"NGOs, they cannot kill people": Cholera Vaccination in the Context of Humanitarian Crises in South Sudan

Cholera is endemic and remains a significant public health problem in places like South Sudan where decades of war have devastated basic infrastructures and left people vulnerable to diseases mostly forgotten in other places. In 2010, the World Health Organization (WHO) recommended that oral cholera vaccination (OCV) be used in conjunction with other cholera prevention and control measures and an OCV stockpile was created to improve access to the vaccines in situations of outbreaks, humanitarian emergencies and other high risk settings. Four years later, following the eruption of a violent political crisis that has left more than 50,000 people dead and another 2.5million displaced, OCV campaigns were conducted in PoCs (Protection of Civilian areas) across South Sudan with vaccines provided from the stockpile. This was the first use of the OCV stockpile in a humanitarian crisis. The potential social and health systems effects of the vaccine have so far been unexplored. This thesis uses qualitative methods to examine the socio-cultural and political dimensions of cholera and OCV campaigns among internally displaced Nuer people living in PoC areas in Juba, South Sudan, and their relation to perceptions of health, cholera risk and vaccination decisions. Interviews were conducted with humanitarian health professionals involved in the cholera response as well as with Nuer residents in the two PoCs where the OCV campaigns were conducted. Their narratives were interpreted with attention to the political and humanitarian crises in South Sudan as well as the humanitarian response by domestic and international actors. This thesis argues that the violent conflict, which led to the displacement of Nuers in Juba into UN-protected areas also led to changes in their conceptualization of risk and health. Both became intertwined in a socio-political narrative, framing the Dinka dominated SPLM government as a source of disease and UN/NGOs as a source of health. Cholera risk and vaccination decisions were described in non-political and political terms. Vaccination decisions were one of few means Nuers had of exercising political autonomy and control. Similarly, for humanitarian health professionals, the provision of OCVs was an essential aspect of building credibility and trust among Nuers in the PoCs. In this context, trust in institutions emerged as the most significant influence in vaccine decision making. The significance of trust, which is not encompassed in a typical “exposure-outcome” framework of epidemiology, also explains why vaccine recipients neither perceived their risk of cholera as diminishing nor perceived a reduced need for preventative practices, such as hand-washing, five months after vaccination. The thesis concludes that vaccination in a humanitarian crisis context warrants re-conceptualization not simply in an equation weighing epidemiological risk and disease perception on the part of the target population, nor a simple decision of doing what is best from the perspective of humanitarian actors, but as part of a complex process also considering the political and social dynamics surrounding health interventions and their influence on public willingness to accept them

Mycorrhizal Association and its Benefits to Allanblackia parviflora Tree Seedlings in the Nursery

Allanblackia species are high value multipurpose indigenous fruit trees whose seeds contain edible oil that has become a foreign exchange earner for rural-based enterprises. Wild harvesting could not sustain the supply to industry and therefore domestication was focused on developing propagation techniques, selecting and collecting elite planting materials. Little emphasis was placed on the soil nutrient requirements where preliminary results showed seedlings grown in rhizosphere soil of wild trees had good growth performance. A study was undertaken to examine microbial-Allanblackia parviflora plant interactions and determine their benefits to nursery seedlings. Roots of wildlings and rhizosphere soil from A. parviflora trees were collected from three forest reserves and the roots assessed for mycorrhizal colonization. Allanblackia parviflora seedlings were raised in different potting media with different ratios and their height and diameter determined. Soil treatments were also analyzed for nutrient and chemical contents. Vesicles, arbuscular structures, hyphal coils and intercellular hyphae were found on root tips of wildlings collected from rhizosphere soil of Allanblackia (AB) trees and seedlings grown in soil treatments containing AB soil. Root colonization of A. parviflora was largely in the form of extensive cell-to-cell growth of hyphal coils characteristic of Paris-type morphology. Addition of Agricultural field soil (Ferric Acrisol, Afs) or Humus (H)+Afs to AB improved height of seedlings. Seedlings grown in AB soil alone increased best in height with age followed by those grown in combination of 75% AB soil and 25% Afs. Available P was highest in Afs (220.84 mgP/kg) and low in AB soil (6.54 mgP/kg) while combination of H + Afs to AB increased K level to 341.34 mgK/kg. The improvement in growth must be due to both vesicular-arbuscular mycorrhizal fungi and soil chemical content of AB soil

Assessing and Strengthening African Universities' Capacity for Doctoral Programmes

Imelda Bates and colleagues developed and validated an evidence-based tool for evaluating doctoral programmes in African universities

Barriers to formal healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana

Abstract: Background: Even though there is a growing literature on barriers to formal healthcare use among older people, little is known from the perspective of vulnerable older people in Ghana. Involving poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme, this study explores barriers to formal healthcare use in the Atwima Nwabiagya District of Ghana. Methods: Interviews and focus group discussions were conducted with 30 poor older people, 15 caregivers and 15 formal healthcare providers in the Atwima Nwabiagya District of Ghana. Data were analysed using the thematic analytical framework, and presented based on an a posteriori inductive reduction approach. Results: Four main barriers to formal healthcare use were identified: physical accessibility barriers (poor transport system and poor architecture of facilities), economic barriers (low income coupled with high charges, and non-comprehensive nature of the National Health Insurance Scheme [NHIS]), social barriers (communication/language difficulties and poor family support) and unfriendly nature of healthcare environment barriers (poor attitude of healthcare providers). Conclusions: Considering these barriers, removing them would require concerted efforts and substantial financial investment by stakeholders. We argue that improvement in rural transport services, implementation of free healthcare for poor older people, strengthening of family support systems, recruitment of language translators at the health facilities and establishment of attitudinal change programmes would lessen barriers to formal healthcare use among poor older people. This study has implications for health equity and health policy framework in Ghana

Proactive prevention: Act now to disrupt the impending non-communicable disease crisis in low-burden populations

Non-communicable disease (NCD) prevention efforts have traditionally targeted high-risk and high-burden populations. We propose an alteration in prevention efforts to also include emphasis and focus on low-risk populations, predominantly younger individuals and low-prevalence populations. We refer to this approach as “proactive prevention.” This emphasis is based on the priority to put in place policies, programs, and infrastructure that can disrupt the epidemiological transition to develop NCDs among these groups, thereby averting future NCD crises. Proactive prevention strategies can be classified, and their implementation prioritized, based on a 2-dimensional assessment: impact and feasibility. Thus, potential interventions can be categorized into a 2-by-2 matrix: high impact/high feasibility, high impact/ low feasibility, low impact/high feasibility, and low impact/low feasibility. We propose that high impact/high feasibility interventions are ready to be implemented (act), while high impact/low feasibility interventions require efforts to foster buy-in first. Low impact/high feasibility interventions need to be changed to improve their impact while low impact/low feasibility might be best re-designed in the context of limited resources. Using this framework, policy makers, public health experts, and other stakeholders can more effectively prioritize and leverage limited resources in an effort to slow or prevent the evolving global NCD crisis.Fil: Njuguna, Benson. Moi Teaching & Referral Hospital; KeniaFil: Fletcher, Sara L.. State University of Oregon; Estados UnidosFil: Akwanalo, Constantine. Moi Teaching & Referral Hospital; KeniaFil: Asante, Kwaku Poku. Kintampo Health Research Centre; GhanaFil: Baumann, Ana. Washington University in St. Louis; Estados UnidosFil: Brown, Angela. Washington University in St. Louis; Estados UnidosFil: Davila Roman, Victor G.. Washington University in St. Louis; Estados UnidosFil: Dickhaus, Julia. New York University Grossman School of Medicine; Estados UnidosFil: Fort, Meredith. Colorado School Of Public Health; Estados UnidosFil: Iwelunmor, Juliet. Saint Louis University; Estados UnidosFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Mohan, Sailesh. Centre For Chronic Disease Control; India. Public Health Foundation Of India; IndiaFil: Mutabazi, Vincent. Regional Alliance For Sustainable Development; RuandaFil: Newsome, Brad. Center for Translation Research and Implementation Science; Estados UnidosFil: Ogedegbe, Olugbenga. New York University Grossman School of Medicine; Estados UnidosFil: Pastakia, Sonak D.. Purdue University College Of Pharmacy; Estados UnidosFil: Peprah, Emmanuel K.. University of New York; Estados UnidosFil: Plange Rhule, Jacob. Ghana College Of Physicians And Surgeons; GhanaFil: Roth, Gregory. University of Washington; Estados UnidosFil: Shrestha, Archana. Kathmandu University School Of Medical Sciences; NepalFil: Watkins, David A.. University of Washington; Estados UnidosFil: Vedanthan, Rajesh. New York University Grossman School of Medicine; Estados Unido

Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff

Objective: COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. Design: Twenty-five semi-structured interviews were conducted (October 2020–January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. Results: Vaccine decision-making processes were underpinned by an overarching theme, ‘weighing up risks of harm against potential benefits to self and others’. Sub-themes included ‘fear of harm’, ‘moral/ethical objections’, ‘potential benefits to self and others’, ‘information and misinformation’, and ‘institutional or workplace pressure’. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. Conclusions: Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake

The development of computational biology in South Africa: successes achieved and lessons learnt

Bioinformatics is now a critical skill in many research and commercial environments as biological data are increasing in both size and complexity. South African researchers recognized this need in the mid-1990s and responded by working with the government as well as international bodies to develop initiatives to build bioinformatics capacity in the country. Significant injections of support from these bodies provided a springboard for the establishment of computational biology units at multiple universities throughout the country, which took on teaching, basic research and support roles. Several challenges were encountered, for example with unreliability of funding, lack of skills, and lack of infrastructure. However, the bioinformatics community worked together to overcome these, and South Africa is now arguably the leading country in bioinformatics on the African continent. Here we discuss how the discipline developed in the country, highlighting the challenges, successes, and lessons learnt

The Role of AGG Interruptions in the Transcription of FMR1 Premutation Alleles

Fragile X associated disorders are caused by a premutation allele in the fragile X mental retardation 1 gene (FMR1) and are hypothesized to result from the toxic effect of elevated levels of expanded FMR1 transcripts. Increased levels of FMR1 mRNA have indeed been reported in premutation carriers; however the mechanism by which expanded alleles lead to elevated levels of FMR1 mRNA in premutation carriers is unknown. Within the CGG repeat tract AGG interruptions are found, generally 1–3 present in normal/intermediate alleles (6–54 CGG repeats) and usually 0–1 in premutation alleles (55–200 CGG repeats). They are present at specific locations, generally occurring after 9 or 10 uninterrupted CGG repeats [(CGG)9AGG(CGG)9AGG(CGG)n]. We evaluated both the number of AGG interruptions and the resulting length of the uninterrupted 3′ CGG repeat pure tract in premutation alleles derived from two large cohorts of male and female carriers to determine whether the presence of AGG interruptions or the length of a pure stretch of CGG repeats influence the levels of FMR1 mRNA in blood. Our findings indicate that neither the number of AGG interruptions, nor their position along the CGG tract have a significant affect on mRNA levels in premutation carriers. We also, as expected based on previous findings, observed a highly significant correlation between CGG repeat number (as both total length and length of pure CGG stretch) and FMR1 mRNA expression levels, in both males and females. Importantly, we did not observe any significant difference in FMR1 mRNA levels in premutation carriers based on age