Low prevalence of intestinal schistosomiasis among fisherfolk living along the River Nile in northwestern Uganda: A biosocial investigation

Georgina Pearson - ORCID 0000-0002-7252-7835 https://orcid.org/0000-0002-7252-7835Mass drug administration has been less successful as a technique for controlling intestinal schistosomiasis (S. mansoni) than anticipated. In Uganda, the mass distribution of praziquantel has been provided to populations at risk of infection since the early 2000s, but prevalence mostly remains high. This is the case, for example, at locations in north-western and south-eastern Uganda. However, there is a remarkable exception. Among Madi fishing populations and their immediate neighbours, living close to the border with South Sudan, the rate of infection has dropped dramatically. A parasitological survey carried out at twelve fishing sites in 2013 identified only three cases of S. mansoni among 383 adults tested. This article asks: why is the prevalence of S. mansoni so low among fisherfolk in northern Uganda? Taking a biosocial approach, it suggests that the mass distribution of drugs, free of charge, has had an impact. However, the low prevalence of infection cannot be attributed to this alone. Other important factors may also have contributed to the decline in infection. These include changing fishing livelihoods, local attitudes to public health interventions, access to water and sanitation facilities, hygiene practices and the use of anti-malarial treatments. Above all, the article highlights the importance of investigating both social and biological dimensions of infection simultaneously, and of recognizing the local complexities of sustainably treating this debilitating parasitic disease.https://doi.org/10.1017/S002193201600023748pubpubS

Cross-Border Dynamics and Healthcare in West Nile, Uganda

Against the backdrop of on-going preparedness work in Uganda as related to the outbreak of Ebola in DRC, this brief summarises key considerations concerning cross-border dynamics and health structures and behaviours in the West Nile sub-region of north-west Uganda. It builds upon the SSHAP brief ‘Uganda-DRC: cross-border dynamics’ (published December 2018). Following the case inAriwara, the research team connected with a number of key informants in Arua who had been involved in previous research and confirmed that, in general, local communities were more concerned (perceived greater risk) about this case than the previous case in Kasese due its close geographic proximity to West Nile, and because cross-border movement (e.g., to the market in Ariwara) is a critical part of everyday life. This brief was drafted by Elizabeth Storer (the London School of Economics and Political Science) and Georgina Pearson (St George’s, University of London), with support from Ingrid Gercama, Theresa Jones and Juliet Bedford (Anthrologica). It builds on longterm ethnographic research on issues related to health and healing conducted in Adjumani, Arua, Maracha and Moyo districts of Uganda between 2009-2018. Earlier field experience was updated with a review of recent published and grey literature, informal discussions with colleagues in Kampala, Arua, Adjumani and Moyo and a rapid assessment within Arua Town (March 2019) and further follow up in July 2019. Additional information was contributed by Dr. David Kaawa-Mafigiri (Makerere University, seconded to UNICEF Uganda). Prior to finalisation, it was reviewed by expert advisors from Anthrologica, University of Durham, Gulu University, London School of Hygiene and Tropical Medicine, Makerere University, UNICEF Eastern and Southern Africa Regional Office. Responsibility for the brief lies with the Social Science in Humanitarian Action Platform (SSHAP).UNICE

Global health, local realities: neglected diseases in northwestern Uganda

This thesis explores the everyday realities of neglected diseases among people living and working along the River Nile in Moyo and Adjumani Districts, northwestern Uganda. It is based on ethnographic-epidemiological fieldwork carried out over sixteen months during 2013 and 2014. The fieldwork included participant-observation, in-depth interviews and a parasitological survey with structured questionnaire. This thesis takes an interdisciplinary approach in studying global health, contributing to literature at the intersection between medicine and anthropology. The neglected tropical diseases are a group of diverse diseases framed in global health around common socio-economic-political features, persisting in poverty. They affect neglected populations, neglected by public health policy. Current approaches to their management are largely a collection of technical, diseasefocused programmes that disregard the politics of poverty. Contemporary debates surround the side-lining of social science literature, and the evidence behind the biomedically focussed disease control programmes. Fisherfolk are said to be vulnerable to a number of these diseases. Diseases such as intestinal schistosomiasis (one of the neglected tropical diseases) persist in fishing areas despite a global public health programme. However, as this study demonstrates, in northwestern Uganda levels of schistosomiasis infection appear to have reduced. This study situates the success of the global health control programme within the local biosocial context. Furthermore, it shows that while one neglected tropical disease is controlled, other diseases persist and emerge. These other diseases explored in this research were Buruli ulcer and Hepatitis B, diseases that challenged the global health concept of neglected tropical diseases. This thesis contributes methodologically to the growing interdisciplinary field of global health. It provides empirically-based biosocial evidence of the local realities of neglected diseases. In taking this approach, it argues that this concept is misleading. While it has illuminated particular problems in global health, the restrictive gaze disregards local public health concerns

Explaining the support for indigenous lockdowns in north-west Uganda during COVID

During 2020, residents of the West Nile sub-region of North West Uganda resisted government-imposed lockdowns and quarantine centres. As an alternative, traditional leaders and elders proposed local techniques for controlling disease outbreaks. Clement Aluma, Innocent Anguyo, Elizabeth Storer and Georgina Pearson (LSE) evaluate these claims, placing resistance in the context of state-distrust and histories of managing infectious diseases. The authors argue for a recognition of the multiple discourses through which political resistance unfolds at state borderlands

Probabilistic flood forecasting

The Environment Agency provides a forecasting and warning service to people at risk from flooding. However, flood forecasts are inherently un- certain. Efforts to quantify the uncertainty based on quantile regression have failed to capture the full extent of the uncertainty associated with significant flooding events. An investigation into factors that may be correlated with the uncertainty lead to the observation that there are structural biases in the model. It is possible to remove these, and thereby reduce the mean square error of the predictions, but the benefit of this is apparent in the prediction of ’normal’ conditions, rather than in flood predictions. Additionally, a tweak to the linear fit in the quantile regression is sug- gested which is better suited to the data

Anxiety in autistic individuals who speak few or no words:A qualitative study of parental experience and anxiety management

Anxiety is a common co-occurring condition in autism and impacts quality of life of autistic individuals and their families; autistic individuals who speak few or no words represent an under-researched group. This qualitative study aimed to understand more about parental recognition and management of anxiety in autistic individuals who speak few or no words. Semi-structured interviews were conducted with parents/carers of 17 autistic individuals (m age = 14.29) recruited from an existing participant database and social media adverts. Using thematic analysis, 15 themes were placed under three a-priori grand themes: parental recognition of anxiety; parental management of anxiety; and anxiety impact on the autistic individual and their family. Due to reduced verbal language use and overlap with other behaviours, parents described difficulties recognising anxiety in their child. However, they also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. The findings of this study can help to inform the development of targeted intervention and assessment measures for anxiety in autistic individuals who speak few or no words. Lay abstract: Anxiety is a common condition in autistic individuals, including those who also have an intellectual disability. Despite this, autistic individuals who have severe to profound intellectual disability, or use few or no words, are often excluded from autism research. There are also very few assessment tools and interventions with known effectiveness for autistic individuals with intellectual disability. In this study, we aimed to learn more about parent/carers experiences of recognising and managing anxiety in autistic individuals who use few or no words. We conducted semi-structured interviews with parents and carers to address three research questions: (1) what techniques and management strategies do parents describe for anxiety-related behaviour in their child; (2) how do communication difficulties impact parental understanding and management of anxiety provoking situations and behaviours; (3) what is the impact of anxiety-related behaviours on the quality of life of autistic individuals and their families? During the interviews, parents described difficulties recognising anxiety in their child, mostly due to reduced verbal language use and anxiety behaviours overlapping with other behaviours (e.g. autism characteristics). However, parents also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. We will use the findings of this study to inform future research to develop assessment tools and interventions for anxiety in autistic individuals who use few or no words

The difference in sleep, sedentary behaviour, and physical activity between older adults with ‘healthy’ and ‘unhealthy’ cardiometabolic profiles: a cross-sectional compositional data analysis approach.

Background Studies have seldom used Compositional Data Analysis (CoDA) to map the effects of sleep, sedentary behaviour, and physical activity on older adults’ cardio-metabolic profiles. This study therefore aimed to illustrate how sleep, sedentary behaviour, and physical activity profiles differ between older adult groups (60–89 years), with ‘low’ compared to those with ‘high’ concentrations of endocrine cardio-metabolic disease risk markers, using CoDA. Method Ninety-three participants (55% female) wore a thigh-mounted triaxial accelerometer for seven consecutive free-living days. Accelerometer estimates of daily average hours of engagement in sedentary behaviour (SB), standing, light-intensity physical activity (LIPA), sporadic moderate-vigorous physical activity (sMVPA, accumulated with bouts between 1 and 10 min), 10-min moderate-vigorous physical activity (10MVPA, accumulated with bouts ≥10 min), in addition to self-reported sleeping hours were reported. Fasted whole blood concentrations of total cholesterol, triglyceride, glucose, and glycated haemoglobin, and serum lipoprotein lipase (LPL), interleukin-6 (IL-6), and procollagen III N-terminal propeptide were determined. Results Triglyceride concentration appeared to be highly dependent on 10MVPA engagement as the ‘low’ and ‘high’ concentration groups engaged in 48% more and 32% less 10MVPA, respectively, relative to the geometric mean of the entire study sample. Time-use composition of the ‘low’ LPL group’s engagement in 10MVPA was 26% less, while the ‘high’ LPL group was 7.9% more, than the entire study sample. Time-use composition of the ‘high’ glucose and glycated haemoglobin groups appeared to be similar as both engaged in more Sleep and SB, and less 10MVPA compared to the study sample. Participants with a ‘low’ IL-6 concentration engaged in 4.8% more Sleep and 2.7% less 10MVPA than the entire study sample. Time-use composition of the Total Cholesterol groups was mixed with the ‘low’ concentration group engaging in more Standing and 10MVPA but less Sleep, SB, LIPA, and sMVPA than the entire study sample. Conclusion Older adults should aim to increase 10MVPA engagement to improve lipid profile and decrease SB engagement to improve glucose profile