Adolescent boys and girls learning, reproducing, and resisting gender norms in Colombia and Uganda: a qualitative comparative study.

There is growing interest in studying inequitable gender norms and their impact on health and wellbeing, particularly among adolescents. Studies have shown that discriminatory gender norms limit girls' access to power within their families and communities, reduce their educational and economic opportunities, and alter their own aspiration and ambitions for their lives. This comparative qualitative study sought to understand how gender norms manifest themselves in the lives of adolescents in two distinct settings: Uganda and Colombia. A total of 133 young people aged 13-21 years from Colombia and 109 from Uganda participated in either focus group discussions or individual semi-structured interviews in May 2017. Results reveal similarities and differences in how norms are learned, reinforced and resisted and how intersecting social factors affect the ability of adolescents to facilitate norm change. A key similarity was the primacy of parents and peers in the transmission and reinforcement of gender norms. However, setting-specific material and structural factors shaped the manifestation of power and policing of gender norms as well as the ability of young people to contest them. Lessons are identified for the future design of effective gender transformative interventions with adolescents.

Bridging the gap: creating a self-sustaining neurosurgical residency program in Haiti.

Given Haiti's longstanding socioeconomic burden and recent environmental and epidemiological catastrophes, the capacity for neurosurgery within Haiti has been limited, and outcomes for patients with neurosurgical conditions have remained poor. With few formally trained neurosurgeons (4) in a country of 10.5 million inhabitants, there is a significant need for the development of formal structured neurosurgical training. To mitigate the lack of neurosurgical care within Haiti, the authors established the first neurosurgical residency program within the country by creating an integrated model that uniquely fortifies existing Haitian neurosurgery with government sponsorship (Haitian Ministry of Health and National Medical School) and continual foreign support. By incorporating web-based learning modules, online assessments, teleconferences, and visiting professorships, the residency aims to train neurosurgeons over the course of 3-5 years to meet the healthcare needs of the nation. Although in its infancy, this model aims to facilitate neurosurgical capacity building by ultimately creating a self-sustaining residency program.

Social network correlates of IPV acceptance in rural Honduras and rural Uganda.

We investigated the household-level social network correlates of acceptance of intimate partner violence (IPV) in rural, agrarian settings of Honduras and Uganda, two low-income countries with unequal access to resources based upon gender. We collected complete social network data in each location (Honduras in 2014 and Uganda in 2012), across a diverse range of relationships, and then created a measure of household cohesion by calculating the degree to which members of a household nominated each other as important social connections. Our measure of IPV acceptance was based on 4 questions from the Demographic Health Survey to assess the conditions under which a person believes that it is acceptable for a man to perpetrate physical violence against his wife or partner and we coded a person as positive on IPV acceptance if they answered positively to any of the four questions. We used logistic regression to calculate the odds that an individual accepted IPV given (1) household level cohesion and (2) the proportion of the household that accepts IPV. We found individuals from more cohesive households were less likely to accept IPV controlling for the overall level of IPV acceptance in the household. Nevertheless, those in households more accepting of IPV were more likely to personally accept IPV. In stratified analyses, when household IPV acceptance was especially high, the benefit of household cohesion with respect to IPV was attenuated. The design and implementation of interventions to prevent IPV should consider household structure and norms rather than focusing only on individuals or couples.

Where We Fall Down: Tensions in Teaching Social Medicine and Global Health.

BACKGROUND: As global health interest has risen, so too has the relevance of education on the social determinants of health and health equity. Social medicine offers a particularly salient framework for educating on the social determinants of health, health disparities, and health equity. SocMed and EqualHealth, 2 unique but related organizations, offer annual global health courses in Uganda, Haiti, and the United States, which train students to understand and respond to the social determinants of health through praxis, self-reflection and self-awareness, and building collaborative partnerships across difference. OBJECTIVES: The aim of this paper is to describe an innovative pedagogical approach to teaching social medicine and global health. We draw on the notion of praxis, which illuminates the value of iterative reflection and action, to critically examine our points of weakness as educators in order to derive lessons with broad applicability for those engaged in global health work. METHODS: The data for this paper were collected through an autoethnography of teaching 10 global health social medicine courses in Uganda and Haiti since 2010. It draws on revealing descriptions from participant observation, student feedback collected in anonymous course evaluations, and ongoing relationships with alumni. FINDINGS: Critical analysis reveals 3 significant and complicated tensions raised by our courses. The first point of weakness pertains to issues of course ownership by North American outsiders. The second tension emerges from explicit acknowledgment of social and economic inequities among our students and faculty. Finally, there are ongoing challenges of sustaining positive momentum toward social change after transformative course experiences. CONCLUSIONS: Although successful in generating transformative learning experiences, these courses expose significant fracture points worth interrogating as educators, activists, and global health practitioners. Ultimately, we have identified a need for building equitable partnerships and intentional community, embracing discomfort, and moving beyond reflection to praxis in global health education.

A year-long caregiver training program improves cognition in preschool Ugandan children with human immunodeficiency virus.

OBJECTIVE: To evaluate mediational intervention for sensitizing caregivers (MISC). MISC biweekly caregiver training significantly enhanced child development compared with biweekly training on health and nutrition (active control) and to evaluate whether MISC training improved the emotional well-being of the caregivers compared with controls. STUDY DESIGN: Sixty of 120 rural Ugandan preschool child/caregiver dyads with HIV were assigned by randomized clusters to biweekly MISC training, alternating between home and clinic for 1 year. Control dyads received a health and nutrition curriculum. Children were evaluated at baseline, 6 months, and 1 year with the Mullen Early Learning Scales and the Color-Object Association Test for memory. Caldwell Home Observation for Measurement of the Environment and videotaped child/caregiver MISC interactions also were evaluated. Caregivers were evaluated for depression and anxiety with the Hopkins Symptoms Checklist. RESULTS: Between-group repeated-measures ANCOVA comparisons were made with age, sex, CD4 levels, viral load, material socioeconomic status, physical development, and highly active anti-retroviral therapy treatment status as covariates. The children given MISC had significantly greater gains compared with controls on the Mullen Visual Reception scale (visual-spatial memory) and on Color-Object Association Test memory. MISC caregivers significantly improved on Caldwell Home Observation for Measurement of the Environment scale and total frequency of MISC videotaped interactions. MISC caregivers also were less depressed. Mortality was less for children given MISC compared with controls during the training year. CONCLUSIONS: MISC was effective in teaching Ugandan caregivers to enhance their children's cognitive development through practical and sustainable techniques applied during daily interactions in the home.

Homozygous sickle cell disease in Uganda and Jamaica a comparison of Bantu and Benin haplotypes / La anemia de células falciformes homocigóticas en Uganda y Jamaica comparación de haplotipos Bantú y Benin

OBJECTIVE: To compare the haematological and clinical features of homozygous sickle cell (SS) disease in Bantu and Benin haplotypes in a cross-sectional study of 115 Ugandan patients attending the Sickle Cell Clinic at Mulago Hospital, Kampala, Uganda, with 311 patients in the Jamaican Cohort Study. METHODS: This involved comparison of clinical features and haematology with special reference to genetic determinants of severity including fetal haemoglobin levels, beta-globin haplotype and alpha thalassaemia status. RESULTS: The Bantu haplotype accounted for 94% of HbS chromosomes in Ugandan patients and the Benin haplotype for 76% of HbS chromosomes in Jamaica. Ugandan patients were marginally more likely to have alpha thalassaemia, had similar total haemoglobin and fetal haemoglobin levels but had higher reticulocyte counts and total bilirubin levels consistent with greater haemolysis. Ugandan patients had less leg ulceration and priapism, but the mode of clinical presentation, prevalence of dactylitis, features of bone pain and degree of delay in sexual development, assessed by menarche, were similar in the groups. In Ugandan patients, a history of anaemic episodes was common but these were poorly documented. CONCLUSION: The haematological and clinical features of the Bantu haplotype in Uganda were broadly similar to the Benin haplotype in Jamaica except for less leg ulceration and priapism and possibly greater haemolysis among Ugandan subjects. Anaemic episodes in Uganda were treated empirically by transfusion often without a clear diagnosis; better documentation including reticulocyte counts and observations on spleen size is necessary to evolve appropriate models of care.

OBJETIVO: Comparar los rasgos clínicos de la anemia de células falciformes homocigóticas (SS) en los haplotipos Bantú y Benin en un estudio transversal de 115 pacientes ugandeses que asisten a la Clínica de la anemia de células falciformes en el Hospital de Mulago, Kampala, Uganda, con 311 pacientes en un estudio de cohorte jamaicano. MÉTODOS: El estudio conllevó la comparación de los rasgos clínicos y hematológicos con referencia especial a los determinantes genéticos de la severidad, incluyendo los niveles de la hemoglobina fetal, haplotipos del gen de la globina beta, y el estado de la alfa talasemia. RESULTADOS: El haplotipo Bantú dio cuenta del 94% de los cromosomas HbS en los pacientes ugandeses, en tanto que los haplotipos Benin dieron cuenta del 76% de los cromosomas de HbS en Jamaica. Los pacientes de Uganda presentaron una probabilidad marginalmente mayor de alfa talasemia, tenían niveles similares de hemoglobina total y hemoglobina fetal, pero en cambio presentaban conteos más altos de reticulocitos así como niveles mayores de bilirrubina total, en correspondencia con una mayor hemólisis. Los pacientes ugandeses presentaban menor ulceración de las piernas y priapismo, pero el modo de presentación clínica, la prevalencia de dactilitis, los rasgos de dolor óseo, y el grado de retraso en el desarrollo sexual, evaluado por la menarquia, fueron similares en todos los grupos. Los pacientes de Uganda se caracterizaron comúnmente por una historia de episodios de anemia, pobremente documentados. CONCLUSIÓN: Los rasgos clínicos y hematológicos del haplotipo Bantú en Uganda fueron considerablemente similares al haplotipo Benin en Jamaica, salvo por una menor presencia de ulceración de las piernas y priapismo, así como posiblemente mayor hemólisis entre los sujetos de Uganda. Los episodios de anemia en Uganda fueron tratados empíricamente mediante transfusión, a menudo sin un diagnóstico claro. Se necesita una mejor documentación - incluyendo conteos de reticulocitos - así como observaciones del tamaño del bazo, a fin de desarrollar modelos de cuidado apropiados.

A historical note on an imported case of loiasis in Rio de Janeiro, Brazil, 1964 / Nota histórica sobre caso importado de loíase no Rio de Janeiro, Brasil, 1964

Loiasis is a filarial disease transmitted by the Chrysops spp. tabanid flies in West and Central Africa. It is most commonly diagnosed by the clinical manifestations of Calabar swellings (transient localized inflammatory edema) or, most dramatically, by the appearance of a migrating worm through the conjunctival tissues or the bridge of the nose. We report the case of a 35-year-old resident in the city of Rio de Janeiro who displayed a moving Loa loa in the bulbar conjunctival tissue two years after returning from a six-month trip to Uganda. Surgical removal of the worm was performed.

A loaíase é uma filaríase transmitida por tabanídeos (mutucas) do gênero Chrysops na África central e ocidental, comumente diagnosticada pela apresentação clínica de edema de Calabar (edema inflamatório transitório e localizado) ou, mais dramaticamente, pela migração de um verme adulto pelo tecido conjuntival ou asa do nariz. Descrevemos o caso clínico de um paciente do sexo masculino, 35 anos, residente no Rio de Janeiro, que se apresentou com um verme adulto de Loa loa migrando sobre o tecido conjuntival bulbar dois anos após retornar de uma viagem de seis meses de duração a Uganda. Procedeu-se a remoção cirúrgica do verme.

Appraisal of oral lesions status of HIV/AIDS patients in South Western Uganda

Aim: To establish a regional surveillance data that may contribute to improvement of oral health prevention/control programs in South Western Uganda. Methods: Using WHO guidelines, HIV-associated oral lesions were identified among 605 HIV/AIDS patients (469 females and 136 males), selected at random from 4 districts of South Western Uganda. Pearson¡¦s Chi square test of independence („´=0.01), was used to compare results. Results: Prevalence of oral lesions was 73.2%. Pseudomembranous Candidiasis (PC) showed the highest overall prevalence of 71.1% (34.9% single and 36.2% mixed); followed by 39.9% prevalence of Erythematous Candidiasis (EC) (13.2%) single; 26.7% mixed) and 18.8% prevalence of Angular Chelitis (AC) (3.1% single and 15.7% mixed). There was: 23.6% co-infection of PC and EC; 12.6% PC and AC, 3.1% were EC and AC, and 17.0% intra-oral pigmentation. Prevalence of oral lesions was significantly (p<0.01) dependent on host pre-exposure to antimicrobials. Conclusions: Oral infections are still highly prevalent among the studied HIV/AIDS patients in South Western Uganda. This observation may be due to inadequate antimicrobial agents and oral/dental care. There¡¦s urgent need to train primary health care workers in management of oral lesions associated with HIV/AIDS. More studies are needed to evaluate HIV/AIDS oral lesions in the populace.

A procura da justiça transicional e os valores tradicionais africanos: um choque de civilizações - o caso de Uganda / La búsqueda de justicia transicional y los valores tradicionales africanos: un choque de civilizaciones - el caso de Uganda / The pursuit of transitional justice and African traditional values: a clash of civilizations - the case of Uganda

Este artigo analisa o papel que a anistia e as práticas tradicionais assumem na promoção da justiça e da reconciliação no norte de Uganda.

This article examines the role that amnesty and traditional practices play in fostering justice and reconciliation in northern Uganda.

Este artículo analiza el papel que desempeñan la amnistía y las prácticas tradicionales en la promoción de la justicia y la reconciliación en el norte de Uganda.

The REFLECT approach to literacy and social change: a gender perspective.

PIP: The introduction to this article on the participatory learning approach to literacy and social change known as REFLECT locates the origins of the approach in the philosophy of Paulo Freire and notes that REFLECT was developed by ACTIONAID in pilot projects in Uganda, Bangladesh, and El Salvador and is now used in 25 countries by 90 groups. REFLECT considers gender equity integral to social change, analyzes the causes of inequalities, creates a process for examining social stratification, addresses conflict as a reality, is an evolving process that embraces innovation, recognizes the importance of individual transformation, and seeks an equitable practice of power at all levels in the process. The article describes how REFLECT sessions are conducted and how they result in women's increased mobility, increased participation in family and community, and changes in the gender division of labor. Examples show how REFLECT sensitizes men as well as women to gender issues, especially if the implementing agency is gender-aware. The article then contrasts the "primer method" of literacy training promoted by the "Women in Development" model to REFLECT's "Gender and Development" (GAD) approach that links literacy to empowerment, raises community consciousness of women's subordination, and creates local-global links. The article concludes by discussing ways to strengthen the GAD/feminist approach in REFLECT, given the fact that it is possible to avoid gender issues in most discussions.^ieng

Men as partners: ideas from four continents.

PIP: As part of its MAP (Men As Partners) Initiative, AVSC collaborated with local organizations to conduct case studies of male reproductive health (RH) services in Colombia, Pakistan, Uganda, and the US. Data were gathered from interviews with a cross-section of providers. The pioneering programs take differing approaches to the provision of services to men such as concentrating on certain age groups, including all men, focusing on family planning, focusing on RH, integrating men's and women's facilities, keeping services separate, and using men's services as a revenue-generating mechanism to subsidize the cost of women's services. The gender of the provider was found to be less important than personal characteristics, and male providers were only found to be necessary in Pakistan. While there is a new focus on caring for couples in the RH field, providers advised that it is critically important for clients to determine whether they wish to be seen individually or in pairs. In each location, cultural factors that were initially considered insurmountable barriers to services failed to have the expected impact. A crucial part of providing services is community outreach through traditional or novel means, such as sending a health educator to areas where groups of men congregate. The case study data are being compiled in complete reports.^ieng

Can AIDS drugs be afforded?

PIP: UNAIDS has launched an 'HIV Drug Access Initiative' in the Ivory Coast, Uganda, Chile, and Vietnam; the pilot project will attempt to improve access to HIV drugs. Public and private sector efforts will be coordinated. The Glaxo Wellcome, Hoffman-La Roche, and Virco pharmaceutical companies will participate. Each country will 1) adapt its present system with regard to HIV and 2) establish both an HIV drug advisory board and a non-profit company which will import the drugs. Health ministries within each country will be required to find sources of funding for the programs. Uganda will probably use funds from its sexually transmitted disease (STD) program, which is supported by the World Bank; the Ivory Coast will combine corporate contributions, new tariffs, and non-profit insurance system monies into a 'solidarity fund.' UNAIDS funds will be used for oversight and evaluation. UNAIDS also released a review of 68 studies which examined the impact of sex education on the sex behavior of young people; it indicated that, in 65 of the studies, sex education did not increase the sexual activity of youth. UNAIDS concluded that quality programs helped delay first intercourse and often reduced the number of sexual partners, resulting in reduced rates of STDs and unplanned pregnancy. UNAIDS further concluded that effective sex education should begin before the onset of sexual activity, and curriculums should be focused. Openness in communicating about sex should be encouraged, and social and media influences on behavior should be addressed. Young people should be taught negotiating skills (how to say 'no' to sex and how to insist on safer sex).^ieng

MotherCare praised in mid-term review.

PIP: The MotherCare Project, a USAID-funded program, is aimed at preventing maternal and perinatal mortality and morbidity. As part of its activities, the project engages in a series of applied research initiatives in different countries and offers short-term technical and training support. Five long-term demonstration projects which form the basic building blocks for program strategies have been developed in five countries. In each of these national demonstration projects, MotherCare aims to fill the gaps which exist in maternity care. In Uganda and Nigeria, training midwives in life-saving skills for dealing with complications has been selected as a priority. The demonstration projects in Bolivia, Guatemala, and Indonesia take a community-oriented approach and are designed to encourage behavior change which boosts maternal and newborn health. In Bolivia, there are plans for hospital staff to discuss MotherCare research findings which show why women are often reluctant to use health services and develop strategies to overcome such barriers. Communities seem to be responding to the stimulus provided by the projects. MotherCare intends to define the essential components of success within each demonstration project for the benefit of planners, policymakers, and researchers involved in safe motherhood. Guidelines for safe motherhood based on the experiences have been developed and these will provide the basis for "A guide to the minimum maternity service package required to detect, treat and prevent maternal and neonatal mortality.^ieng

Nutrition and function, with emphasis on physical activity.

PIP: Consumption of insufficient quantities of food would result to energy deficiency in children, and this can be prevented by early assessment of changes in physical activity. This paper focuses on the effects of general undernutrition on physical activity and on growth, behavior, and cognitive development in Mexico, Uganda, Colombia, and Guatemala. The paper contains studies investigating the influence of undernutrition on physical activity; total energy expenditure; level of physical fitness; influence of physical activity and growth; and relationship of physical activity with behavior and cognitive development. The level of energy expenditure between nutritional groups could be accounted for the smaller size of the body among undernourished children. On the other hand, physiological potential to physically perform work can be maintained by children with mild or moderate malnutrition, but their smaller size limits their output. Lastly, increased physical activity of children receiving food supplementation was associated with exploratory and behavioral differences compared with nonsupplemented children.^ieng

Uganda does what it can for women.

PIP: Uganda is a fertile, but poor, predominately rural country that was a British protectorate from 1894 until 1962. Uganda made significant achievements in the delivery of health care and education until the rule of Idi Amin (1971-79), when the country was plunged into chaos. The current Ugandan president enjoys broad-based support and has responded to the health care crisis by creating a national system of Resistance Councils using traditional networks to monitor local health developments. The health priorities for women in Uganda include improving maternal-child health; combating AIDS, rape, and sexual abuse; increasing use of family planning; understanding and working to change the cultural context that shapes reproductive health and sex behavior (such as "sugar daddies," older men who entice sex from young girls with presents and money); and expanding women's rights so that they can improve their health.^ieng

Observations on kangaroo baby care.

PIP: The author's visit to "kangaroo care" programs in Guatemala and Colombia has led Uganda's University of Kampala to consider the introduction of this innovation in its neonatal special care unit. Such programs, which place premature infants in direct contact with their mother's skin during breastfeeding, represents a simple, inexpensive strategy for infant survival in developing countries and eliminates the need for mechanical incubators. Research conducted at the Hospital Universitario de Valle in Cali, Colombia, found that falls in the infant's body temperature. In the Latin American programs, premature infants are entered into the breastfeeding program immediately after delivery.^ieng

USAID steps up anti-AIDS program.

PIP: This article considers the epidemic proportion of AIDS in developing countries, and discusses the U.S. Agency for International Development's (USAID) reworked and intensified strategy for HIV infection and AIDS prevention and control over the next 5 years. Developing and launching over 650 HIV and AIDS activities in 74 developing countries since 1986, USAID is the world's largest supporter of anti-AIDS programs. Over $91 million in bilateral assistance for HIV and AIDS prevention and control have been committed. USAID has also been the largest supporter of the World Health Organization's Global Program on AIDS since 1986. Interventions have included training peer educators, working to change the norms of sex behavior, and condom promotion. Recognizing that the developing world will increasingly account for an ever larger share of the world's HIV-infected population, USAID announced an intensified program of estimated investment increasing to approximately $400 million over a 5-year period. Strategy include funding for long-term, intensive interventions in 10-15 priority countries, emphasizing the treatment of other sexually transmitted diseases which facilitate the spread of HIV, making AIDS-related policy dialogue an explicit component of the Agency's AIDS program, and augmenting funding to community-based programs aimed at reducing high-risk sexual behaviors. The effect of AIDS upon child survival, adult mortality, urban populations, and socioeconomic development in developing countries is discussed. Program examples are also presented.^ieng