The body unbound: ritual scarification and autobiographical forms in Wole Soyinka’s Aké: the years of childhood

The scarification in Aké is invested with major significance apropos Soyinka’s ideas on African subjectivity. Scarification among the Yoruba is one of the rites of passage associated with personal development. Scarification literally and metaphorically “opens” the person up socially and cosmically. Personal formation and self-realization are enabled by the Yoruba social code brought into being by its mythology. The meaning of the scarification incident in Aké is profoundly different. Determined by the form of autobiography which creates a self-constituting subject, the enabling Yoruba sociocultural context is elided. The story of Soyinka’s personal development is allegorical of the story of the development of the modern African subject. For Soyinka, the African subject is a rational subject whose constitution precludes the splitting of the scientific and spiritual which is a consequence of the Cartesian rupture. The African subject should be open to other subjects and the object world. Subjectivity constituted by the autobiographical mode closes off the opening up symbolically signalled by scarification.Web of Scienc

Imported Plasmodium falciparum malaria in HIV-infected patients: a report of two cases

As HIV becomes a chronic infection, an increasing number of HIV-infected patients are travelling to malaria-endemic areas. Association of malaria with HIV/AIDS can be clinically severe. Severe falciparum malaria is a medical emergency that is associated with a high mortality, even when treated in an Intensive Care Unit. This article describes two cases of HIV-positive patients, who returned from malaria-endemic areas and presented a parasitaemia > 5% of erythrocytes and clinical signs of severe falciparum malaria, both with > 350 CD4 cell count/μl, absence of chemoprophylaxis and successful response. Factors like drug interactions and the possible implication of anti-malarial therapy bioavailability are all especially interesting in HIV-malaria co-infections

Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria

Quinine remains an important anti-malarial drug almost 400 years after its effectiveness was first documented. However, its continued use is challenged by its poor tolerability, poor compliance with complex dosing regimens, and the availability of more efficacious anti-malarial drugs. This article reviews the historical role of quinine, considers its current usage and provides insight into its appropriate future use in the treatment of malaria. In light of recent research findings intravenous artesunate should be the first-line drug for severe malaria, with quinine as an alternative. The role of rectal quinine as pre-referral treatment for severe malaria has not been fully explored, but it remains a promising intervention. In pregnancy, quinine continues to play a critical role in the management of malaria, especially in the first trimester, and it will remain a mainstay of treatment until safer alternatives become available. For uncomplicated malaria, artemisinin-based combination therapy (ACT) offers a better option than quinine though the difficulty of maintaining a steady supply of ACT in resource-limited settings renders the rapid withdrawal of quinine for uncomplicated malaria cases risky. The best approach would be to identify solutions to ACT stock-outs, maintain quinine in case of ACT stock-outs, and evaluate strategies for improving quinine treatment outcomes by combining it with antibiotics. In HIV and TB infected populations, concerns about potential interactions between quinine and antiretroviral and anti-tuberculosis drugs exist, and these will need further research and pharmacovigilance

Mixed-methods evaluation of integrating female genital schistosomiasis management within primary healthcare: a pilot intervention in Ogun State, Nigeria

Background: Detection and management of female genital schistosomiasis (FGS) within primary healthcare is crucial for achieving schistosomiasis elimination, however, current technical strategies are not feasible in many settings. In Nigeria, there are currently no established standard operating procedures to support front-line health workers. This article presents an evaluation of piloting an FGS care package in two LGAs of Ogun State, Nigeria. Methods: We used quantitative and qualitative analysis, including 46 interviews with patients, health workers and the quality improvement team; observations of training, learning sessions and supervision across 23 heath facilities; and records of patients detected and managed. Results: Of 79 women and girls who were screened, 66 were treated and followed up. Health workers assimilated knowledge of FGS and effectively diagnosed and managed patients, demonstrating the feasibility of using symptomatic screening and treatment tools to diagnose and care for women or girls with suspected FGS. Challenges included establishing a referral pathway to tertiary care for patients with complications, insecurity, gender norms that limited uptake and sensitization, the limited capacity of the workforce, conflicting priorities and praziquantel acquisition. Conclusions: Simple tools can be used in primary healthcare settings to detect and manage women and girls with FGS. Contextual challenges must be addressed. Sustainability will require political and financial commitments

A quality improvement approach in co-developing a primary healthcare package for raising awareness and managing female genital schistosomiasis in Nigeria and Liberia

Background: Girls and women living in endemic areas for urogenital schistosomiasis may have lifelong vulnerability to female genital schistosomiasis (FGS). For >2 decades, the importance of FGS has been increasing in sub-Saharan Africa, but without established policies for case detection and treatment. This research aimed to understand the level of FGS knowledge of frontline health workers and health professionals working in endemic areas and to identify health system needs for the effective management of FGS cases and prevention of further complications due to ongoing infections. Methods: Workshops were conducted with health workers and stakeholders using participatory methods. These workshops were part of a quality improvement approach to develop the intervention. Results: Health workers’ and system stakeholders’ knowledge regarding FGS was low. Participants identified key steps to be taken to improve the diagnosis and treatment of FGS in schistosomiasis-endemic settings, which focused mainly on awareness creation, supply of praziquantel, development of FGS syndromic management and mass administration of praziquantel to all eligible ages. The FGS intervention component varies across countries and depends on the health system structure, existing facilities, services provided and the cadre of personnel available. Conclusion: Our study found that co-developing a new service for FGS that responds to contextual variations is feasible, promotes ownership and embeds learning across health sectors, including healthcare providers, NTD policymakers and implementers, health professionals and community health workers

Bypass urbanism: Re-ordering center-periphery relations in Kolkata, Lagos and Mexico City

This paper introduces the concept of “bypass urbanism” to account for a process of urbanization that is reordering center-periphery relations of urban regions into new hierarchies. Bypass urbanism became visible through a comparison of large-scale urban transformations at the peripheries of Kolkata, Lagos, and Mexico City by zooming out and considering their impacts on the socio-spatial structure of the extended urban regions. Bypass urbanism is not emerging from the construction of a singular new town or real estate project, but is the result of the simultaneous development of an ensemble of various independent but related projects. Therefore, bypass urbanism usually does not emanate from a coherent planning initiative, even less so from a hidden “master plan” at the hands of any single developer or state agency, but it emerges through a convergence of interests over large areas of land at the geographical periphery of urban regions that have been made available for new urban developments by various measures. We understand bypass urbanism as a multidimensional process that includes material-geographical bypassing, the bypassing of regulatory frameworks, and socio-economic bypassing in everyday life. It results in the creation of exclusive and excluding spaces that enable middle and upper-class lifestyles, at the same time leading to the peripheralization of extant urban areas that are bypassed and neglected. The massive scale of bypass urbanism that we have observed represents a new quality of urban development resulting not in isolated urban enclaves or archipelagos, but in the fundamental restructuring of the extended urban region with far reaching and incalculable repercussions

Widerspread Hypopigmentation Secondary to the Prolonged use of Highly Potent Steroidal Cream in Lichen Planus.

A 24-year old Nigerian woman presented at our clinic with extensive hypopigmentation following the use of very potent steroidal cream in widerspread lichen planus. She was treated with intramuscular injection of triamcinolone acetonide and the associated secondary bacterial infection was treated with an antibiotic. The cosmetic result at 18 months follow-up was impressive. (Key words: Lichen planus, triamcinolone acetonide, hypopigmentation). Sahel Med. J. Vol.6(3) 2003: 91-9

A descriptive cross-sectional survey of prevalence, knowledge and perceptions of acne vulgaris among secondary school students in Nigeria

Acne vulgaris is a pilosebaceous gland disorder affecting mostly teenagers. Most Nigerian youths attend secondary schools during the teen-age period yet information on the prevalence, knowledge and perceptions of acne vulgaris among them is scanty. The present study was designed to evaluate the prevalence, knowledge and perceptions of acne vulgaris among secondary school students in Nigeria. A standard pre-tested questionnaire on acne was administered to consenting secondary school students in 3 urban towns of Nigeria. The questionnaire measured acne knowledge, beliefs and perception. Respondents who claimed to have acne had visual facial examination to confirm their self-assessment. Responses were matched with demographic data. Responses from 1777 students were analysed. Six hundred and fifty nine of 1552 students who responded to the presence of acne (42.5 %) had acne. Mildly severe acne was the predominant type with over 80% respondents having knowledge of acne and 60% had family history. Many respondents were conscious of their facial appearance, believed that acne patients should be empathized and avoid certain occupation. On the other hand, acne sufferers were not bothered by the disorder and only a few had ever sought medical help. This study thus established that Acne is well recognized by Nigerian secondary school students. Health education program on acne is needed to improve the understanding of some youths about the condition. Keywords: prevalence, acne knowledge, students, Nigeria Nigerian Medical Practitioner Vol. 48(3) 2005: 73-7