Vulnerability of Adolescents to HIV/AIDS in Malawi

This thesis aims at examining vulnerability to HIV/AIDS among adolescents in Malawi. The study uses mixed methods that combine quantitative and qualitative techniques in order to better understand whether there are significant variations in the pattern of sexual behaviour between adolescent orphans and non-orphans. Results of a quantitative analysis (n=1214) revealed that orphans are less likely to undertake voluntary counseling and testing (VCT) for HIV/AIDS, that they tend to experience their first sexual intercourse earlier in life, and that they are generally more likely to engage in high risk sexual behavior than non-orphans. In addition, female orphans in particularly are less likely to abstain from sex or to use a condom. The qualitative analysis (n=82) revealed that female orphans’ high risk sexual behaviour is closely linked to a well-established inter-household casual labour relation locally known as ganyu. While providing an escape from extreme poverty, ganyu is increasingly associated with a practice of sexual exchange between those who offer it and those who perform it. This study makes important contributions to theory, methodology and policy. Theoretically, the study shows that orphans’ heightened vulnerability to HIV/AIDS in Malawi is in part rooted in their socioeconomic disadvantage and the lack of social support, but in ways that markedly differ between male and female orphans. Building on survey findings in order to examine the role played by the social and spatial environment in shaping vulnerability to HIV/AIDS also demonstrates the value of combining quantitative and qualitative methods. The presence of a large and highly vulnerable orphan population in a country already overburdened with one of the worst HIV/AIDS prevalence rates in the world raises searching questions regarding new fault lines of the epidemic, and unravels complex policy challenges

Regionalism, Food Security and Economic Development

It is remarkable that Africa, with enormous resource endowments and with more than 70 percent of the population engaged in agriculture, cannot feed itself. This background paper offers a critical assessment of the potential of regional trade and integration in addressing the enduring challenge of food insecurity in Africa. Drawing on the literature, the paper argues that regionalism offers enormous opportunities and synergies for enhancing economic growth, food supply, and stability of food prices that cannot be easily addressed by individual countries when they operate in isolation from each other. To demonstrate the potential of regional integration for achieving food security in Africa, this paper starts by providing a conceptual framework that outlines the dimensions that link regional cooperation and food security. An overview of the key policy initiatives that are currently underway at enhancing integration at the continental level and in various regional blocs follows this introduction. The paper then progresses to a review of the extent of economic integration among African countries, with particular focus on the agriculture and food trade. It then presents a discussion on potential areas of integration followed by an examination of capacity issues that need policy attention in order to improve the potential of continental and regional integration in improving national and household food security among African countries

Pregnancy intention and gestational age at first antenatal care (ANC) visit in Rwanda

The final publication is available at Elsevier via https://dx.doi.org/10.1016/j.midw.2018.08.017 © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/Background With antenatal care (ANC) coverage now widely seen as a success story in Sub-Sahara Africa (SSA), attention has begun to shift towards exploring the full life-saving potential that ANC holds. Objectives This study examines association between pregnancy intention and gestational age at first antenatal care (ANC) visit in Rwanda, where ANC coverage is nearly universal. Methods We use survival analysis and apply the lognormal model in Stata SE 15 to compute time ratios (TR) that provide a direct metric for time to first ANC check-up. Results Despite nearly universal coverage, only 25% of pregnant mothers start ANC within the timeframe recommended by WHO. Women with unintended pregnancies are even more likely to delay ANC (TR = 11.4%, Z = 2.48, p < 0.05) than women with intended pregnancies. The effect of pregnancy intention on time to first ANC accentuates when we control for parity in the hazard models. There is also educational divide, with early start of ANC limited to pregnant women with secondary education or higher. Interaction effects suggest significant interaction between parity (≥ 4) and unintended pregnancy (TR = 11.1%, Z = -2.07, p < 0.05) on gestational age at first ANC. Other predictors of time to first ANC are contact with health care provider and perceived barriers. Conclusion With near universal coverage, the next big challenge to harness the full life-saving potential of ANC in Rwanda would be ramping up prompt start of prenatal care, timeliness of successive checkup intervals, and adherence to recommended number of visits, as opposed to simply increasing attendance. Preventing unwanted pregnancies in multiparous mothers through family planning would also significantly to the goal of universal ANC coverage in Rwanda

Major flaws in conflict prevention policies towards Africa : the conceptual deficits of international actors’ approaches and how to overcome them

Current thinking on African conflicts suffers from misinterpretations oversimplification, lack of focus, lack of conceptual clarity, state-centrism and lack of vision). The paper analyses a variety of the dominant explanations of major international actors and donors, showing how these frequently do not distinguish with sufficient clarity between the ‘root causes’ of a conflict, its aggravating factors and its triggers. Specifically, a correct assessment of conflict prolonging (or sustaining) factors is of vital importance in Africa’s lingering confrontations. Broader approaches (e.g. “structural stability”) offer a better analytical framework than familiar one-dimensional explanations. Moreover, for explaining and dealing with violent conflicts a shift of attention from the nation-state towards the local and sub-regional level is needed.Aktuelle Analysen afrikanischer Gewaltkonflikte sind häufig voller Fehlinterpretationen (Mangel an Differenzierung, Genauigkeit und konzeptioneller Klarheit, Staatszentriertheit, fehlende mittelfristige Zielvorstellungen). Breitere Ansätze (z. B. das Modell der Strukturellen Stabilität) könnten die Grundlage für bessere Analyseraster und Politiken sein als eindimensionale Erklärungen. häufig differenzieren Erklärungsansätze nicht mit ausreichender Klarheit zwischen Ursachen, verschärfenden und auslösenden Faktoren. Insbesondere die richtige Einordnung konfliktverlängernder Faktoren ist in den jahrzehntelangen gewaltsamen Auseinandersetzungen in Afrika von zentraler Bedeutung. Das Diskussionspapier stellt die große Variationsbreite dominanter Erklärungsmuster der wichtigsten internationalen Geber und Akteure gegenüber und fordert einen Perspektivenwechsel zum Einbezug der lokalen und der subregionalen Ebene für die Erklärung und Bearbeitung gewaltsamer Konflikte

Persistent misconceptions about HIV transmission among males and females in Malawi

Background: The prevalence of HIV in Malawi is one of the highest in sub-Saharan Africa, and misconceptions about its mode of transmission are considered a major contributor to the continued spread of the virus. Methods: Using the 2010 Malawi Demographic and Health Survey, the current study explored factors associated with misconceptions about HIV transmission among males and females. Results: We found that higher levels of ABC prevention knowledge were associated with lower likelihood of endorsing m

Arsenic-phosphorus interactions in the soil-plant-microbe system: dynamics of uptake, suppression and toxicity to plants

High arsenic (As) concentrations in the soil, water and plant systems can pose a direct health risk to humans and ecosystems. Phosphate (Pi) ions strongly influence As availability in soil, its uptake and toxicity to plants. Better understanding of As(V)-Pi interactions in soils and plants will facilitate a potential remediation strategy for As contaminated soils, reducing As uptake by crop plants and toxicity to human populations via manipulation of soil Pi content. However, the As(V)-Pi interactions in soil-plant systems are complex, leading to contradictory findings among different studies. Therefore, this review investigates the role of soil type, soil properties, minerals, Pi levels in soil and plant, Pi transporters, mycorrhizal association and microbial activities on As-Pi interactions in soils and hydroponics, and uptake by plants, elucidate the key mechanisms, identify key knowledge gaps and recommend new research directions. Although Pi suppresses As uptake by plants in hydroponic systems, in soils it could either increase or decrease As availability and toxicity to plants depending on the soil types, properties and charge characteristics. In soil, As(V) availability is typically increased by the addition of Pi. At the root surface, the Pi transport system has high affinity for Pi over As(V). However, Pi concentration in plant influences the As transport from roots to shoots. Mycorrhizal association may reduce As uptake via a physiological shift to the mycorrhizal uptake pathway, which has a greater affinity for Pi over As(V) than the root epidermal uptake pathway

The Lancet Commission on peaceful societies through health equity and gender equality

The multiple and overlapping crises faced by countries, regions, and the world appear unprecedented in their magnitude and complexity. Protracted conflicts continue and new ones emerge, fuelled by geopolitics and social, political, and economic pressures. The legacy of the COVID-19 pandemic, economic uncertainty, climatic events ranging from droughts to fires to cyclones, and rising food insecurity add to these pressures. These crises have exposed the inadequacy of national and global leadership and governance structures. The world is experiencing a polycrisis—ie, an interaction of multiple crises that dramatically intensifies suffering, harm, and turmoil, and overwhelms societies' ability to develop effective policy responses. Bold approaches are needed to enable communities and countries to transition out of harmful cycles of inequity and violence into beneficial cycles of equity and peace. The Lancet Commission on peaceful societies through health equity and gender equality provides such an approach. The Commission, which had its inaugural meeting in May, 2019, examines the interlinkages between Sustainable Development Goal 3 (SDG3) on health; SDG5 on gender equality; and SDG16 on peace, justice, and strong institutions. Our research suggests that improvements to health equity and gender equality are transformative, placing societies on pathways towards peace and wellbeing. Four key messages emerge from our research. First, health equity and gender equality have a unique and powerful ability to contribute to more peaceful societies. This Commission recognises the complex web of factors that contribute to conflict. Moreover, health equity and gender equality are themselves shaped by social and economic processes that are complex, contextually specific, and unfold over long timescales. Even accounting for this complexity, our Commission provides evidence that improvements in health equity and gender equality can place societies on pathways to peace. Health equity and gender equality are powerful agents of transformation because they require definitive actions, namely tangible and sustained policies that improve health and gender equality outcomes. We refer to these definitive actions as the mechanisms of health equity and gender equality. Health equity requires countries to embrace the right to health, acknowledge disparities, and recognise that universal access to health-care services is crucial for human potential and dignity. Gender equality requires laws to protect the rights of women and sexual and gender minorities. All individuals need equal access to education, resources, technology, infrastructure, and safety and security to enable participation in the economy, civil society, and politics. Processes to advance health equity and gender equality are more powerful when they operate together, through access to comprehensive sexual and reproductive health services. Advocacy is also an essential component as it builds a social consensus that the principles of health equity and gender equality apply to all individuals, regardless of their gender or other forms of identity. These tangible actions or mechanisms transform capabilities, a term that we define here as what people are able to do and to be. With improved health equity and gender equality, individuals can access economic resources and assets, live in safety and security, and exercise greater agency. Through these changes, human capital improves and economic growth becomes more inclusive. Social capital is strengthened and social norms are altered to inhibit violence and aggression. Although political processes are characterised by short-term dynamics, the institutionalisation of gender equality and health equity improves the quality of governance and can strengthen the social contract between the government and the citizenry. These processes interact with each other in self-reinforcing feedback loops creating beneficial cycles that influence the dynamics of economic, social, and political systems. For countries locked in harmful cycles of inequity, conflict, and instability, our research suggests that improvements in gender equality and health equity help nudge them onto pathways towards peace. Second, to deliver the promise of the Commission's research, health equity and gender equality principles and processes must be led by communities and tailored to their context. Local and national actors must drive improvements in health equity and gender equality, a process we refer to as change from the inside out. Although communities benefit from evidence from other contexts, we highlight the danger of importing policy models from other contexts. Health and gender systems are social systems, deeply intertwined in culture, contexts, and politics. Tangible and sustained improvements require gender equality and health equity mechanisms to be led by national actors, rooted in the local context, shaped by data, sustained through national systems, and accountable to communities. Efforts to improve gender equality are always contentious, but are transformative, enabling the recognition of the equal rights of women, girls, and sexual and gender minorities within the private and public spheres. Our Commission supports the call from decolonisation advocates for structural reform of global development processes to enable locally driven, context-specific change. However, we also stress that these local and national efforts should leverage and build upon the global scaffolding or architecture of norms, initiatives, funding, and institutions designed to advance health equity and gender equality. Third, within the health sector and beyond, the Commission calls on policy makers to embrace, advocate for, and advance health equity and gender equality. In the health sector, services and systems must adopt, implement, and be accountable to benchmarks for gender equal health responses. The health sector is a key social, economic, and political institution. Individuals engage with health services throughout their lifespan. Health professionals are respected leaders within their communities. Given their reproductive and caregiving roles, women are a majority of users as well as providers of health care. Yet health services and systems can reflect and reinforce implicit biases that undermine access to and delivery of services and the effectiveness of health policy decisions. The gender-blind response to the COVID-19 pandemic and the tolerance of sexual exploitation within humanitarian contexts are examples of the failure to integrate gender equality principles within health sector strategies and responses. Our Commission provides definitive benchmarks for gender equal health services and humanitarian action. If policy makers advance these benchmarks, health outcomes as well as the level of gender equality would improve. Finally, given the evidence we present in this Commission, health equity and gender equality must form an integral part of national and global processes to promote peace and wellbeing. The beneficial cycles of health equity and gender equality unfold over long time scales. Conflict management and humanitarian efforts understandably prioritise short-term interventions to reduce human suffering and stop violence. However, given the path dependencies established by such engagement, gender equality and health equity must be built into these short-term interventions. When integrating health equity and gender equality into humanitarian and conflict management interventions, we need to better analyse conflict dynamics and understand what conditions foster backlash, including when and how best to confront, counter, navigate, and minimise backlash. Gender equality and health equity processes must also recognise how gender norms impact men and boys, and not assume women and girls have the power to single-handedly transform their environments. Policy processes from the UN Sustainable Development Goals to the Group of Seven and Group of 20 Agendas present an important opportunity to advance this agenda. Although global initiatives can provide financial and technical support, gender or health outcomes cannot be instrumentalised or pursued for the interests of external actors rather than for the benefit of communities. The Lancet Commission provides an agenda for a path forward, rooted in a vision of our shared human dignity and collective responsibility to build a more equitable world. This agenda takes communities, governments, and international agencies on a challenging and sometimes contentious journey forward. We can accept the challenge and leverage this moment of opportunity to advance this agenda, or our politics and policies can entrench inequities and create the conditions for a more conflictual world. The choice is ours.The Swedish MFA, the Ministry of Social Affairs and Health in Finland, Canada's International Development Research Centre, and a donor whose organisation's policy is to remain anonymous but is known to The Lancet.https://www.thelancet.com/journals/lanhiv/home2024-05-04hj2024EconomicsSDG-03:Good heatlh and well-beingSDG-05:Gender equalitySDG-16:Peace,justice and strong institution

Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio

Distinct clinical and immunological profiles of patients with evidence of SARS-CoV-2 infection in sub-Saharan Africa

Although the COVID-19 pandemic has left no country untouched there has been limited research to understand clinical and immunological responses in African populations. Here we characterise patients hospitalised with suspected (PCR-negative/IgG-positive) or confirmed (PCR-positive) COVID-19, and healthy community controls (PCR-negative/IgG-negative). PCR-positive COVID-19 participants were more likely to receive dexamethasone and a beta-lactam antibiotic, and survive to hospital discharge than PCR-negative/IgG-positive and PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants exhibited a nasal and systemic cytokine signature analogous to PCR-positive COVID-19 participants, predominated by chemokines and neutrophils and distinct from PCR-negative/IgG-negative participants. PCR-negative/IgG-positive participants had increased propensity for Staphylococcus aureus and Streptococcus pneumoniae colonisation. PCR-negative/IgG-positive individuals with high COVID-19 clinical suspicion had inflammatory profiles analogous to PCR-confirmed disease and potentially represent a target population for COVID-19 treatment strategies