BACKGROUND: Obstetric fistula is a severe condition which can have devastating consequences for a woman’s life. Despite a considerable literature, very little is known about its prevalence. This project was conducted to carry out a situational analysis of fistula services in South Sudan and to pilot test the Key Informant Method (KIM) to estimate the prevalence of fistula in a region of South Sudan. METHODS: Key stakeholder interviews, document reviews and fistula surgery record reviews were undertaken. A KIM survey was conducted in a district of Western Bahr-el-Ghazal in January 2012. One hundred sixty-six community-based distributors, traditional birth attendants and village midwives were trained as key informants to identify women with fistula in the community. Women identified were subsequently examined by an obstetrician and nurse to verify whether they had a fistula. RESULTS: There were limited fistula repair services in South Sudan. Approximately 50–80 women per year attend periodic campaigns, with around half having a fistula and receiving a repair. On average a further 5 women a year received fistula repair from hospital services. Ten women with potential fistula were identified via KIM; all confirmed by the obstetrician. Of these, three were from the survey area, which had 8,865 women of reproductive age (15–49 years). This gives a minimal estimated prevalence of at least 30 fistulas per 100,000 women of reproductive age (95% CI 10–100). CONCLUSIONS: Routine fistula repair services available do not meet the population’s needs. The pilot study suggests that KIM can be used to identify women with fistula in the community. Data on fistula are generally poor; the KIM methodology we used in South Sudan yielded a lower fistula prevalence than estimates reported previously in the region.
Visceral leishmaniasis (VL), caused predominantly by Leishmania donovani and transmitted by both Phlebotomus orientalis and Phlebotomus martini, is highly endemic in East Africa where approximately 30 thousands VL cases are reported annually. The largest numbers of cases are found in Sudan - where Phlebotomus orientalis proliferate in Acacia forests especially on Sudan’s eastern border with Ethiopia, followed by South Sudan, Ethiopia, Somalia, Kenya and Uganda. Long-standing civil war and unrest is a dominant determinant of VL in East African countries. Here we attempt to identify the correlation between VL epidemics and civil unrest.
Black men in the United States have substantially higher prostate cancer incidence rates than the general population. The extent to which this incidence disparity is because prostate cancer is more prevalent, more aggressive, and/or more frequently diagnosed in black men is unknown.
The recent wave of mobilizations in the Arab world and across Western countries has generated much discussion on how digital media is connected to the diffusion of protests. We examine that connection using data from the surge of mobilizations that took place in Spain in May 2011. We study recruitment patterns in the Twitter network and find evidence of social influence and complex contagion. We identify the network position of early participants (i.e. the leaders of the recruitment process) and of the users who acted as seeds of message cascades (i.e. the spreaders of information). We find that early participants cannot be characterized by a typical topological position but spreaders tend to be more central in the network. These findings shed light on the connection between online networks, social contagion, and collective dynamics, and offer an empirical test to the recruitment mechanisms theorized in formal models of collective action.
To assess the 2012 cost utility of cataract surgery in the United States and to compare 2012 cost-utility data with those from 2000.
The Central African Republic is one of the world’s most vulnerable countries, suffering from chronic poverty, violent conflicts and weak disaster resilience. In collaboration with Doctors without Borders/Médecins Sans Frontières (MSF), this study presents a novel approach to collect information about socio-economic vulnerabilities related to malnutrition, access to resources and coping capacities. The first technical test was carried out in the North of the country (sub-prefecture Kabo) in May 2015. All activities were aimed at the investigation of technical feasibility, not at operational data collection, which requires a random sampling strategy. At the core of the study is an open-source Android application named SATIDA COLLECT that facilitates rapid and simple data collection. All assessments were carried out by local MSF staff after they had been trained for one day. Once a mobile network is available, all assessments can easily be uploaded to a database for further processing and trend analysis via MSF in-house software. On one hand, regularly updated food security assessments can complement traditional large-scale surveys, whose completion can take up to eight months. Ideally, this leads to a gain in time for disaster logistics. On the other hand, recording the location of every assessment via the smart phones' GPS receiver helps to analyze and display the coupling between drought risk and impacts over many years. Although the current situation in the Central African Republic is mostly related to violent conflict it is necessary to consider information about drought risk, because climatic shocks can further disrupt the already vulnerable system. SATIDA COLLECT can easily be adapted to local conditions or other applications, such as the evaluation of vaccination campaigns. Most importantly, it facilitates the standardized collection of information without pen and paper, as well as straightforward sharing of collected data with the MSF headquarters or other aid organizations.
Chronic kidney disease (CKD) is an emerging non-communicable disease worldwide. The Arab countries have a high prevalence of CKD risk factors, e.g. diabetes, obesity and hypertension. Unfortunately, the magnitude of CKD in the Arab world has not been studied well. This review presents the current data on CKD in the Arab world and proposes a call for action to address this rising epidemic.
Endemic animal diseases such as tsetse-transmitted trypanosomosis are a constant drain on the financial resources of African livestock keepers and on the productivity of their livestock. Knowing where the potential benefits of removing animal trypanosomosis are distributed geographically would provide crucial evidence for prioritising and targeting cost-effective interventions as well as a powerful tool for advocacy. To this end, a study was conducted on six tsetse-infested countries in Eastern Africa: Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda. First, a map of cattle production systems was generated, with particular attention to the presence of draught and dairy animals. Second, herd models for each production system were developed for two scenarios: with or without trypanosomosis. The herd models were based on publications and reports on cattle productivity (fertility, mortality, yields, sales), from which the income from, and growth of cattle populations were estimated over a twenty-year period. Third, a step-wise spatial expansion model was used to estimate how cattle populations might migrate to new areas when maximum stocking rates are exceeded. Last, differences in income between the two scenarios were mapped, thus providing a measure of the maximum benefits that could be obtained from intervening against tsetse and trypanosomosis. For this information to be readily mappable, benefits were calculated per bovine and converted to US$ per square kilometre. Results indicate that the potential benefits from dealing with trypanosomosis in Eastern Africa are both very high and geographically highly variable. The estimated total maximum benefit to livestock keepers for the whole of the study area amounts to nearly US$ 2.5 billion, discounted at 10% over twenty years - an average of approximately US$ 3300 per square kilometre of tsetse-infested area - but with great regional variation from less than US$ 500 per square kilometre to well over US$ 10,000. The greatest potential benefits accrue to Ethiopia, because of its very high livestock densities and the importance of animal traction, but also to parts of Kenya and Uganda. In general, the highest benefit levels occur on the fringes of the tsetse infestations. The implications of the models' assumptions and generalisations are discussed.
Active screening by mobile teams is considered the most effective method for detecting gambiense-type human African trypanosomiasis (HAT) but constrained funding in many post-conflict countries limits this approach. Non-specialist health care workers (HCWs) in peripheral health facilities could be trained to identify potential cases for testing based on symptoms. We tested a training intervention for HCWs in peripheral facilities in Nimule, South Sudan to increase knowledge of HAT symptomatology and the rate of syndromic referrals to a central screening and treatment centre.
Methodologies to measure gender-based violence (GBV) have received inadequate attention, especially in humanitarian contexts where vulnerabilities to violence are exacerbated. This paper compares the results from individual audio computer-assisted self-administered (ACASI) survey interviews with results from participatory social mapping activities, employed with the same sample in two different post-conflict contexts. Eighty-seven internally displaced adolescent girls from the Democratic Republic of the Congo and 78 Sudanese girls living in Ethiopian refugee camps were interviewed using the two methodologies. Results revealed that the group-based qualitative method elicited narratives of violence focusing on events perpetrated by strangers or members of the community more distantly connected to girls. In contrast, ACASI interviews revealed violence predominantly perpetrated by family members and intimate partners. These findings suggest that group-based methods of information gathering frequently used in the field may be more susceptible to socially accepted narratives. Specifically, our findings suggest group-based methods may produce results showing that sexual violence perpetrated by strangers (e.g., from armed groups in the conflict) is more prevalent than violence perpetrated by family and intimate partners. To the extent this finding is true, it may lead to a skewed perception that adolescent GBV involving strangers is a more pressing issue than intimate partner and family-based sexual violence, when in fact, both are of great concern.