Application of international Human Rights instruments (IHRIs) by domestic courts : a comparative study of Rwanda and Ghana

The essence of human rights and their dimension goes beyond national level. It is universal because it is inherent to human kind. The main source of human rights norms is international human rights instruments. The concern for human rights has grown worldwide and therefore they have been given priority by most nations. They are more and more integrated into national legal frameworks mainly in states constitutions with more or less enforcing mechanisms. As far as the realization of rights is concerned various mechanisms are involved on different levels: international, regional and national. Each of the three levels has its advantages and disadvantages. Yet, the local mechanisms appear to be more effective and adequate given the fact that they are closer to the real subject of the rights (the individuals). In point of fact, human rights involve mainly the relationships between individuals and states but sometimes also between individuals living somewhere in a nation.Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2011.http://www.chr.up.ac.za/nf2012Centre for Human RightsLL

The Dynamics of Collective Farming: A Case Study of Fish Farm Cooperatives in the Prefectures of Butare and Gikongoro, Rwanda.

Cooperative fish farming not only insures a wider distribution of land and fish farming technology resources to larger segments of the population, but also makes possible the integration of limited individual resources into sizable and economically more viable production and marketing units. On the basis that more efficient internal organization can lead to greater cooperative performance, the purpose of this study is to identify organizational attributes and practices associated with effectiveness of fish farming cooperatives in Rwanda. Data for the study were obtained from a sample of 200 fish farm groups selected in the prefectures of Butare and Gikongoro, Rwanda. Information on the characteristics of each group was gathered from three of its leaders. Regression analyses were used to test the association between structural characteristics and organizational practices and the performance of the cooperatives. Given the magnitude of the Beta coefficients, the following variables were found to significantly and positively affect production levels: (1) the length of time groups have been together doing fish farming business; (2) democratic leadership style; (3) the extent to which each member does all pond management operations, on a rotational basis; (4) the frequency of reports made by the control and supervision boards; (5) the number of members who are 26-45 years old; (6) the degree of family ties among members; (7) membership size; and (8) the extent to which groups implement arrangements designed to compensate for failure to provide labor contributions. In order of their importance, the following variables were found to influence sustainability: (1) the extent to which each member does all pond management operations on a rotational basis; (2) the frequency of general assembly meetings; (3) the length of time members have been together doing fish farming business; (4) the number of 25-46 years old members; (5) membership size; and (6) the extent of friendship among members. A number of recommendations for the development and improvement of fish farm cooperatives were derived from the findings of the study

Spontaneous fetal reduction in triplets and prolongation of twin pregnancy for 111 days as an outpatient: a case report

Background: Multiple gestation has been on the rise because of advancement in assisted reproductive technology. Triplet pregnancy is associated with fetal loss and preterm birth as its major complications. Spontaneous triplet pregnancy is rare. In the case of fetal loss, delayed interval delivery has been used to achieve delivery of the retained fetuses. There is no common approach to delayed interval delivery. Case A 31-year-old East African lady with spontaneous triplet pregnancy presented to our institution at gestation age of 19 weeks with features of threatened miscarriage. One fetus was miscarried, and delayed interval delivery was done as an outpatient. At gestation age of 35 weeks, she delivered healthy twins by cesarean section. Conclusion Delayed interval delivery improves neonatal outcomes of high-order pregnancy after fetal loss even in a resource-limited setting

Authorship Equity and Gender Representation in Global Oncology Publications

Purpose: Authorship gender disparities persist across academic disciplines, including oncology. However, little is known about global variation in authorship gender distribution. Methods: This retrospective cross-sectional study describes the distribution of author gender as determined from the first name across variables such as authorship position (first, middle, and last), country region, and country income level. The 608 articles with 5,302 authors included in this analysis were published in the Journal of Clinical Oncology Global Oncology, from its inception in October 2015 through March 2020. Primary outcome measure was author gender on the basis of first name probabilities assessed by genderize.io. World Bank classification was used to categorize the country region and income level. Odds ratios were used to describe associations between female last authorship and representation in other authorship positions. Results: Although female authors were in the minority across all authorship positions, they were more under-represented in the last author position with 190 (32.1%) female, compared with 252 (41.4%) female first authors and 1,564 (38.1%) female middle authors. Female authors were most under-represented among authors from low-income countries, where they made up 21.6% of first authors and 9.1% of last authors. Of all the regions, sub-Saharan Africa and South Asia had the lowest percentage of female authors. Compared with articles with male last authors, those with female last authors had odds ratios (95% CI) of 2.2 (1.6 to 3.2) of having female first authors and 1.4 (0.9 to 2.1) of having 50% or more female middle authors. Conclusion: There are wide regional variations in author gender distribution in global oncology. Female authors remain markedly under-represented, especially in lower-income countries, sub-Saharan Africa, and South Asia. Future interventions should be tailored to mitigate these disparities

Bilateral tubal ectopic gestation: Complication in a patient with previous ectopic pregnancy, rare case report

Introduction: Ectopic pregnancy results of implantation of conceptus outside of endometrial cavity. It remains an important cause of maternal mortality. Spontaneous bilateral tubal pregnancies are the rare form of ectopic and are considered spontaneous when no fertility treatments are involved. Case findings: A 31-year-old nulliparous woman presented at the Family Medicine Clinic with complaints of non- specific mild lower abdominal pain for 3 days and amenorrhea for 5 weeks. Transvaginal Ultrasound showed bilateral unruptured adnexa pregnancies. The trial of medical therapy was done without success and later lap- arotomy salpingostomy was done. One year later patient was able to conceive and delivery well by cesareans section. Discussion: Bilateral ectopic pregnancy is a unique from of twin pregnancy frequently occurring with assisted reproductive technology rather than spontaneous pregnancy. Diagnosis of bilateral ectopic pregnancy is often challenging as the clinical symptoms and signs may not be indicative of bilateral involvement. Laboratory test with βhcg levels cannot suggestive if is unilateral or bilateral nature and sonographers may be falsely reassured if they are not careful and satisfied with visualization of ectopic gestation on one side. Laparoscopic salpingostomy or salpingectomy is the gold standard treatment modality for bilateral tubal ectopic pregnancy although lapa- rotomy may be indicated in unstable patient. Conclusion and recommendation: Therefore, any women in childbearing age presenting with clinical features of acute lower abdominal pain should be considered to have potential ectopic gestation

Sexual Risk Behavior in HIV-Uninfected Pregnant Women in Western Uganda

Our aim was to identify sexual risk behavior among HIV-negative pregnant women in Kabarole District, Uganda, by conducting a cross-sectional study among 1610 women within three healthcare settings. One in six women engaged in HIV-specific risk behaviors including multiple sexual partners or alcohol abuse; 80% of the pregnant women reported to generally abstain from using condoms. In multivariate analysis, predictors of sexual risk behavior included being a client of the public health facilities as compared to the private facility (AOR 3.6 and 4.8, p < 0.001), being single, widowed or divorced or not cohabiting with the partner (AOR 4.7 and 2.3, p < 0.001), as well as higher household wealth (AOR 1.8, p < 0.001) and lack of partner status knowledge (AOR 1.6, p = 0.008). Self-estimated risk perception was linked with engagement in HIV-related risk behaviors except for alcohol abuse. Our findings indicate that reducing risky behaviors in pregnancy in order to prevent HIV should be a high-priority public health concern

Shortness of breath in a young lady, rare case report of thoracic endometriosis

Introduction and importance: Endometrial glandular tissue can implant in the thorax of women suffering from endometriosis. The clinical presentation is depends on site of implantation. Complications include pneumothorax, pneumohemothorax or hemothorax. Case presentation: A 31 year old woman with history of infertility presented with shortness of breath and was found to have a significant right sided pneumohemothorax. Drainage was done followed by chemical pleurodesis using bleomycin with resolution of symptoms on her follow up. Clinical discussion: Thoracic endometriosis tend to present with chronic or sub-acute symptoms which are nonspecific symptoms leading to late diagnosis. Video Assisted Thoracoscopic surgery offer both diagnostic and therapeutic in thoracic endometriosis. However in limited settings chemical pleurodesis can be carried out done to prevent recurrence of shortness of breath due to thoracic endometriosis. Conclusion: Therefore, clinical suspicion of thoracic endometriosis in evaluation of shortness of breath in a young lady with history of infertility or pelvic surgery is indispensable

Innovative Use of mHealth and Clinical Technology for Oncology Clinical Trials in Africa

Utilization of clinical technology and mobile health (mHealth) is expanding globally. It is important to reflect on how their usage and application could translate in low- and middle-income country (LMIC) settings. With the exponential growth and advancements of mobile and wireless technologies, LMICs are prime to adapt such technologies to potentially democratize and create solutions to health-related challenges. The role of these technologies in oncology clinical trials continues to expand. The lure of mHealth promises disruptive technology that may change the way clinical trials are designed and conducted in many settings. Its applicability in the African context is currently under consideration. Although potentially of expanding benefit, the role of these technologies requires careful and nuanced evaluation of the context in which they might be applied to harness their full potential, while mitigating possible harms or preventing further deepening of disparities within populations. Moreover, technology and digital innovations are no substitute for poor referral pathways and dysfunctional health systems and can only complement or enhance definite strategies aimed at strengthening these health system

Diagnostic challenge of perimenopause molar pregnancy in a 52-year-old lady: Case report

Introduction and importance: Gestational trophoblastic disease is an uncommon group of pregnancy-related dis- orders, with a course of trophoblastic proliferation, including hydatidiform mole (Agha et al., 2020), invasive and metastatic mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelial trophoblastic tumor. Choriocarcinoma and trophoblastic tumor of the placenta are the most important tumors associated with pregnancy. Case findings: A 52-year-old woman Para 2 Living 3, 3 years post-menopausal presented with prolong per vaginal bleeding for five weeks accompanied by lower abdominal pain. Diagnosis of gestational trophoblastic disease (choriocarcinoma type) was made by using beta HCG, radiology, and histology report. Patient underwent total abdominal hysterectomy and bilateral salphingo-opherectomy, followed by 2 cycles of chemotherapy. Discussion: Trophoblast disease of pregnancy disease includes a unique tissue group with a wide range of endocrine and angiogenic functions derived from placental trophoblasts. They are associated with uncommon, interrelated conditions, which differ according to the following parameters: invasion, regression, metastasis, and recurrence rate. Beta HCG remains initial investigation to be taken in patients suspecting trophoblastic disease. Conclusion and recommendations: Gestational trophoblastic disease should be considered in the differential diagnosis of peri and postmenopausal vaginal bleeding. Long term follows up with beta HCG needs to be done to detect recurrence

Locally Advanced Cervical Carcinoma Management

Cervical cancer is a public health burden to Low and Middle Income countries. Whereas strides are being made in the management of malignancies worldwide, resources limited settings are confronted with the paucity of basic awareness, health professionals, diagnosis and management modalities, all contributing to cervical cancer disease late presentation. Among available treatment modalities, the mainstay of treatment for locally advanced cervical cancer remains radiation therapy combined with chemotherapy. Radiation is delivered through external radiation and brachytherapy. The evidence leading to the decision making, the modern management modalities and the general side effects, will be reviewed here