10 research outputs found
The traumatic experience and sexual violence in Halima Bashir’s tears of the desert
No full textEl objetivo principal de este trabajo se centra en el análisis de la experiencia traumática de la escritora sudanesa Halima Bashir en su obra autobiográfica Las lágrimas del desierto. A la hora de analizar la obra hemos tenido en cuenta los postulados del trauma para entender la función de la memoria como herramienta a partir de la cual la memoria individual de Halima se convierte en memoria colectiva para los sudaneses oprimidos en Darfur. La obra de Halima, aunque se centra en la experiencia de violación de un individuo, implica un mensaje político y un testimonio histórico de las atrocidades en Darfur.This paper applies trauma theory to Tears of the Desert, an autobiography written by the Sudanese author Halima Bashir. It examines the traumatic experience of the protagonist Halima Bashir who has been raped during Darfur conflict. In applying the aforementioned theory, this paper shows how the traumatic memory of Halima stands as a collective memory for the oppressed Sudanese in Darfur. Halima’s work, although focusing on the rape experience of an individual, implies a political message that many Sudanese were subjected to physical and psychological traumas as they were bearing witness to the conflict in Darfur
Groth and Yield of Soybean (Glycine Max (L.) Merrill) as Influenced by Organic and Inorganic Fertilizers
No full textA pot experiment was conducted in the Screen House of the Department of Agronomy, Faculty of Agriculture, Bayero University, Kano to determine the effects of organic and inorganic fertilizers on the growth and yield of Soybean (Glycine max (L.) Merr). The treatments consisted of factorial combinations of three Soybean varieties (TGX1835-10E, TGX1987-62F, and TGX1740-2E) and five levels of fertilizers (control, 244.44 kg ha-1 NPK, 10 t ha-1 poultry manure, 5 t ha-1 poultry manure + 244.44 kg ha-1 NPK, and 2.5 t ha-1 poultry manure + 355.55 kg ha-1 NPK). This was laid out in a Completely Randomized Design (CRD) replicated three times. Vegetative traits were taken at 5, 7 and 9 weeks after sowing and reproductive traits were measured at maturity stage. Variety effect was significant on plant height, number of branches plant-1, leaf area, number of pods plant-1, weight of grains plant-1 and 100 seed weight. Variety TGX 1835-10E proved superior to TGX 1987-62F and TGX 1740-2E. Combination of 2.5 t ha-1 + 355.55 kg ha-1 NPK recorded tallest plant, highest number of branches plant-1, widest leaf area and higher number of pods plant-1. Applying 5 t ha-1 poultry manure + 244.44 kg ha-1 of NPK to TGX1740-2E recorded heavier seed weight than other treatment combinations. Variety TGX1835-10E out yielded other varieties tested while combination of 2.5 t ha-1of poultry manure and 355.5 kg ha-1 of NPK proved to be superior to other rates and combinations of fertilizers
Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study
No full textBackground: Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. Reliable, prospective, contemporary surgical outcome data are scarce in these settings. This study aimed to investigate surgical outcomes following surgery for intestinal typhoid. Methods: Two multicentre, international prospective cohort studies of consecutive patients undergoing surgery for gastrointestinal typhoid perforation were conducted. Outcomes were measured at 30 days and included mortality, surgical site infection, organ space infection and reintervention rate. Multilevel logistic regression models were used to adjust for clinically plausible explanatory variables. Effect estimates are expressed as odds ratios (ORs) alongside their corresponding 95% confidence intervals. Results: A total of 88 patients across the GlobalSurg 1 and GlobalSurg 2 studies were included, from 11 countries. Children comprised 38.6% (34/88) of included patients. Most patients (87/88) had intestinal perforation. The 30-day mortality rate was 9.1% (8/88), which was higher in children (14.7 vs. 5.6%). Surgical site infection was common, at 67.0% (59/88). Organ site infection was common, with 10.2% of patients affected. An ASA grade of III and above was a strong predictor of 30-day post-operative mortality, at the univariable level and following adjustment for explanatory variables (OR 15.82, 95% CI 1.53–163.57, p = 0.021). Conclusions: With high mortality and complication rates, outcomes from surgery for intestinal typhoid remain poor. Future studies in this area should focus on sustainable interventions which can reduce perioperative morbidity. At a policy level, improving these outcomes will require both surgical and public health system advances
Contextualising Menopause in Nigeria: A Qualitative Analysis From the MARiE Project
No full textObjective To explore Nigerian women's lived experiences of menopause and identify sociocultural, structural, and health‐system factors shaping symptom recognition, care‐seeking, and wellbeing, using in‐depth qualitative inquiry. Design Qualitative interview study. Setting Urban, peri‐urban, and rural communities across Nigeria. Participants Post‐menopausal women aged 40–66 years experiencing natural, surgical, or medical menopause. Methods As part of the Nigerian arm of the MARIE project, semi‐structured qualitative interviews were conducted with purposively sampled post‐menopausal women to capture diverse menopausal stages, socioeconomic positions, and geographic contexts. Interviews were analysed using thematic analysis informed by an equity‐centred, intersectional framework. Multiple researchers independently coded transcripts, with iterative discussion and triangulation to enhance analytic rigour and validity. Results Three interrelated themes characterised menopausal experiences in Nigeria. First, structural health‐system inequalities were evident, including limited anticipatory information, inadequate clinician training, fragmented care pathways, and restricted access to hormone replacement therapy and non‐hormonal treatments. Second, sociocultural and gendered norms shaped symptom interpretation and disclosure, with menopause often framed as a natural or inevitable life stage requiring endurance rather than care, compounded by stigma and silencing within families and communities. Third, women demonstrated adaptive coping and resilience, relying on peer networks, faith‐based practices, and self‐management strategies in the absence of formal support. Urban participants reported comparatively better access to information and services, while rural women described pronounced neglect and dependence on informal care. Conclusions This qualitative study provides the first in‐depth, context‐specific account of menopausal experiences among Nigerian women, revealing substantial inequities driven by sociocultural beliefs, economic constraints, and systemic gaps in healthcare provision. The findings underline the urgent need for culturally sensitive, equity‐oriented menopause care in Nigeria, including integration into primary healthcare, improved professional training, affordable access to evidence‐based treatments, and public health education to reduce stigma and unmet need
Global warming and malaria: a call for accuracy
No full textFor more than a decade, malaria has held a prominent place in speculations on the impacts of global climate change. Mathematical models that “predict? increases in the geographic distribution of malaria vectors and the prevalence of the disease have received wide publicity. Efforts to put the issue into perspective1, 2, 3, 4 and 5 are rarely quoted and have had little influence on the political debate. The model proposed by Frank C Tanser and colleagues6 in The Lancet and the accompanying Commentary by Simon Hales and Alistair Woodward7 are typically misleading examples.The relation between climate and malaria transmission is complex and varies according to location,2 yet Tanser et al base their projections on thresholds derived from a mere 15 African locations. Slight adjustments of values assigned to such thresholds and rules can influence spatial predictions strongly.8 The authors invest considerable effort in assessing the sensitivity of their model to climate change scenarios but do not report the internal sensitivities to thresholds and rules. The predictive skill of their model is low (63% sensitivity, 95% CI 61–65%) but they consider projections acceptable if prevalence is projected “to within a month? (presumably +/- 1 month?), thereby biasing their model towards success. A model covering an entire year in a parasite-positive site would always be correct, although in such areas it would be relatively insensitive to climate. By contrast, sites in which transmission is seasonal would provide a more reliable test of accuracy, but estimation is more difficult because climate sensitivity is greater. Furthermore, because parasite clearance in communities is not instantaneous,9 spot samples of parasitaemia on survey dates are not a suitable indicator of the duration of the transmission season. Lastly, “person/months? are unsuitable as a measure of transmission: an extension of season from 1 to 4 months will have more impact than from 10 to 12 months. According to their model, an extension of transmission from 11 to 12 months results in 106 more person/months in a population of 106 people, whereas an extension from 1 to 5 months gives the same increase in a population of 250·000.What Tanser and colleagues have modelled is merely the duration of the transmission season, which they interpret as “heightened transmission? and increased incidence. A greater failing is their reliance on “parasite-ratio studies?. The relations between transmission season and parasite prevalence, and parasite prevalence and clinical disease, are unclear but unlikely to be linear. Moreover, they use 1995 data for human populations, although these are projected to double by 2030. In addition, the proportion living in urban areas—with a specific climate10 and orders of magnitude less malaria transmission11 and 12—is projected to rise from 37% to 53%.13 For all these reasons, we do not accept the model as a “baseline against which interventions can be planned?.It is regrettable that many involved in this debate ignore the rich heritage of literature on the subject. For example, in 1937, in his classic textbook,14 L W Hackett stated: “Everything about malaria is so moulded and altered by local conditions that it becomes a thousand different diseases and epidemiological puzzles. Like chess, it is played with a few pieces, but is capable of an infinite variety of situations?. A pressing question in Hackett's time was the changing distribution of the disease in Europe. On the role of climate, he wrote: “Certainly, climate lays down the broad lines of malaria distribution…Nevertheless, although this is a very simple and plausible explanation…even the early malariologists felt that there was something unsatisfactory about it…malaria has not so much receded as it has contracted, oftentimes toward the north…Thus in Germany it is the northern coast which is still malarious, the south is free…There is, therefore, no climatic reason why (malaria) should have abandoned south Germany or the French Riviera?.We quote Hackett because we feel that the classic components of science—unbiased observation and systematic experimentation—cannot be sidestepped with models that omit many of his chess pieces. Yet Hales and Woodward7 begin by stating: “The present geographical distribution of malaria is explained by a combination of environmental factors (especially climate) and social factors (such as disease-control measures)?. In our opinion, “even the early malariologists? would surely disagree: much of the decline of malaria in Europe took place without control measures during a period when the climate was warming.The text by Hales and Woodward that follows displays a lack of knowledge. Thus, “Most people at risk of malaria live in areas of stable transmission…? is simply wrong. It is true that in many parts of the world malaria is termed “stable? because transmission remains relatively constant from year to year, the disease is endemic, the collective immunity is high, and epidemics are uncommon. However, in many other regions, the disease is endemic but “unstable? because annual transmission varies considerably, and the potential for epidemics is great. Climatic factors, particularly rainfall, are sometimes, but by no means always, relevant.15Again, “On the fringes of endemic zones, where transmission is limited by rainfall…there are strong seasonal patterns, and occasional major epidemics? is also wrong. In many regions, far from any “fringes?, malaria is endemic, stable, but highly seasonal. For example, in semi-arid regions of Mali, transmission is restricted to the rainy season, from July to September. The same 3 months constituted the transmission season for Plasmodium falciparum in Italy before it was eliminated.16 Paradoxically, in parts of the Sudan, rainfall is restricted to a month at most, but malaria is transmitted throughout the year. Female Anopheles gambiae survive drought and heat by resting in dwellings and other sheltered places.17 Blood feeding and transmission continue, but the mosquitoes do not develop eggs until the rains return. This phenomenon, termed gonotrophic dissociation, is remarkably similar to the winter survival strategy of Anopheles atroparvus, the principal vector of malaria in Holland until the mid 20th century.16By contrast, malaria is unstable in many regions that normally have abundant rainfall, and epidemics occur during periods of drought. An illustrative example is the catastrophic 1934–35 epidemic in Ceylon (now Sri Lanka), estimated to have killed 100·000 people.18 Worst hit was the south-western quadrant of the country, where average annual rainfall is greater than 250 cm, and malaria was endemic, but unstable and relatively infrequent. The dominant vector, Anopheles culicifacies, breeds along the banks of rivers and tends to be scarce in normal years. In the years 1928–33 there was abundant rainfall, river flow was high, A culicifacies was rare, and the human population was exceptionally malaria-free. However, after failure of two successive monsoons, the drying rivers produced colossal numbers of A culicifacies, and the resulting epidemic was exacerbated by the low collective immunity. In the drier parts of the island, where A culicifacies was dominant but transmission was more stable, immunity protected the population from the worst ravages of the disease.Hales and Woodward state that “the underlying problem? of the future “extension of seasonality? of malaria is “pollution of the atmosphere?, and call for rich countries to “recognise their obligations to the poorest by substantially reducing fossil-fuel consumption?. We understand public anxiety about climate change, but are concerned that many of these much-publicised predictions are ill informed and misleading. We urge those involved to pay closer attention to the complexities of this challenging subject. <br/
Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries
No full textBackground: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars (216 compared with 6 (95% confidence interval [CI]: −1) difference in costs. In India, the average cost for high FiO2 was 195 for low FiO2 leading to a −15 to −1164 compared with 93 (95% CI: −65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this
Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis
No full textObjective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally
Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries
No full textSurgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study
No full textSurgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings
