Masquerades form an important part of indigenous African religions, and headpieces of masks are found all over the world as an iconic African art form. Contrary to expectation, however, the... Show moreMasquerades form an important part of indigenous African religions, and headpieces of masks are found all over the world as an iconic African art form. Contrary to expectation, however, the geographical distribution of masking is very restricted, occurring only in three areas of the continent, mainly situated in the forested zones. I explain this peculiar distribution by tracing the ecological and historical parameters of the societies that harbor mask rituals. The main ecological factors are the absence of cattle and the type of horticulture, while a crucial historical element is the long history of slave raiding and trading to which the continent has been subjected. These factors have led to societies in which both gender and local power arrangements show a marked indeterminacy, operating as internal arenas between men and women, and between different groups of men. Crucial in the explanation of masquerades is the fact that masking is completely absent from societies that practice cattle husbandry with the Bos indicus species (zebu). Since sleeping sickness prohibits cattle husbandry, wherever the tsetse fly thrives, masks appear. Show less
Now that the goal of universal primary education has been achieved in Ghana, the nation’s aim is to expand higher education as a key to development. We argue that this expansion will necessitate... Show moreNow that the goal of universal primary education has been achieved in Ghana, the nation’s aim is to expand higher education as a key to development. We argue that this expansion will necessitate the gradual addition of Ghanaian languages as a medium of instruction. We innovatively explain why this is so by comparing the achievements of the Ghanaian education system with one of the best education systems in the world. We use the conceptual distinction between ‘discerned’ and ‘designed’ languages to discuss the problem of which languages to choose. We propose five scientific principles that could guide the introduction of Ghanaian languages and suggest concrete steps that could be taken over the coming years to make the transition practically possible. As such, we present a way of looking at using indigenous languages as a medium of instruction that has relevance for other African countries as well. Show less
This study examines the impact of armed conflicts on the fiscal capacity of African governments. It made use of a data set covering 1997–2021 for 50 countries, as well as the system dynamic... Show moreThis study examines the impact of armed conflicts on the fiscal capacity of African governments. It made use of a data set covering 1997–2021 for 50 countries, as well as the system dynamic generalised method of moment estimation technique. The results show that, in the short run, conflicts undermine tax revenue, mount pressure on military expenditure, and force governments to rely more on mineral resource rents for their fiscal needs. As conflicts persist, this fiscal feature changes to a pattern that reflects a decline in mineral resource earnings and an increase in tax revenue. The impact on public health expenditure also changes from an increasing to a decreasing pattern, whereas the positive impact on military expenditure and external borrowing persists over time. The findings suggest that African countries in conflict can address their fiscal challenges by observing these patterns and putting in place policies that protect public resources (e.g., the adoption of digital financial technology protocols to facilitate remote revenue collection and strategic protection of mineral resource-endowed zones from insurgents' control). Overall, enhancing government effectiveness and strengthening the institutions of governance is important to facilitate a quick return to normalcy in the event of conflict and to prevent future conflicts. Show less
While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore,... Show moreWhile facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants' perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers' clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained. Trial registration number: NCT04685668 Show less
The content of education and the medium in which it is delivered are generally seen as two different things: a curriculum that is in need of being “decolonised” can still be delivered in a colonial... Show moreThe content of education and the medium in which it is delivered are generally seen as two different things: a curriculum that is in need of being “decolonised” can still be delivered in a colonial language. Likewise, a curriculum that is colonial in nature could in theory be delivered in any medium of instruction. This article argues that, seen from a macro perspective, this belief is incorrect. In African settings (and probably elsewhere as well), the medium of instruction and the content of that instruction are intricately linked. Evolution towards a decolonial educational system has to include a change in the medium of instruction if it is to be successful. Show less
Anazodo, U.C.; Ng, J.J.; Ehiogu, B.; Obungoloch, J.; Fatade, A.; Mutsaerts, H.J.M.M.; ... ; Consortium Advanced MRI Education Research in Africa (CAMERA) 2022
Magnetic resonance imaging (MRI) technology has profoundly transformed current healthcare systems globally, owing to advances in hardware and software research innovations. Despite these advances,... Show moreMagnetic resonance imaging (MRI) technology has profoundly transformed current healthcare systems globally, owing to advances in hardware and software research innovations. Despite these advances, MRI remains largely inaccessible to clinicians, patients, and researchers in low-resource areas, such as Africa. The rapidly growing burden of noncommunicable diseases in Africa underscores the importance of improving access to MRI equipment as well as training and research opportunities on the continent. The Consortium for Advancement of MRI Education and Research in Africa (CAMERA) is a network of African biomedical imaging experts and global partners, implementing novel strategies to advance MRI access and research in Africa. Upon its inception in 2019, CAMERA sets out to identify challenges to MRI usage and provide a framework for addressing MRI needs in the region. To this end, CAMERA conducted a needs assessment survey (NAS) and a series of symposia at international MRI society meetings over a 2-year period. The 68-question NAS was distributed to MRI users in Africa and was completed by 157 clinicians and scientists from across Sub-Saharan Africa (SSA). On average, the number of MRI scanners per million people remained at less than one, of which 39% were obsolete low-field systems but still in use to meet daily clinical needs. The feasibility of coupling stable energy supplies from various sources has contributed to the growing number of higher-field (1.5 T) MRI scanners in the region. However, these systems are underutilized, with only 8% of facilities reporting clinical scans of 15 or more patients per day, per scanner. The most frequently reported MRI scans were neurological and musculoskeletal. The CAMERA NAS combined with the World Health Organization and International Atomic Energy Agency data provides the most up-to-date data on MRI density in Africa and offers a unique insight into Africa's MRI needs. Reported gaps in training, maintenance, and research capacity indicate ongoing challenges in providing sustainable high-value MRI access in SSA. Findings from the NAS and focused discussions at international MRI society meetings provided the basis for the framework presented here for advancing MRI capacity in SSA. While these findings pertain to SSA, the framework provides a model for advancing imaging needs in other low-resource settings. Show less
While there is increasing academic analysis and policy concern regarding growing inequality and the need for more inclusive development trajectories, it is equally important to advance our... Show moreWhile there is increasing academic analysis and policy concern regarding growing inequality and the need for more inclusive development trajectories, it is equally important to advance our understanding of the pathways to attain more inclusive development in practice. This paper serves as the introduction to a special issue examining the empirical outcomes and processes of inclusive development policies in selected countries in Africa. The paper presents a policy implementation and assessment framework as a lens that connects the diferent case studies. The framework links general inclusive development strategies in employment, social protection and governance, to the participation and representation of the various stakeholders as well as the monetary and non-monetary transaction costs in accessing and/or implementing these programmes on the ground in diferent national and sub-national contexts. Based on the fndings of the 9 case studies, the paper also advances policy directions and operational frameworks to attain more inclusive development in practice.[Résumé]. Bien qu’il existe une analyse académique croissante, et une préoccupation politique envers la montée des inégalités et la nécessite de trajectoires de développement plus inclusives, il est tout aussi important d’avancer notre compréhension des chemins qui permettent—dans la pratique—d’atteindre un développement plus inclusif. Cet article sert d’introduction à un numéro spécial examinant les résultats empiriques et les processus de développement inclusifs dans certains pays en Afrique. L’article présente un cadre d’implémentation et évaluation des politiques, tel que un prisme qui connecte les diférents études de cas. Ce cadre relie des stratégies de développement générales (dans l’emploi, la protections sociale, et la gouvernance) à la participation et la représentation de diférents partis intéressés, aussi qu’aux aux couts de transaction (monétaires et autres) dans l’accès à ces programmes et à leur implémentation sur le terrain, dans des contextes nationales et sous-nationales. Nous basant sur les résultats de ces 10 études de cas, l’article avance des directions de politique et des cadres opérationnels, ayant comme but la réalisation pratique d’un développement plus inclusif. Show less
Bertola, L.D.; Vermaat, M.; Lesilau, F.; Chege, M.; Tumenta, P.N.; Sogbohossou, E.A.; ... ; Vrieling, K. 2022
Background Previous phylogeographic studies of the lion (Panthera leo) have improved our insight into the distribution of genetic variation, as well as a revised taxonomy which now recognizes a... Show moreBackground Previous phylogeographic studies of the lion (Panthera leo) have improved our insight into the distribution of genetic variation, as well as a revised taxonomy which now recognizes a northern (Panthera leo leo) and a southern (Panthera leo melanochaita) subspecies. However, existing whole range phylogeographic studies on lions either consist of very limited numbers of samples, or are focused on mitochondrial DNA and/or a limited set of microsatellites. The geographic extent of genetic lineages and their phylogenetic relationships remain uncertain, clouded by massive sampling gaps, sex-biased dispersal and incomplete lineage sorting. Results In this study we present results of low depth whole genome sequencing and subsequent variant calling in ten lions sampled throughout the geographic range, resulting in the discovery of >150,000 Single Nucleotide Polymorphisms (SNPs). Phylogenetic analyses revealed the same basal split between northern and southern populations, as well as four population clusters on a more local scale. Further, we designed a SNP panel, including 125 autosomal and 14 mitochondrial SNPs, which was tested on >200 lions from across their range. Results allow us to assign individuals to one of these four major clades (West & Central Africa, India, East Africa, or Southern Africa) and delineate these clades in more detail. Conclusions The results presented here, particularly the validated SNP panel, have important applications, not only for studying populations on a local geographic scale, but also for tracing samples of unknown origin for forensic purposes, and for guiding conservation management of ex situ populations. Thus, these genomic resources not only contribute to our understanding of the evolutionary history of the lion, but may also play a crucial role in conservation efforts aimed at protecting the species in its full diversity. Show less
Okere, N.E.; Meta, J.; Maokola, W.; Martelli, G.; Praag, E. van; Naniche, D.; ... ; Hermans, S. 2022
Background: Differentiated service delivery (DSD) offers benefits to people living with HIV (improved access, peer support), and the health system (clinic decongestion, efficient service delivery).... Show moreBackground: Differentiated service delivery (DSD) offers benefits to people living with HIV (improved access, peer support), and the health system (clinic decongestion, efficient service delivery). ART clubs, 15–30 clients who usually meet within the community, are one of the most common DSD options. However, evidence about the quality of care (QoC) delivered in ART clubs is still limited.Materials and methods: We conducted a concurrent triangulation mixed-methods study as part of the Test & Treat project in northwest Tanzania. We surveyed QoC among stable clients and health care workers (HCW) comparing between clinics and clubs. Using a Donabedian framework we structured the analysis into three levels of assessment: structure (staff, equipment, supplies, venue), processes (time-spent, screenings, information, HCW-attitude), and outcomes (viral load, CD4 count, retention, self-worth).Results: We surveyed 629 clients (40% in club) and conducted eight focus group discussions, while 24 HCW (25% in club) were surveyed and 22 individual interviews were conducted. Quantitative results revealed that in terms of structure, clubs fared better than clinics except for perceived adequacy of service delivery venue (94.4% vs 50.0%, p = 0.013). For processes, time spent receiving care was significantly more in clinics than clubs (119.9 vs 49.9 minutes). Regarding outcomes, retention was higher in the clubs (97.6% vs 100%), while the proportion of clients with recent viral load <50 copies/ml was higher in clinics (100% vs 94.4%). Qualitative results indicated that quality care was perceived similarly among clients in clinics and clubs but for different reasons. Clinics were generally perceived as places with expertise and clubs as efficient places with peer support and empathy. In describing QoC, HCW emphasized structure-related attributes while clients focused on processes. Outcomes-related themes such as improved client health status, self-worth, and confidentiality were similarly perceived across clients and HCW.Conclusion: We found better structure and process of care in clubs than clinics with comparable outcomes. While QoC was perceived similarly in clinics and clubs, its meaning was understood differently between clients. DSD catered to the individual needs of clients, either technical care in the clinic or proximate and social care in the club. Our findings highlight that both clinic and DSD care are required as many elements of QoC were individually perceived. Show less
How do natural disasters affect the treatment of civilians by non-state actors? On the one hand, conflict literature argues that adverse shocks influence the strategic interplay between rebel... Show moreHow do natural disasters affect the treatment of civilians by non-state actors? On the one hand, conflict literature argues that adverse shocks influence the strategic interplay between rebel groups and the government, potentially increasing the level of violence against civilians. On the other hand, sociological research on natural disasters argues that they increase social integration and cooperation and are thus expected to reduce the risk of violent behaviour. In this study, we contend that the dynamics of violence against civilians are different in the short term and long term after a disaster strikes. We argue that natural disasters lead to a decrease in violence against civilians perpetrated by rebel groups in the short run. However, over time this temporary improvement in social integration starts to decline, increasing the level of civilian victimization. To examine this potential temporal dynamic, we combine georeferenced information on one-sided violence (Armed Conflict Location & Event Data; ACLED) and data on disasters (Emergency Event Database; EM-DAT). Our results confirm the expected dynamic effects. This research has important implications for our understanding of how disasters can influence the relationship between civilians, rebel groups, and governments. Show less
Slam poets in Africa are part of an emerging social movement. In this article, the focus is on women in this upcoming slam movement in francophone Africa. For these women, slam has meant a change... Show moreSlam poets in Africa are part of an emerging social movement. In this article, the focus is on women in this upcoming slam movement in francophone Africa. For these women, slam has meant a change in their lives as they have found words to describe difficult experiences that were previously shrouded in silence. Their words, performances and engaged actions are developing into a body of popular knowledge that questions the status quo and relates to the ‘emerging consciousness’ in many African urban societies of unequal, often gendered, power relations. The women who engage in slam have thus become a voice for the emancipation of women in general. Show less
Trove opens possibilities for collaborative, transnational and comparative research from scholars in the Global South, who often work with limited financial resources. Indeed, Trove has been... Show moreTrove opens possibilities for collaborative, transnational and comparative research from scholars in the Global South, who often work with limited financial resources. Indeed, Trove has been indispensable for the South African-based historians in the International Studies Group, who would otherwise face difficulties accessing Australian primary sources. It also enables Australian perspectives to be incorporated into African histories, fostering the emergence of new historical insights. However, mass digitisation has the potential to create an unevenness in transnational history by privileging certain connections, particularly between British settler colonies. These reflections will offer crucial perspectives from a network of early career historians outside Australia. Show less
How does interethnic marriage influence the occurrence of ethnic violence in sub-Saharan Africa? Previous studies on the relationship between intergroup contact and conflict onset have produced... Show moreHow does interethnic marriage influence the occurrence of ethnic violence in sub-Saharan Africa? Previous studies on the relationship between intergroup contact and conflict onset have produced mixed findings. Some scholars have argued that this might be due to the way interethnic contact is measured. Building on insights of social psychology, this study examines the influence of interethnic marriage as the ultimate form of positive intergroup contact. In doing so, we combine information of the Demographic and Health Surveys with event data on ethnic conflict. Our analysis shows that areas with higher levels of exogamy significantly experience less ethnic conflict. Show less
Lalaye, D.; Bruijn, M.E. de; Jong, T.P.V.M. de 2021
This study determined the contribution of a mobile health (M-health) system to the treatment of Schistosoma haematobiumin a region of Chad where S. haematobium is endemic. M-health involves the use... Show moreThis study determined the contribution of a mobile health (M-health) system to the treatment of Schistosoma haematobiumin a region of Chad where S. haematobium is endemic. M-health involves the use of a mobile phone for health care. The study compared the prevalence of schistosomiasis in an area with an M-health system, newly installed in 2014, with an area without an adequate health infrastructure. Data were gathered after the M-health system had been running for 3 years. We took urine samples from children age 1 to 15 years, for a total of 200 children in a village in the M-health area and 200 in a village in a non-M-health area. Urine was checked for urinary schistosomiasis by using dipsticks for microhematuria and, in cases of positive dipstick results, microscopy was used to detect eggs. Comparison between the areas allowed us to assess the effectiveness of the installed M-health system after 3 years of operation. Based on dipstick outcomes, the non-M-health area had an infection rate of 51.5% compared with 29% in the M-health area. Microscopy results in non-M-health and M-health were 27.5% and 21%, respectively. The dipstick result difference between M-health and non-M-health areas was statistically significant. Dipsticks were more reliable than microscopy for the detection of schistosomiasis, especially in areas without qualified personnel. Based on these results, M-health proved its ability to reduce the infection rate of urogenital schistosomiasis, and the implementation of M-health shows great promise in areas where this disease is endemic and where no mass drug administration is provided. Show less
Isfordink, C.J.; Laar, T.J.W. van de; Rebers, S.P.H.; Wessels, E.; Molenkamp, R.; Knoester, M.; ... ; Schinkel, J. 2021
Background. The majority of hepatitis C virus (HCV) infections are found in low- and middle-income countries, which harbor many region-specific HCV subtypes. Nevertheless, direct-acting antiviral ... Show moreBackground. The majority of hepatitis C virus (HCV) infections are found in low- and middle-income countries, which harbor many region-specific HCV subtypes. Nevertheless, direct-acting antiviral (DAA) trials have almost exclusively been conducted in high-income countries, where mainly epidemically spread HCV subtypes are present. Recently, several studies have demonstrated suboptimal DAA efficacy for certain nonepidemic subtypes, which could hamper global HCV elimination. Therefore, we aimed to evaluate DAA efficacy in patients treated for a nonepidemic HCV genotype infection in the Netherlands.Methods. We performed a nationwide retrospective study including patients treated with interferon-free DAAs for an HCV genotype other than 1a/1b/2a/2b/3a/4a/4d. The genotype was determined by NS5B region phylogenetic analysis. The primary end point was SVR-12. If stored samples were available, NS5A and NS5B sequences were obtained for resistance-associated substitutions (RAS) evaluation.Results. We included 160 patients, mainly infected with nonepidemic genotype 2 (41%) and 4 (31%) subtypes. Most patients were from Africa (45%) or South America (24%); 51 (32%) were cirrhotic. SVR-12 was achieved in 92% (140/152) of patients with available SVR-12 data. Only 73% (8/11) genotype 3-infected patients achieved SVR-12, the majority being genotype 3b patients with 63% (5/8) SVR. Regardless of SVR, all genotype 3b patients had 30K and 31M RAS.Conclusions. (T)he DAA efficacy we observed in most nonepidemic genotypes in the Netherlands seems reassuring. However, the low SVR-12 rate in subtype 3b infections is alarming, especially as it is common in several HCV-endemic countries. Alongside earlier results, our results indicate that a remaining challenge for global HCV elimination is confirming and monitoring DAA efficacy in nonepidemic genotypes. Show less
Kate, L. ten; Braam, A.W.; Dijk, R.A. van; Ravesteyn, J. van; Bergmans, F. 2020
The current study focuses on care for West African Victims of human trafficking (VHTs) in The Netherlands and addresses the question of how (1) social and legal professionals and (2) religious... Show moreThe current study focuses on care for West African Victims of human trafficking (VHTs) in The Netherlands and addresses the question of how (1) social and legal professionals and (2) religious leaders of African-led migrant (Pentecostal) churches perceive their relationship with these VHTs. Thematic analyses of qualitative interviews (N = 21) revealed that both groups share the perception that VHTs are vulnerable, especially in view of so-called voodoo spells. Social and legal professionals noticed that West African VHTs prototypically appear as ‘demanding’ in a rather pro-active manner. Religious leaders on the other hand indicated that the VHTs feel at ease in the church in a more adaptive sense and may find ways of changing their lives after experiencing the Pentecostal “deliverance” ritual. Show less
Background Caesarean section (C-section) rates are often low among the poor and very high among the better-off in low- and middle-income countries. We examined to what extent these differences are... Show moreBackground Caesarean section (C-section) rates are often low among the poor and very high among the better-off in low- and middle-income countries. We examined to what extent these differences are explained by medical need in an African context. Methods We analyzed electronic records of 12,209 women who gave birth in a teaching hospital in Kenya in 2014. C-section rates were calculated by socioeconomic position (SEP), using maternal occupation (professional, small business, housewife, student) as indicator. We assessed if women had documented clinical indications according to hospital guidelines and if socioeconomic differences in C-section rates were explained by indication. Results Indication for C-section according to hospital guidelines was more prevalent among professionals than housewives (16% vs. 9% of all births). The C-section rate was also higher among professionals than housewives (21.1% vs. 15.8% [OR 1.43; 95%CI 1.23-1.65]). This C-section rate difference was largely explained by indication (4.7 of the 5.3 percentage point difference between professionals and housewives concerned indicated C-sections, often with previous C-section as indication). Repeat C-sections were near-universal (99%). 43% of primary C-sections had no documented indication. Over-use was somewhat higher among professionals than housewives (C-section rate among women without indication: 6.6 and 5.5% respectively), which partly explained socioeconomic differences in primary C-section rate. Conclusions Socioeconomic differences in C-section rates can be largely explained by unnecessary primary C-sections and higher supposed need due to previous C-section. Prevention of unnecessary primary C-sections and promoting safe trial of labor should be priorities in addressing C-section over-use and reducing inequalities. Tweetable abstract Unnecessary primary C-sections and ubiquitous repeat C-sections drive overall C-section rates and C-section inequalities. Show less
