Bark-cloth of the Baganda people of Southern Uganda: a record of continuity and change from the late eighteenth century to the early twenty-first century

Despite the increased interest in the study of the history of African textiles since the last quarter of the past century, less attention has been paid to the study of bark-cloth, a fabric design tradition that predates the technology of weaving. Made by way of stripping, scraping and beating the inner bark of certain plants, most commonly the ficlus species, bark-cloth served various socio-cultural functions among different ethnic communities in Africa, Southeast Asia, South America, and in the Polynesian islands of the Southern Pacific. This study examines the notion of continuity and change in the role and meaning of bark-cloth of the Baganda people of the kingdom of Buganda in southern Uganda, in East Africa, from the late eighteenth-century to the early twenty-first century. Used in various forms, including among others, as a shroud. and during the investiture of the heir to the throne, and to the heads of the independent family units. bark-cloth has continued to serve as a connecting thread between the past and present generations of the Baganda society. However. the study also reveals that the role and meaning of bark-cloth of the Baganda is no longer confined within the cultural boundaries; other factors have come into play since the mid nineteenth-century when the external (non-African) communities first infiltrated the interior of East Africa. It has been argued that the role and meaning of bark-cloth of the Baganda is in a continuous flux contingent on the dynamics of the social. economic. cultural and political structures at a given historical moment in Buganda. Hence. the study analises the extent of Swahili-Arab influence. Western Christianity, colonialism and education, international tourism, intra-regional and regional trade, and local politics to the redefinition of bark-cloth of the Baganda in the past almost two and half centuries. The study makes an important and necessary contribution to scholarship of the history of East African textiles and material culture

An African-European network of design universities fostering the goal of sustainable energy for all

This paper presents the intermediate results of the Learning Network on Sustainable Energy Systems (LeNSes) an African-European multi-polar network for curriculum development on Design for Sustainability (DfS) focused on Distributed Renewable Energy (DRE) and Sustainable Product-Service Systems (S.PSS). The paper discusses the convergence between the S.PSS and DRE models as promising approaches to provide sustainable energy solutions for all by increasing its access and improving efficiency in use. Currently, the project partners are collaboratively developing new curricula focused on these combined approaches. The paper examines the S.PSS and DRE models and how they can be used to develop and implement sustainable energy solutions for all within the African context. The research hypothesis is that S.PSS could be applied to DRE to offer a range of benefits such as: economic, environmental and socio-ethical. The paper describes some of the project activities that includes: development of a new modular and adaptable package of learning resources focused on DRE and S.PSS for the design discipline; implementation of pilot courses at African Higher Educational Institutions (HEIs) targeted at undergraduate and graduate students, practitioners and companies; and development of an open web platform for distributed production and transfer of knowledge and know-how in this area. The innovation of the project described in the paper is twofold, firstly by developing unique curricula based on design for sustainability focused on S.PSS and DRE applied to the African contexts, and secondly by delivering it through an open platform for free and in copy-left. This will equip design students in African universities with a broad knowledge base, as well as effective methods and tools with which to play an active role in the development and diffusion of sustainable energy systems

Designing Sustainable Energy for All. Sustainable Product-Service System Design Applied to Distributed Renewable Energy

Access to energy is one of the greatest challenges for many people living in low-income and developing contexts, as around 1.4 billion people lack access to electricity. Distributed Renewable Energy systems (DRE) are considered a promising approach to address this challenge and provide energy access to all. However, even if promising, the implementation of DRE systems is not always straightforward. The book analyses, discusses and classifies the promising Sustainable Product-Service System (S.PSS) business models to deliver Distributed Renewable Energy systems in an effective, efficient and sustainable way. Its message is supported with cases studies and examples, discussing the economic, environmental and socioethical benefits as well as its limitations and barriers to its implementation. An innovative design approach is proposed and a set of design tools are supplied, enabling readers to create and develop Sustainable Product-Service System (S.PSS) solutions to deliver Distributed Renewable Energy systems. Practical applications of the book’s design approach and tools by companies and practitioners are discussed and the book will be of interest to readers in design, industry, governmental institution, NGOs as well as researchers

Designing Sustainable Energy for All. Sustainable Product-Service System Design Applied to Distributed Renewable Energy

This book aims to share its contents with everyone who is interested to know more about designing Sustainable Product-Service System (S.PSS) applied to Distributed Renewable Energy (DRE), towards sustainable energy access for All. The book is organised to provide an overview of the topic and as well to support the design in practice. For this reason, the book includes strategies and guidelines, as well as a collection of case studies of Sustainable Product-Service System (S.PSS) applied to Distributed Renewable Energy (DRE) solutions. Additionally, are presented the method and support tools for designers

Impact of Antimalarial Treatment and Chemoprevention on the Drug Sensitivity of Malaria Parasites Isolated from Ugandan Children

Changing treatment practices may be selecting for changes in the drug sensitivity of malaria parasites. We characterized ex vivo drug sensitivity and parasite polymorphisms associated with sensitivity in 459 Plasmodium falciparum samples obtained from subjects enrolled in two clinical trials in Tororo, Uganda, from 2010 to 2013. Sensitivities to chloroquine and monodesethylamodiaquine varied widely; sensitivities to quinine, dihydroartemisinin, lumefantrine, and piperaquine were generally good. Associations between ex vivo drug sensitivity and parasite polymorphisms included decreased chloroquine and monodesethylamodiaquine sensitivity and increased lumefantrine and piperaquine sensitivity with pfcrt 76T, as well as increased lumefantrine sensitivity with pfmdr1 86Y, Y184, and 1246Y. Over time, ex vivo sensitivity decreased for lumefantrine and piperaquine and increased for chloroquine, the prevalences of pfcrt K76 and pfmdr1 N86 and D1246 increased, and the prevalences of pfdhfr and pfdhps polymorphisms associated with antifolate resistance were unchanged. In recurrent infections, recent prior treatment with artemether-lumefantrine was associated with decreased ex vivo lumefantrine sensitivity and increased prevalence of pfcrt K76 and pfmdr1 N86, 184F, and D1246. In children assigned chemoprevention with monthly dihydroartemisinin-piperaquine with documented circulating piperaquine, breakthrough infections had increased the prevalence of pfmdr1 86Y and 1246Y compared to untreated controls. The noted impacts of therapy and chemoprevention on parasite polymorphisms remained significant in multivariate analysis correcting for calendar time. Overall, changes in parasite sensitivity were consistent with altered selective pressures due to changing treatment practices in Uganda. These changes may threaten the antimalarial treatment and preventive efficacies of artemether-lumefantrine and dihydroartemisinin-piperaquine, respectively

Few Losses to Follow-up in a Sub-Saharan African Cancer Cohort via Active Mobile Health Follow-up

Accurate survival estimates are needed for guiding cancer control efforts in sub-Saharan Africa, but previous studies have been hampered by unknown biases due to excessive loss to follow-up (LTFU). In the African Breast Cancer-Disparities in Outcomes Study, a prospective breast cancer cohort study, we implemented active mobile health follow-up, telephoning each woman or her next-of-kin (NOK) trimonthly on her mobile phone to update information on her vital status. Dates of every contact with women/NOK were analyzed from diagnosis in 2014-2017 to the earliest of September 1, 2018, death, or 3 years postdiagnosis. The cumulative incidence of being LTFU was calculated considering deaths as competing events. In all, 1,490 women were followed for a median of 24.2 (interquartile range (IQR), 14.2-34.5) months, corresponding to 8,529 successful contacts (77% of total contacts) with the women/NOK. Median time between successful contacts was 3.0 (IQR, 3.0-3.7) months. In all, 71 women (5.3%) were LTFU at 3 years: 0.8% in Nigeria, 2.2% in Namibia, and 5.6% in Uganda. Because of temporary discontinuity of active follow-up, 20.3% of women were LTFU after 2 years in Zambia. The median time to study notification of a death was 9.1 (IQR, 3.9-14.0) weeks. Although the present study was not a randomized controlled trial, in this cancer cohort with active mobile health follow-up, LTFU was much lower than in previous studies and enabled estimation of up-to-date and reliable cancer survival

Phenotypic and genotypic analyses to guide selection of reverse transcriptase inhibitors in second-line HIV therapy following extended virological failure in Uganda

Objectives We investigated phenotypic and genotypic resistance after 2 years of first-line therapy with two HIV treatment regimens in the absence of virological monitoring. Methods NORA [Nevirapine OR Abacavir study, a sub-study of the Development of AntiRetroviral Therapy in Africa (DART) trial] randomized 600 symptomatic HIV-infected Ugandan adults (CD4 cell count <200 cells/mm3) to receive zidovudine/lamivudine plus abacavir (cABC arm) or nevirapine (cNVP arm). All virological tests were performed retrospectively, including resistance tests on week 96 plasma samples with HIV RNA levels ≥1000 copies/mL. Phenotypic resistance was expressed as fold-change in IC50 (FC) relative to wild-type virus. Results HIV-1 RNA viral load ≥1000 copies/mL at week 96 was seen in 58/204 (28.4%) cABC participants and 21/159 (13.2%) cNVP participants. Resistance results were available in 35 cABC and 17 cNVP participants; 31 (89%) cABC and 16 (94%) cNVP isolates had a week 96 FC below the biological cut-off for tenofovir (2.2). In the cNVP arm, 16/17 participants had resistance mutations synonymous with high-level resistance to nevirapine and efavirenz; FC values for etravirine were above the biological cut-off in 9 (53%) isolates. In multivariate regression models, K65R, Y115F and the presence of thymidine analogue-associated mutations were associated with increased susceptibility to etravirine in the cABC arm. Conclusions Our data support the use of tenofovir following failure of a first-line zidovudine-containing regimen and shed further light on non-nucleoside reverse transcriptase inhibitor hypersusceptibility

System design for sustainable energy for all: A new knowledge base and know-how developed within the LeNSes European and African project

Design for Sustainabilit

Routine versus clinically driven laboratory monitoring of HIV antiretroviral therapy in Africa (DART): a randomised non-inferiority trial.

BACKGROUND: HIV antiretroviral therapy (ART) is often managed without routine laboratory monitoring in Africa; however, the effect of this approach is unknown. This trial investigated whether routine toxicity and efficacy monitoring of HIV-infected patients receiving ART had an important long-term effect on clinical outcomes in Africa. METHODS: In this open, non-inferiority trial in three centres in Uganda and one in Zimbabwe, 3321 symptomatic, ART-naive, HIV-infected adults with CD4 counts less than 200 cells per microL starting ART were randomly assigned to laboratory and clinical monitoring (LCM; n=1659) or clinically driven monitoring (CDM; n=1662) by a computer-generated list. Haematology, biochemistry, and CD4-cell counts were done every 12 weeks. In the LCM group, results were available to clinicians; in the CDM group, results (apart from CD4-cell count) could be requested if clinically indicated and grade 4 toxicities were available. Participants switched to second-line ART after new or recurrent WHO stage 4 events in both groups, or CD4 count less than 100 cells per microL (LCM only). Co-primary endpoints were new WHO stage 4 HIV events or death, and serious adverse events. Non-inferiority was defined as the upper 95% confidence limit for the hazard ratio (HR) for new WHO stage 4 events or death being no greater than 1.18. Analyses were by intention to treat. This study is registered, number ISRCTN13968779. FINDINGS: Two participants assigned to CDM and three to LCM were excluded from analyses. 5-year survival was 87% (95% CI 85-88) in the CDM group and 90% (88-91) in the LCM group, and 122 (7%) and 112 (7%) participants, respectively, were lost to follow-up over median 4.9 years' follow-up. 459 (28%) participants receiving CDM versus 356 (21%) LCM had a new WHO stage 4 event or died (6.94 [95% CI 6.33-7.60] vs 5.24 [4.72-5.81] per 100 person-years; absolute difference 1.70 per 100 person-years [0.87-2.54]; HR 1.31 [1.14-1.51]; p=0.0001). Differences in disease progression occurred from the third year on ART, whereas higher rates of switch to second-line treatment occurred in LCM from the second year. 283 (17%) participants receiving CDM versus 260 (16%) LCM had a new serious adverse event (HR 1.12 [0.94-1.32]; p=0.19), with anaemia the most common (76 vs 61 cases). INTERPRETATION: ART can be delivered safely without routine laboratory monitoring for toxic effects, but differences in disease progression suggest a role for monitoring of CD4-cell count from the second year of ART to guide the switch to second-line treatment. FUNDING: UK Medical Research Council, the UK Department for International Development, the Rockefeller Foundation, GlaxoSmithKline, Gilead Sciences, Boehringer-Ingelheim, and Abbott Laboratories