July 2017 with funding from the UK National Institute for Health Research (NIHR) Global Health Research Units and Groups Programme. We describe the GDAR Network as a case example and a potential model for research generation and capacity strengthening for others committed to addressing the upstream determinants of NCDs in LMICs. We highlight the dual equity targets of research generation and capacity strengthening in the description of the four work packages. The work packages focus on learning from the past through identifying evidence and policy gaps and priorities, understanding the present through adolescent lived experiences of healthy eating and physical activity, and co-designing future interventions with non-academic stakeholders. CONCLUSION: We present five lessons learned to date from the GDAR Network activities that can benefit other global health research partnerships. We close with a summary of the GDAR Network contribution to cultivating sustainable capacity strengthening and cutting-edge policy-relevant research as a beacon to exemplify the need for such collaborative groups

The Cost-Effectiveness of Intermittent Preventive Treatment for Malaria in Infants in Sub-Saharan Africa

BACKGROUND: Intermittent preventive treatment in infants (IPTi) has been shown to decrease clinical malaria by approximately 30% in the first year of life and is a promising malaria control strategy for Sub-Saharan Africa which can be delivered alongside the Expanded Programme on Immunisation (EPI). To date, there have been limited data on the cost-effectiveness of this strategy using sulfadoxine pyrimethamine (SP) and no published data on cost-effectiveness using other antimalarials. METHODS: We analysed data from 5 countries in sub-Saharan Africa using a total of 5 different IPTi drug regimens; SP, mefloquine (MQ), 3 days of chlorproguanil-dapsone (CD), SP plus 3 days of artesunate (SP-AS3) and 3 days of amodiaquine-artesunate (AQ3-AS3).The cost per malaria episode averted and cost per Disability-Adjusted Life-Year (DALY) averted were modeled using both trial specific protective efficacy (PE) for all IPTi drugs and a pooled PE for IPTi with SP, malaria incidence, an estimated malaria case fatality rate of 1.57%, IPTi delivery costs and country specific provider and household malaria treatment costs. FINDINGS: In sites where IPTi had a significant effect on reducing malaria, the cost per episode averted for IPTi-SP was very low, USD 1.36-4.03 based on trial specific data and USD 0.68-2.27 based on the pooled analysis. For IPTi using alternative antimalarials, the lowest cost per case averted was for AQ3-AS3 in western Kenya (USD 4.62) and the highest was for MQ in Korowge, Tanzania (USD 18.56). Where efficacious, based only on intervention costs, IPTi was shown to be cost effective in all the sites and highly cost-effective in all but one of the sites, ranging from USD 2.90 (Ifakara, Tanzania with SP) to USD 39.63 (Korogwe, Tanzania with MQ) per DALY averted. In addition, IPTi reduced health system costs and showed significant savings to households from malaria cases averted. A threshold analysis showed that there is room for the IPTi-efficacy to fall and still remain highly cost effective in all sites where IPTi had a statistically significant effect on clinical malaria. CONCLUSIONS: IPTi delivered alongside the EPI is a highly cost effective intervention against clinical malaria with a range of drugs in a range of malaria transmission settings. Where IPTi did not have a statistically significant impact on malaria, generally in low transmission sites, it was not cost effective

Implications of COVID-19 control measures for diet and physical activity, and lessons for addressing other pandemics facing rapidly urbanising countries.

At the time of writing, it is unclear how the COVID-19 pandemic will play out in rapidly urbanising regions of the world. In these regions, the realities of large overcrowded informal settlements, a high burden of infectious and non-communicable diseases, as well as malnutrition and precarity of livelihoods, have raised added concerns about the potential impact of the COVID-19 pandemic in these contexts. COVID-19 infection control measures have been shown to have some effects in slowing down the progress of the pandemic, effectively buying time to prepare the healthcare system. However, there has been less of a focus on the indirect impacts of these measures on health behaviours and the consequent health risks, particularly in the most vulnerable. In this current debate piece, focusing on two of the four risk factors that contribute to >80% of the NCD burden, we consider the possible ways that the restrictions put in place to control the pandemic, have the potential to impact on dietary and physical activity behaviours and their determinants. By considering mitigation responses implemented by governments in several LMIC cities, we identify key lessons that highlight the potential of economic, political, food and built environment sectors, mobilised during the pandemic, to retain health as a priority beyond the context of pandemic response. Such whole-of society approaches are feasible and necessary to support equitable healthy eating and active living required to address other epidemics and to lower the baseline need for healthcare in the long term

Comparative Economic Evaluation of Haemophilus influenzae Type b Vaccination in Belarus and Uzbekistan

BACKGROUND: Hib vaccine has gradually been introduced into more and more countries during the past two decades, partly due to GAVI Alliance support to low-income countries. However, since Hib disease burden is difficult to establish in settings with limited diagnostic capacities and since the vaccine continues to be relatively expensive, some Governments remain doubtful about its value leading to concerns about financial sustainability. Similarly, several middle-income countries have not introduced the vaccine. The aim of this study is to estimate and compare the cost-effectiveness of Hib vaccination in a country relying on self-financing (Belarus) and a country eligible for GAVI Alliance support (Uzbekistan). METHODS AND FINDINGS: A decision analytic model was used to estimate morbidity and mortality from Hib meningitis, Hib pneumonia and other types of Hib disease with and without the vaccine. Treatment costs were attached to each disease event. Data on disease incidence, case fatality ratios and costs were primarily determined from national sources. For the Belarus 2009 birth cohort, Hib vaccine is estimated to prevent 467 invasive disease cases, 4 cases of meningitis sequelae, and 3 deaths, while in Uzbekistan 3,069 invasive cases, 34 sequelae cases and 341 deaths are prevented. Estimated costs per discounted DALY averted are US$9,323 in Belarus and US$ 267 in Uzbekistan. CONCLUSION: The primary reason why the cost-effectiveness values are more favourable in Uzbekistan than in Belarus is that relatively more deaths are averted in Uzbekistan due to higher baseline mortality burden. Two other explanations are that the vaccine price is lower in Uzbekistan and that Uzbekistan uses a three dose schedule compared to four doses in Belarus. However, when seen in the context of the relative ability to pay for public health, the vaccine can be considered cost-effective in both countries