Devisch R.,Africa University
Anthropology and Medicine | Year: 2012
Branching out from recent perspectives on divination in Africa, this study explores a fresh approach that engages in a constructive dialogue between local knowledge practices and Western-derived human sciences. A first section positions this essay within an emerging debate over the perspectival ontological turn in anthropology - in line with Viveiros de Castro (2004) - which holds that people's culture-specific ontology - such as, envisaging some propensity in the fabric between the human, things, fauna, flora and inter-worldly force-fields - is most explicitly voiced in the divinatory oracle and expressed in the ensuing healing and societal redress. The study then outlines the post-Lacanian matrixial model, defined by Ettinger (2006), that re-examines the originary processes unlocking, and inter-connecting in, the matrixial borderzone between body and psyche of mother and foetus or infans. A second section then focuses on the oracular scrutiny typically employed by the mediumistic Yaka diviner in southwestern DR Congo. Such practice, it is contended, induces the diviner to sense out in the consulting kin group the bewitching force-effects and the unspeakable in the inter-generational realm. The oracle unconceals some unguessed fate in the client's inter-generational line, in particular the inter-corporeal embeddedness of latent memory traces and forces of ill-bearing. Third, the study will conclude by evaluating - along the terms of the local culture's genius - the perspectivist stance and matrixial model. © 2012 Taylor & Francis. Source
Hallfors D.D.,Pacific Institute for Research and Evaluation |
Cho H.,Pacific Institute for Research and Evaluation |
Rusakaniko S.,University of Zimbabwe |
Mapfumo J.,Africa University |
And 4 more authors.
Journal of Adolescent Health | Year: 2015
Purpose We examine effects of school support as a structural HIV prevention intervention for adolescent female orphans in Zimbabwe after 5 years.Methods Three hundred twenty-eight orphan adolescent girls were followed in a clustered randomized controlled trial from 2007 to 2010. The experimental group received school fees, uniforms, and school supplies and were assigned a school-based "helper." In 2011-2012, the control group received delayed partial treatment of school fees only. At the final data point in 2012, survey, HIV, and Herpes Simplex Virus Type 2 (HSV-2) biomarker data were collected from approximately 88% of the sample. Bivariate and multivariate analyses were conducted on end point outcomes, controlling for age, religious affiliation, and baseline socioeconomic status.Results The two groups did not differ on HIV or HSV-2 biomarkers. The comprehensive 5-year intervention continued to reduce the likelihood of marriage, improve school retention, improve socioeconomic status (food security), and marginally maintain gains in quality of life, even after providing school fees to the control group.Conclusions Paying school fees and expenses resulted in significant improvements in life outcomes for orphan adolescent girls. Biological evidence of HIV infection prevention, however, was not observed. Our study adds to the growing body of research on school support as HIV prevention for girls in sub-Saharan Africa, but as yet, no clear picture of effectiveness has emerged. © 2015 Society for Adolescent Health and Medicine. All rights reserved. Source
Frehywot S.,George Washington University |
Vovides Y.,Georgetown University |
Talib Z.,George Washington University |
Mikhail N.,George Washington University |
And 6 more authors.
Human Resources for Health | Year: 2013
Background: In the face of severe faculty shortages in resource-constrained countries, medical schools look to e-learning for improved access to medical education. This paper summarizes the literature on e-learning in low- and middle-income countries (LMIC), and presents the spectrum of tools and strategies used.Methods: Researchers reviewed literature using terms related to e-learning and pre-service education of health professionals in LMIC. Search terms were connected using the Boolean Operators " AND" and " OR" to capture all relevant article suggestions. Using standard decision criteria, reviewers narrowed the article suggestions to a final 124 relevant articles.Results: Of the relevant articles found, most referred to e-learning in Brazil (14 articles), India (14), Egypt (10) and South Africa (10). While e-learning has been used by a variety of health workers in LMICs, the majority (58%) reported on physician training, while 24% focused on nursing, pharmacy and dentistry training. Although reasons for investing in e-learning varied, expanded access to education was at the core of e-learning implementation which included providing supplementary tools to support faculty in their teaching, expanding the pool of faculty by connecting to partner and/or community teaching sites, and sharing of digital resources for use by students. E-learning in medical education takes many forms. Blended learning approaches were the most common methodology presented (49 articles) of which computer-assisted learning (CAL) comprised the majority (45 articles). Other approaches included simulations and the use of multimedia software (20 articles), web-based learning (14 articles), and eTutor/eMentor programs (3 articles). Of the 69 articles that evaluated the effectiveness of e-learning tools, 35 studies compared outcomes between e-learning and other approaches, while 34 studies qualitatively analyzed student and faculty attitudes toward e-learning modalities.Conclusions: E-learning in medical education is a means to an end, rather than the end in itself. Utilizing e-learning can result in greater educational opportunities for students while simultaneously enhancing faculty effectiveness and efficiency. However, this potential of e-learning assumes a certain level of institutional readiness in human and infrastructural resources that is not always present in LMICs. Institutional readiness for e-learning adoption ensures the alignment of new tools to the educational and economic context. © 2013 Frehywot et al.; licensee BioMed Central Ltd. Source
Hallfors D.,Pacific Institute for Research and Evaluation |
Cho H.,Pacific Institute for Research and Evaluation |
Rusakaniko S.,University of Zimbabwe |
Iritani B.,Pacific Institute for Research and Evaluation |
And 2 more authors.
American Journal of Public Health | Year: 2011
Objectives: Using a randomized controlled trial in rural eastern Zimbabwe, we tested whether comprehensive support to keep orphan adolescent girls in school could reduce HIV risk. Methods: All orphan girls in grade 6 in 25 primary schools were invited to participate in the study in fall 2007 (n=329). Primary schools were randomized to condition. All primary schools received a universal daily feeding program; intervention participants received fees, uniforms, and a school-based helper to monitor attendance and resolve problems. We conducted annual surveys and collected additional information on school dropout, marriage, and pregnancy rates. We analyzed data using generalized estimating equations over 3 time points, controlling for school and age at baseline. Results: The intervention reduced school dropout by 82% and marriage by 63% after 2 years. Compared with control participants, the intervention group reported greater school bonding, better future expectations, more equitable gender attitudes, and more concerns about the consequences of sex. Conclusions: We found promising evidence that comprehensive school support may reduce HIV risk for orphan girls. Further study, including assessment of dose response, cost benefit, and HIV and herpes simplex virus 2 biomarker measurement, is warranted. Source
Peterson I.,University of Swaziland |
Togun O.,Medical Research Council UK the Gambia Unit |
De Silva T.,University of Swaziland |
De Silva T.,University College London |
And 7 more authors.
AIDS | Year: 2011
OBJECTIVES:: This study's objective was to assess outcomes in HIV-1 and HIV-2 infected antiretroviral therapy (ART)-naïve patients starting ART in the Gambia, West Africa. DESIGN:: A cohort design was used to estimate survival in ART patients and determine whether survival and time to virologic failure varied across patient subgroups. METHODS:: Mortality, virologic failures and CD4 cell recovery were assessed in a clinical cohort of patients from the Genito-Urinary Medicine (GUM) clinic of the MRC Laboratories in the Gambia. Kaplan-Meier estimates of survival were determined for mortality and virologic failure. A Cox proportional hazards model was used to identify baseline demographic, clinical, immunologic and virologic factors associated with increased risk of death. RESULTS:: The overall Kaplan-Meier estimate of survival to 36 months was 73.4% (66.5, 80.3). Survival was marginally higher in HIV-2-infected patients compared to HIV-1-infected patients; it was significantly higher in patients with a baseline CD4 lymphocyte cell count of greater than 50 cells/μl compared to those with a baseline CD4 count of less than 50 cells/μl. CD4 cell recovery was faster in HIV-1-infected individuals compared to HIV-2-infected patients up to 24 months, although this did not result higher mortality in the latter group. No differences in virologic failure were observed by HIV type. CONCLUSION:: HIV-1 and HIV-2-infected patients receiving ART in a clinical setting in the Gambia had good survival to 36 months. HIV-2-infected patients did as well as HIV-1-infected patients in terms of long-term immunological and virological responses and overall survival. © 2011 Wolters Kluwer Health Lippincott Williams & Wilkins. Source