Parenting experiences of couples living with human immunodeficiency virus: A qualitative study from rural Southern Malawi

The advent of antiretroviral therapy (ART) has allowed couples living with human immunodeficiency virus (HIV) to live longer and healthier lives. The reduction in the mother-to-child transmission of HIV has encouraged some people living with HIV (PLWH) to have children. However, little is known about the parenting experiences of couples living with HIV (CLWH). The aim of this qualitative study was to explore and describe parenting  experiences of seroconcordant couples who have a child while living with HIV in Malawi. Data were collected using in-depth interviews with 14 couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa  communities from July to December 2010. The research findings shows that irrespective of kinship organization, economic hardships, food insecurity, gender-specific role expectations and conflicting information from health institutions and media about sources of support underpin their parenting roles. In addition, male spouses are directly involved in household activities, childcare and child feeding decisions, challenging the existing  stereotyped gender norms. In the absence of widow inheritance, widows from patrilineal communities are not receiving the expected support from the deceased husband relatives. Finally, the study has shown that CLWH are able to find solutions for the challenges they encounter. Contrary to existing belief that such who have children depend solely on public aid. Such claims without proper knowledge of local social cultural contexts, may contribute to stigmatizing CLWH who continue to have children. The study is also relevant to PLWH who, although not parents themselves, are confronted with a situation where they have to accept responsibility for raising children from their kin. We suggest the longer-term vision for ART wide access in Malawi to be broadened beyond provision of ART to incorporate social and economic interventions that support the rebuilding of CLWH social and economic lives. The interventions must be designed using a holistic multi-sector approach.Keywords: Malawi, couples, experiences, HIV and AIDS, parentingL’ave`nement de la the´rapie antire´trovirale a permis couples vivant avec le VIH de vivre plus longtemps et en meilleure sante´. La re´duction de la transmission du VIH de la me`re a` l’enfant a encourage´ certaines personnes vivant avec le VIH ont deux enfants. Cependant, on sait peu sur les expe´riences parentales des  couples vivant avec le VIH. Le but de cette e´tude qualitative e´tait d’explorer et de´crire des expe´riences  parentales des couples se´roconcordants qui ont un enfant tout en vivant avec le VIH au Malawi. Les donne´es  ont e´te´ collecte´es abuser des entrevues en profondeur avec des quatorze couples dessein e´chantillonne´s dans les communaute´s matriline´aires et patriline´aires Chiradzulu, Chikhwawa de Juillet jeu. De´cembre 2010.  Les re´sultats de recherche montrent que, inde´pendamment de l’organisation de la parente´, les difficulte´s  e´conomiques, l’inse´curite´ alimentaire, le roˆle des attentes spe´cifiques de genre et des informations  contradictoires des institutions de sante´ et les me´dias au sujet des sources de soutien angoisse leur roˆle  parental En outre, les conjoints de sexe masculin sont directement implique´s dans les activite´s de me´nage,  garde d’enfants et les de´cisions de l’alimentation des enfants, contestant la norme de genre ste´re´otype´s existant. En l’absence de l’he´ritage des veuves, veuves des communaute´s patriline´aires ne rec¸oivent pas le  soutien attendu de la famille du mari de´funt. Enfin, l’e´tude a montre´ que les couples vivant avec le VIH sont  a` l’aise pour trouver des solutions aux de´fis qu’ils rencontrent. Contrairement deux croyance existante que ce  qui ont des enfants de´pendent uniquement sur l’aide publique. Ces revendications sans la connaissance de  contextes socioculturels locaux, peut contribuer a` stigmatiser les couples vivant avec le VIH qui continuent deux  ont des enfants. L’e´tude est e´galement pertinent pour les personnes vivant avec le VIH qui, bien que non les  parents themelves, sont confronte´s a` une situation ou` ils doivent accepter la responsabilite´ d’e´lever les enfants de leurs parents. Nous sugge´rons la vision a` long terme de la the´rapie antire´trovirale large acce`s au Malawi a` eˆtre e´largi au-dela` de la fourniture d’un traitement antire´troviral deux interventions sociales et e´conomiques Incorporer qui soutiennent la reconstruction des couples vivant avec le VIH vie sociale et  e´conomique. Les interventions doivent eˆtre conc¸ues utilisation excessive d’une approche multi-sectorielle  globale.Mots cle´s: Malawi, les couples, les expe´riences, le VIH et le SIDA, la parentalite

When female circumcision comes to the West: Attitudes toward the practice among Somali Immigrants in Oslo

Somalia is the country with the highest prevalence of female circumcision in the world, this affects Somali diaspora as well. The article investigates whether or not Somali immigrants’ attitudes in Oslo toward the practice has improved in favor of its abandonment.Soomaaliya waa dalka adduunka ugu badan gudniinka haweenka, arrintaanna waxay saamayn ku leedahay xitaa qurbajoogta soomaaliyeed. Maqaalku wuxuu baarayaa haddii qaxootiga soomaaliyeed ee Oslo uu wax iska beddelay kategidda adeegsiga gudniikaas.La Somalia è il paese con la più alta prevalenza di circoncisione femminile al mondo, e questo influisce anche sulla diaspora somala. L'articolo indaga se l'atteggiamento nei confronti di questa pratica degli immigrati somali a Oslo è migliorato a favore del suo abbandono

Reproductive decisions of couples living with HIV in Malawi: What can we learn for future policy and research studies?

Background:  The rapid scale-up of free antiretroviral therapy has lead to decline in adult mortality at the population level and reduction of vertical transmission. Consequently, some couples living with HIV are maintaining their reproductive decisions; marrying and having children. This paper analyses policies and guidelines on HIV, AIDS and sexual and reproductive health in Malawi for content on marriage and childbearing for couples living with HIV.Methods:  A qualitative study using interpretive policy analysis approach was conducted from July to December 2010 in two phases. First, data on access to HIV, AIDS and sexual and reproductive health services were collected using in-depth interviews with twenty couples purposively sampled in matrilineal Chiradzulu and patrilineal Chikhwawa communities. Secondly,data were collected from Malawi policies and guidelines on HIV, AIDS and sexual and reproductive health. The documents were reviewed for content on marriage and childbearing for couples living with HIV. Data were analysed using framework approach for applied policy analysis.Results: Four categories emerged from each phase. From the study, we extracted health workers attitudes, weak linkage between HIV, AIDS and sexual and reproductive health services, contradictory messages between media and the hospitals and lack of information as factors directly related to guidelines and policies. Analysis of guidelines and policies showed nonprescriptiveness on issues of HIV, AIDS and reproduction: they do not reflect the social cultural experiences of couples living with HIV. In addition, there is; lack of clinical guidelines, external influence on adoption of the policies and guidelines and weak linkages between HIV and AIDS and sexual and reproductive health services.Conclusion: This synthesis along with more detailed findings which are reported in other published articles, provide a strong basis for updating the policies and development of easy-to-follow guidelines in order to effectively provide services to couples living with HIV in Malawi

Interaction between Cape hake spawning and the circulation in the northern Benguela upwelling ecosystem

Cape hake in Namibian waters are demersal and mesopelagic spawners, spawning peaking offshore between 100 and 400 m deep, depending on local environmental conditions. The cross-shelf circulation, low-oxygen layers and mesoscale gyres are three important environmental factors influencing hake spawning behaviour and subsequent transport of the spawning products. Normally, hake spawn offshore near the bottom at depths of 150–400 m. However, during one cruise, spawning was concentrated below several subsurface mesoscale gyres, resulting in reduced dispersion of the eggs and larvae. When the low-oxygen layer above the bottom is pronounced, hake spawning has been observed close to the top of the layer at oxygen concentrations as low as 0.2–0.3 ml l-1. The relatively small size of the eggs and their high specific gravity make them ascend quite slowly from the spawning depths, 10–40 m per day. Consequently, hake eggs spawned deeper than 200 m hatch before they reach the upper mixed layer. The newly hatched larvae are relatively undeveloped, without functional eyes or mouth, and display little swimming activity during their first hours, but laboratory observations have revealed subsequent periods of downward swimming activity. Based on current field observations, on buoyancy measurements of eggs and larvae and on observed larval behaviour, it is concluded that hake eggs and larvae are transported onshore by features of the upwelling subsurface circulation that compensate for offshore movement of surface water. This may be the basic mechanism concentrating early juvenile hake nearshore. Spawning activity near the low-oxygen layer might be a behavioural adaptation to minimize egg predation, because few other species are expected to survive such low concentrations of oxygen.Keywords: buoyancy, eggs, larvae, recruitment processes, retention, vertical distributionAfrican Journal of Marine Science 2001, 23: 317–33

Attitudes toward female circumcision among Somali immigrants in Oslo: a qualitative study

Due to its negative impact on public health, female circumcision (FC) has gained increased attention from international communities and the Norwegian public in recent decades. In 1995, the Norwegian government outlawed the practice and simultaneously developed a package of measures aimed at preventing and ultimately eradicating FC in Norway. Like many other Western countries, immigrants of Somali descent constitute the largest immigrant group in Norway from countries with FC traditions. Although this immigrant group is often perceived as a cultural society that supports FC generally as a practice, there appears to be a lack of studies that explore the impact of acculturation and the Western social context on Somali immigrants’ attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Oslo, Norway to the practice of FC. Findings from this qualitative study indicate that Somalis in Oslo have, to a large extent, changed their attitude toward the practice. This was proven by the presence in Oslo of a large number of Somali parents who left their daughters uncut as well as Somali girls, boys, men, and women who attribute being uncircumcised a high status. This study adds to the knowledge of the process of abandonment of FC among immigrants in the Western countries. The study highlights the success that has been achieved in improving attitudes toward the practice of the Somali community in Oslo, Norway, as well as emerging challenges that need to be addressed further

Mixing and its effects on biogeochemistry in the persistently stratified, deep, tropical Lake Matano, Indonesia

This is the publisher's version, also available electronically from http://www.aslo.orgIn the > 590-m deep, tropical Lake Matano (Indonesia), stratification is characterized by weak thermal gradients (< 2°C per 500 m) and weak salinity gradients (< 0.14% per 500 m). These gradients persist over seasons, decades, and possibly centuries. Under these nearly steady-state conditions, vertical eddy diffusion coefficients (Kz) cannot be estimated by conventional methods that rely on time derivatives of temperature distributions. We use and compare several alternative methods: one-dimensional k-ε modeling, three-dimensional hydrodynamic modeling, correlation with the size of Thorpe instabilities, and correlation with the stability frequency. In the thermocline region, at 100-m depth, the Kz is ~ 5 × 10-6 m2 s-1, but, below 300 m, the small density gradient results in large (20 m) vertical eddies and high mixing rates (Kz ~ 10-2 m2 s-1). The estimated timescale of water renewal in the monimolimnion is several hundred years. Intense evaporation depletes the surface mixed layer of 16O and 1H isotopes, making it isotopically heavier. The lake waters become progressively isotopically lighter with depth, and the isotopic composition in the deep waters is close to those of the ground and tributary waters. The vertical distribution of Kz is used in a biogeochemical reaction-transport model. We show that, outside of a narrow thermocline region, the vertical distributions of dissolved oxygen, iron, methane, and phosphorus are shaped by vertical variations in transport rates, rather than by sources or sinks

The biogeochemistry of tropical lakes: A case study from Lake Matano, Indonesia

This is the publisher's version, also available electronically from http://onlinelibrary.wiley.comWe examined the chemical composition of the water column of Lake Matano, Sulawesi Island, Indonesia, to document how the high abundances of Fe (hydr)oxides in tropical soils and minimal seasonal temperature variability affect biogeochemical cycling in lakes. Lake Matano exhibits weak thermal stratification, yet a persistent pycnocline separates an oxic epilimnion from anoxic meta- and hypolimnions. The concentration of soluble P in the epilimnetic waters is very low and can be attributed to scavenging by Fe (hydr)oxides. Chromium concentrations in the epilimnion are high (up to 180 nmol L−1), but below U.S. Environmental Protection Agency guidelines for aquatic ecosystems. The concentration of chromium decreases sharply across the oxic-anoxic boundary, revealing that the hypolimnion is a sink for Cr. Flux calculations using a one-dimensional transportreaction model for the water column fail to satisfy mass balance requirements and indicate that sediment transport and diagenesis play an important role in the exchange of Fe, Mn, P, and Cr between the epilimnion and hypolimnion. Exchange of water between the epilimnion and hypolimnion is slow and on a time scale similar to temperate meromictic lakes. This limits recycling of P and N to the epilimnion and removal of Cr to the hypolimnion, both of which likely restrict primary production in the epilimnion. Owing to the slow exchange, steep concentration gradients in Fe and Mn species develop in the metalimnion. These concentration gradients are conducive to the proliferation of chemoautotrophic and anoxygenic phototrophic microbial communities, which may contribute a significant fraction to the total primary production in the lake

Caesarean Section among Referred and Self-Referred Birthing Women: A Cohort Study from a Tertiary Hospital, Northeastern Tanzania.

The inequity in emergency obstetric care access in Tanzania is unsatisfactory. Despite an existing national obstetric referral system, many birthing women bypass referring facilities and go directly to higher-level care centres. We wanted to compare Caesarean section (CS) rates among women formally referred to a tertiary care centre versus self-referred women, and to assess the effect of referral status on adverse outcomes after CS. We used data from 21,011 deliveries, drawn from the birth registry of a tertiary hospital in northeastern Tanzania, during 2000-07. Referral status was categorized as self-referred if the woman had bypassed or not accessed referral, or formally-referred if referred by a health worker. Because CS indications were insufficiently registered, we applied the Ten-Group Classification System to determine the CS rate by obstetric group and referral status. Associations between referral status and adverse outcomes after CS delivery were analysed using multiple regression models. Outcome measures were CS, maternal death, obstetric haemorrhage ≥ 750 mL, postpartum stay > 9 days, neonatal death, Apgar score < 7 at 5 min and neonatal ward transfer. Referral status contributed substantially to the CS rate, which was 55.0% in formally-referred and 26.9% in self-referred birthing women. In both groups, term nulliparous singleton cephalic pregnancies and women with previous scar(s) constituted two thirds of CS deliveries. Low Apgar score (adjusted OR 1.42, 95% CI 1.09-1.86) and neonatal ward transfer (adjusted OR 1.18, 95% CI 1.04-1.35) were significantly associated with formal referral. Early neonatal death rates after CS were 1.6% in babies of formally-referred versus 1.2% in babies of self-referred birthing women, a non-significant difference after adjusting for confounding factors (adjusted OR 1.37, 95% CI 0.87-2.16). Absolute neonatal death rates were > 2% after CS in breech, multiple gestation and preterm deliveries in both referral groups. Women referred for delivery had higher CS rates and poorer neonatal outcomes, suggesting that the formal referral system successfully identifies high-risk birth, although low volume suggests underutilization. High absolute rates of post-CS adverse outcomes among breech, multiple gestation and preterm deliveries suggest the need to target self-referred birthing women for earlier professional intrapartum care

Recruitment Variability in North Atlantic Cod and Match-Mismatch Dynamics

Background Fisheries exploitation, habitat destruction, and climate are important drivers of variability in recruitment success. Understanding variability in recruitment can reveal mechanisms behind widespread decline in the abundance of key species in marine and terrestrial ecosystems. For fish populations, the match-mismatch theory hypothesizes that successful recruitment is a function of the timing and duration of larval fish abundance and prey availability. However, the underlying mechanisms of match-mismatch dynamics and the factors driving spatial differences between high and low recruitment remain poorly understood. Methodology/Principal Findings We used empirical observations of larval fish abundance, a mechanistic individual-based model, and a reanalysis of ocean temperature data from 1960 to 2002 to estimate the survival of larval cod (Gadus morhua). From the model, we quantified how survival rates changed during the warmest and coldest years at four important cod spawning sites in the North Atlantic. The modeled difference in survival probability was not large for any given month between cold or warm years. However, the cumulative effect of higher growth rates and survival through the entire spawning season in warm years was substantial with 308%, 385%, 154%, and 175% increases in survival for Georges Bank, Iceland, North Sea, and Lofoten cod stocks, respectively. We also found that the importance of match-mismatch dynamics generally increased with latitude. Conclusions/Significance Our analyses indicate that a key factor for enhancing survival is the duration of the overlap between larval and prey abundance and not the actual timing of the peak abundance. During warm years, the duration of the overlap between larval fish and their prey is prolonged due to an early onset of the spring bloom. This prolonged season enhances cumulative growth and survival, leading to a greater number of large individuals with enhanced potential for survival to recruitment

Benefit of pazopanib in advanced gastrointestinal stromal tumours : results from a phase II trial (SSG XXI, PAGIST)

Background: Patients with advanced gastrointestinal stromal tumours (GISTs) resistant to the tyrosine kinase inhibitors imatinib and sunitinib may be treated with regorafenib, which resulted in a median progression-free survival (PFS) of 4.8 months in the GRID trial. Also, pazopanib, another tyrosine kinase inhibitor, has been studied in a randomized, placebo-controlled trial (PAZOGIST) in the third line, which showed a PFS of 45.2% 4 months after study entry, but patients intolerant to sunitinib were also included. We designed another trial evaluating pazopanib, enrolling only patients with progression on both imatinib and sunitinib. Patients and methods: Since all eligible patients had progressive disease, we preferred a non-randomized, phase II multicentre trial so that all patients could receive a potentially active drug. Patients had a progressive metastatic or locally advanced GIST and were >= 18 years of age, with a performance status of 0-2, and sufficient organ functions. The primary endpoint was disease control rate (defined as complete remission thorn partial remission thorn stable disease) at 12 weeks on pazopanib. A Simon's two-stage analysis was used with an interim analysis 12 weeks after enrollment of the first 22 patients, and if passed, there was a full enrolment of 72 patients. GIST mutational analysis was done, and most patients had pazopanib plasma concentration measured after 12 weeks. Results: Seventy-two patients were enrolled. The disease control rate after 12 weeks was 44%, and the median PFS was 19.6 weeks (95% confidence interval 12.6-23.4 weeks). Pazopanib-related toxicity was moderate and manageable. No statistically significant differences were found related to mutations. Plasma concentrations of pazopanib had a formal but weak correlation with outcome. Conclusion: Pazopanib given in the third line to patients with GIST progressing on both imatinib and sunitinib was beneficial for about half of the patients. The PAGIST trial confirms the results from the PAZOGIST trial, and the median PFS achieved seems comparable to the PFS achieved with regorafenib in the third-line setting.Peer reviewe