Gambian Community Research Articles

Collective capabilities: overcoming energy scarcity through power sharing

The research explores the intersection of social relations and energy capabilities in the Global South. Specifically, it provides insight into everyday �sharing practices� in overcoming electricity scarcity. This is based on a decade of regular immersions in a rural Gambian community which was supported by a range of qualitative methods including observations and semi-structured interviews. Findings suggest that energy capabilities can be improved at different scales in the community through sharing practices that are historically rooted in social norms and values. This is conceptualised here as collective energy capabilities for mitigating energy scarcity. However, currently sharing practices do not easily translate into sustainable and bottom-up management of collectively used or owned energy assets to achieve more systemic shifts towards democratic models of energy for all.

Persistent and Emerging Pneumococcal Carriage Serotypes in a Rural Gambian Community After 10 Years of Pneumococcal Conjugate Vaccine Pressure.

The continuing impact of pneumococcal conjugate vaccines (PCVs) in regions with high pneumococcal transmission is threatened by the persistence of vaccine serotypes (VTs) and the emergence of nonvaccine serotypes (NVTs). In 2016, we conducted a cross-sectional carriage survey (CSS5) in a community where PCV7 was first introduced in 2006 during a cluster-randomized trial conducted before nationwide introduction of PCV7 (2009) and PCV13 (2011). We estimated prevalence of PCV13 VT and NVT by age and compared these with earlier surveys before (CSS0), during (CSS1-3), and after the trial but before PCV13 (CSS4). Genomic analysis was conducted for the nontypeable pneumococci. Prevalence of PCV13 VT carriage decreased during the 10 years between CSS0 and CSS5 across all age groups (67.6% to 13.5%, P < .001; 59.8% to 14.4%, P < .001; 43.1% to 17.9%, P < .001; and 24.0% to 5.1%, P < .001, in <2, 2-4, 5-14, and ≥15 years, respectively). However, there was no difference between CSS4 and CSS5 in children ≥2 years and adults (children <2 years, no data). The prevalence of PCV13 NVT increased between CSS0 and CSS5 for children <2 years but decreased in older children and adults. In CSS5, serotypes 3, 6A, and 19F were the most common VT and nontypeable isolates were the most common NVT. Among nontypeable isolates, 73.0% lost the ability to express a capsule. Of these, 70.8% were from a VT background. The decrease in PCV13 VT that has occurred since the introduction of PCV13 appears to have plateaued. Significant carriage of these serotypes remains in all age groups.

Belief systems enforcing female genital mutilation in Europe

Purpose – Despite numerous studies on FGM, little is known about belief systems that support FGM in the EU. The purpose of this paper is to explore the dynamic nature of belief systems and enforcement mechanisms that perpetuate FGM among three African migrant communities in the EU. Design/methodology/approach – This paper is based on data collected through community-based participatory action research in three communities: Eritrean and Ethiopian community in Palermo, Italy; Guinea Bissauan community in Lisbon, Portugal; and Senegalese and Gambian community in Banyoles, Spain. A total of 24 FGDs and 70 in-depth narrative interviews were conducted for the research. Findings – The research finds that belief systems supporting the practice of FGM among African migrants in the European diaspora are similar to those in their home countries. Beliefs structured around religion, sexuality, decency, marriage and socialisation are particularly significant in perpetuating FGM in the study migrant communities. These are enforced through sanctions and social expectations from the migrants’ home and host communities. Research limitations/implications – Members of the migrant communities that were the focus of this research are ethnically diverse; therefore it is possible that differences in the practice of and views on FGM by various ethnicities may have been masked. Also, due to close linkages between the migrants and their home countries it was hard to delineate beliefs that are specific to the host countries. In addition, it was difficult to assess the level of education of the migrants and how this may have impacted on their beliefs due to their contrasting and inconsistent educational backgrounds. Originality/value – This paper provides evidence to show that the practice of FGM among migrants in the EU is driven by both social norms and individual (parent) behaviour and therefore there is a need for interventions to focus on individual behaviour change and social norm transformation techniques. It also suggests that beliefs around FGM have remained socially significant among migrants despite their exposure to European culture because such beliefs are used to promote the moral standards of girls, marriageability of women, respectability of families, and the assertion of cultural and religious identity in the migrants’ new environment. The paper further underscores the role of migrants’ European context as well as the home country in strengthening beliefs that perpetuate FGM in the EU.

Pneumococcal Antibody Concentrations of Subjects in Communities Fully or Partially Vaccinated with a Seven-Valent Pneumococcal Conjugate Vaccine

BackgroundA recent trial with PCV-7 in a rural Gambian community showed reduced vaccine-type pneumococcal carriage in fully vaccinated compared with control communities. We measured pneumococcal polysaccharide antibody concentrations in this trial to understand further the mechanisms underlying the observed changes.MethodsA single-blind, cluster-randomized (by village) trial was conducted in 21 Gambian villages. In 11 villages, all residents received PCV-7 (Vaccine group); in 10 control villages only children <30 months old or those born during the study received PCV-7. Subjects over the age of 30 months resident in vaccine villages received a single dose of PCV-7 whilst those in control villages received a single dose of a serogroup C meningococcal conjugate vaccine. Serum antibody concentrations against specific pneumococcal polysaccharides were measured in approximately 200 age-stratified subjects before, 4–6, 12 and 24 months following vaccination.ResultsBaseline pneumococcal antibody concentrations were generally high and increased with age up to 10 years. One dose of PCV-7 increased geometric mean antibody concentrations (GMC) in vaccinated versus control villages for vaccine serotypes 6B and 18C, and 4 and 18C, in the young (under 5 years) and older age groups (5+ years) respectively. There were significantly higher proportions of subjects in the vaccinated than in the control communities with an antibody concentration believed to protect against carriage (>5.0 µg/mL) for all but serotype 9V of the PCV-7 serotypes in the older group, but not in the younger age group.ConclusionHigher antibodies in vaccinated communities provide an explanation for the lower pneumococcal carriage rates in fully vaccinated compared to control communities.Trial RegistrationControlled-Trials.com ISRCTN51695599 51695599.

Chlamydia trachomatis ompA Variants in Trachoma: What Do They Tell Us?

BackgroundTrachoma, caused by Chlamydia trachomatis (Ct), is the leading infectious cause of blindness. Sequence-based analysis of the multiple strains typically present in endemic communities may be informative for epidemiology, transmission, response to treatment, and understanding the host response.MethodsConjunctival and nasal samples from a Gambian community were evaluated before and 2 months after mass azithromycin treatment. Samples were tested for Ct by Amplicor, with infection load determined by quantitative PCR (qPCR). ompA sequences were determined and their diversity analysed using frequency-based tests of neutrality.ResultsNinety-five of 1,319 (7.2%) individuals from 14 villages were infected with Ct at baseline. Two genovars (A and B) and 10 distinct ompA genotypes were detected. Two genovar A variants (A1 and A2) accounted for most infections. There was an excess of rare ompA mutations, not sustained in the population. Post-treatment, 76 (5.7%) individuals had Ct infection with only three ompA genotypes present. In 12 of 14 villages, infection had cleared, while in two it increased, probably due to mass migration. Infection qPCR loads associated with infection were significantly greater for A1 than for A2. Seven individuals had concurrent ocular and nasal infection, with divergent genotypes in five.ConclusionsThe number of strains was substantially reduced after mass treatment. One common strain was associated with higher infection loads. Discordant genotypes in concurrent infection may indicate distinct infections at ocular and nasal sites. Population genetic analysis suggests the fleeting appearance of rare multiple ompA variants represents purifying selection rather than escape variants from immune pressure. Genotyping systems accessing extra-ompA variation may be more informative.

Cervical human papillomavirus infection and squamous intraepithelial lesions in rural Gambia, West Africa: viral sequence analysis and epidemiology

The development of effective strategies against cervical cancer in Africa requires accurate type specific data on human papillomavirus (HPV) prevalence, including determination of DNA sequences in order to maximise local vaccine efficacy. We have investigated cervical HPV infection and squamous intraepithelial lesions (SIL) in an unselected cohort of 1061 women in a rural Gambian community. Squamous intraepithelial lesions was diagnosed using cytology and histology, HPV was typed by PCR-ELISA of DNA extracts, which were also DNA sequenced. The prevalence of cervical HPV infection was 13% and SIL were observed in 7% of subjects. Human papillomavirus-16 was most prevalent and most strongly associated with SIL. Also common were HPV-18, -33, -58 and, notably, -35. Human papillomavirus DNA sequencing revealed HPV-16 samples to be exclusively African type 1 (Af1). Subjects of the Wolof ethnic group had a lower prevalence of HPV infection while subjects aged 25–44 years had a higher prevalence of cervical precancer than older or younger subjects. This first report of HPV prevalence in an unselected, unscreened rural population confirms high rates of SIL and HPV infection in West Africa. This study has implications for the vaccination of Gambian and other African populations in the prevention of cervical cancer.

Re-emergence of Chlamydia trachomatis infection after mass antibiotic treatment of a trachoma-endemic Gambian community: a longitudinal study

Community-wide mass antibiotic treatment is a central component of trachoma control. The optimum frequency and duration of treatment are unknown. We measured the effect of mass treatment on the conjunctival burden of Chlamydia trachomatis in a Gambian community with low to medium trachoma prevalence and investigated the rate, route, and determinants of re-emergent infection. 14 trachoma-endemic villages in rural Gambia were examined and conjunctival swabs obtained at baseline, 2, 6, 12, and 17 months. Mass antibiotic treatment with azithromycin was given to the community at baseline. C trachomatis was detected by qualitative PCR and individual infection load then estimated by real-time quantitative PCR. C trachomatis was detected in 95 (7%) of 1319 individuals at baseline. Treatment coverage was 83% of the population (1328 of 1595 people). The effect of mass treatment was heterogeneous. In 12 villages all baseline infections (34 [3%] of 1062 individuals) resolved, and prevalence (three [0.3%]) and infection load remained low throughout the study. Two villages (baseline infection: 61 [24%] of 257 individuals) had increased infection 2 months after treatment (74 [30%]), after extensive contact with other untreated communities. Subsequently, this value reduced to less than half of that before treatment (25 [11%]). Mass antibiotic treatment generally results in effective, longlasting control of C trachomatis in this environment. For low prevalence regions, one treatment episode might be sufficient. Infection can be reintroduced through contact with untreated populations. Communities need to be monitored for treatment failure and control measures implemented over wide geographical areas.

Cytokine and Fibrogenic Gene Expression in the Conjunctivas of Subjects from a Gambian Community Where Trachoma Is Endemic

The role of immunity in blinding trachoma is unclear. Conjunctival gene expression was measured in a population where trachoma is endemic. Proinflammatory (tumor necrosis factor alpha and interleukin-1beta [IL-1beta]), anti-inflammatory (IL-10), and fibrogenic (matrix metalloprotease 9) gene expression was increased in active trachoma. Markers indicative of T-cell response (gamma interferon, IL-4, IL-12p40, and perforin) were increased when chlamydial infection was present.

Maintaining Difference and Managing Change: Female Agrarian Clientelist Relations in a Gambian Community

AbstractThe introduction of dry-season vegetable cultivation on a large scale in Brikama, The Gambia in the early 1970s has led to the development of a new labour system amongst female farmers whereby strangers or clients are given access to land primarily in the dry season for vegetable cultivation in exchange for providing unremunerated labour for hosts for the cultivation of rice in the rainy season. Hosts, who either claim descent from the founding families or have married into founding families, have access to land and control its distribution for women's crops. This article examines the way in which social difference is played out in the acquisition of land and labour through the establishment of agrarian clientelist relations. Agrarian clientelist relations are about the maintenance of host–stranger distinctions and the management of social difference within a rapidly changing Gambian political economy. The nature of these clientelist relations is changing because of the changing relations of agrarian production, related in turn to the introduction of cooperative gardens in the region, the increasing scarcity of farming land and the increasing political power of strangers on a local and national level. The youth, particularly those who are educated, are moving out of farming altogether. Consequently, female hosts are increasingly reliant on their clients' labour. I argue that female hosts attempt to manage these processes of change out of a need to maintain the particular power relations that form the basis for host–stranger distinctions and their existing claims to land and labour. The article examines the tensions and the intra-gender struggles that emerge between female hosts and their client-strangers. In refusing to take the initiative to set up cooperative gardens, female hosts have maintained what they see as their rightful claims to their land and their clients' labour. Hegemonic notions of ‘the correctness of practices’, associated with host–stranger identities, have informed hosts' behaviour and that of their clients, and ultimately influenced the nature of resource allocation.

Maintaining Difference and Managing Change: Female Agrarian Clientelist Relations in a Gambian Community

Maintaining Difference and Managing Change: Female Agrarian Clientelist Relations in a Gambian Community

16-Year-Old Boy With Gross Hematuria

16-Year-Old Boy With Gross Hematuria

Plasma carotenoid and vitamin E concentrations in women living in a rural west African (Gambian) community.

Vitamin E and carotenoid pigments are important nutrients for the maintenance of health and protection of tissues against free radical damage. They also play a potential role in disease-risk-prediction and -protection, but little is known about their physiological and sociodemographic correlates and determinants, especially in a West African context. As part of a study of reproductive health in rural Gambian women, blood samples were obtained from 1286 women aged 15 to 54 years, living in the Farafenni area of The Gambia. Measurement of two forms of vitamin E and six carotenoids in plasma was performed by high performance liquid chromatography. All eight components, but especially the carotenoids: lycopene, alpha- and beta-carotene, exhibited a major seasonal variation, with maximum levels between May and July, corresponding to the end of the "mango" season and the beginning of the "rainy" season. Only the tocopherols varied significantly (increasing) with age. Several unexpected ethnic group differences were observed, and canthaxanthin was present at lower concentrations in women with manual occupations, compared to those with non-manual occupations. There were also significant differences associated with pregnancy and the postpartum period, especially for the tocopherols, but fewer differences associated with marital status. The observed patterns confirm that there are important seasonal, physiological, possibly genetic, and sociodemographic determinants of these nutrients in blood plasma, which may have significance for health and longevity.

Prevalence of herpes simplex type 2 and syphilis serology among young adults in a rural Gambian community.

To estimate prevalence and risk factors for herpes simplex 2 (HSV2) positivity, syphilis and Chlamydia trachomatis infection among rural people aged 15-34 in the Gambia. Questionnaires and serum samples were collected from 1076 men and women aged 15-34 during a cross sectional prevalence survey in a rural area of the Gambia. Sera were screened for antibodies to herpes simplex virus type 2 (HSV2), and for syphilis using Treponema pallidum haemagglutination assay (TPHA) and rapid plasma reagin (RPR) tests. Urine was tested by polymerase chain reaction (PCR) for C trachomatis infection. 28% of women and 5% of men were HSV2 ELISA positive; 10% of women and 2% of men were TPHA positive; and 7% of women and 1% of men were both RPR and TPHA positive. Out of 1030 urine sample tested only six were positive for C trachomatis. 7% of those who reported never having sex were positive for one or other of these tests. Prevalences of all STIs increased with age and were higher in women than men. Women were much less likely than men to seek treatment for STI symptoms at a health centre. Married people were at increased risk of an STI compared with single people. Jola and Fula women had a higher prevalence of HSV2 than women from other ethnic groups, and Fulas also had a higher prevalence of RPR/TPHA positivity. The limited number of sexual behaviour questions were not significantly associated with STIs after adjustment for age, marital status, and ethnic group. The prevalences of the ulcerative infections HSV2 and syphilis in this population are a cause for concern. In a setting where HIV1 prevalence remains low this indicates an urgent need for STI control and behaviour change programmes to prevent an HIV epidemic. Concerns about the validity of reported sexual behaviour data high light the necessity of biological markers in the evaluation of behaviour change programmes.

Human leucocyte antigen (HLA) and malaria morbidity in a Gambian community

Human leucocyte antigen (HLA) class I and class II typing was performed on 177 children in a rural area of The Gambia who were followed for 2 years in a longitudinal study of malaria morbidity. A comparison was made between those who experienced an episode of clinical malaria in one or both years and those who showed no evidence of infection in either year. No convincing association was found between morbidity and class I phenotype. An overall association of morbidity with the distribution of class II haplotypes was seen, but associations with individual DR-DQ haplotypes were not conclusive.

Seasonal variation of paediatric diseases in The Gambia, west Africa.

In a 3-year prospective study of 9584 consecutive paediatric admissions to the Royal Victoria Hospital in Banjul, The Gambia, we examined the impact of seasonal variations in childhood diseases. The four principal diseases (falciparum malaria, pneumonia, gastro-enteritis and malnutrition) all peaked in September to October following the rainy season. The mortality rate was also higher in the rainy season than in the dry season. Of the 1525 children with cerebral malaria, 83% were admitted during the extended rainy season from July to December. With the emergence of chloroquine-resistant malaria over the 3 years, there was a 27% annual increase in severe anaemia owing to malaria. The median age of malarial anaemia (23 months) was significantly younger than that of cerebral malaria (42 months). Malnutrition peaked immediately following the annual rainy season epidemics of bacterial gastro-enteritis but was not associated with the cool dry season rotavirus outbreaks. Rainy season diarrhoea was also associated with more persistent diarrhoea, an older mean age and a higher mortality. Meningitis was caused by either pneumococcus or Haemophilus influenzae in 64% of cases, of whom 19% were 0-2 months of age. Causes of death in hospital showed good agreement with Gambian community studies. We conclude that analysis of hospital data in a developing country can give accurate information on childhood morbidity and mortality patterns which can be used to set priorities for health care interventions. Seasonal variation is a cardinal feature of paediatric diseases in this part of Africa, and accentuates the vulnerability of children in poor families.

Energy expenditure of Gambian women during peak agricultural activity measured by the doubly-labelled water method.

The doubly-labelled water (2H218O) method was used to measure total energy expenditure (TEE) in ten non-pregnant, non-lactating (NPNL), six pregnant (P) and fourteen lactating (L) women in a rural Gambian community. Measurements were made on free-living subjects at a period of peak energetic stress when high agricultural work loads coincided with a hungary season to induce moderately severe negative energy balance. TEE averaged 10.42 (SD 2.08) MJ/d, equivalent to 1.95 (SD 0.38) times resting metabolic rate (RMR). The energy cost of physical activity plus thermogenesis, derived as TEE-RMR, averaged 4.94 (SD 1.96) MJ/d. Expressed per kg body-weight (103 kJ/kg per d) this component of expenditure was 2.5 times greater than comparative values from inactive, affluent women studied previously (39 kJ/kg per d). Estimated energy intake (EI) in a subset of the women (n 13) was only 4.80 (SD 1.58) MJ/d, yielding an apparent deficit of 6.08 MJ/d between EI and TEE. Weight changes suggested that endogenous fat oxidation accounted for only about 0.85 MJ/d, leaving an unexplained difference of over 5 MJ/d. Critical analysis of possible errors suggests that the new doubly-labelled water method has provided the most reliable estimates and that the estimates of EI were substantially in error. This finding has important consequences for other food intake studies.

Nutritional status and risk of morbidity among young Gambian children allowing for social and environmental factors

A prospective study of the relationship between anthropometric indices and subsequent morbidity was conducted during 2 seasons in young children in an urban Gambian community. Children with low height-for-age at the beginning of the rainy season had a significantly higher prevalence of diarrhoea and fever during the next 4 months, even after controlling for the possible confounding effects of a range of social, economic and environmental factors. The association was weaker in the dry season. This indicates that the increased prevalence of symptoms among stunted children is not solely attributable to environmental factors, and suggests that impaired growth is associated with impaired host response to infection.

Alternative measures of diarrhoeal morbidity and their association with social and environmental factors in urban children in The Gambia

Diarrhoeal morbidity was studied during a 15-week period of the rainy season in 244 children aged 6 to 35 months in an urban Gambian community. The average prevalence of diarrhoea was 12·0% and the mean number of episodes per child varied between 2·4 and 2·9 depending on the definition of an episode. The number of chronic episodes lasting 14 d or more was tripled when 7 rather than one diarrhoea-free days were required to define a new episode. Neither prevalence nor the number of episodes varied significantly with age or sex. There was little association between the social and environmental characteristics of the children and diarrhoeal morbidity. The implications of using differing measures of diarrhoeal morbidity are discussed.

Socio‐economic factors associated with child growth in two seasons in an Urban Gambian Community

The relationships between nutritional status and 24 social and economic factors were investigated during the dry season and at the end of the rainy season in about 300 children aged 6 to 35 months living in the urban community of Bakau in The Gambia. Height‐for‐age was associated with the style of house and various other factors related to living conditions, the presence of the father in the compound and the parity of the mother. The associations were similar in both seasons. Weight‐for‐age showed similar, though weaker, associations in the rainy season, but there was little relationship between the socio‐economic factors and weight‐for‐age during the dry season. Few children had low weight‐for‐height in this community, and there was little relationship between weight‐for‐height and socio‐economic factors. This study emphasises the need to consider the effect of seasonal variations when assessing the relationship between nutritional status and socio‐economic factors.

Isotope renography and urinary schistosomiasis: a study in a Gambian community

A transportable apparatus for isotope renography, which allowed deconvolution analysis, was used to study the prevalence and prognosis of abnormalities associated with urinary schistosomiasis. Before carrying out studies in a heavily infected community, observations were made in a non-endemic area to allow derivation of criteria for abnormality. Comparison of the findings in the two areas showed that changes suggesting urinary tract obstruction were more common in the endemic area in subjects between nine and 45 years but not in older subjects. Measurements of effective renal plasma flow showed renal function was impaired in the endemic area in subjects older than 17 years but not in younger subjects. In the endemic area the results of renography were unrelated to the urinary egg count of the subjects examined, but there was an improvement in the abnormal renograms in a group of subjects aged between nine and 20 years who were re-examined a year after treatment with metrifonate. Follow-up data about 316 subjects was obtained two years after renography. Nine subjects had died, including four of the five subjects with abnormalities suggesting both obstruction and over-all loss of renal function. These findings, which are comparable to the results of similar studies using radiological techniques, suggest urinary schistosomiasis may be a significant cause of mortality in adults in intensely infected communities.