Performing and Counter-performing Borders: Feminist Stories of Migrant Rights Activism in the United Kingdom

This thesis examines the performance and performativity of migrant rights activism resisting and challenging the state bordering practices in the UK and providing a grid through which we can comprehend the multi-various migrant solidarities and struggles across the UK. The study presents an array of female voices, rising out of the current migrant rights movement. These include: a) nine women, whose journeys to becoming committed activists at the forefront of the movement are examined; b) an evaluation of the performances of Nine Lives Theatre and how it challenges conformity to dominant political scripts and c) the symbolic performances of three significant acts of resistance: Hope Space, the Yarl’s Wood demonstrations and the Refugees Welcome march. By exploring this chorus of narratives, the research enquires into the emergent interventions and developments of activism, and asks what materials, physical as well as symbolic, can be drawn upon in the ongoing task of un-scribing the state’s border markers. Situated within the feminist anti-bordering research tradition, the study combines narrative and performance-based methodological approaches and tells a story about multiple articulations of migrant dissent, whilst capturing more fully the dynamic quality of the struggle. The findings of this study point to a complexity of contingent and predisposed practices of state bordering in the asylum system and beyond. As borders are not static, so the migrant rights struggle is responsively fluid to counter them. Through narrative means and performance analysis of individuals and groups in the movement, this thesis seeks to articulate the necessity of counter-performance for sustained activism

A guide to appropriate use of Correlation coefficient in medical research

Correlation is a statistical method used to assess a possible linear association between two continuous variables. It is simple both to calculate and to interpret. However, misuse of correlation is so common among researchers that some statisticians have wished that the method had never been devised at all. The aim of this article is to provide a guide to appropriate use of correlation in medical research and to highlight some misuse. Examples of the applications of the correlation coefficient have been provided using data from statistical simulations as well as real data. Rule of thumb for interpreting size of a correlation coefficient has been provide

Statistical Pitfalls in Medical Research

In conducting and reporting of medical research, there are some common pitfalls in using statistical methodology which may result in invalid inferences being made. This paper is aimed to highlight to inexperienced statisticians or non-statistician some of the common statistical pitfalls encountered when using statistics to interpret data in medical research. We also comment on good practices to avoid these pitfalls. Malawi Medical Journal Vol. 20 (1) 2008 pp. 15-1

Identifying risk factors for the development of sepsis during adult severe malaria.

BACKGROUND: Severe falciparum malaria can be compounded by bacterial sepsis, necessitating antibiotics in addition to anti-malarial treatment. The objective of this analysis was to develop a prognostic model to identify patients admitted with severe malaria at higher risk of developing bacterial sepsis. METHODS: A retrospective data analysis using trial data from the South East Asian Quinine Artesunate Malaria Trial. Variables correlating with development of clinically defined sepsis were identified by univariable analysis, and subsequently included into a multivariable logistic regression model. Internal validation was performed by bootstrapping. Discrimination and goodness-of-fit were assessed using the area under the curve (AUC) and a calibration plot, respectively. RESULTS: Of the 1187 adults with severe malaria, 86 (7.3%) developed clinical sepsis during admission. Predictors for developing sepsis were: female sex, high blood urea nitrogen, high plasma anion gap, respiratory distress, shock on admission, high parasitaemia, coma and jaundice. The AUC of the model was 0.789, signifying modest differentiation for identifying patients developing sepsis. The model was well-calibrated (Hosmer-Lemeshow Chi squared = 1.02). The 25th percentile of the distribution of risk scores among those who developed sepsis could identify a high-risk group with a sensitivity and specificity of 70.0 and 69.4%, respectively. CONCLUSIONS: The proposed model identifies patients with severe malaria at risk of developing clinical sepsis, potentially benefiting from antibiotic treatment in addition to anti-malarials. The model will need further evaluation with more strictly defined bacterial sepsis as outcome measure

Predictors of Optimum Uptake of Intermittent Presumptive Treatment of Malaria During Pregnancy Among Women at Navakholo Sub-County, Kakamega County - Kenya

Introduction. Malaria in pregnancy is associated with high incidences of maternal and neonatal mortality in malaria endemic regions. World Health Organization recommends Intermittent Presumptive treatment of malaria in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP). It is recommended that every pregnant woman receives at least three doses administered one month apart up to the time of delivery. Despite increased antenatal clinic attendance and concerted efforts to address known barriers to uptake of malaria preventive measures in Navakholo Sub-County, uptake of three or more IPTp-SP doses in the Sub-County has remained low. Objective. This study aimed at determining predictors of optimum uptake of intermittent presumptive treatment of malaria in pregnancy among women in Navakholo Sub-County. Methodology. This was a cross sectional study using mixed methods of data collection. The study was carried out in Navakholo Sub-County, Kakamega County, Kenya. Multistage cluster sampling method was employed to attain sample size (n = 608). Data was analyzed using descriptive statistics, bivariate and multivariate logistic regression while thematic analysis was used for qualitative data. Strength of association between independent variables and dependent variables was measured using odd ratio and p ≤ 0.05 used to reject null hypothesis of no association between independent variables and the main outcome which was the uptake of optimum doses of IPTp-SP. Results. Out of the 587 participants, 294(50.1%) took optimum doses (three or more doses) of IPTp-SP, 248(42.2%) took IPTp-SP partially (one-two doses) and 45 (7.7%) did not take any dose.  The following variables were statistically significantly associated with uptake of optimum doses of IPTp-SP: having attained secondary level of education and above (OR = 0.6, 95% CI 0.4-0.98, p = 0.01); distance to health facility (OR = 0.2, 95% CI 0.06-0.8, p = 0.02); perception that SP drugs are not safe during pregnancy (OR = 7.3, 95% CI 1.5-35.7, p = < 0.01); opening of health facilities daily (OR = 161.8, 95% CI 29.5-885.7 p < 0.0001) and giving clients return dates (OR = 21.2, 95% CI 7.9-56.5, p = < 0 .0001). Conclusion: Key factors that determine optimum uptake of IPTp-SP in the study area are: having attained at least secondary level of education; perceived safety of SP drugs; distance to health facility; opening of health facility daily and giving of return dates to clients. Recommendation: - Community awareness through health education to increase awareness on the risks of malaria in pregnancy and safety of SPs in pregnancy.  The study further recommends that the daily opening of facilities within the study area, ensure return dates are given at every visit and introduction of mobile clinics to those who are staying far away from the nearest health facility. Keywords; IPTp-SP, Malaria in Pregnancy, Optimum uptake of IPTp-SP doses, Navakholo Sub-County. DOI: 10.7176/JHMN/60-08 Publication date:March 31st 201

A Competing-Risk Approach for Modeling Length of Stay in Severe Malaria Patients in South-East Asia and the Implications for Planning of Hospital Services.

Background: Management of severe malaria with limited resources requires comprehensive planning. Expected length of stay (LOS) and the factors influencing it are useful in the planning and optimisation of service delivery. Methods: A secondary, competing-risk approach to survival analysis was performed for 1217 adult severe malaria patients from the South-East Asia Quinine Artesunate Malaria Trial. Results: Twenty percent of patients died; 95.4% within 7 days compared to 70.3% of those who were discharged. Median time to discharge was 6 days. Compared to quinine, artesunate increased discharge incidence (subdistribution-Hazard ratio, 1.24; [95% confidence interval 1.09-1.40]; P = .001) and decreased incidence of death (0.60; [0.46-0.80]; P < .001). Low Glasgow coma scale (discharge, 1.08 [1.06-1.11], P < .001; death, 0.85 [0.82-0.89], P < .001), high blood urea-nitrogen (discharge, 0.99 [0.99-0.995], P < .001; death, 1.00 [1.00-1.01], P = .012), acidotic base-excess (discharge, 1.05 [1.03-1.06], P < .001; death, 0.90 [0.88-0.93], P < .001), and development of shock (discharge, 0.25 [0.13-0.47], P < .001; death, 2.14 [1.46-3.12], P < .001), or coma (discharge, 0.46 [0.32-0.65], P < .001; death, 2.30 [1.58-3.36], P < .001) decreased cumulative incidence of discharge and increased incidence of death. Conventional Kaplan-Meier survival analysis overestimated cumulative incidence compared to competing-risk model. Conclusions: Clinical factors on admission and during hospitalisation influence LOS in severe malaria, presenting targets to improve health and service efficiency. Artesunate has the potential to increase LOS, which should be accounted for when planning services. In-hospital death is a competing risk for discharge; an important consideration in LOS models to reduce overestimation of risk and misrepresentation of associations

Prevalence and Risk Factors for Trachoma in Central and Southern Malawi

BACKGROUND: Trachoma, one of the neglected tropical diseases is suspected to be endemic in Malawi. OBJECTIVES: To determine the prevalence of trachoma and associated risk factors in central and southern Malawi. METHODOLOGY/PRINCIPAL FINDINGS: A population based survey conducted in randomly selected clusters in Chikwawa district (population 438,895), southern Malawi and Mchinji district (population 456,558), central Malawi. Children aged 1-9 years and adults aged 15 and above were assessed for clinical signs of trachoma. In total, 1010 households in Chikwawa and 1016 households in Mchinji districts were enumerated within 108 clusters (54 clusters in each district). A total of 6,792 persons were examined for ocular signs of trachoma. The prevalence of trachomatous inflammation, follicular (TF) among children aged 1-9 years was 13.6% (CI 11.6-15.6) in Chikwawa and 21.7% (CI 19.5-23.9) in Mchinji districts respectively. The prevalence of trachoma trichiasis (TT) in women and men aged 15 years and above was 0.6% (CI 0.2-0.9) in Chikwawa and 0.3% (CI 0.04-0.6) in Mchinji respectively. The presence of a dirty face was significantly associated with trachoma follicular (TF) in both Chikwawa and Mchinji districts (P10%), and warrants the trachoma SAFE control strategy to be undertaken in Chikwawa and Mchinji districts

Platelet-Induced Clumping of Plasmodium falciparum–Infected Erythrocytes from Malawian Patients with Cerebral Malaria—Possible Modulation In Vivo by Thrombocytopenia

Platelets may play a role in the pathogenesis of human cerebral malaria (CM), and they have been shown to induce clumping of Plasmodium falciparum–parasitized red blood cells (PRBCs) in vitro. Both thrombocytopenia and platelet-inducedPRBCclumping are associated with severe malaria and, especially, withCM.In the present study, we investigated the occurrence of the clumping phenomenon in patients with CM by isolating and coincubating their plasma and PRBCs ex vivo. Malawian children with CM all had low platelet counts, with the degree of thrombocytopenia directly proportional to the density of parasitemia. Plasma samples obtained from these patients subsequently induced weak PRBC clumping. When the assays were repeated, with the plasma platelet concentrations adjusted to within the physiological range considered to be normal, massive clumping occurred. The results of this study suggest that thrombocytopenia may, through reduction of platelet-mediated clumping of PRBCs, provide a protective mechanism for the host during CM

Pharmacokinetics and safety profile of artesunate-amodiaquine co-administered with antiretroviral therapy in malaria uninfected HIV-positive Malawian adults.

There are limited data on the pharmacokinetic and safety profiles of artesunate-amodiaquine in human immnunodeficiency virus infected (HIV+) individuals receiving antiretroviral therapy. In a two-step intensive sampling pharmacokinetic trial, we compared area under the concentration time curve from 0 to 28 days (AUC0-28 days) of an active metabolite of amodiaquine, desethylamodiaquine, and treatment-emergent adverse events between antiretroviral therapy naive HIV+ adults and those taking nevirapine and ritonavir-boosted lopinavir-based antiretroviral therapy. In step 1, malaria uninfected adults (n=6/arm) received half the standard adult treatment regimen of artesunate-amodiaquine. In step 2, another cohort (n=25/arm) received the full regimen. In step 1, there were no safety signals and significant differences in desethylamodiaquine AUC0-28 days among participants in the ritonavir-boosted lopinavir, nevirapine and antiretroviral therapy-naive arms. In step 2, compared with the antiretroviral therapy-naive arm, participants in the ritonavir-boosted lopinavir arm had 51% lower desethylamodiaquine AUC0-28 days, (geometric mean [95% CI]; 23,822 [17,458-32506] vs 48,617 [40,787-57,950] ng.hr/mL, p < 0.001). No significant differences in AUC0-28 days were observed between nevirapine and antiretroviral therapy-naïve arms. Treatment-emergent transaminitis was higher in the nevirapine (20% [5/25]) than the antiretroviral therapy naïve (0.0% [0/25]) arm (risk difference 20% [95% CI:4.3-35.7] p=0.018). Ritonavir-boosted lopinavir antiretroviral regimen was associated with reduced desethylamodiaquine exposure which may compromise artesunate-amodiaquine’s efficacy. Co-administration of nevirapine and artesunate amodiaquine may be associated with hepatoxicity

Risk factors for Anopheles mosquitoes in rural and urban areas of Blantyre District, southern Malawi

BackgroundAlthough urban malaria transmission is low and seasonal, it remains a major public health problem. This study aimed at demonstrating the presence of Anopheles mosquitoes and their potential to transmit malaria in urban settings.MethodsTwo cross-sectional surveys were carried out in Blantyre District, Malawi, during the dry and wet seasons of 2008 and 2010, respectively. A map of Blantyre was divided into a grid of 400 cells, of which 60 cells were randomly selected. Five households located within 100 m from the centre of each selected cell were enrolled, a standard questionnaire was administered, and indoor resting mosquitoes were sampled.ResultsIn 2008 and 2010, a total of 960 and 1045 mosquitoes were collected,  respectively. Anopheles funestus comprised 9.9% (n = 95) and 10.3% (n = 108) during the two surveys, respectively. Anopheles gambiae sensu lato (s.l.) was rarely detected during the second survey (n = 6; 0.6%). Molecular identification was performed on samples collected during the first survey, and An. funestus sensu stricto (s.s.) was the only sibling species detected. All the Anopheles mosquitoes were collected from households located in rural areas of Blantyre and none from urban areas. In univariate analysis, the presence of open eaves was associated with increased Anopheles prevalence, both during the dry (incidence rate ratio, IRR = 4.3; 95% CI 2.4 – 7.6) and wet (IRR = 2.47; 95% CI 1.7 – 3.59) seasons.  Chances of detecting Anopheles spp. decreased with increasing altitude (IRR = 0.996; 95% CI 0.995 – 0.997) and during the dry season, but increased during the wet season (IRR = 1.0017; 95% CI 1.0012 – 1.0023). These factors remained significant following a multiple Poisson regression analysis. No association was found between insecticide-treated bednet ownership and the number of Anopheles mosquitoes detected.ConclusionsThe presence of An. funestus s.s and An. gambiae s.l. in the periphery of Blantyre city was an indication that malaria transmission was potentially taking place in these areas