̽��ֱ�� of Cambridge - Uganda

Phone-based HIV support system repurposed for COVID-19 monitoring in Uganda

lw355 — Wed, 22 Jul 2020 07:50:39 +0000

People entering Uganda have been required to quarantine for 14 days as part of the country’s lockdown measures, during which time they are monitored by the Ugandan Ministry of Health for development of COVID-19 symptoms.

Cambridge researcher Dr Rosalind Parkes-Ratanshi and her team have been helping the Ministry monitor and support quarantined individuals using a voice and SMS messaging system, Call for Life Uganda (C4LU). ̽��ֱ��tool was rapidly adapted for COVID-19 by Parkes-Ratanshi, who is based jointly at Cambridge’s Institute of Public Health and leads the Academy for Health Innovation at Infectious Diseases Institute, Makerere ̽��ֱ��, Uganda.

̽��ֱ��C4LU system regularly phones quarantined individuals to request they report any symptoms. ̽��ֱ��automated system then generates symptom reports and anything of potential concern is flagged to healthcare professionals for triaging. This eases the burden on healthcare workers of widespread check-ups in person or by phone.

Parkes-Ratanshi and colleagues at the Infectious Diseases Institute have been using the tool for the past four years to monitor HIV patients, in collaboration with Janssen: Pharmaceutical companies of Johnson & Johnson. When the coronavirus pandemic reached Uganda, the team rapidly repurposed the system they had developed, re-scripting for COVID-19 and recording the messages in 11 of the languages spoken in Uganda.

“ ̽��ֱ��total number of COVID-19 cases in Uganda has been low so far, with just over 1,000 cases across the whole country,” says Parkes-Ratanshi, who is currently based in Uganda. “Almost all cases seem to be linked to returning travellers and so the quarantine system and lockdown have been vital to slow the spread of the pandemic.”

Currently, the team are monitoring around 250 people using C4LU, with a total of 599 having participated so far. “Only a very small number of people have then needed to be tested for COVID-19, which shows the benefits of having a tool that can take pressure off the health system by reducing unnecessary visits,” she says.

Although Uganda has been fortunate in not suffering the scale of cases seen in some countries, Parkes-Ratanshi is mindful that there could be a future surge in infection. “We could see a time when regular monitoring on a wider scale would be beneficial. A system like this could reduce the number of individual calls coming in to the Ministry of Health – it could take some of the burden.”

So far, the team has focused on implementation – getting the system up and running, and triaging for possible COVID-19 cases that require confirmatory tests. They are now adding a research component, so that they can learn more about the impact of the technology, with funding from Cambridge ̽��ֱ��’s Global Challenges Research Fund QR.

̽��ֱ��team has been asked by the Ugandan Ministry of Health to add a layer of mental health support to the tool, adds Parkes-Ratanshi. “Once you’ve gone through your symptom reporting, you might then be asked a couple of screening questions about anxiety or mental health issues. Depending on the answer, we could then offer mental health support for those people who may not need active care or active testing, but have got anxiety or mental health issues related to COVID. We think that this will also be exceedingly important to help in a situation where the health care system is very stretched.”

Crucially, the technology is appropriate to the context, says Parkes-Ratanshi: “Around 75% of people have phones in Uganda, so phone-based technology seems to be a very good way of doing this kind of public health monitoring. But it would be no good taking say a smartphone app developed in the UK and thinking it would work for Africa. Even those people who’ve got smartphones may not have access to the internet on the day they need it. So our technology is developed to work on low-cost mobile and analogue phones.”

C4LU itself is based on an open source digital system developed originally for tuberculosis patients by Janssen. “Time and resources are limited in sub-Saharan Africa. We don’t really want to be experimenting with new stuff in a pandemic, which is why we’re glad to apply our experience using this tool for HIV to COVID-19.”

Rosalind Parkes-Ratanshi is supported by several of Cambridge’s interdisciplinary networks and initiatives – Public Health, Cambridge-Africa, Infectious Diseases and Global Challenges.

How you can support Cambridge’s COVID-19 research

A cost-effective phone-based system developed by a Cambridge researcher and her Ugandan colleagues to support HIV patients has been rapidly adapted by the team to help the Ugandan Ministry of Health monitor those in quarantine during the coronavirus pandemic.

We could see a time when regular monitoring on a wider scale would be beneficial. A system like this could reduce the number of individual calls coming in to the Ministry of Health – it could take some of the burden

Rosalind Parkes-Ratanshi

Infectious Diseases Institute

Call For Life

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Two million years of human stories

sjr81 — Thu, 12 Oct 2017 07:00:57 +0000

One of the overarching mottos and principles of the Museum is “Look. Look again.” Spread over three floors, with ground-breaking exhibitions and one million objects in its stores, the Museum presents endless opportunities for visitors and researchers to look, then look again.

Among its collections are objects that speak to us of love and loss, conflict and war, and life and death. These objects of material culture communicate to us in many different ways – if we learn how to observe and listen to the myriad stories they have to tell.

But what is the place and purpose of ethnographic museums in the UK in the 21st century? As time marches us further and further away from Britain’s own contentious history of exploration and the Empire, can and should we be comfortable with such repositories – born from an imperial legacy that painted a quarter of the globe red?

For Professor Nicholas Thomas, Director of the Museum of Archaeology and Anthropology (MAA), the answers are clear. He believes that at a time when questions of cultural and religious differences are highly contentious, the renewal of displays that stimulate cross-cultural curiosity are more important than ever.

“ ̽��ֱ��objects in MAA are not ‘dead’ objects,” he says. “ ̽��ֱ��Museum is a place that brings its collections to life through its interactions with the public as well as the indigenous communities from which these artefacts originate, not to mention the world-class research that scholars and academics from Cambridge and around the globe undertake here every day.

“Museum collections are not just a mass gathering of objects, but a complex set of relationships, things, documents, images and people. Each collection is a tangled formation of material culture and human intention. We’re dealing not with lifeless data, but with people’s interests in making, using, collecting, interpreting, classifying and reclaiming things.

“That’s what makes our collections in particular so rich; it’s the web of information that might lie behind a single object of encounter that ensures such objects resonate to this day.”

MAA’s collections are extraordinary for a museum of its size. Fewer than 1% of its objects can be on display at any given time, but the stores are actively researched by a bewildering range of global scholars.

̽��ֱ��Museum contains significant material from all over the world, with some of its best-documented collections hailing from the Pacific, including the world’s most important collection from the first voyage of Captain James Cook.

Cook’s three voyages of 1768–1780 were formative for the histories of exploration, anthropology, natural history and the Empire, and marked a new epoch in contacts between Europeans and indigenous peoples across the Pacific Islands and around the Pacific Rim.

Bequeathed by Cook’s patron Lord Sandwich to Trinity College in Cambridge and transferred to MAA during the early 20th century, the collection is probably the first extensive, systematically made ethnographic collection from any part of the world.

Recent projects have included research published in the leading archaeological journal Antiquity on the origins and history of a unique and enigmatic sculpture from the Cook collection. ̽��ֱ��carving, which features two double humanoid figures and a quadruped, is one of the Museum’s best-known objects and was long attributed to the Austral Islands in French Polynesia.

However, wood isotope analysis reveals that it is in fact from Tahiti, and carbon dating suggests that the work was 50–80 years old by the time Cook acquired it, changing our understanding of Oceania’s art history. Probably an element of a gateway into a sacred precinct, the carving was most likely preserved as a relic before being presented to the explorer. Its gifting implies the wish to build relationships with visitors who were perceived as powerful partners at that time.

It is often assumed that artefacts in ethnographic collections were appropriated from the communities that created them. Although some objects were indeed looted, many collections were created more collaboratively through trade and deliberate gift-giving.

MAA also holds important material from Uganda, brought to Cambridge primarily by the prominent missionary and ethnographer John Roscoe. Roscoe’s donations were supplemented by artefacts such as the necklet shown here. Worn by a royal bodyguard, it was gifted in 1902 by Apolo Kagwa, Katikiro (Prime Minister) of Uganda and the author of important anthropological studies, who travelled to England for the coronation of Edward VII.

Sixty years later, Abu Mayanja, a Cambridge law graduate and Minister for Education in the newly independent nation, asked the ̽��ֱ�� to return certain sacred objects, which were repatriated, and remain on display in the Uganda Museum today.

“I think we see the repatriation question as an opportunity to open up a dialogue – rather than a threat,” adds Thomas. “MAA has a distinguished record in engaging with indigenous people in a sustained way. We have had many extended engagements and collaborations around research that have been very rewarding for all the parties involved. It’s also been an extremely positive experience to share our collections through lending to major exhibitions in the countries of origin.

“Another more meaningful way of working with indigenous communities has been projects such as ‘Pacific Presences’, funded currently for five years through a European Research Council advanced grant. Work on material culture almost inevitably involves international collaboration, and we have done so with many small, experimental exhibitions, sharing photographs with communities in the Pacific, as well as through work with partner museums across Europe.

“Benin bronzes notoriously exemplify colonial confrontation and conflict in Africa in the 1890s. We try at once to be upfront about difficult histories, and to communicate the complications of the histories. Like most museums, we receive very few outright repatriation requests. Many indigenous peoples prioritise working together. They see these objects as ambassadors for their cultures.”

Inset image: Sculpture of two double humanoid figures and a quadruped, one of a hundred artefacts brought back by Captain James Cook from his first voyage on the Endeavour, and presented by him to his Admiralty patron Lord Sandwich, who donated the collection to Trinity College, which in turn transferred the artefacts to the Museum of Archaeology and Anthropology in the early 20th century. Credit: Museum of Archaeology and Anthropology.

Every object in the Museum of Archaeology and Anthropology tells not just one but many stories. ̽��ֱ��Museum’s collections chronicle two million years of human history, revealing the diversity of human life over millennia and the ongoing dynamism of world cultures in the present. Many individual artefacts reflect histories and cultures that are contested.

Each collection is a tangled formation of material culture and human intention. We’re dealing not with lifeless data, but with people’s interests in making, using, collecting, interpreting, classifying and reclaiming things.

Nicholas Thomas

Museum of Archaeology and Anthropology

Necklet worn by a royal bodyguard, gifted in 1902 by Apolo Kagwa, Katikiro of Uganda

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Opinion: ̽��ֱ��ICC can’t live with Africa, but it can’t live without it either

fpjl2 — Wed, 15 Mar 2017 10:01:27 +0000

On the first of February, 2017, the African Union issued a resolution encouraging member states to withdraw from the International Criminal Court (ICC). Whatever comes of it, the reported plan is the culmination of a highly publicised pushback by African states, which have accused the court of political bias, interference in African affairs and even racism.

Today’s African opposition represents a crisis for the 15-year-old court. But it’s also a symptom of a deeper dilemma faced by the ICC: how to enforce international criminal law impartially in a world of vast inequalities of power?

As I argue in a recent article, the ICC sought to escape this dilemma by focusing exclusively on Africa. At first, African states went along with it because cooperation entailed significant benefits. When the ICC shifted gears, however, and began to prosecute African heads of state instead of siding with them, the relationship went sour.

Africa’s push back is thus a result of the ICC’s own strategy for the continent. But it also needs to be seen in the context of Africa’s long experience of damaging foreign intervention within a highly inequitable international order.

̽��ֱ��ICC’s Africa strategy

Without Africa to turn to, the ICC may not have survived in the post-9/11 world. ̽��ֱ��Middle East was ablaze with US wars, and the US actively threatened the court’s survival. ̽��ֱ��ICC was without enforcement power and depended on state cooperation to conduct investigations and arrest suspects. So it had to avoid US opposition, while finding support for its prosecutions.

Africa seemed the perfect target for the ICC’s first cases. ̽��ֱ��continent was politically marginal enough that intervention there wouldn’t interfere with US interests. In addition, Africa was politically weak enough that those subject to intervention were considered unlikely to challenge the court.

Involvement was made easier by a history of Africa being represented as a terrain of barbaric violence, of savages committing atrocities against victims in need of a Western saviour. This humanitarian image fit squarely with the international court’s stark moral narrative of inhuman criminals and helpless innocents.

In 2003, Luis Moreno-Ocampo was elected as the ICC’s first Chief Prosecutor. Once he embarked on his Africa adventure, another advantage became clear. African heads of state could be encouraged to refer situations in their own countries to the ICC in a tacit bargain: African leaders provided assistance in arresting suspects, and the ICC gave those leaders effective immunity in return.

Uganda, for instance, called in the ICC to investigate the Lord’s Resistance Army (LRA). ̽��ֱ��ICC eagerly undertook the case with close assistance from the Ugandan military, for all purposes taking Uganda’s side in its long-running civil war.

While no one disputes the LRA’s brutality, the ICC’s selective approach raised deep concerns. ̽��ֱ��Ugandan government was also accused of war crimes and crimes against humanity as part of its counterinsurgency. Despite demands for equal justice for both sides, the ICC has failed to issue any arrest warrants for Ugandan government officials.

In the ICC’s early years, Africa thus came to the court’s rescue. It could avoid US censure while claiming that it was ending global impunity by pursuing a few minor Congolese or Ugandan rebels. Meanwhile, African leaders obtained a new tool in their arsenal of external support to use against internal opposition.

A shift

This cosy relationship changed when the ICC started going after African state elites.

̽��ֱ��ICC thought it could depend on Western support to trump African sovereignty. While it was proven correct in Libya, it was wrong in Sudan and Kenya. For their part, while many African states were happy to cooperate with the ICC when it served their interests, when the court turned against them, accusations of neocolonialism were soon heard.

̽��ֱ��ICC made gestures to appease its critics. It appointed an African Chief Prosecutor and opened the first formal investigation outside Africa. But these efforts failed, and African states stepped up their opposition. First Burundi, and then ̽��ֱ��Gambia and South Africa, declared their intention to exit the Rome Statute. Then came last month’s AU resolution.

̽��ֱ��ICC and its supporters have taken an uncompromising stance on African moves to withdraw. Moreno-Ocampo denounced uncooperative African heads of state as being complicit with genocide and abandoning African victims.

Of course, the declared intention by ̽��ֱ��Gambia or Burundi to withdraw from the ICC can be seen, in part, as defensive moves by authoritarian leaders looking to shield themselves from prosecution.

However, to reduce all African opposition against the ICC to the self-interest of African elites ignores the context of Africa’s response. It fails to see that African states and people are justified in having very real concerns about the way the ICC has intervened in the continent, given Africa’s historical experience with destructive international interference.

A decade of criticisms

For one thing, for African actors to reject the ICC’s current involvement in the continent is not to reject international law. Africa has its own histories and traditions of international law, in which international law has been used in the struggle for self-determination, dignity, and sovereign equality within the international community. An ICC that can interfere arbitrarily with fundamental internal political processes, or undermine regional efforts at peace and security, has no place within these African traditions of law.

Africa’s opposition has a specific material foundation - specifically, the ongoing commodity boom, fuelled by heightened demand from rising global powers. For instance, in Kenya, the backlash against the ICC has been couched in an anti-imperialist narrative of a declining West and a future of growth for Africa.

While the pushback by African states has gained the most attention, and poses the greatest threat to the court, it had been foreshadowed by over a decade of intense criticism by African civil societies, peace activists, and academics. They have accused the ICC of taking sides in conflict, being a tool of Western powers, of manipulating victims, and of undermining African ideals of reconciliation.

Today, it’s becoming clear that the ICC cannot live with Africa, given that it faces opposition both for its alliances with African state elites as well as for its efforts to prosecute those elites.

But it’s equally doubtful that the ICC can live without Africa, since intervening anywhere else looks increasingly far fetched. ̽��ֱ��ICC seems unable to prosecute anyone except minor African rebels who have fallen out with their state sponsors and former African heads of state who have been overthrown by Western military intervention.

̽��ֱ��ICC can try to dump the blame for its current problems on the continent, but this dilemma is one that the court looks to have little chance of escaping.

This article was published on ̽��ֱ��Conversation.

̽��ֱ��International Criminal Court’s focus on African states has led to pushback from the continent, yet intervening anywhere else looks increasingly unlikely, argues Adam Branch from the Department of POLIS.

Roman Boed

International Criminal Court, ̽��ֱ��Hague

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Under pressure: the battle to have a baby in Africa

lw355 — Thu, 16 Feb 2017 09:40:43 +0000

As a young doctor in Uganda a few years ago, Dr Annettee Nakimuli was told that nothing could be done about a complication of pregnancy that was putting thousands of pregnant women a year at risk of death.

She remembers the frustration: “I felt like we were accomplices in this war of sorts. People say we do not remember the words of our enemies but the silence of our friends. I did not want to accept that it was beyond hope.”

̽��ֱ��disease is pre-eclampsia, a condition that is thought to be caused by the placenta developing abnormally. Women with pre-eclampsia often experience very high blood pressure, which can be fatal without medical intervention. Although the condition affects women worldwide, in African women it is more common and particularly severe. It also occurs earlier in pregnancy and can recur in subsequent pregnancies.

“What makes pre-eclampsia such a challenge is it has been impossible to predict or prevent,” explains Professor Ashley Moffett, from Cambridge’s Department of Pathology and Centre for Trophoblast Research, who is an expert on the disease.

“It’s been called the ‘silent killer’ because many women cannot feel the danger sign that their blood pressure is rising until it’s too late. Even when it is detected the only course of action is constant monitoring, and ultimately the only cure is delivery – sometimes at too early a stage for the baby to survive,” adds Moffett.

̽��ֱ��silent killer

Nakimuli knows only too well the difficulties that African women face. Today she’s an obstetrician in Mulago Hospital, Kampala, where 33,000 babies are born each year. It has the highest number of live births of any hospital in the world (around 100 per day), and 15% of pregnancies develop life-threatening complications such as pre-eclampsia, haemorrhage, obstructed labour and sepsis. She describes herself and her colleagues as being “on the front line” in the battle against death in pregnancy and childbirth.

“I would often see women who had had four or more Caesarean sections with no living child – they continued exposing themselves to the danger until they had a baby,” says Nakimuli, who is also a lecturer at Makerere ̽��ֱ��. “I felt like not sitting back and just saying this is a disease with theories.”

Seven years ago, she began work with Moffett through the Cambridge-Africa Programme, first as a MUII PhD fellow registered at Makerere ̽��ֱ��, then as a MUII postdoctoral fellow and now as a research collaborator. Based in Kampala throughout, she would periodically travel to Cambridge to learn new techniques, analyse samples and spend time with Moffett trying to unravel why a complex disease is so much worse in Africa.

A few years earlier, Moffett had discovered that, when the placenta is formed, a remarkable ‘boundary-setting’ process occurs between the mother and the fetus deep within the lining of the womb.

“ ̽��ֱ��placenta must invade the mother enough to access nourishment for the growing baby, yet not so much as to penetrate through the uterus,” she explains. “Placentation is a setting up of the territorial boundary between two genetically different individuals – the mother and her baby, who carries genes from the father. It needs to be in exactly the right place for both to survive and thrive.”

Moffett found that maternal immune cells called uterine natural killer cells mediate the compromise between mother and baby. These cells have unique proteins on their surface called killer-cell immunoglobulin receptors (KIRs), which recognise proteins called MHC on the invading fetal cells. Certain combinations of maternal KIR genes and fetal MHC genes are associated with pre-eclampsia, whereas other KIR genes appear to protect against the disease.

But why would women of African descent suffer so much more from pre-eclampsia than other women? “There was an assumption in Africa that there was a socioeconomic reason, like poverty,” says Nakimuli. “I was convinced that there was something biological.”

Nakimuli set about recruiting 750 mothers at Mulago Hospital to what is the largest genetic study of pre-eclampsia conducted in Africa. She collected blood and umbilical cord samples and, in Cambridge, ‘typed’ the DNA to look at all the genetic variation. “It was kind of a high-risk project, but my determination kept my hope alive. I wanted to find big things.”

Her hunch proved right. She found that the KIR genes that protect African women against pre-eclampsia are different from those that protect European women. Moreover, the risky combination of maternal KIR and fetal MHC proteins occurs at a much higher frequency in sub-Saharan Africa than anywhere else in the world.

We think that women of African ancestry may have these risk genes because of certain beneficial selective pressures, otherwise why would genes that kill mothers and babies be so common in the population?
Ashley Moffett

̽��ֱ��findings immediately opened up new avenues of research into the biology of pre-eclampsia. ̽��ֱ��study also has implications for understanding infectious diseases, as Moffett explains: “We think that women of African ancestry may have these risk genes because of certain beneficial selective pressures, otherwise why would genes that kill mothers and babies be so common in the population? People with the gene that causes sickle-cell anaemia are able to fend off malaria – perhaps something similar is happening for KIR genes? And so now we are starting work to see whether the genes are protecting against infections such as measles, HIV and malaria.”

Africa's Voices

While Nakimuli and Moffett continue pinpointing the genetic basis of pre-eclampsia, and hope to bring out the first comprehensive textbook on African obstetrics, they are aware that one of the key issues surrounding pregnancy is that too many African women go to hospital too late, leaving it until their complications are advanced and dangerous.

“There’s a general lack of awareness and understanding,” explains Nakimuli. “There isn’t even an Ugandan word for pre-eclampsia. ̽��ֱ��closest people get to describing the condition is ‘having hypertension which is different from the other hypertension when you’re not pregnant’. It becomes a mouthful.”

Last year she took part in a series of radio programmes in Uganda as ‘Doctor Annettee’, the on-air doctor ready to answer questions from the audience. ̽��ֱ��programmes were part of an innovative Cambridge-led research project, ‘Africa’s Voices’, which uses interactive radio and mobile communications to gather and analyse the views of ordinary citizens.

“Because of the high rates of maternal mortality, a coping mechanism among Ugandan women is to consider pregnancy as being about bravery and fortitude,” says Nakimuli. “This way of coping might however lead to late self-diagnosis of the warning signs.”

“Sociocultural beliefs like coping mechanisms will determine how people behave,” says Dr Sharath Srinivasan, who is Head of Cambridge’s Centre of Governance and Human Rights and leads Africa’s Voices, “and so it’s important to understand a person’s thinking to support better maternal and neonatal health policies.”

However, the challenge has always been how to collect and assess all of the different ‘voices’ from hard-to-reach African communities. Srinivasan and colleagues realised that Africa’s digital revolution – particularly the widespread use of mobile phones and SMS messaging – could provide the answer when combined with the huge popularity of local radio stations and the team’s technical know-how.

̽��ֱ��team developed a format in which a radio presenter would play a real-life testimonial – such as a woman relaying the complications of her pregnancy – and then invite listeners to reply to a related question by sending a text to a toll-free number. Each respondent would subsequently receive an SMS sociodemographic survey to complete.

“What makes this set-up so rich is the fact that ordinary citizens are encouraged to voice their views. They aren’t restricted by a poll-style yes/no answer,” says Srinivasan. “We’ve developed a methodology that can take this data, which is often complex, unstructured and in more than one local language, and analyse it with qualitative social science and computational techniques to draw out key themes and insights.”

During Africa’s Voices pilot phase, the team used this format in eight sub-Saharan countries, working with nine radio stations, and choosing radio presenters who have a good relationship with their audience. In these ‘social spaces’, they probed beliefs on HIV/AIDS, vaccination, women’s issues, agriculture and governance processes.

Now spun-out of the ̽��ֱ�� as a non-profit organisation, Africa’s Voices works in East Africa with NGOs, health agencies and media organisations, and maintains strong links with researchers such as Nakimuli and Moffett.

An interactive radio project to shed light on pregnancy complications like pre-eclampsia was recently completed with three local language radio stations in Kampala, Uganda, and rich insights emerged into the perceived causes of complications in pregnancy. One finding is the difference in beliefs between men and women.

“Men, more than women, tend to think that the causes of complications are related to enduring traits of the mothers – their biology or their personality – but that the risk of complications is more likely to happen to other women, not their own partner,” explains Srinivasan.

“Women on the other hand are more likely to believe that complications arise because of factors that they can control – such as their lifestyle. Both women and men agree that insufficient health provision is the major reason women delay seeking healthcare.”

Srinivasan suggests from his experience that governments and service deliverers are keen to listen intelligently to what people are saying and to organise their work more attentively to the world views and collective beliefs of the populations they serve. “Sociocultural beliefs that limit the seeking of healthcare are addressable,” he says. “Interventions that engage women and communities in conversations can help change beliefs, opinions and norms, and thus behaviour patterns.”

"We needed to study the disease in Africa"

When Nakimuli is asked what her own research findings on the genetics of pre-eclampsia will mean for the mothers she sees every day on the wards at Mulago hospital, she is pragmatic.

“Can it help medically? We are still far from that,” she says. “Yes, theoretically we can predict risk by genotyping pregnant mothers, but we are in a low-resource setting – everything needs to be cost-effective. Really we need to develop a bedside test that doesn’t require costly and time-consuming laboratory analysis. Then we could know which women need to be monitored carefully.”

Sociocultural beliefs that limit the seeking of healthcare are addressable. Interventions that engage women and communities in conversations can help change beliefs, opinions and norms, and thus behaviour patterns

Sharath Srinivasan

In the seven years since Nakimuli first embarked on her studies to understand why so many women die in pregnancy, Cambridge-Africa research partnerships with Mulago Hospital have widened considerably. They now include pharmacist Dr Ronald Kiguba and Professor Sheila Bird OBE (Medical Research Council Biostatistics Unit, Cambridge) investigating how to report medication errors and adverse drug reactions; microbiologist Dr David Kateete and Professor Stephen Bentley (Wellcome Trust Sanger Institute) tracking how infections like MRSA spread through hospitals; and a group of obstetricians and midwives from Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust looking at best practice with their contemporaries in Kampala.

Meanwhile, a typical day at Mulago Hospital will bring around five pre-eclamptic pregnancies and several cases of obstructed labour, preterm birth and stillbirths; and a team of five doctors will be supervising 80–100 deliveries.

Funds are being sought by Cambridge-Africa to help set up an African Centre of Excellence in Pregnancy and Childbirth at Mulago Hospital, in partnership with Makerere ̽��ֱ��’s College of Health Sciences. “We would like to train more specialised staff who in turn will train the next generation, and we want to turn new understanding of pregnancy complications into clinical interventions,” explains Nakimuli.

Looking back to when she decided not to accept that nothing could be done about pre-eclampsia, Nakimuli says: “I was convinced that the reason we didn’t know much about the disease was because we’d been looking in the wrong place. We needed to study the disease in Africa. After all, if you want to study a disease properly, then you should look at the population most affected by it.”

Dr Annettee Nakimuli was funded by the Makerere ̽��ֱ��-Uganda Virus Research Institute Infection and Immunity Research Training Programme (MUII).

Inset images: Top: Dr Annettee Nakimuli; Bottom: radio interview with 'Dr Annettee' at Akaboozi FM in Kampala, Uganda, as part of the Africa's Voices study (credit: Rainbow Wilcox, Africa's Voices).

To keep up to date with the latest stories about Cambridge’s engagement with Africa, follow #CamAfrica on Twitter.

A complication of pregnancy that causes the mother’s blood pressure to rise – often fatally – is more common in women of African descent than any other. Research in Uganda by African and Cambridge researchers is helping to uncover why.

I felt like we were accomplices in this war of sorts. People say we do not remember the words of our enemies but the silence of our friends. I did not want to accept that it was beyond hope

Annettee Nakimuli

DFID

Suffering from pre-eclampsia, this young mother had to undergo a Caesarean to deliver her twin boys, seen here in the arms of her mother (Malawi)

Graduate, get a job … make a difference #6

Cambridge graduates enter a wide range of careers but making a difference tops their career wish lists. Read about Kathryn Savage who now works in Uganda to improve health service delivery and increase utilisation by strengthening the leadership skills of health workers and district health teams. 'Graduate, get a job … make a difference' is a series in which inspiring graduates from the last three years describe Cambridge, their current work and their determination to give back.

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Graduate, get a job … make a difference #6

ta385 — Thu, 16 Feb 2017 09:00:00 +0000

Kathryn Savage (Trinity College), BA Modern & Medieval Languages (2016)

I graduated last year and now work in Uganda with Pepal Foundation, a small UK-based NGO partnered with a large Ugandan NGO, Baylor College of Medicine. Our project aims to improve health service delivery and increase utilisation by strengthening the leadership skills of health workers and district health teams.

Our three year pilot runs until December 2017 in 270 facilities in two regions. ̽��ֱ��hope is to expand the project across Uganda by including it in the Ministry of Health's overall budget and training plans for newly-qualified clinical staff. We also hope that our model can be implemented in other countries.

My role is in monitoring the success of the project in its current form and coming up with improvements for when it is (hopefully) made fully functional across multiple areas of the country.

What Cambridge did for me

I probably spent more time doing extra-curricular activities than studying, from playing Blues football to being on my college May Ball committee. Cambridge definitely taught me that you really need to enjoy whatever you spend the majority of your time doing, which for most people is working.

I’d spent a lot of time in Latin America on my gap year and then my year abroad so I knew I wanted to work in a different part of the world with unfamiliar challenges. I first came to Uganda as a volunteer using money from a fund from my college, Trinity, and was then offered a year-long contract.

Unfortunately, I don’t currently use my languages at all in my job but having a very packed schedule has certainly equipped me with the skills to balance lots of competing interests. When studying a humanities subject you realise you could never exhaust the endless amount of reading that you could do, and it’s the same in terms of workload in the NGO world, where you feel like however much you do there’s always more.

My Motivation

I tried out the corporate sector during a couple of internships, thinking that I would get as much as I could from the training there to take into the NGO sector, but then I realised I couldn’t even handle that. I wanted to do something I’d be proud of from the beginning and something that I could explain to my friends without having translate lots of incomprehensible corporate jargon.

People who do amazing work in very under-resourced environments, like the many Ugandan healthcare workers that I’ve worked with, really inspire me. I think that we could learn a lot from them in the UK.

I would consider doing a Masters in Global Public Health or perhaps running projects for a larger NGO. But I think I’d like to work in the UK at some point as, whilst there’s so much to be done here, there are also a lot of social issues in the UK that I’d like to understand more and get involved with.

Applying to Cambridge

I applied to study law and went to the interview having had one practice session at school with someone who seemed to be learning from me about basic legal concepts rather than the other way around! However, my parents were very supportive and I was luckily able to go into the interview without too much pressure and thinking that fate would decide the outcome.

I initially began studying law but soon realised that I needed to be studying languages, having applied on deferral and spent time travelling in Latin America during my gap year. I just didn’t feel like I’d exhausted my love for languages during those six months and really wanted to build on my knowledge. Despite the initial false start, it was definitely the right decision and I’m very grateful that my college allowed me to change subject.

Cambridge graduates enter a wide range of careers but making a difference tops their career wish lists. In this series, inspiring graduates from the last three years describe Cambridge, their current work and their determination to give back.

People who do amazing work in very under-resourced environments really inspire me.

Kathryn Savage (Alumna)

Cambridge and Africa

Our Spotlight on Africa showcases links between our university and the African continent and has been launched to coincide with the Africa special of our Research Horizons magazine.

Under pressure: the battle to have a baby in Africa

A complication of pregnancy that causes the mother’s blood pressure to rise – often fatally – is more common in women of African descent than any other. Read about research in Uganda by African and Cambridge researchers that’s helping to uncover why.

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

Yes

̽��ֱ��Bible as a weapon of war

sjr81 — Wed, 08 Feb 2017 12:13:21 +0000

In 2012, one of the world’s most wanted war criminals, Joseph Kony, became one of the most repeated names on the planet thanks to a YouTube documentary (Kony 2012) and a call to action that sought to expose the terror and slaughter he inflicted on thousands of men, women and children in Central Africa.

Indicted by the International Criminal Court for crimes against humanity, Kony is now believed to be in hiding with his followers. He remains the genocidal leader of the murderous Lord’s Resistance Army (LRA) who claimed to have been sent by God to liberate the people of Northern Uganda from the rival National Resistance Army (NRA). From the start of their insurgency in 1987, Kony’s LRA claimed as their major objective the establishment of a government based on the Ten Commandments.

In the decades since, his army – often made up of thousands of forcibly conscripted child soldiers – have wounded, widowed and orphaned indiscriminately as they prosecuted a campaign of violence with a vigour befitting Kony’s vengeful readings of the Old Testament.

In the process, the LRA are thought to have displaced as many as two million Ugandans, the vast majority from Uganda’s Acholiland, where Kony originally hails from.

Today, Acholiland is a haunted place; haunted by the ghosts and memories of a recent past that has been written in blood rather than ink during nearly two decades of conflict.

But what happens when former LRA soldiers, those who have used the Bible as a weapon of war, return home from the front lines? How do former soldiers – male and female, adults and children – learn to reread and reinterpret scriptures that once spoke to them of fire and brimstone?

Kony says it is God who sent him to kill people so nobody should stop him. You know this thing is very difficult to understand as Kony refers us to the Bible... In Kony’s time, God has sent the Holy Spirit, and it is the one which is doing the work through Kony.
Zacchaeus, a former LRA commander

This is the puzzle facing Dr Helen Nambalirwa Nkabala from Makerere ̽��ֱ�� in Uganda. As a CAPREx fellow, she spent time in Cambridge working with Dr Emma Wild-Wood, from the Faculty of Divinity and the Cambridge Centre for Christianity Worldwide.

Nambalirwa Nkabala interviewed returning LRA soldiers in Uganda in order to examine how a positive engagement with biblical texts – especially those that seem to support violence – can help to promote peace instead.

She says: “My project identifies difficult texts in the Old Testament and seeks to identify the means by which they can be used in a constructive and meaningful way – with the central focus being on whether a particular interpretation promotes human dignity or not.

“ ̽��ֱ��way the LRA used the Bible, in a literal sense, to justify their violent actions has caused a complete overturn of the social and generational structures of the Acholi people.

“ ̽��ֱ��former LRA members I interviewed claim that all their actions are in accordance with Bible teachings; obedience to the law meant that anyone considered to have broken the Ten Commandments had to be destroyed.”

Kelly, a former child soldier, told Nambalirwa Nkabala that the Bible teaches that ‘somebody who does not obey must be killed’. This is the level of indoctrination that Cambridge researchers are trying to untangle as they work alongside Acholi leaders of varying denominations to promote peace and reconciliation using texts that were once wielded to justify murder on an industrial scale.

However, their work is complicated by the fact that Acholi cultural beliefs – as well as some readings of the Old Testament – also permit killing in exceptional circumstances, meaning that the LRA may have appropriated elements of Acholi culture to justify their own murderous ideology. For instance, the Achioli Chief and elders can pass ngolo kop me too – or ‘judgement of death’ – where killing is permitted, Likewise, Kony, a former altar boy in the Catholic Church, was brought up by a catechist father whom Nambalirwa Nkabala believes exposed him to Old Testament passages of death and punishment from an early age.

“Former LRA soldiers must be ready to reread the texts they were exposed to in a different way,” adds Nambalirwa Nkabala. “Texts with a violent message should be read with an ethical and nonviolent stance. Rather than passively accept what the text says, we must engage in dialogue with it. It is every Christian’s duty to expose and challenge any textual message which permits violence.

“ ̽��ֱ��Bible must be read contextually. By asking about the role of the text to a particular context, interpreters will automatically be pushed into the habit of checking what implications a particular reading/interpretation could have on a particular community.”

Wild-Wood met with Christian and Muslim leaders of the Acholi Religious Leaders Peace Initiative (ARLPI) during her trip to Uganda in 2015 as she sought to understand how the Bible is now being used to rebuild society. She was struck by the commitment to peace across differing faiths and denominations.

“A great deal of thought has gone into how former combatants can be rehabilitated,” says Wild-Wood. “From my focus groups, the religious leaders were optimistic about the future, but the challenges are many. They are dealing with people who are very traumatised. Some see the LRA soldiers as perpetrators, some see them as victims. But there is a recognition that people have dealt with awful situations – and may fall apart afterwards.”

When you look at what happened in the north and you go to the Bible and you read from the beginning to the last part you may find that 90 per cent of what happened here is in the Bible. Whatever has happened is exactly how God designed it.
Steve, a former LRA commander

Wild-Wood says that the ARLPI’s initial desire to publicise the atrocities being carried out by the LRA – and to protect civilians where possible – has now refocused to aid the process of reintegrating former combatants, and is working alongside international charities like World Vision to facilitate the transfer of former LRA soldiers from reception centres back to their communities.

“Projects of post-war reconciliation often engage with traditional beliefs and customs in order to effect lasting peace,” adds Wild-Wood. “Acholiland is no exception, and Acholi practices have been ultilised in restoring human relations. However, in the LRA and the wider population there are many Christians and a significant number of Muslims. It is important to engage the beliefs of those religious traditions when working towards long-term solutions to the destruction of society.”

While there may be a distance yet to travel, Nambalirwa Nkabala remains optimistic about Uganda’s future as it seeks to heal the deep scars caused by Kony and the decades of division and war he brought to his country.

“ ̽��ֱ��advantage in all this is that the Acholi have a deep sense of community and solidarity,” she says. “This is exemplified in the various means they use to reincorporate wrongdoers back into their community. If the Acholi communities can be encouraged to maintain their cultural values of healing and reconciliation – even while reading texts that may have a violent message – then they can in the future avoid situations that can lead to the destruction and erosion of these most important of values.”

Dr Helen Nambalirwa Nkabala was funded by the Cambridge-Africa Partnership for Research Excellence (CAPREx) and ̽��ֱ��ALBORADA Trust, through the Cambridge-Africa Programme.

To keep up to date with the latest stories about Cambridge’s engagement with Africa, follow #CamAfrica on Twitter.

How do former Lord’s Resistance Army soldiers – men, women and children who have used the Bible as a weapon of war – learn to reread the scriptures once they return home? This is the puzzle facing researchers from Uganda and Cambridge.

̽��ֱ��way the LRA used the Bible, in a literal sense, to justify their violent actions has caused a complete overturn of the social and generational structures of the Acholi people."

Helen Nambalirwa Nkabala

Charles Roffey

Kony 2012

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" ̽��ֱ��Professor is World Cup": understanding ‘secret’ urban languages

pbh25 — Wed, 22 Apr 2015 12:56:30 +0000

Uganda has one of the world’s largest percentages of people under 30 – more than 78% of its 37 million citizens, according to a report by the United Nations Population Fund. Many do not use the commonly spoken languages of Uganda (Kiswahili, English and Luganda) in everyday speech but instead express themselves in an ever-evolving street language called Luyaaye.

Originally a ‘secret language’ spoken by criminals, Luyaaye has grown in popularity because it’s seen as more playful and less traditional by many of its speakers, with its “joyful” use of English, Luganda and other languages.

Many of those who use Luyaaye are concentrated within Kampala, the capital city of a country that faces many challenges, including serious health problems. To combat these threats to health – and to get other social messages across – the government must communicate with its population effectively. This means using Luyaaye alongside the official languages, argue researchers from Africa and Cambridge who are working collaboratively as part of the Cambridge-Africa Partnership for Research Excellence (CAPREx).

Dr Saudah Namyalo from Makerere ̽��ֱ�� and Dr Jenneke van der Wal from Cambridge’s Department of Theoretical and Applied Linguistics have joined forces to understand how this increasingly popular, yet currently undocumented, urban language is built. ̽��ֱ��need is increasing, said Namyalo, as more people come to use forms of Luyaaye to communicate. “It is currently classified as an Urban Youth Language but it is becoming more widespread and used by some older people.”

Such languages are not unique to Uganda – elsewhere, forms of multicultural British English, the Dutch street language ‘straattaal’ and the ‘Camfranglais’ of the Cameroon are all examples of languages that have evolved out of, and usurped, the country’s mother tongue in certain communities, explained Namyalo.

These languages are fast-moving in their appropriation of new words, often borrowing them from TV, films and music. “I love the speed at which Luyaaye changes,” she said. “For instance, the World Cup was seen as a very positive thing. So world cup quickly became a shorthand for ‘a good thing’ or ‘excellent’.

“For a lot of people, Luyaaye is for fun – it is just for laughs! It often uses metonymy [calling something not by its own name but by a name linked to it] with surprising and comic results. So a Professor is someone with ‘street smarts’ who has learned to beat the authorities, to get away with anything.”

However, the language also has its darker side. ̽��ֱ��growth of Luyaaye began in the 1970s during the Idi Amin reign. “Illegal trade grew and it is thought that the language provided a code to serve those people who were involved in trade between Nairobi and Kampala. It was mostly spoken by the illiterate, young business community,” Namyalo explained.

Even today its past continues to influence its development as Luyaaye helps criminals conduct business and exclude the uninitiated from their ranks, said Namyalo. “Kampala is divided into five divisions and they are Luyaaye territories. If you are a criminal you are not supposed to cross into another territory – or you risk being burnt alive. ̽��ֱ��Luyaaye you use can show which division you are from or it can be used to uncover if you do not belong.”

Namyalo points to these past links with criminality as a factor in the reticence of the establishment in accepting Luyaaye: “Higher society does not take the language, or those who use it, seriously. When you use Luyaaye you are thought of as uncultured, and yet it is the more meaningful language for the youth than Luganda or other formal languages used in Uganda.”

She has begun the process of documenting this little-studied and evolving language, and would like to produce a dictionary. From her research, she now thinks of the language in terms of ‘layers’, each layer representing a slightly different set of vocabulary. ̽��ֱ��secret language used by criminals is what she calls ‘core’ Luyaaye, while the second layer is spoken by the youth, and the outer layer is the ‘ordinary’ Luyaaye, easiest to understand and popular with the general public.

Her work has so far concentrated on the lexical (word meaning) aspects of the language, but her collaboration with Van der Wal will allow them to examine the syntax (how sentences are constructed) of Luyaaye as compared with Luganda.

An expert in Bantu languages like Luganda, Van der Wal is also a member of a large-scale project to investigate the basic building blocks that underpin how languages of the world are structured – the Rethinking Comparative Syntax (ReCoS) project funded by the European Research Council and led by Professor Ian Roberts, also in the Department of Theoretical and Applied Linguistics.

“ ̽��ֱ��ability to speak a language is something very special – it is unique and part of what makes us human beings,” explained Van der Wal. “I want to find out what allows us to make grammatical sentences and how this varies between languages. For instance, unlike in some neighbouring languages, in Luganda you can say a word in two different ways: you can talk about eating rice (omuceere), but leave off the first vowel (mucheere) and it suggests you are only eating rice – it gives an exclusive focus on the rice.”

Namyalo’s visit to Cambridge and Van der Wal’s recent visit to Uganda were funded by CAPREx and the Alborada Research Fund, both of which are initiatives within the umbrella Cambridge-Africa Programme at the ̽��ֱ�� of Cambridge. ̽��ֱ��Programme aims to strengthen Africa’s capacity for research by equipping African researchers with skills and resources, and to promote mutually beneficial, long-term collaborations with African researchers across a wide range of disciplines.

For Van der Wal, research in Africa with African academics has been vital for enabling her to carry out meaningful research: “I loved working with Saudah in Uganda and listening to the languages as spoken. It was great to do field work together and get my hands dirty – well, get my ears dirty – and learn about yet another Bantu language.”

Namyalo sees the project as vital for helping her country combat some of its most challenging difficulties. “Programmes have been carried out to spread information about AIDS but even with increased dissemination there was a decrease in the take-up of that information. When asked what would help, people said ‘speak our language’.”

CAPREx is funded by the Carnegie Corporation of New York, the Alborada Trust and the Isaac Newton Trust

Inset image: Dr Jenneke van der Wal and Dr Saudah Namyalo

Research into a ‘playful’ and increasingly popular urban language that grew out of the necessity for criminals to hide their true intent could help organisations in Uganda communicate better with the country’s huge young population.

When you use Luyaaye you are thought of as uncultured, and yet it is the more meaningful language for the youth than Luganda or other formal languages used in Uganda

Saudah Namyalo

Understanding ‘secret’ urban language

Rod Waddington

Strolling, Uganda

Luyaaye

While the basic syntactic framework for Luyaaye is Luganda, it borrows words from English, with dashes of Sheng, Kiswahili and Sudanese.

As well as borrowing whole words it also borrows suffixes and affixes such as the English –ing which becomes –inga in Luyaaye.

Quite often when speakers use English words they do not alter the spelling, so that front page is used to mean 'forehead' and blood used to mean 'brother' or 'sister'.

̽��ֱ��language also uses metaphor, thus okusunagitta literally means 'to play a guitar' but actually means 'to scratch', and I would like to kill a chimpanzee means 'I would like to go to the toilet'.

It also uses tricks like antonym – making the meaning the opposite of what is said, so okwesalaobuwero means 'dressed in old cloth' but actually means to be smartly dressed.

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Urbanisation of rural Africa associated with increased risk of heart disease and diabetes

cjb250 — Tue, 29 Jul 2014 18:00:00 +0000

Over 530 million people live in rural areas of sub-Saharan Africa, where rates of cardiovascular and metabolic diseases tend to be much lower than in urban areas. However, many of these areas are becoming increasingly urbanised, with people living within larger populations in more built-up environments, with better access to education, health facilities and utilities, for example.

In an attempt to better understand the impact that urbanisation is having on communities, a team of researchers from the ̽��ֱ�� of Cambridge, the Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, and Deakin ̽��ֱ�� in Australia analysed data from 7,340 people aged 13 years and above across 25 villages in Uganda. Each individual was allocated an ‘urbanicity score’ and this was compared to their lifestyle risk factors, such as alcohol consumption, fruit and vegetable consumption, body mass index (BMI) and physical activity. ̽��ֱ��results are published today in the journal PLOS Medicine.

Dr Manjinder Sandhu from the Department of Public Health and Primary Care at the ̽��ֱ�� of Cambridge, joint senior author of the study, says: “Over half a billion people live in rural areas across sub-Saharan Africa. We need to understand how the health of these populations will change as the areas develop and become more urbanised to enable countries to plan future healthcare programmes and develop interventions to reduce this risk.”

̽��ֱ��researchers found that levels of urbanicity varied markedly across the villages, ranging from those without educational facilities or electricity in households, to villages with a public telephone and a dispensary. However, despite the features of urbanisation being relatively modest, living in more urban villages was associated with increased prevalence of cardiovascular disease risk factors such as physical inactivity, low fruit and vegetable consumption, heavy drinking and high body mass index, even after controlling for other factors such as socioeconomic status.

Johanna Riha, first author and a Gates Cambridge Scholar at the ̽��ֱ�� of Cambridge, says: “Development in rural areas will provide people with much needed access to education, healthcare and improved sanitation, with very positive health benefits. But it could be a double-edged sword and come at a cost of a greater incidence of diseases such as heart disease and diabetes.”

Professor Janet Seeley, joint senior author from the London School of Hygiene & Tropical Medicine, adds: “Even a small increase in a person’s level of urbanicity appears to be associated with poorer lifestyle choices that raise their risk of cardiovascular and metabolic diseases. As better infrastructure, education and healthcare systems are being developed, we should look for ways to use them to provide an opportunity to design and deliver interventions to help reduce the risk of these diseases.”

̽��ֱ��study was supported in part by the African Partnership for Chronic Disease Research.

̽��ֱ��increasing urbanisation of rural areas in sub-Saharan Africa could lead to an explosion in incidences of heart disease and diabetes, according to a new study carried out in Uganda which found that even small changes towards more urban lifestyles was associated with increased risk of cardiovascular and metabolic diseases.

Development in rural areas will provide people with much needed access to education, healthcare and improved sanitation... But it could come at a cost of a greater incidence of heart disease and diabetes

Johanna Riha

neiljs

Uganda

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