Resisting control of neglected tropical diseases: dilemmas in the mass treatment of schistosomiasis and soil-transmitted helminths in north-west Uganda

A strong case has recently been made by academics and policymakers to develop national programmes for the integrated control of Africa’s ‘neglected tropical diseases’. Uganda was the first country to develop a programme for the integrated control of two of these diseases: schistosomiasis and soil-transmitted helminths. This paper discusses social responses to the programme in Panyimur, north-west Uganda. It shows that adults are increasingly rejecting free treatment. Resistance is attributed to a subjective fear of side-effects; divergence between biomedical and local understandings of schistosomiasis/bilharzia; as well as inappropriate and inadequate health education. In addition, the current procedures for distributing drugs at a district level are problematic. Additional research was carried out in neighbouring areas to explore the generalizability of findings. Comparable problems have arisen. It is concluded that the national programme will not fulfil its stated objectives of establishing a local demand for mass treatment unless it can establish more effective delivery strategies and promote behavioural change in socially appropriate ways. To do so will require new approaches to social, economic and political aspects of distribution. There are reasons why populations infected with the ‘neglected tropical diseases’ are themselves neglected. Those reasons cannot just be wished away

Will mass drug administration eliminate lymphatic filariasis? Evidence from northern coastal Tanzania

Copyright @ 2012 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and 85 reproduction in any medium, provided the original author and source are credited. The article was made available through the Brunel University Open Access Publishing Fund.This article documents understandings and responses to mass drug administration (MDA) for the treatment and prevention of lymphatic filariasis among adults and children in northern coastal Tanzania from 2004 to 2011. Assessment of village-level distribution registers, combined with self-reported drug uptake surveys of adults, participant observation and interviews, revealed that at study sites in Pangani and Muheza districts the uptake of drugs was persistently low. The majority of people living at these highly endemic locations either did not receive or actively rejected free treatment. A combination of social, economic and political reasons explain the low uptake of drugs. These include a fear of treatment (attributable, in part, to a lack of trust in international aid and a questioning of the motives behind the distribution); divergence between biomedical and local understandings of lymphatic filariasis; and limited and ineffective communication about the rationale for mass treatment. Other contributory factors are the reliance upon volunteers for distribution within villages and, in some locations, strained relationships between different groups of people within villages as well as between local leaders and government officials. The article also highlights a disjuncture between self-reported uptake of drugs by adults at a village level and the higher uptake of drugs recorded in official reports. The latter informs claims that elimination will be a possibility by 2020. This gives voice to a broader problem: there is considerable pressure for those implementing MDA to report positive results. The very real challenges of making MDA work are pushed to one side - adding to a rhetoric of success at the expense of engaging with local realities. It is vital to address the kind of issues raised in this article if current attempts to eliminate lymphatic filariasis in mainland coastal Tanzania are to achieve their goal.This work is funded from the Bill and Melinda Gates Foundation

Changing authoritarians\u27 attitudes: The role of authority legitimacy

This study investigated the tendency of right-wing authoritarians (RWAs) to yield to established and legitimate authorities. University students enrolled in an Introductory Psychology course read two persuasive passages. One passage concerned whether homosexuals should be allowed to become schoolteachers, while the other discussed whether an aggressive proselytizing religious group should be allowed to recruit students on university campuses. Some of the participants were informed that the passage was written by a highly established and legitimate authority; others were told the passage came from a less established and legitimate authority. In addition, the passages were manipulated so that half supported and half argued against the relevant issue. Participants’ attitudes towards these issues were assessed both before and after reading each passage and an attitude change score was calculated. It was proposed that the authoritarian submission component of the high RWA\u27s personality predisposes authoritarians to use a decision-making heuristic akin to Established and legitimate authorities are usually correct when responding to a persuasive message. Therefore, it was expected that high RWAs’ attitudes towards the issues would be more influenced by the authority legitimacy of the passage authors than would those of low RWAs. Contrary to expectations, high RWAs were Q9; influenced by the authority legitimacy manipulation. However, high RWAs, more often than low RWAs, reported an intention to comply with a counter-attitudinal law. They also tended to rate established and legitimate authorities as having more authority over their personal attitudes concerning the two issues than did low RWAs. Several explanations are discussed concerning why the high RWAs were not influenced by the authority legitimacy manipulation within the persuasion context of this study

Doctor of Philosophy

dissertationHigh-performance supercomputers on the Top500 list are commonly designed around commodity CPUs. Most of the codes executed on these machines are message-passing codes using the message-passing toolkit (MPI). Thus it makes sense to look at these machines from a holistic systems architecture perspective and consider optimizations to commodity processors that make them more efficient in message-passing architectures. Described herein is a new User-Level Notification (ULN) architecture that significantly improves message-passing performance. The architecture integrates a simultaneous multithreaded (SMT) processor with a user-level network interface (NI) that can directly control the execution scheduling of threads on the processor. By allowing the network interface to control the execution of message handling code at the user level, the operating system (OS) related overhead for handling interrupts and user code dispatch related to notifications is eliminated. By using an SMT processor, message handling can be performed in one thread concurrent to user computation in other threads, thus most of the overhead of executing message handlers can be hidden. This dissertation presents measurements showing the OS overheads related to message-passing are significant in modern architectures and describes a new architecture that significantly reduces these overheads. On a communication-intensive real-world application, the ULN architecture provides a 50.9% performance improvement over a more traditional OS-based NIC and a 5.29-31.9% improvement over a best-of-class user-level NIC due to the user-level notifications

Exploration for volcanogenic sulphide mineralisation at Benglog, north Wales

Exploration for volcanogenic sulphide mineralisation around Benglog is one of three investigations designed to assess the metallogenic potential of the Ordovician Aran Volcanic Group. Detailed geological mapping in the Benglog area enabled an interpretation of the volcanic environment, critical to such an assessment, to be made. The eruptive rocks are acid and basic in composition; the acid rocks are mostly ash-flow tuffs derived from outside the area, whereas the basic rocks have a local derivation. They are all interbedded with dark grey or black silty mudstone and were probably erupted in a submarine environment. Contemporaneous dolerite sills were intruded into wet sediment. This environment was suitable for volcanogenic exhalative sulphide deposits to form and indications of a metallogenic horizon were found at the top of the Y Fron Formation in the form of abundant pyrite, minor pyrrhotite and minor base metal enrichment. Soil samples, analysed for copper, lead and zinc, were collected and geophysical surveys were carried out along eleven east-west trending traverse lines 300 m apart across the volcanic succession. Indications were found of minor vein mineralisation at dolerite intrusion margins and locally along faults. Very high chargeability and low resistivity anomalies over mudstones did not spatially coincide with geochemical anomalies in soil, but the secondary redistribution of metals in soils and variable thickness of overburden precluded confident interpretation of the source of many soil anomalies. Geochemical drainage data, in conjunction with rock analyses, show strong barium enrichment in mudstones which could be volcanogenic in origin but related to two separate eruptive episodes. The findings of the survey were inconclusive. An environment suitable for the formation of volcanogenic exhalative sulphide deposits was established, but the geochemical and geophysical surveys located only minor vein mineralisation and tenuous indications of other styles of mineralisation. Recommendations are made for further work

#PublicAuthority: what will happen when there is another epidemic? Ebola in Mathiane, Sierra Leone

Melissa Parker and Tim Allen discover how long-standing customary forms of governance played a critical role in ending the Ebola outbreak in Sierra Leone

Freeing Space for NASA: Incorporating a Lossless Compression Algorithm into NASA's FOSS System

NASA's Fiber Optic Strain Sensing (FOSS) system can gather and store up to 1,536,000 bytes (1.46 megabytes) per second. Since the FOSS system typically acquires hours - or even days - of data, the system can gather hundreds of gigabytes of data for a given test event. To store such large quantities of data more effectively, NASA is modifying a Lempel-Ziv-Oberhumer (LZO) lossless data compression program to compress data as it is being acquired in real time. After proving that the algorithm is capable of compressing the data from the FOSS system, the LZO program will be modified and incorporated into the FOSS system. Implementing an LZO compression algorithm will instantly free up memory space without compromising any data obtained. With the availability of memory space, the FOSS system can be used more efficiently on test specimens, such as Unmanned Aerial Vehicles (UAVs) that can be in flight for days. By integrating the compression algorithm, the FOSS system can continue gathering data, even on longer flights

Deworming delusions? Mass drug administration in East African schools

Recent debates about deworming school-aged children in East Africa have been described as the ‘Worm Wars’. The stakes are high. Deworming has become one of the top priorities in the fight against infectious diseases. Staff at the World Health Organization, the Gates Foundation and the World Bank (among other institutions) have endorsed the approach, and school-based treatments are a key component of large-scale mass drug administration programmes. Drawing on field research in Uganda and Tanzania, and engaging with both biological and social evidence, this article shows that assertions about the effects of school-based deworming are over-optimistic. The results of a much-cited study on deworming Kenyan school children, which has been used to promote the intervention, are flawed, and a systematic review of randomized controlled trials demonstrates that deworming is unlikely to improve overall public health. Also, confusions arise by applying the term deworming to a variety of very different helminth infections and to different treatment regimes, while local-level research in schools reveals that drug coverage usually falls below target levels. In most places where data exist, infection levels remain disappointingly high. Without indefinite free deworming, any declines in endemicity are likely to be reversed. Moreover, there are social problems arising from mass drug administration that have generally been ignored. Notably, there are serious ethical and practical issues arising from the widespread practice of giving tablets to children without actively consulting parents. There is no doubt that curative therapy for children infected with debilitating parasitic infections is appropriate, but overly positive evaluations of indiscriminate deworming are counter-productive