10 research outputs found
Communication inside the LRA: Militarization of Acoli Language, a Cultural Patriotism or mere Rebel Indoctrination?
No full textIn an ideal situation, there should be no positive effect of the LRA war in Northern Uganda, but what of the real testimonies that the LRA war brought in many development partners with school fees scholarships through institutions like Acoli Education Initiatives, Invisible Children, Windle Trust Uganda among others. But where are they going to pay for school, the northern children in ‘war affected areas’, and others up to universities, if it were not because of the devastating effect of the war on Education? This is still without the many successful grants and PhD projects completed within Uganda and around the globe based on LRA attachment to spirituality, transitional justice or interrogating the Acoli traditional justice system versus international laws. A debate can be constructed, if necessary, that the authorities on the LRA scholarships are from the global north -meaning the war pulled scholars from their comfort zones. Secondarily, what do we owe this to? For lack of a better word, other scholars would call it the ‘unintended’ positive effect of the war. This journal paper borrows the philosophy that if you are telling a story, it should be told up-side-down. Chimamanda Ngozi, the Nigerian writer, baptised it as a one-sided story and called it the danger of a single story (Adichie 2009). Schulz, Apio et al (2024) tell us about the ‘Love and Care in the LRA’, which this paper calls bravery, with all the horror stories of the LRA! This paper is grounded in some of these philosophies of Adichie (2009) and Schulz, Apio et al. (2024) of telling all sides of the story, attempting to reconstruct the LRA use of Acoli language throughout their military operations as a demonstration of Acoli cultural attachment, loyalty and depiction of Acoli cultural patriotism or activism argued by this paper. This was through using secondary data review and holding in-depth purposive interviews with four former LRA returnees plus two cultural chiefs, including extracting the archival journalistic records of the first author, who was an active journalist in northern Uganda for over 10 years between 2010 and 2021. This journal paper, however, does not underscore the pain and sufferings, the LRA brought on the people of Uganda and other neighbouring countries. However, this paper just gives an ontological side of the LRA, which is hard to find in terms of their particular role in promoting Acoli culture by using Acoli language as their military operational medium of communicatio
High prevalence of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan: a community-based survey
No full textPurpose: To determine the prevalence and incidence of epilepsy in an onchocerciasis endemic region of South Sudan.
Methods: In May 2018, a door-to-door household survey was conducted in 8 study sites in an onchocerciasis endemic area in Maridi County.
Results: A total of 2511 households agreed to participate in the study, corresponding to 17,652 individuals. An epilepsy screening questionnaire identified 799 persons suspected to have epilepsy (4.5%); in 736 of the 766 persons (96.1%) seen by a clinical officer the diagnosis of epilepsy was confirmed. Adding 38 persons who were not seen but with a positive answer to a combination of screening questions, 774 persons (4.4%) had epilepsy. Epilepsy prevalence was highest in the 11–20 age group (10.5%); 66 persons with epilepsy (PWE) developed their first seizures in the year preceding the survey (annual incidence = 373.9/100.000). Neurocysticercosis cannot explain the high epilepsy prevalence since no pigs are kept in the area. Independent risk factors for
epilepsy included male gender, belonging to a “permanent household” and a farming family, and living in a village bordering the Maridi River. Only 7209 (40.8%) of the population took ivermectin in 2017.
Conclusion: A very high prevalence and incidence of epilepsy was observed in several villages in Maridi County located close to the Maridi River and the Maridi dam. Urgent action is needed to prevent children in Maridi County from developing OAE by strengthening the onchocerciasis elimination program.R Colebunders received funding from the European Research Council (ERC 671051
High prevalence of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan : a community-based survey
No full textAbstract: Purpose: To determine the prevalence and incidence of epilepsy in an onchocerciasis endemic region of South Sudan. Methods: In May 2018, a door-to-door household survey was conducted in 8 study sites in an onchocerciasis endemic area in Maridi County. Results: A total of 2511 households agreed to participate in the study, corresponding to 17,652 individuals. An epilepsy screening questionnaire identified 799 persons suspected to have epilepsy (4.5%); in 736 of the 766 persons (96.1%) seen by a clinical officer the diagnosis of epilepsy was confirmed. Adding 38 persons who were not seen but with a positive answer to a combination of screening questions, 774 persons (4.4%) had epilepsy. Epilepsy prevalence was highest in the 11-20 age group (10.5%); 66 persons with epilepsy (PWE) developed their first seizures in the year preceding the survey (annual incidence = 373.9/100.000). Neurocysticercosis cannot explain the high epilepsy prevalence since no pigs are kept in the area. Independent risk factors for epilepsy included male gender, belonging to a "permanent household" and a farming family, and living in a village bordering the Maridi River. Only 7209 (40.8%) of the population took ivermectin in 2017. Conclusion: A very high prevalence and incidence of epilepsy was observed in several villages in Maridi County located close to the Maridi River and the Maridi dam. Urgent action is needed to prevent children in Maridi County from developing OAE by strengthening the onchocerciasis elimination program
Some economic consequences of the transition from civil war to peace
No full textDrawing on evidence from Africa - especially Ethiopia and Uganda - the authors of this volume draw conclusions about economic policy in the aftermath of civil war. A sample of conclusions follows. Civil wars differ from international wars. They are informal, often have no clear beginning and end, weaken rather than strengthen the authority of the state, and leave two unreconciled armies to be demobilized within one territory. Civil wars erode the institutions of civil society, leading to a decline in the stock of social capital, which takes some time to restore. Private investment and government revenue are slow to recover, and military expenditures are not easily reduced. As a result, there is little or no peace dividend in the short run. The period of transition to peace is a particularly suitable time for radical policy reform, despite the high degree of polarization typical in countries engaged in civil war. And speedy reform, far from increasing uncertainty, is likely to reduce it. After a civil war, private agents are fearful both of each other and of the government. This, perhaps even more than physical damage to infrastructure, hinders private-sector-led recovery, as irreversible investment is delayed despite being financeable. The transition to peace is primarily the transition from fear and the defensive responses that became ingrained in wartime. The peace dividend comes as a gradual recovery of confidence induces repatriation of financial and human capital. Such confidence can be boosted by the early sequencing of investment-sensitive policy reforms and by preserving low inflation through direct consumer price index targeting. Lack of confidence can be compensated for by temporary undervaluation of the exchange rate, or however, may prove more difficult to make credibly time-bound. Finally, aid can permit accelerated rehabilitation of the infrastructure (especially transport networks) needed to return to a market economy. Contrary to the studies hypothesis, the authors found that demobilization - at least in Uganda - did not lead to a significant upsurge in insecurity. In the short term, demobilization significantly reduced crime, unless the demobilized lacked access to land. If the demobilized returned to their home areas and were given some assistance, with identifiable exceptions they were able to find income-earning opportunities.Debt Markets,Emerging Markets,Economic Theory&Research,,Investment and Investment Climate
Additional file 1; of The effect of bi-annual community-directed treatment with ivermectin on the incidence of epilepsy in onchocerciasis endemic villages in South Sudan: a study protocol
No full textMultilingual abstracts in the five official working languages of the United Nations. (PDF 877 kb
Clinical characteristics of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan
No full textAbstract: Purpose: To describe the clinical manifestations of persons with epilepsy (PWE) in onchocerciasis endemic villages in South Sudan. Methods: During a survey in Maridi County in May 2018, PWE were interviewed and examined in their households by a clinical officer or medical doctor. Onchocerciasis-associated epilepsy (OAE) was defined as >= 2 seizures without any obvious cause, starting between the ages of 3-18 years in previously healthy persons who had resided for at least 3 years in the onchocerciasis endemic area. Results: Seven hundred and thirty-six PWE were included in the study; 315 (42.8%) were females; median age was 18 years. A variety of seizure types were reported: generalized tonic-clonic seizures in 511 PWE (69.4%), absences in 15 (2.0%), focal motor seizures with full awareness in 7 (1.0%), focal motor seizures with impaired awareness in 25 (3.4%), brief episodes of hallucinations in 316 (43.9%) and nodding seizures in 335 (45.5%). The median age of onset of all seizures was 10 years, and 8 years for nodding seizures. PWE with nodding seizures presented with more cognitive disabilities. The diagnostic criteria for OAE were met by 414 (85.2%) of the 486 PWE with complete information. Eighty (11.0%) PWE presented with Nakalanga features. Only 378 (51.4%) PWE were taking anti-epileptic treatment. Conclusion: PWE presented with a wide spectrum of seizures. The high percentage of PWE who met the diagnostic criteria for OAE suggests that better onchocerciasis control could prevent new cases. Urgent action is needed to close the anti-epileptic treatment gap
Persons with onchocerciasis-associated epilepsy and nodding seizures have a more severe form of epilepsy with more cognitive impairment and higher levels of Onchocerca volvulus infection
No full textAbstract: Aims. Following previous reports of very high epilepsy prevalence in the onchocerciasis-endemic villages in Maridi County, South Sudan, a study was conducted to investigate the association between the level of Onchocerca volvulus infection, epilepsy, and related outcomes. Methods. In December 2018, persons with epilepsy (PWE) were recruited from villages where an epilepsy prevalence of 4.4% (range: 3.5-11.9%) was documented. We enrolled 318 participants from whom two skin snips were taken for microscopic detection of O. volvulus microfilariae (mf). Seizure history was obtained for all PWE and their degree of disability assessed using the modified Rankin scale. Results. Almost all (84.9%) PWE had detectable mf in their skin snips. Onchocerciasis-infected PWE experienced nodding seizures more often than uninfected PWE (p=0.034). Moreover, persons with nodding seizures had more frequent seizures (p<0.001) and higher disability scores (p<0.001), and were more often cognitively impaired and younger at the time of their first epileptic seizure (nine years vs 12 years, p<0.001) compared to PWE without nodding seizures. Based on multivariate models, nodding seizures were associated with higher mf densities (aOR: 1.022; 95% CI: 1.005-1.041). Epilepsy onset at a younger age was associated with a worse outcome. Higher frequency of seizures, longer duration of epilepsy and younger age were associated with increased disability. Regular antiepileptic drug use was associated with better cognitive and disability outcomes. Conclusion. PWE with nodding seizures have a more severe form of onchocerciasis-associated epilepsy, with earlier seizure onset and higher levels of O. volvulus infection. Younger PWE were prone to worse epilepsy outcomes, which would be prevented with regular antiepileptic treatment
The effect of bi-annual community-directed treatment with ivermectin on the incidence of epilepsy in onchocerciasis endemic villages in South Sudan: a study protocol
No full textBACKGROUND: Nodding syndrome (NS) is a devastating epileptic illness of unknown aetiology mainly affecting children 5-15 years of age. Head nodding distinguishes NS from other forms of epilepsy. Other manifestations of the illness include mental and physical growth retardation. Many children die as a result of falling in fires or drowning. Recently, it was shown that NS is only one of the phenotypic presentations of onchocerciasis associated epilepsy (OAE). Despite the strong epidemiological association between epilepsy and onchocerciasis, the causal mechanism is unknown. After implementation of bi-annual community directed treatment with ivermectin (CDTi) and larviciding of rivers in northern Uganda, new cases of NS have ceased, while new cases continue to emerge in South Sudanese onchocerciasis-endemic areas with an interrupted CDTi programme. This study is designed to evaluate the potential effects of bi-annual CDTi on reducing the incidence of NS/OAE in onchocerciasis-endemic areas in South Sudan. METHODS: A pre-intervention door-to-door population-based household survey will be conducted in selected onchocerciasis-endemic villages in Mundri and Maridi Counties, which have a high prevalence of epilepsy. Using a validated questionnaire, the entire village will be screened by community research assistants for suspected epilepsy cases. Suspected cases will be interviewed and examined by a trained clinical officer or medical doctor who will confirm or reject the diagnosis of epilepsy. Bi-annual CDTi will be implemented in the villages and a surveillance system for epilepsy set up. By implementing an epilepsy onchocerciasis awareness campaign we expect to obtain > 90% CDTi coverage of eligible individuals. The door-to-door survey will be repeated two years after the baseline survey. The incidence of NS/OAE will be compared before and after bi-annual CDTi. DISCUSSION: Our study is the first population-based study to evaluate the effect of bi-annual CDTi to reduce the incidence of NS/OAE. If the study demonstrates such a reduction, these findings are expected to motivate communities in onchocerciasis-endemic regions to participate in CDTi, and will encourage policy makers, funders and other stakeholders to increase their efforts to eliminate onchocerciasis
Isoniazid preventive therapy completion between July-September 2019: A comparison across HIV differentiated service delivery models in Uganda
No full textPLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication of
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
https://doi.org/10.1371/journal.pone.0296239Background
Tuberculosis (TB) remains the leading cause of death among people living with HIV
(PLHIV). To prevent TB among PLHIV, the Ugandan national guidelines recommend Isoniazid
Preventive Therapy (IPT) across differentiated service delivery (DSD) models, an effective
way of delivering ART. DSD models include Community Drug Distribution Point
(CDDP), Community Client-led ART Delivery (CCLAD), Facility-Based Individual Management
(FBIM), Facility-Based Group (FBG), and Fast Track Drug Refill (FTDR). Little is
known about the impact of delivering IPT through DSD.
Methods
We reviewed medical records of PLHIV who initiated IPT between June-September 2019 at
TASO Soroti (TS), Katakwi Hospital (KH) and Soroti Regional Referral Hospital (SRRH).
We defined IPT completion as completing a course of isoniazid within 6–9 months. We utilized
a modified Poisson regression to compare IPT completion across DSD models and
determine factors associated with IPT completion in each DSD model.
Results
Data from 2968 PLHIV were reviewed (SRRH: 50.2%, TS: 25.8%, KH: 24.0%); females:
60.7%; first-line ART: 91.7%; and Integrase Strand Transfer Inhibitor (INSTI)-based regimen:
61.9%. At IPT initiation, the median age and duration on ART were 41.5 (interquartile
range [IQR]; 32.3–50.2) and 6.0 (IQR: 3.7–8.6) years, respectively. IPT completion overall was 92.8% (95%CI: 91.8–93.7%); highest in CDDP (98.1%, 95%CI: 95.0–99.3%) and lowest
in FBG (85.8%, 95%CI: 79.0–90.7%). Compared to FBIM, IPT completion was significantly
higher in CDDP (adjusted rate ratio [aRR] = 1.15, 95%CI: 1.09–1.22) and CCLAD
(aRR = 1.09, 95% CI 1.02–1.16). In facility-based models, IPT completion differed between
sites (p<0.001). IPT completion increased with age for FBIM and CCLAD and was lower
among female participants in the CCLAD (aRR = 0.82, 95%CI 0.67–0.97).
Conclusion
IPT completion was high overall but highest in community-based models. Our findings provide
evidence that supports integration of IPT within DSD models for ART delivery in
Uganda and similar settings.This project was funded by the Ugandan
Ministry of Health and by grant # OPP1152764
from the Bill & Melinda Gates Foundation. The
funders had no role in study design, data collection
and analysis, decision to publish, or preparation of
the manuscript
