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

#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

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

Intra-individual variation in children\u27s physical activity patterns: Implications for measurement

Children\u27s physical activity (PA) patterns change form day to day. This intra-individual variability affects precision when measuring key physical activity and sedentary behavior variables. This paper discusses strategies to reduce the random error associated with intra-individual variability and demonstrates the implications for assessing PA when varying number of days are sampled. Self-reported data collected on two hundred and ninety eight 13- to 14-year-olds were used to compare estimates of PA and sedentary behaviour derived from between 1 and 7 days of recall data. Large intra-individual coefficients of variation were calculated for physical activity level (14.5%), moderate-to-vigorous physical activity (83.4%), screen time (60.8%) and sleep (12.2%). While the magnitude of error associated with estimating means decreased as more days were sampled, the paper notes that depending on the nature of the research question being asked, fewer days may yield sufficiently precise estimates. Therefore, researchers should conduct power analyses based on estimated inter- and intra-individual variability and sample size to determine how many days to sample when assessing children\u27s PA patterns

Debunking delusions around deworming

Tim Allen and Melissa Parker argue that a biosocial approach is necessary for ‘deworming’ to succeed in improving lives

Spelling ability influences early letter encoding during reading: Evidence from return-sweep eye movements.

In recent years, there has been an increase in research concerning individual differences in readers’ eye movements. However, this body of work is almost exclusively concerned with the reading of single-line texts. While spelling and reading ability have been reported to influence saccade targeting and fixation times during intra-line reading, where upcoming words are available for parafoveal processing, it is unclear how these variables impact fixations adjacent to return-sweeps. We, therefore, examined the influence of spelling and reading ability on return-sweep and corrective saccade parameters for 120 participants engaged in multiline text reading. Less skilled readers and spellers tended to launch their return-sweeps closer to the end of the line, prefer a viewing location closer to the start of the next, and made more return-sweep undershoot errors. We additionally report several skillrelated differences in readers’ fixation durations across multiline texts. Reading ability influenced all fixations except those resulting from return-sweep error. In contrast, spelling ability influenced only those fixations following accurate return-sweeps— where parafoveal processing was not possible prior to fixation. This stands in contrasts to an established body of work where fixation durations are related to reading but not spelling ability. These results indicate that lexical quality shapes the rate at which readers access meaning from the text by enhancing early letter encoding, and influences saccade targeting even in the absence of parafoveal target information

Scientific rationale for selecting northern Eumenides Dorsum (9 deg - 11 deg N latitude, 159 deg - 162 deg longitude) as a potential Mars Pathfinder landing site

The proposed site is the northernmost occurrence of the Medusae Fossae Formation (MFF), and lies at or below the -2 km contour. The MFF is the famous radar 'stealth' deposit that extends from south of Olympus Mons westward across southern Amazonis Planitia to southern Elysium Planitia. The MFF appears to be composed of some kind of wind-eroded friable material, the origin of which is very problematic. It appears to be a radar-absorbing material, whereas Mars' south polar layered deposits appear bright in the same scenes. Synthetic aperture radar images of young terrestrial ash deposits in the Andes also appear relatively bright. The MFF's radar signature appears to require a uniformly fine-grained material (on the order of dust-sized to fine sand-sized) at least several meters thick, in order not to transmit reflections off underlying terrain or internal reflective horizons. The proposed Pathfinder landing site lies on a relatively smooth, 'unmodified' portion of the MFF, more than 100 km away from its northern and western edges, which exhibit evidence of eolian etching in the form of closely spaced yardings. There are no large craters or steep slopes within a few hundred kilometers of the landing site