Resisting control of neglected tropical diseases: dilemmas in the mass treatment of schistosomiasis and soil-transmitted helminths in north-west Uganda

A strong case has recently been made by academics and policymakers to develop national programmes for the integrated control of Africa’s ‘neglected tropical diseases’. Uganda was the first country to develop a programme for the integrated control of two of these diseases: schistosomiasis and soil-transmitted helminths. This paper discusses social responses to the programme in Panyimur, north-west Uganda. It shows that adults are increasingly rejecting free treatment. Resistance is attributed to a subjective fear of side-effects; divergence between biomedical and local understandings of schistosomiasis/bilharzia; as well as inappropriate and inadequate health education. In addition, the current procedures for distributing drugs at a district level are problematic. Additional research was carried out in neighbouring areas to explore the generalizability of findings. Comparable problems have arisen. It is concluded that the national programme will not fulfil its stated objectives of establishing a local demand for mass treatment unless it can establish more effective delivery strategies and promote behavioural change in socially appropriate ways. To do so will require new approaches to social, economic and political aspects of distribution. There are reasons why populations infected with the ‘neglected tropical diseases’ are themselves neglected. Those reasons cannot just be wished away

Will mass drug administration eliminate lymphatic filariasis? Evidence from northern coastal Tanzania

Copyright @ 2012 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and 85 reproduction in any medium, provided the original author and source are credited. The article was made available through the Brunel University Open Access Publishing Fund.This article documents understandings and responses to mass drug administration (MDA) for the treatment and prevention of lymphatic filariasis among adults and children in northern coastal Tanzania from 2004 to 2011. Assessment of village-level distribution registers, combined with self-reported drug uptake surveys of adults, participant observation and interviews, revealed that at study sites in Pangani and Muheza districts the uptake of drugs was persistently low. The majority of people living at these highly endemic locations either did not receive or actively rejected free treatment. A combination of social, economic and political reasons explain the low uptake of drugs. These include a fear of treatment (attributable, in part, to a lack of trust in international aid and a questioning of the motives behind the distribution); divergence between biomedical and local understandings of lymphatic filariasis; and limited and ineffective communication about the rationale for mass treatment. Other contributory factors are the reliance upon volunteers for distribution within villages and, in some locations, strained relationships between different groups of people within villages as well as between local leaders and government officials. The article also highlights a disjuncture between self-reported uptake of drugs by adults at a village level and the higher uptake of drugs recorded in official reports. The latter informs claims that elimination will be a possibility by 2020. This gives voice to a broader problem: there is considerable pressure for those implementing MDA to report positive results. The very real challenges of making MDA work are pushed to one side - adding to a rhetoric of success at the expense of engaging with local realities. It is vital to address the kind of issues raised in this article if current attempts to eliminate lymphatic filariasis in mainland coastal Tanzania are to achieve their goal.This work is funded from the Bill and Melinda Gates Foundation

The psychological distress of the young driver: a brief report

Objective: To explore the role of psychological distress in the self-reported risky driving of young novice drivers. Design: Cross-sectional online survey of 761 tertiary students aged 17-25 years with an intermediate (Provisional) driving licence who completed Kessler’s Psychological Distress Scale and the Behaviour of Young Novice Drivers Scale. Setting: Queensland, Australia, August-October 2009. Main outcome measures: Psychological distress, risky driving. Results: Regression analyses revealed that psychological distress uniquely explained 8.5% of the variance in young novice’s risky driving, with adolescents experiencing psychological distress also reporting higher levels of risky driving. Psychological distress uniquely explained a significant 6.7% and 9.5% of variance in risky driving for males and females respectively. Conclusions: Medical practitioners treating adolescents who have been injured through risky behaviour need to aware of the potential contribution of psychological distress, whilst mental health professionals working with adolescents experiencing psychological distress need to be aware of this additional source of potential harm. The nature of the causal relationships linking psychological distress and risky driving behaviour are not yet fully understood, indicating a need for further research so that strategies such as screening can be investigated

The Effects of Physiological Arousal on Measures of Upper Extremity Position Sense in Healthy Young Adults

The purpose of this investigation was to examine the effects of physiological arousal on the ability to perceive upper extremity position in healthy young adults. Heart rate measurements and blood pressure measurements were taken at pre-established intervals during data collection. Pre-stressor and post-stressor upper extremity trials were also recorded. Twenty participants, 12 females and 8 males, with a mean age of 22.3 (20 33) years comprised the experimental sample. Participants in the experimental sample underwent a combination of the Stroop color-word task and simple math problems to produce a state of arousal and were pre and post tested for upper extremity position sense. The absolute error score averages were calculated for each subject. The pre-test absolute error scores and post-test absolute error scores were compared. A paired t»test revealed a significant difference (p\u3c .05) between the pre-test trials and the post-test trials. The purpose of this investigation was to examine how arousal effects position sense in healthy young adults. The results suggest under a state of arousal proprioceptive measures decrease. The decrease in perception ability is attributed to changes within the central nervous system, specifically the sympathetic nervous system

Ten Economic Facts About Crime and Incarceration in the United States

Crime and high rates of incarceration impose tremendous costs on society, with lasting negative effects on individuals, families, and communities. Rates of crime in the United States have been falling steadily, but still constitute a serious economic and social challenge. At the same time, the incarceration rate in the United States is so high -- more than 700 out of every 100,000 people are incarcerated -- that both crime scholars and policymakers alike question whether, for nonviolent criminals in particular, the social costs of incarceration exceed the social benefits

#PublicAuthority: what will happen when there is another epidemic? Ebola in Mathiane, Sierra Leone

Melissa Parker and Tim Allen discover how long-standing customary forms of governance played a critical role in ending the Ebola outbreak in Sierra Leone

Deworming delusions? Mass drug administration in East African schools

Recent debates about deworming school-aged children in East Africa have been described as the ‘Worm Wars’. The stakes are high. Deworming has become one of the top priorities in the fight against infectious diseases. Staff at the World Health Organization, the Gates Foundation and the World Bank (among other institutions) have endorsed the approach, and school-based treatments are a key component of large-scale mass drug administration programmes. Drawing on field research in Uganda and Tanzania, and engaging with both biological and social evidence, this article shows that assertions about the effects of school-based deworming are over-optimistic. The results of a much-cited study on deworming Kenyan school children, which has been used to promote the intervention, are flawed, and a systematic review of randomized controlled trials demonstrates that deworming is unlikely to improve overall public health. Also, confusions arise by applying the term deworming to a variety of very different helminth infections and to different treatment regimes, while local-level research in schools reveals that drug coverage usually falls below target levels. In most places where data exist, infection levels remain disappointingly high. Without indefinite free deworming, any declines in endemicity are likely to be reversed. Moreover, there are social problems arising from mass drug administration that have generally been ignored. Notably, there are serious ethical and practical issues arising from the widespread practice of giving tablets to children without actively consulting parents. There is no doubt that curative therapy for children infected with debilitating parasitic infections is appropriate, but overly positive evaluations of indiscriminate deworming are counter-productive

Debunking delusions around deworming

Tim Allen and Melissa Parker argue that a biosocial approach is necessary for ‘deworming’ to succeed in improving lives

Epidemics

This chapter reflects on the changing nature of humanitarian engagement with epidemics. Case studies analysing outbreaks of cholera in North Kivu, Zaire in 1994 and Haiti in 2010 as well as an outbreak of polio in the Horn of Africa in 2013 demonstrate the importance of looking behind narratives of ‘success’ and ‘failure’ to explore the challenges facing humanitarian agencies working in diverse social, political and resource-poor settings. Many of these challenges remain enduring, with the recent outbreak of Ebola in West Africa demonstrating that both the scale and nature of humanitarian assistance is currently being shaped by narratives linking health and disease with global security. It is also evident that assistance tends to be more effective in those places where humanitarian agencies co-ordinate their activities, while simultaneously adapting their work to the unique social, political and economic contexts in which epidemics occur