African Academy Research Articles

African-led health research and capacity building- is it working?

BackgroundAfrica bears a disproportionately high burden of globally significant disease but has lagged in knowledge production to address its health challenges. In this contribution, we discuss the challenges and approaches to health research capacity strengthening in sub-Saharan Africa and propose that the recent shift to an African-led approach is the most optimal.Methods and findingsWe introduce several capacity building approaches and recent achievements, explore why African-led research on the continent is a potentially paradigm-shifting and innovative approach, and discuss the advantages and challenges thereof. We reflect on the approaches used by the African Academy of Sciences (AAS)-funded Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE) consortium as an example of an effective African-led science and capacity building programme. We recommend the following as crucial components of future efforts: 1. Directly empowering African-based researchers, 2. Offering quality training and career development opportunities to large numbers of junior African scientists and support staff, and 3. Effective information exchange and collaboration. Furthermore, we argue that long-term investment from international donors and increasing funding commitments from African governments and philanthropies will be needed to realise a critical mass of local capacity and to create and sustain world-class research hubs that will be conducive to address Africa’s intractable health challenges.ConclusionsOur experiences so far suggest that African-led research has the potential to overcome the vicious cycle of brain-drain and may ultimately lead to improvement of health and science-led economic transformation of Africa into a prosperous continent.

Africa’s response to the COVID-19 pandemic: A review of the nature of the virus, impacts and implications for preparedness

Background: COVID-19 continues to wreak havoc in different countries across the world, claiming thousands of lives, increasing morbidity and disrupting lifestyles. The global scientific community is in urgent need of relevant evidence, to understand the challenges and knowledge gaps, as well as the opportunities to contain the spread of the virus. Considering the unique socio-economic, demographic, political, ecological and climatic contexts in Africa, the responses which may prove to be successful in other regions may not be appropriate on the continent. This paper aims to provide insight for scientists, policy makers and international agencies to contain the virus and to mitigate its impact at all levels. Methods: The Affiliates of the African Academy of Sciences (AAS), came together to synthesize the current evidence, identify the challenges and opportunities to enhance the understanding of the disease. We assess the potential impact of this pandemic and the unique challenges of the disease on African nations. We examine the state of Africa’s preparedness and make recommendations for steps needed to win the war against this pandemic and combat potential resurgence. Results: We identified gaps and opportunities among cross-cutting issues which is recommended to be addressed or harnessed in this pandemic. Factors such as the nature of the virus and the opportunities for drug targeting, point of care diagnostics, health surveillance systems, food security, mental health, xenophobia and gender-based violence, shelter for the homeless, water and sanitation, telecommunications challenges, domestic regional coordination and financing. Conclusion: Based on our synthesis of the current evidence, while there are plans for preparedness in several African countries, there are significant limitations. Multi-sectoral efforts from the science, education, medical, technological, communication, business and industry sectors as well as local communities is required in order to win this fight.

An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries

An appeal for practical social justice in the COVID-19 global response in low-income and middle-income countries

Bridging the gender equality gap in STEM to transform the pipeline in Africa: the African Research Academies for Women (ARA-W) summer research programme

BackgroundAlthough progress has been made in developed countries to increase the representation of women in science, technology, engineering, and mathematics (STEM), women in African countries lag behind. Stark gender disparities exist in STEM in Africa due to economic, environmental, sociocultural, and personal factors. Here, we describe the African Research Academies for Women (ARA-W) summer undergraduate research programme that seeks to reverse the under-representation of women in STEM through fellowship opportunities with mentored training at reputable academic and research institutions. MethodsApplicants are selected through a competitive application process on the basis of academic performance, STEM experience, their personal statement, and career potential. Fellows are paired with established leaders in their fields who provide rigorous mentoring for 8 weeks. Fellows submit weekly progress reports, complete a community service project, and participate in a final presentation. FindingsSince 2014, 65 fellows have completed projects on topics including the transmission dynamics of malaria, in-vitro procedures for evaluating cytotoxicity and use of high-performance liquid chromatography, palliative-care training for caregivers of cancer patients, and converting plastic wastes into biodiesel. Mean age of participants was 20 years and 76%, 11%, and 14% studied science, technology, and engineering, respectively. All fellows attended universities in Ghana at the time of participation. InterpretationSecuring funding to cover the full costs of the programme is a challenge. ARA-W is a volunteer-led organisation, which significantly reduces overhead costs. However, because there is no paid full-time staff, we must be mindful of coordinating responsibilities around teammates' schedules. We plan to increase enrolment by 20 fellows every year, and finalise the development of MentorSpace, an online professional mentorship pairing platform to connect individuals affiliated with ARA-W. Through ARA-W's MentorSpace, fellows can connect with an expanded network both within and outside their fields. New fellows will connect with our alumni network, using their knowledge and experience to open doors for future scholars. We have begun to collaborate with academic institutions in Nigeria to allow our model to be translated across Africa. FundingIndividuals and organisations donate to ARA-W to support our mission.

History of academic family medicine in South Africa - When did it start?

The literature on the history of family medicine as an academic discipline locates its beginning with the establishment of two faculties linked to the Royal College of General Practice in 1958. However, the history of Community Oriented Primary Care documents, how the Kark’s moved from Pholela in KwaZulu-Natal, were involved with the establishment of the Natal Medical School in Durban. As part of this a Department of Social, Preventative and Family Medicine was established in 1956 with Dr Sidney Kark as its first Head of Department. The South African Academy of Family Practice and Primary Care established in 1980 explicitly orientated itself in relation to public healthcare (PHC). We need to re-claim the history of Community Oriented Primary Care as part of the history of family medicine and proudly trace our current ethos and values to the seminal work of the Kark’s.

Enhancing African orphan crops with genomics.

The African Orphan Crops Consortium promotes the strategic, genome-enabled improvement of under-researched crops for biodiversity-based, nutritious food solutions in Africa. The African Plant Breeding Academy empowers the continent’s plant breeders to apply advanced genetic approaches and shared genetic solutions to the task of tailoring the immense diversity of underutilized crops to the needs of Africa’s producers, processors and consumers.

Vitamin D Deficiency in Young African Children

Background: Vitamin D deficiency is linked to infections, rickets, and poor child development. However, data on the vitamin D status of African children are limited. We examined the prevalence and predictors of low vitamin D status in young African children. Methods: We measured 25-hydroxyvitamin D (25OHD), C-reactive protein (CRP), malaria parasitaemia, and anthropometry among 3880 children aged 0-8 years living in Kenya, Uganda, Burkina Faso, and South Africa. We evaluated associations between vitamin D status and country, age, sex, anthropometric indices, inflammation and malaria parasitaemia in regression analyses and structural equation models. Findings: The overall prevalence of vitamin D deficiency using 25OHD cut-offs of <30 nmol/L and <50 nmol/L was 0·7% (95% CI 0·5, 1·0) and 7·4% (95% CI 6·6, 8·3) respectively, while 35·4% (95% CI 33·9, 36·9) of children had levels between 50–75 nmol/L. Overall geometric mean 25OHD level was 78·1 nmol/L (95% CI 77·3, 78·9) and median age was 22·1 months (interquartile range 12·1, 25·2). Vitamin D deficiency was more prevalent in South African and in older children. 25OHD levels were lower in children with malaria parasitaemia and higher in those with inflammation, but were not associated with sex, stunting, underweight or wasting. Interpretation: Only 1% and 7% of children were vitamin D deficient as defined by 25OHD levels <30 nmol/L and <50 nmol/L, respectively. Latitude, age and prevalence of inflammation and malaria should be considered in strategies to assess and manage vitamin D deficiency in young children living in Africa. Funding Statement: This work was funded by Wellcome [grant numbers SHA 110255, TNW 202800, AJM 106289 and AME 064693, 079110, 095778], and with core awards to the KEMRI-Wellcome Trust Research Programme [203077]. AA is supported by the Intramural Research Program of the National Institutes of Health in the Center for Research on Genomics and Global Health (CRGGH). The CRGGH (1ZIAHG200362) is supported by the National Human Genome Research Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the Center for Information Technology, and the Office of the Director at the National Institutes of Health. RMM and JMM are supported through the Developing Excellence in Leadership, Training and Science (DELTAS) Africa Initiative [DEL-15-003]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from Wellcome [107769] and the UK government. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Informed written consent was obtained from all children’s parents or guardians before inclusion in the study. Ethical approvals were granted by the Scientific Ethics Review Unit of the Kenya Medical Research Institute (KEMRI/SERU/CGMR-C/046/3257) in Kenya, the Uganda Virus Research Institute (GC/127/12/07/32) and Uganda National Council for Science and Technology (MV625) in Uganda, by Ministere de la Recherche Scientifique et de l’Innovation (reference 2014-12-151) in Burkina Faso, the University of Witwatersrand Human Research (M130714) in South Africa and in the UK by the London School of Hygiene and Tropical Medicine (A340) and the Oxford Tropical Research Ethics Committees (39-12, 41-12, 42-14, and 1042-13).

The African Academy of Sciences Research Management Programme in Africa

The Research Management Programme in Africa (ReMPro Africa) is an initiative of The African Academy of Sciences (The AAS) which aims to fill critical gaps in the African research ecosystem to support a vibrant research culture and leadership at universities and research institutions. The AAS recognizes that the business of doing research is all-encompassing and the lack of specialist research management profesionals threatens the integrity and quality of research coming out of African institutions. ReMPro Africa aims to transform research management at the institutional level by addressing the key interconnected strands of leadership, sustainability, standards and individual capacity development.

Improving the quality of clinical training in the workplace: implementing formative assessment visits

Family physicians have a key role to play in strengthening district health services in South Africa. There are a number of barriers to the supply of these specialists in family medicine, one of which is the quality of workplace-based training and low pass rate in the national exit examination. The South African Academy of Family Physicians in collaboration with the Royal College of General Practitioners has adopted a short course to train clinical trainers and a process of formative assessment visits (FAVs) for clinical trainers in the workplace. Training programmes have struggled to implement the FAVs and this article reports on the experience at Stellenbosch University and the issues identified. Clinical trainers who participated in FAVs mostly set developmental goals for themselves that focused on improving the learning environment and consolidating personal skills in training and assessment. The FAVs were beneficial for the family physician trainers, their managers and the academic family physicians at the university. The tools and process for conducting the FAVs may be of value to other programmes.

H-Index Has More Than Quantity (Publication Productivity) And Quality (Citation Impact) Nomological Dimensions

Of all the bibliometric parameters, the h-index is the most widely used to gauge the academic productivity and contribution to disciplines. In 2005, Hirsch proposed the h-index as a robust indicator of the quantity (number of publications) and quality (impact of the citations) of a scientific publication, but this speculation has not been empirically tested. This investigation determined the contributions of quantity and quality dimensions to the prediction of h-index and identify which of the dimension is the most viable in predicting it. The h-index, total number of publications, citation, and co-authorship counts for the 80 medical and health sciences fellows of the African Academy of Sciences were obtained from the Scopus database. The h-index is significantly related to publication (r = .388, p&lt;.001), citation (r = .309, p&lt;.01) and co-authorship (r = .246, p&lt;.05) counts. The three independent variables combined significantly predicted h-index (F (3, 76) = 4.68, p&lt;.01, R2 = .156). Although the regression model is a good fit for the data, only 15.6% of the variance in h-index was accounted for by the three bibliometric parameters. Publication count is the only viable predictor, explaining 15.1% out of the 15.6% total variability in the h-index. The remaining 84.4% variance that is unexplained in this study suggests that h-index has more than the quantity and quality nomological dimensions. Follow up studies should explore the predictive viability of other bibliometric measures such as the number of “reads,” book and chapter authorships, invited presentation engagements and conference proceedings.

A reflective note: AJOM Inaugural Junior Faculty Fellowship

ABSTRACTIn recognizing the persistent publishing challenge among African-based scholars, the African Academy of Management (AFAM) and the Africa Journal of Management (AJOM) joined forces to explore various alternatives to address the challenge. The creation of the Junior Faculty Fellowship is the outcome of that collaboration that seeks to build academic relationships between institutions and Faculty. This paper captures the reflections of the inaugural Fellow, Dr. Juliana Mulaa Namada. As we follow her journey between 2017 and 2019, we learn about relationship building. She shares details of her participation at the Academy of Management (AOM) conference in Chicago, Ill., her engagement with colleagues at the host institution, the University of Wisconsin-Whitewater, and the opportunities to test her skills in writing and publishing. In doing so, we learn of the benefits and challenges of a truly global Fellowship whose value extends beyond the immediate mentor-mentee relationship.

Prevalence and Correlates of Posttraumatic Stress Disorder and Common Mental Disorders in Lay Health Workers Working on the Friendship Bench Program in Zimbabwe

Background: Task-shifting using lay health workers (LHWs) to reduce the treatment gap for mental, neurological and substance use disorders is a common feature in health care systems in low and middle-income countries where medical professionals are scarce. The Friendship Bench is a collaborative stepped care intervention for common mental disorders delivered by LHWs in over 70 primary health care facilities in Zimbabwe. In recent years there has been concern about the mental health of over 300 LHWs delivering the intervention due to the stressful nature of the work on the FB and their exposure to vicarious trauma. This study aimed to establish the prevalence and factors associated with common mental disorders such as depression and anxiety (CMD) and post-traumatic stress disorder (PTSD) among the LHWs. Methods: A random sample of LHWs (n=182) working for the FB for more than 2 years had the previously validated Posttraumatic Stress Disorder Checklist (PCL-5) and the Shona Symptom Questionnaire (SSQ-14) administered to them by independent and trained research assistants. Outcomes: 11 LHWs presented with low probable PTSD (6%), CMD was found in 17 cases (11%). Interpretation: The prevalence of PTSD and CMD of LHWs is significantly lower than their clients' despite the stressful nature of their work and the burden of being exposed to the same risk factors. There is need for further studies to understand the protective mechanisms that may be associated with this work. Funding Statement: This study was funded by Grand Challenges Canada, award number 0087-04, awarded to Prof Dr Dixon Chibanda. Declaration of Interests: The authors declare that they have no conflict of interest except for DC who is supported through the DELTAS Africa Initiative [DEL-15-01]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [DEL-15-01] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those 63 of AAS, NEPAD Agency, Wellcome Trust or the UK government. Ethical Approval Statement: The study was approved by the Medical Research Council of Zimbabwe and by the Health Research Ethics Committee at Stellenbosch University in line with the ethical principles stated by the Helsinki Declaration. Informed consent was obtained from all individual participants included in the study.

Xpert MTB/Rif Ultra for the Diagnosis of HIV-Associated Tuberculous Meningitis: A Prospective Validation

Introduction: Tuberculous meningitis accounts for 1-5% of tuberculosis (TB) cases. Diagnostic delay contributes to poor outcomes. We evaluated the performance of the new Xpert MTB/Rif Ultra (Ultra) for TB meningitis diagnosis. Methods: In a prospective diagnostic accuracy study, we tested the cerebrospinal fluid (CSF) of adults presenting with sub-acute meningitis to Mulago and Mbarara Hospitals, Uganda. We centrifuged the CSF, resuspended the cell pellet in 2mL CSF and tested 0.5ml aliquots with Ultra, Xpert, and mycobacterial growth indicator tube (MGIT) culture. We quantified diagnostic performance against 1) the uniform case definition of probable or definite TB meningitis and 2) a composite microbiological reference standard. Findings: From November 2016 to January 2019, we screened 466 adults with suspected meningitis and tested 204 for TB meningitis. Uniform clinical case definition classified 51 participants as probable/definite TB meningitis. Against this uniform case definition, Ultra had 76% sensitivity (39/51) compared with Xpert 56% (25/45; P=0·001) or culture 61% (27/44; P=0·02). Against the composite reference standard, Ultra had sensitivity of 93% (39/42), higher than Xpert at 66% (25/38; p=0·006) or culture at 72% (27/37; p=0·09). Ultra detected nine TB meningitis cases missed by Xpert and culture. In multivariate analysis, decreasing CSF glucose was a predictor of definite TB meningitis (P=0.001). Interpretation: Ultra detects TB meningitis with higher sensitivity than Xpert and culture in this HIV-positive population. However, with a negative predictive value of 93% Ultra cannot be used as a 'rule out' test. Clinical judgement and novel highly sensitive point of care tests are still required. Funding Statement: This research was made possible through support from the National Institute of Neurologic Disorders and Stroke (R01NS086312), the Fogarty International Center (K01TW010268, K43TW010718), and National Institute of Allergy and Infectious Diseases (T32AI055433). Declaration of Interests: FVC is supported through a Wellcome Trust Clinical PhD Fellowship (Grant no. 210772/Z/18/Z). FVC is an honorary fellow of the Makerere University – Uganda Virus Research Institute Centre of Excellence for Infection and Immunity Research and Training (MUII-plus). MUII-plus is supported through the DELTAS Africa Initiative (Grant no. 107743). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS), Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (Grant no. 107743) and the UK Government. The MRC/UVRI and LSHTM Uganda Research Unit is jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. All other authors have nothing to disclose. Ethics Approval Statement: Institutional review board and Uganda National Council of Science and Technology approvals were obtained and informed consent was obtained from participants or their surrogate (in patients with altered mental status). The study was conducted in line with the Standards for Reporting Diagnostic Accuracy Studies.

The decolonial Aquinas? Discerning epistemic worth for Aquinas in the decolonial academy

As the ideological constructor of the destruction of colonised peoples and knowledge, Western philosophy must bear its burden for complicity. Decoloniality is amid the discourses of critique contra modernity and its denigration of the colonised. In the South African academy, for instance, much support has been validly rendered to decoloniality, consequently those employing “Western” frameworks should be challenged to constant re-evaluation. Here, the virtues and vices of decoloniality will not be considered. Rather a discernment will be undertaken of the “epistemic worth” of conducting – specifically mediaeval and Western – philosophical research amid calls for the decentring of Western epistemological dominance, within the tradition of Saint Thomas Aquinas in the decolonial milieu. The argument is proffered – from multifold perspectives – that Aquinas, as both pre-modern and pre-colonial, does have relevance to the decolonial academic climate. The case is defended that Arabic philosophers importantly influenced Aquinas’ work, thus, demonstrating his openness to non-Western thought. Furthermore, from an epistemological perspective, it is contended that Aquinas’ placing of the subject at the focal point of adequations to truth by credencing the situatedness of the perceiver, deconstructs modern objectivity, which in itself has caused considerable damage to non-Western epistemologies. Aquinas’ epistemic relevance in this context, it is argued, may contribute to a median between demonstrable science and the multi-layered context of the epistemic subject.

Effectiveness of a Psychological Intervention Delivered by General Nurses for Alcohol Use Disorders in People Living with HIV in Zimbabwe: A Cluster Randomised Controlled Trial

Background: Limited data exist on the effectiveness of interventions for alcohol use disorders (AUD) in people living with HIV which can be delivered in general health care settings in low- and middle- income countries (LMIC). Methods: Sixteen public health facilities (clusters) were selected nationally through stratified randomisation and then randomised 1: 1 to Motivational Interviewing blended with brief Cognitive Behavioural Therapy (MI-CBT) or to Enhanced Usual Care (EUC). Inclusion criteria for individuals were adults aged 18 years-plus living with HIV who met criteria for AUD defined by Alcohol Use Disorders Identification Test (AUDIT) score of 6 for women and 7 for men. Nurses working in these health facilities were trained to deliver the treatments. Participants in the MI-CBT clusters received 10 sessions. Participants in EUC clusters received 3 sessions of psychoeducation based on the WHO Mental Health Gap Intervention Guide. The primary outcome was change in the AUDIT score at 6 months post-randomization. Secondary outcomes were viral load and functioning, measured by the WHODAS 2.0. A random-effects analysis-of-covariance model was used accounting for the cluster design. Findings: 234 participants were enrolled across 16 clinics, with a mean age of 43.3 years (9.1). 78.6% of the participants were male. 175 (74.8%) were followed up at 6 months. At 6 months follow-up AUDIT score fell by 6.15 (95% CI -6.3; -6.0) points in the MI-CBT arm and by 3.09 (95% CI -3.2; -2.9) points in the EUC arm. The drop in the AUDIT score was significantly greater in the MI-CBT arm compared to EUC: mean difference -2.26 (95% CI -4.53 to -0.01) (p=0.05). The viral load fell and general function improved in both arms with no statistically significant difference between arms. Interpretations: Nurses in government primary care and hospital facilities in low-income countries can be trained to deliver low-cost interventions that can reduce AUDs among PLWH. For people living with HIV, studies with long-term follow-up are needed to show whether longer interventions using Motivational Interviewing-CBT techniques are cost-effective compared to short interventions based on psychoeducation and feedback about alcohol use. Trial Registration: Pan African Clinical Trial Registry, PACTR201509001211149. Funding Statement: Research reported in this publication was supported by the Fogarty International Center (Office of The Director, National Institutes Of Health (OD), National Institute of Nursing Research (NINR), National Institute of Mental Health (NIMH), National Institute of Dental & Craniofacial Research (NIDCR), National Institute of Neurological Disorders and Stroke (NINDS), National Heart, Lung, and Blood Institute (NHLBI), Fogarty International Center (FIC)) of the National Institutes of Health, award D43 TW010137, the DELTAS Africa Initiative [DEL-15-01]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [DEL-15-01] and the UK government, Grant Number D43TW010313-02S3 from the National Institutes of Health, Fogarty International Center and the National Research Founding through Funding to Professor Soraya Seedat SARChi Research Chairs. The study also received support from King’s College London Partnership Fund for viral load testing. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center or the National Institutes of Health, the DELTAS Africa Initiative, King’s College London and the National Research Foundation SARChi Research Chairs. As an FIC scholar, MM also received research training from the Clinical and Translational Science Institute (award UL1TR001412). Declaration of Interests: All authors declare no conflict of interest. Ethics Approval Statement: Stellenbosch Health Research Ethics Committee (HREC) (SI/10/14/222) and the Medical Research Council of Zimbabwe (MRCZ) (A/1936) provided ethics approval.

Estimating the Hidden Burden of Iron Deficiency Among African Children

Background: Iron deficiency (ID) is a major public health burden in African children and accurate prevalence estimates are important for effective nutritional interventions. However, ID may be commonly underestimated in Africa because most measures of iron status are altered by inflammation and infections such as malaria. Methods: We assayed iron and inflammatory biomarkers in 4,853 children aged 0-8 years from Kenya, Uganda, Burkina Faso, South Africa, and The Gambia. We described iron status and its relationship with age, sex, malaria parasitaemia, inflammation, stunting, underweight, and wasting. We defined ID using the WHO ferritin-based definition (ferritin 5mg/L)) and then used regression modelling, correcting for inflammation and malaria, to estimate 'true' prevalence of ID. We further investigated the utility of other iron biomarkers in predicting ID. Findings: The prevalence of ID was highest at one year of age and in male children. Stunting and underweight were associated with anaemia and iron deficient erythropoiesis. Inflammation and malaria parasitaemia significantly influenced all iron biomarkers, although transferrin saturation was least affected. The WHO definition of ID did not identify 27·0% of Burkinabe, 21·4% of Kenyan, 20·0% of Ugandan, 16·8% of Gambian, and 8·5% of South African children with 'true' iron deficiency. This 'hidden burden' increased with age and with increasing prevalence of inflammation and malaria. We observed similar prevalences of ID using regression modelling and transferrin saturation <11%. Interpretation: The prevalence of ID may be underestimated in African children using the WHO definition because inflammation and malaria obscure the 'true' burden. Transferrin saturation is least affected by inflammation and malaria and may more accurately determine the burden of ID. Funding Statement: This work was funded by Wellcome (Grant numbers [110255/Z/15/Z to SHA], [202800/Z/16/Z to TNW; 106289/Z/14/Z to AJM; and 064693, 079110, 095778 to AME] and with core awards to the KEMRI-Wellcome Trust Research Programme (203077/Z/16/Z), The Wellcome Centre for Human Genetics (090532/Z/09/Z, 203141) and the Wellcome Sanger Institute (098051, 206194). AJM was also supported by an Oxford University Clinical Academic School Transitional Fellowship and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. JMM was funded through the DELTAS Africa Initiative (DEL-15-003). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [107769/Z/10/Z] and the UK government. The Gambian studies were supported by National Institute of Child Health and Development, Bill and Melinda Gates Foundation, core funding MC-A760-5QX00 to the MRC Unit The Gambia/MRC International Nutrition Group by the UK MRC and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement. This project also received funding from the European Research Council (ERC) under the European Union’s (Seventh Framework Programme [FP7/2007-2013]) (Grant agreement No 294557 to AVSH). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Ethical approvals were obtained for Kilifi, Kenya (by the Scientific Ethics Review Unit of the Kenya Medical Research Institute (KEMRI/SERU/CGMR-C/046/3257/2983)); Entebbe, Uganda (locally by the Uganda Virus Research Institute (GC/127/12/07/32) and Uganda National Council for Science and Technology (MV625), and in the UK by the London School of Hygiene and Tropical Medicine (A340) and Oxford Tropical Research (OTR) (39-12, 42-14 and 37-15) Ethics Committees); Banfora, Burkina Faso (by Ministere de la Recherche Scientifique et de l’Innovation in Burkina Faso (2014-12-151) and the OTR Ethics Committees (41-12)); Soweto, South Africa (by the University of Witwatersrand Human Research (M130714) and the OTR Ethics Committees (1042-13 and 42-14)); and West Kiang, The Gambia (by the Gambian Government/Medical Research Council Ethics Committee (874/830)).

Despite huge investment to contain AMR, recent reports of increased occurrence of superbugs are terrifying

Antimicrobial resistance (AMR) which is considered a significant global health crisis continues to evolve and spread across the globe. If no adequate strategies are put in place to halt its rapid spread, routine surgical and medical procedures would become impossible without effective antimicrobials. By the year 2050, AMR is estimated to cost 10 million lives and about US$100 trillion annually. Growing concerns due to the escalating spread of multidrug resistant organisms have forced the World Health Organisation (WHO), the Centre for Disease Control and Prevention (CDC), European Commission of the EU, the UK Department of Health and the African Academy of Sciences to put strategies against AMR in place. However, despite efforts to halt AMR, recent reports show disturbing trends of difficult-to-treat deadly infections including gonorrhoea, typhoid, pneumonia, influenza, HIV, malaria and tuberculosis. This article bolsters the need for a comprehensive, real-time and improved surveillance of multidrug resistant organisms, sustained and coordinated action against AMR, development of new antibiotics and vaccines, prevention and control of diseases, improved sanitation and hygiene, sustained research, development of rapid diagnostics as well as provision of affordable and accessible health services.

“How Little Progress”? A Political Economy of Postcolonial Nutrition

“How Little Progress”? A Political Economy of Postcolonial Nutrition

(De)coloniality through Indigeneity:Deconstructing Calls to Decolonise in the South African and Canadian University Contexts

The ways in which Africanisation and decolonisation in the South African academy have been framed and carried out have been called into question over the past several years, most notably in relation to modes of silencing and epistemic negation, which have been explicitly challenged through the student actions. In a similar vein, Canada’s commitments to decolonising its university spaces and pedagogies have been the subject of extensive critique, informed by (still unmet) claims to land, space, knowledge, and identity. Despite extensive critique, policies and practices in both South African and Canadian academic spaces remain largely unchanged, yet continue to stand as evidence that decolonisation is underway. In our paper, we begin to carefully articulate an understanding of decolonisation in the academy as one which continues to carry out historical relations of colonialism and race. Following the work of Eve Tuck and Wayne Yang (2012), we begin the process of “de-mythologising” decolonisation, by first exposing and tracing how decolonising claims both reinforce and recite the racial and colonial terms under which Indigeneity and Blackness are “integrated” in the academy. From our respective contexts, we trace how white, western ownership of space and knowledge in the academy is reaffirmed through processes of invitation, commodification, and erasure of Indigenous/Black bodies and identities. However, we also suggest that the invitation and presence of Indigenous and Black bodies and identities in both academic contexts are necessary to the reproduction and survival of decolonising claims, which allows us to begin to interrogate how, why, and under what terms bodies and identities come to be “included” in the academy. We conclude by proposing that the efficacy of decoloniality lies in paradigmatic and epistemic shifts which begin to unearth and then unsettle white supremacy in both contexts, in order to proceed with aims of reconciliation and reclamation.

Constructies met krijgen en kry: Een vergelijking vanuit (diachroon) constructiegrammaticaal perspectief

Zowel Nederlands krijgen als Afrikaans kry maken deel uit van verschillende constructies met een verbale aanvulling in de vorm van een voltooid deelwoord of infinitief, waarin krijgen/ kry gedeeltelijk geauxiliariseerd is. Dit artikel gaat vanuit een contrastief en (diachroon) constructiegrammaticaal perspectief in op de formele en semantische eigenschappen van die constructies. Aangetoond wordt dat de Afrikaanse resultatieve constructie met kry + voltooid deelwoord zich verder heeft ontwikkeld dan haar Nederlandse tegenhanger met krijgen + voltooid deelwoord. Daartegenover staat dat in het Nederlands een frequent gebruikt krijgen-passief is ontstaan dat in het Afrikaans niet echt van de grond is gekomen, en dat er in het hedendaagse Nederlands ook aanwijzingen zijn voor productief gebruik van een modale constructie met krijgen + te-infinitief. De data voor het onderzoek komen hoofdzakelijk uit het SoNaR-corpus en het Taalkommissiekorpus.