Fluid identities : contextualising genital reconstructive surgery after female circumcision in Burkina Faso : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Anthropology at Massey University, Auckland, New Zealand.

Female circumcision procedures were traditionally performed on many girls and women in Burkina Faso. These practices were outlawed in 1996, and are now termed ‘female genital mutilation’ by the government and activists trying to stop them. About thirtyfive years ago, Pierre Foldès, a French urologist who was on a humanitarian mission to West Africa, developed a surgical procedure to alleviate health problems associated with these practices. He later refined his procedure and started using it to also restore clitoral anatomy and function. This surgery, which is presented as two distinct procedures in Burkina Faso, is now performed by some indigenous doctors in Ouagadougou and Bobo-Dioulasso. In this ethnographic study, I explore the reasons motivating some Burkinabe women to seek genital reconstructive surgery, the impact this surgery has on them and societal attitudes towards this surgery and these women. I discuss concepts of gender and embodiment in relation to Burkinabe girls’ and women’s health and sexuality by considering their understanding of what is normal, healthy, natural, complete, sexually attractive and feminine. I also consider the manner in which the meanings of these notions are changing depending on the prevailing discourse. I argue that the salience of the discourse promoted by the Burkinabe government and activists working to end female circumcision in the urban areas of Burkina Faso is compounding the harm associated with this practice. It has led some circumcised women to view themselves, and to be viewed by others, as unhealthy and sexually defective, and to believe that they need genital reconstructive surgery. Yet, limited information about this surgery, its cost and taboos associated with sex and sexuality limit women’s access to the surgery. I further argue that that some Burkinabe women in the Raëlian Movement are co-opting the discourse that paints circumcised women as victims to create spaces where they can remodel typical Burkinabe values, but also exercise those which are particular to their religion. They have thus embraced genital reconstructive surgery to reconstruct not just their bodies, but also their identity as healthy and sensual women

The use of the flipped classroom approach in the teaching of english in a public secondary school in Nairobi County, Kenya: an action research study

Flipped Classroom approach is a new pedagogic approach that leverages educational technology to replace passive learning, which is commonly associated with lecture method of teaching, with active learning, in which students are responsible for producing meaning and finding connections using the content supplied outside of the classroom. The purpose of this action research was to see how the flipped classroom may be used to teach and learn English at a Kenyan public secondary school. Data was collected through document analysis, semi structured interviews, focus group discussions, reflective conversations and lesson observations. Findings from the study indicate that using of the flipped classroom approach in teaching of English improves learners’ attitude towards English, takes care of individual learning styles and engages all learners in the classroom, provides for collaborative learning and leads to better understanding of concepts. The study also identified lesson planning for the activities to be carried out in the classroom as the key component of a successful flipped classroom. Further, effective implementation of the teaching approach requires the teacher to monitor learning, have a student accountability mechanism that will guarantee their interaction with the material provided outside class and possess technological competence to design lessons appropriately. In addition, the study identified lack of technological infrastructure and time constraints as hindrances to the implementation of the flipped classroom. The study recommends that teachers align pedagogical practices with the ubiquitous digital technology and learner centered methods of teaching. Further, teachers should be facilitators who assist students in constructing their own learning as opposed to teachers as the focal point of learning. Teachers should also horn their technological skills so that they are comfortable using ICT in the teaching and learning process

Continuing communicable disease burden in Eritrea

Background and method

Awareness, attitudes and knowledge of evidence-based medicine: A cross-sectional baseline survey among academic healthcare practitioners in Namibia

This cross-sectional study examined the awareness, attitudes and knowledge of  evidence-based medicine (EBM) among academics in higher education institutions in Namibia, Mozambique, Lesotho and Botswana. Data were collected using a convenient sampling technique and analyzed by SPSS. Thirty-eight academics completed an  anonymous questionnaire. Most (76%) of the respondents were aware of the Cochrane Collaboration and 97% have heard about EBM, of whom 89% perceived its benefits.  Yet, 74% lacked high level of EBM knowledge, 76% had no formal EBM training and  92% were unfamiliar with the Cochrane library. Motivation to attend EBM training was  high among the respondents. Our results highlight the inadequacy of EBM knowledge and training among academics. There is a need to train academics in EBM in order to improve the practice of EBM in teaching.Keywords: Academic, evidence-based medicine, knowledge, attitude, Cochrane Library, Namibia

The risk of pathogenic intestinal parasite infections in Kisii Municipality, Kenya

<p>Abstract</p> <p>Background</p> <p>Intestinal parasitic infections are among the most common infections worldwide. Various epidemiological studies indicate that the prevalence of intestinal parasites is high especially in developing countries, although in many of these, the environmental risk factors have not been clearly elucidated. The objective of this study was to determine the risk of pathogenic intestinal parasites infections in Kisii Municipality.</p> <p>Methods</p> <p>Random sampling was used in the selection of the study samples. Stool parasitological profiles of food handlers were done by direct smear and formalin-ethyl acetate sedimentation method. Both vegetable and meat samples were examined for the presence of intestinal parasites. The storage and meat handling practices of the various butcheries were observed.</p> <p>Results</p> <p>Types of samples examined for occurrence of intestinal parasites includes, a total of 84 vegetable, 440 meat and 168 stool samples. Fifty five (65.5%) vegetable, 334 (75.9%) meat and 69 (41.1%) of the stool samples were found positive for intestinal parasites indicating a high overall risk (66.18%) for intestinal parasite infections. Of the parasites detected, the most common parasites infesting the foodstuffs and infecting the food handlers were <it>Ascaris lumbricoides </it>and <it>Entamoeba histolytica</it>. Parasites were significantly less likely to be present on meat that was refrigerated during display than meat that was displayed at ambient temperature.</p> <p>Conclusion</p> <p>There is a high risk of infection with intestinal parasites in the sampled Municipal markets. About half of the food handlers surveyed (41.1 %) at the Municipal Hospital had one or more parasitic infections. Furthermore, meat (65.5%) and vegetables (75.9%) sold at the Municipal market were found to be contaminated with parasites hence the inhabitants requires a need for education on food safety, good distribution practices and improvement on sanitary conditions.</p

Roll back malaria - an African success story in Eritrea

No Abstract

Presumptive treatment of fever cases as malaria: help or hindrance for malaria control?

BACKGROUND: Malaria incidence has been reported to be falling in several countries in sub-Saharan Africa in recent years. This fall appears to have started before the widespread introduction of insecticide-treated nets. In the new era of calls to eliminate and eradicate malaria in sub-Saharan Africa, exploring possible causes for this fall seem pertinent. PRESENTATION OF THE HYPOTHESIS: The authors explore an argument that presumptive treatment of fever cases as malaria may have played a role in reducing transmission of malaria by the prophylactic effect of antimalarials and their widespread use. This strategy, which is already in practise is termed Opportunistic Presumptive Treatment (OPT). TESTING THE HYPOTHESIS: Further comparison of epidemiological indicators between areas with OPT and more targeted treatment is required. If data suggest a benefit of OPT, combining long acting antimalarials that have an anti-gametocyticidal activity component plus using high levels of vector control measures may reduce transmission, prevent resistant strains spreading and be easily implemented. IMPLICATIONS OF THE HYPOTHESIS: OPT is practised widely by presumptive treatment of fever in health facilities and home management of fever. Improving diagnosis using rapid diagnostic tests and thus reducing the number of doses of antimalarials given may have counter intuitive effects on transmission in the context of elimination of malaria in high to moderate transmission settings

Comparative Field Evaluation of Combinations of Long-Lasting Insecticide Treated Nets and Indoor Residual Spraying, Relative to Either Method Alone, for Malaria Prevention in an Area where the main Vector is Anopheles Arabiensis.

Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are commonly used together in the same households to improve malaria control despite inconsistent evidence on whether such combinations actually offer better protection than nets alone or IRS alone. Comparative tests were conducted using experimental huts fitted with LLINs, untreated nets, IRS plus untreated nets, or combinations of LLINs and IRS, in an area where Anopheles arabiensis is the predominant malaria vector species. Three LLIN types, Olyset®, PermaNet 2.0® and Icon Life® nets and three IRS treatments, pirimiphos-methyl, DDT, and lambda cyhalothrin, were used singly or in combinations. We compared, number of mosquitoes entering huts, proportion and number killed, proportions prevented from blood-feeding, time when mosquitoes exited the huts, and proportions caught exiting. The tests were done for four months in dry season and another six months in wet season, each time using new intact nets. All the net types, used with or without IRS, prevented >99% of indoor mosquito bites. Adding PermaNet 2.0® and Icon Life®, but not Olyset® nets into huts with any IRS increased mortality of malaria vectors relative to IRS alone. However, of all IRS treatments, only pirimiphos-methyl significantly increased vector mortality relative to LLINs alone, though this increase was modest. Overall, median mortality of An. arabiensis caught in huts with any of the treatments did not exceed 29%. No treatment reduced entry of the vectors into huts, except for marginal reductions due to PermaNet 2.0® nets and DDT. More than 95% of all mosquitoes were caught in exit traps rather than inside huts. Where the main malaria vector is An. arabiensis, adding IRS into houses with intact pyrethroid LLINs does not enhance house-hold level protection except where the IRS employs non-pyrethroid insecticides such as pirimiphos-methyl, which can confer modest enhancements. In contrast, adding intact bednets onto IRS enhances protection by preventing mosquito blood-feeding (even if the nets are non-insecticidal) and by slightly increasing mosquito mortality (in case of LLINs). The primary mode of action of intact LLINs against An. arabiensis is clearly bite prevention rather than insecticidal activity. Therefore, where resources are limited, priority should be to ensure that everyone at risk consistently uses LLINs and that the nets are regularly replaced before being excessively torn. Measures that maximize bite prevention (e.g. proper net sizes to effectively cover sleeping spaces, stronger net fibres that resist tears and burns and net use practices that preserve net longevity), should be emphasized

Declining Burden of Malaria Over two Decades in a Rural Community of Muheza District, North-Eastern Tanzania.

The recently reported declining burden of malaria in some African countries has been attributed to scaling-up of different interventions although in some areas, these changes started before implementation of major interventions. This study assessed the long-term trends of malaria burden for 20 years (1992--2012) in Magoda and for 15 years in Mpapayu village of Muheza district, north-eastern Tanzania, in relation to different interventions as well as changing national malaria control policies.\ud Repeated cross-sectional surveys recruited individuals aged 0 -- 19 years from the two villages whereby blood smears were collected for detection of malaria parasites by microscopy. Prevalence of Plasmodium falciparum infections and other indices of malaria burden (prevalence of anaemia, splenomegaly and gametocytes) were compared across the years and between the study villages. Major interventions deployed including mobile clinic, bed nets and other research activities, and changes in national malaria control policies were also marked. In Magoda, the prevalence of P. falciparum infections initially decreased between 1992 and 1996 (from 83.5 to 62.0%), stabilized between 1996 and 1997, and further declined to 34.4% in 2004. A temporary increase between 2004 and 2008 was followed by a progressive decline to 7.2% in 2012, which is more than 10-fold decrease since 1992. In Mpapayu (from 1998), the highest prevalence was 81.5% in 1999 and it decreased to 25% in 2004. After a slight increase in 2008, a steady decline followed, reaching <5% from 2011 onwards. Bed net usage was high in both villages from 1999 to 2004 (>=88%) but it decreased between 2008 and 2012 (range, 28% - 68%). After adjusting for the effects of bed nets, age, fever and year of study, the risk of P. falciparum infections decreased significantly by >=97% in both villages between 1999 and 2012 (p < 0.001). The prevalence of splenomegaly (>40% to <1%) and gametocytes (23% to <1%) also decreased in both villages.Discussion and conclusionsA remarkable decline in the burden of malaria occurred between 1992 and 2012 and the initial decline (1992 -- 2004) was most likely due to deployment of interventions, such as bed nets, and better services through research activities. Apart from changes of drug policies, the steady decline observed from 2008 occurred when bed net coverage was low suggesting that other factors contributed to the most recent pattern. These results suggest that continued monitoring is required to determine causes of the changing malaria epidemiology and also to monitor the progress towards maintaining low malaria transmission and reaching related millennium development goals