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MyChild Solution is an innovative Electronic Immunisation Register (EIR) reliant on Smart Paper Technology, thereby eliminating the need for electronic devices and internet connectivity at the point-of-care. The goal of this study is to characterise the quality of routine immunisation data generated using MyChild Solution compared to data obtained through the conventional health management information system (HMIS) used in The Gambia. We used the World Health Organization's (WHO) Data Quality Review (DQR) Toolkit to evaluate MyChild Solution's data quality in the 19 health facilities across two regions implementing MyChild Solution in The Gambia at the time of the evaluation. We evaluated all applicable data quality metrics as well as additional metrics of interest, including the incidence of recording errors, the incidence of incomplete indicator level data, and implausible dates. Where possible, we compared results to those of the conventional HMIS. Both MyChild Solution and the conventional HMIS produced 100% complete and timely data in their reference years. Both systems had no moderate or extreme outliers and showed the expected Penta 1 to Penta 3 dropout direction. However, the proportion of verification factors that are not acceptable was higher in the conventional HMIS. MyChild Solution was found to near perfectly (99.98%) digitise scanned documents. These and other data quality indicators evaluated demonstrate that MyChild Solution produces high quality data with high completeness, timeliness, and consistency compared to the conventional HMIS system. MyChild Solution produces high quality data as per the DQR Toolkit metrics and other metrics of interest of interest. The more internally consitent data produced through MyChild Solution compared to the conventional HMIS demonstrates its potential for supporting data-driven decision-making in immunisation. [ABSTRACT FROM AUTHOR]

Simple robust approaches are needed to monitor the prevalence and incidence of HIV in Africa. The aim of this study was to evaluate the use of dried blood spot (DBS) as an alternative to serum or plasma for sentinel surveillance. Paired DBS and blood samples were obtained from 200 patients attending a genito-urinary medicine clinic in West Africa. The gold standard of diagnosis was based on the combination of 3 enzyme-linked immunosorbent assays (ELISA) using serum. The presence of HIV antibodies in eluates of dried blood spots was detected by ELISA, Gelatin Particle Assay (GPA) and Pepti-Lav 1-2 in 5 different testing strategies. All 200 eluates were tested individually, and in addition pools of 5 eluates each were tested. The sensitivity of the testing strategies ranged from 95.0% (83.1 - 99.4%) to 100% and the specificity from 97.5% (93.7 - 99.3%) to 100%. Testing in pools of 5 did not affect sensitivity. Dried blood spots were easy to work with. Test kit and laboratory consumable costs varied between 492 pounds and 1037 pounds (unpooled strategies) and 163 pounds and 421 pounds (pooled). The monospecific ELISAs used in this study are no longer in production; currently available differentiating assays need to be tested. DBS are recommended for sentinel surveillance in Africa.

In the Gambia, female fertility societies known as kanyeleng are made up of women who have experienced infertility or the death of a young child. They employ musical performance and fertility ritual practices to support members and promote the health of women and babies. This paper examines the changing forms of creativity and connection practiced by kanyeleng performers through engagement with social media in the context of the COVID-19 pandemic. Drawing on interviews, focus group discussions and participant observation conducted in person and online (2021–2022), we show that while WhatsApp provided an opportunity for kanyeleng to build new social connections and experiment with new forms of musical creativity, it also presented challenges, including inequities in access, and increased misinformation and mistrust of health workers. Going beyond formulations of domestication of technology within private home spaces, we theorise kanyeleng domestication as a process of incorporating social media into their existing ritual practice of claiming public space and power. Finally, we argue that understanding changing forms of communication and connectedness in the Global South demands new methodological approaches to engage participants whose voices are often marginalised in research on social media. [ABSTRACT FROM AUTHOR]

Introduction: In the Global South, (in)fertility care is scarcely recognized as a priority, yet the government of The Gambia has recently included it as one of the key priorities in its reproductive health strategic plan. This inclusion appears to be the result of years of engagement between policy actors, academic researchers, and activists in the field of reproductive health and specifically of infertility. However, the operationalization of the strategic plan may be hampered by multiple factors. The research aims to identify and analyze challenges that may impede the effective implementation of the strategic plan, thereby providing policy action points and practical guidance into the operationalization of (in)fertility care in the context of The Gambia's health system. Methods: This is a mixed-methods study with data from a survey and semi-structured interviews collected between 2020 and 2021 in The Gambia that were separately published. In this paper, we present the triangulation of quantitative and qualitative data using a convergence coding matrix to identify relevant policy action points. Results: Six fertility care policy action points, driven by data, arose from the triangulation and interpretation process, specifically: (i) establishing and maintaining political commitment and national priority for fertility care; (ii) creating awareness and increasing the involvement of men in SRH and fertility; (iii) ensuring data-driven health policymaking; (iv) offering and regulating affordable IVF alternatives; (v) improving knowledge of and means for fertility care provision; and (vi) enhancing the collaboration among stakeholders and building links with the private healthcare sector. Conclusion: This study found the implementation of the fertility care-related activities in the reproductive health strategic plan may face challenges that require careful mitigation through a holistic approach. Such an approach conceptualizes infertility not just as a biomedical issue but as a broader one that incorporates educational and socio-emotional aspects, including male and (not only) female involvement in sexual and reproductive health. Moreover, it is supported by a comprehensive health management information system that includes capturing data on the demand for, and access to, infertility services in The Gambia health system. [ABSTRACT FROM AUTHOR]

The paper examines the Civil Service Reform (CSR) agenda in The Gambia from 2008 - 2015. The study identifies the motives for the civil service reforms in the country during the study period. The paper reviewed theoretical concepts to provide context and clear understanding of terms and concepts used in the paper. CSRs have been undertaken across the world for various reasons. The civil service is an important machinery for the delivery of services to the citizenry and development of the society. Initial attempts on civil service reforms focused more on affordability in terms of the wage bill. This has been a key pillar of the Structural Adjustment Programmes of the 1980s. The focus has evolved to include performance management, capacity building, and improving service delivery. The paper employed desk review and documentary analysis as research method in analysing CSRs in The Gambia. The study reviewed CSR strategy 2008 - 2011 and the CSR programme 2012 - 2015 with a view to establishing the objectives of the reforms and the extent to which these objectives were achieved. As part of its efforts to reform the Gambian civil service and to control the wage bill, the government conducted a nationwide staff and/or payroll verification exercise to eliminate ghost workers and enhance the integrity of the payroll. However, this paper established that some of the key objectives of the civil service reform agenda have not been achieved. The objectives of improved pay and pension, control of the wage bill, the establishment of a performance management system and culture, and capacity building of key institutions have not been achieved. [ABSTRACT FROM AUTHOR]

Copyright of Critical African Studies is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Accurate assessment of water resources at the watershed level is crucial for effective integrated watershed management. While semi-distributed/distributed models require complex structures and large amounts of input data, conceptual models have gained attention as an alternative to watershed modeling. In this paper, the performance of the GR4J conceptual model for runoff simulation in the Gambia watershed at Simenti station is analyzed over the calibration (1981–1990) and validation period (1991–2000 and 2001–2010). The main inputs to conceptual models like GR4J are daily precipitation data and potential evapotranspiration (PET) measured from the same catchment or a nearby location. Calibration of these models is typically performed using the Nash–Sutcliffe daily efficiency with a bias penalty as the objective function. In this case, the GR4J model is calibrated using four optimization parameters. To evaluate the effectiveness of the model's runoff predictions, various statistical measures such as Nash–Sutcliffe efficiency, coefficient of determination, bias, and linear correlation coefficient are calculated. The results obtained in the Gambia watershed at Simenti station indicate satisfactory performance of the GR4J model in terms of forecast accuracy and computational efficiency. The Nash–Sutcliffe (Q) values are 0.623 and 0.711 during the calibration period (1981–1990) and the validation period (1991–2000), respectively. The average annual flow observed during the calibration period is 0.385 mm while it increases with a value of 0.603 mm during the validation period. As for the average flow simulated by the model, it is 0.142 mm during the calibration period (i.e., a delay of 0.142 mm compared to the observed flow), 0.626 mm in the validation period (i.e., an excess of 0.023 mm compared to the observed flow). However, this study is significant because it shows significant changes in all metrics in the watershed sample under different scenarios, especially the SSP245 and SSP585 scenarios over the period 2021–2100. These changes suggest a downward trend in flows, which would pose significant challenges for water management. Therefore, it is clear that sustainable water management would require substantial adaptation measures to cope with these changes. [ABSTRACT FROM AUTHOR]

Undernourishment is a persistent public health problem contributing to increased mortality in children under five in low-income countries, likely exacerbated by socio-economic disparities within communities. This paper aimed to examine the effect of wealth-related inequality on undernutrition in children under five in low, lower-middle, and upper-middle-income countries (LMICs). We analyzed cross-sectional data from the demographic and health survey program collected between 2017 and 2022 from 24 LMICs. Children born within 5 years preceding the survey were included in the analysis. Child undernutrition was the dependent variable (measured by stunting, wasting, and underweight) and country-level wealth-based inequality was the independent variable assessed by concentration index values stratified by the World Bank's income categories. Within country inequality of child undernutrition was determined by concentration index (C) values with 95% confidence intervals (95% CI) and sub-group analysis by place of residence and sex of the child. We then fit bootstrapped meta-regression to check the variation in inequality of child undernutrition across different income category countries. The analysis was controlled by potential confounding variables. From the total sample size of 334,502 children included in the study, 35% were undernourished. Wealth-related inequality in child undernutrition was observed in 11 countries, consistently across income categories. Child undernutrition was highly concentrated among the poor households of Türkiye [C: − 0.26, 95% CI − 0.31 to − 0.20], and Cameroon [C: − 0.19, 95% CI − 0.22 to − 0.17], and relatively it was less concentrated among the poor in Liberia [C: − 0.07, 95% CI − 0.11 to − 0.04], and Gambia [C: − 0.07, 95% CI − 0.11 to − 0.04]. There is no difference in undernutrition associated with inequality between the three broad LMIC categories. The wealth-related inequality in child undernutrition within many of the included countries is still very significant. However, the economic category of countries made no difference in explaining wealth-related inequality in child undernutrition. Inter-sectoral collaboration to fight poverty and render special attention to the disadvantaged population segments would potentially help to address the observed inequity. [ABSTRACT FROM AUTHOR]

Background: Data at primary healthcare (PHC) clinics are handwritten in registers by nurses for submission to the District Health Information System (DHIS). Compared to pen and paper, data capture, using handheld computers, has fewer errors, is more efficient and is readily accepted by users. This study describes the process of developing a tablet computer programme to capture data, and explores nurses' experiences of using tablets at a community health centre. Method: OpenDataKit® was used to design XForms for touchscreen entry. Data for tuberculosis screening were captured by nurses on Android® 9.7-inch tablets over a week. Their experience was explored by means of a focus group interview. Results: Data were recorded for 24 patients and seamlessly transferred for analysis. Nurses thought that the tablets were easy to use and saved time. They would be happy to use tablets in preference to pen and paper. They expressed a desire to extend the use of tablets to other areas of their work. Conclusion: Tablet computers were readily accepted by the nurses. They are a feasible alternative to pen and paper for recording data at point of care. This tablet-based system could be used to transfer PHC data directly to the DHIS. [ABSTRACT FROM AUTHOR]

Purpose: While the possibility of a university fostering sustainable development is present in the extant literature and policy documents, the idea still warrants further consideration. Therefore, this paper aims to identify the nature and outcomes of the university's engagement with Indigenous communities and perceptions of Indigenous knowledge systems in both academic and non-academic activities, and what might be required to foster the university's contributions towards sustainable development. Design/methodology/approach: A qualitative case study of the only public university in The Gambia was conducted, including non-university actors. Interviews and focus group discussion methods were used, and these enabled close collaboration between researchers and participants, and the latter were empowered to describe their perceptions of reality. Findings: Three major sets of findings emerged from the analysis of the transcripts from interviews and focus group discussions with the university and community members. These are the limited nature of and outcomes from university–community engagement, the sustainable outcomes of Indigenous practices and ideas for Indigenising university engagement for sustainable development. Practical implications: Particular implications of the study that underpins this paper can be underscored; these include: a contribution to the literature on ways of connecting Indigenous communities with universities, and to a conceptualisation of the Indigenised university; a provision of insights into the connectivity between university community engagement, Indigenous knowledge systems and sustainable development; the creation of a context for subsequent studies on practical steps that universities might take in the direction of epistemic justice and sustainable development for all; and heightening the intractability of theoretical and philosophical issues of epistemology, knowledge ecology and epistemological justice, as they reveal themselves in practice, in complex situations. Originality/value: Matters of the university reaching out to Indigenous peoples have yet to find their way into conceptualisations of the university for sustainable development. This paper addresses this gap in the existing literature by advancing possibilities for the Indigenised university for sustainable development to emerge. [ABSTRACT FROM AUTHOR]

The incidence and prevalence of type 2 diabetes mellitus (T2DM) and hypertension (and their comorbidity) have been increasing in sub-Saharan Africa, including The Gambia. Diet is a critical driver of these public health problems, and diet-related health education is a major strategy employed for their prevention and management. The aim of this paper is to explore the lived experiences of diet-related health education among individuals with comorbid type 2 diabetes and hypertension in Serrekunda, The Gambia, a subject hitherto unexplored in the country. The study employed a qualitative (interpretivist) methodology. Thirty-two interviews were conducted with 18 participants, with most participating in two interviews at separate time-points between November 2018 and July 2019. In addition to participant validation, the two points in time interviews elicited more depth and provided rich data. The data were analysed using Braun and Clarke's six-phased approach to Thematic Analysis. Four main themes were generated in relation to the experiences: (i) one-off blanket dietary advice (ii) education in a vacuum (iii) diabetes-hypertension diet dichotomy and (iv) imbalanced power relationship. The study underscores the need for a reconfiguration of diet-related health education in The Gambia to include lived experiences as critical components of health promotion in tackling T2DM and hypertension. This requires an ecological approach, critical health education, regulations on unhealthy foods, and active participation of individuals as equal partners in health education. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Climate change is one of the existential threats of modern times, which deserves urgent attention by policymakers. The objective of this paper is to comprehend the impact of climate change on the Gambian economy both in the short and long-run. METHODS: This paper analyses time series data from 1969 to 2016. The study incorporated rainfall and temperature as proxies of climate change into the Cobb- Douglas production function. The Augmented Dickey-Fuller and the Phillips-Perron stationarity test for unit root found that the growth rate of rainfall is not statistically significant with the Mackinnon approximate p-value for z (t) =0.2306. The first lag is significant at 5% and 10% but has a negative coefficient in the first differential up to the fourth lag. In contrast, the growth rate of temperature is statistically significant with a p-value of 0.0196. FINDINGS: The findings revealed that human capital growth is not significantly related to economic growth in The Gambia. In the long-run, the growth rates of climate change variables are all statistically significant and associated with a negative impact on economic growth. For the short-run, the lag difference of rainfall against its own lag is statistically significant and has a positive impact on economic growth. The lag difference in the growth rate of the Gross Domestic Product is not statistically significantly related to the growth rate of rainfall. CONCLUSION: The Gambia is vulnerable to climate change shocks, consequently climate change will negatively impact economic growth resulting in high unemployment, low productivity, and high poverty rate. [ABSTRACT FROM AUTHOR]

Across sub-Saharan Africa many communities lack reliable access to mains electricity, and therefore depend upon unconventional power sources to recharge their mobile phones. Many of these informal recharging centres are powered by a diesel generator or solar panel. Furthermore, many of these same communities are frequently served by broken water pumps. Previous reports indicate that many individuals are prepared to pay a small regular fee to recharge their mobile phone, while their local water point committee lacks sufficient funds to keep their water infrastructure maintained. This paper presents a novel funding strategy aimed at helping communities cover the maintenance costs of their local water supply. This premise was demonstrated using a pilot system in The Gambia which combined a solar-powered community water point with an off-grid smart battery rental hub for everyday electricity needs such as mobile phone charging. The paper presents preliminary field data from this site and explores the wider context surrounding the pilot system. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Elementary Education / Revija za Elementarno Izobraževanje is the property of University of Maribor, Faculty of Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Post malarial neurological syndrome (PMNS) occurs as a sequel of cerebral malaria which is the most deadly form of severe malaria. In holo-endemic regions (areas of high malarial transmission) all forms of severe malaria as well as cerebral malaria usually occur in children and those who are semi or non-immune like pregnant women, migrants as well as tourists. It also occurs in hypo-endemic regions (areas of limited malarial transmission with low immunity) and malaria- free zones. Survivors however may have neurologic complications after recovery. PMNS has been reported in many parts of the world. Being a sequel to cerebral malaria, it is uncommon in adults who were born and reside in a holo-endemic region all their lives. Case report: This is the case of an 18 year old Gambian who has lived in The Gambia all his life that had PMNS five days after recovery from cerebral malaria. Methods: This was a predominantly web based literature search. The search comprise all case reports, original articles and reviews on PMNS or neurological deficits associated with malaria or noted after malaria infection. The search engines used were Google, Yahoo and Google scholar. Results: A total of 62 papers were found. These were used for this review of the literature. Conclusion: Cerebral malaria also occurs in adults in holo-endemic areas though rare and some of the survivors may develop PMNS. It is commoner in the youth age group. There is need for further studies since the youth may be a possible new 'vulnerable group' in holoendemic areas. This may lead to the widening the targeted group for malaria control in the regions of high malarial transmission. [ABSTRACT FROM AUTHOR]

The end of a long-standing autocratic regime in The Gambia renewed EUrope's geopolitical interest in the externalisation of (return) migration management to the West African country. Since 2017, EUrope has financed several programmes implemented by a combination of international and local actors. Analysing original qualitative data through the lens of the sociology of translation (SoT) offered by actor-network theory (ANT), this paper explores the incorporation of locally owned civil society organisations (CSOs) within the socio-material network of externalisation. As such, it engages with the understudied perspective of Southern implementers in the context of migration management. In our analysis, we put central two notions of SoT: interessement and enrolment. With the first, we show how the development and migrant-protection interests of locally owned CSOs are brought in alignment with the EUropean objective of curtailing irregular migration. This process of interessement is never complete, but leaves room for excess positions, which here correspond to the locally owned CSOs' criticism of EUrope's appropriation of Gambian natural resources, practical organisation of migration management and excessive immobilisation of Gambians. The notion of enrolment refers to the processes of negotiation addressing part of these excess positions. Even with enrolment being successful, locally owned CSOs keep imagining, and to some extent, performing alternative ways of dealing with migration. Such alternative thinking and practicing will overtake the EUropean only if multiple and stable connections arise around it. Our ANT-driven analysis demonstrates that local implementers endorse EUropean migration management because they broadly see it as beneficial; yet, with their criticism, requests and imagination, manage to limitedly alter it, and may, potentially, transform it. [ABSTRACT FROM AUTHOR]

Executive functions (EFs) in early childhood are predictors of later developmental outcomes and school readiness. Much of the research on EFs and their psychosocial correlates has been conducted in high-income, minority world countries, which represent a small and biased portion of children globally. The aim of this study is to examine EFs among children aged 3-5 years in two African countries, South Africa (SA) and The Gambia (GM), and to explore shared and distinct predictors of EFs in these settings. The SA sample (N = 243, 51.9% female) was recruited from low-income communities within the Cape Town Metropolitan area. In GM, participants (N = 171, 49.7% female) were recruited from the rural West Kiang region. EFs, working memory (WM), inhibitory control (IC) and cognitive flexibility (CF), were measured using tablet-based tasks. Associations between EF task performance and indicators of socioeconomic status (household assets, caregiver education) and family enrichment factors (enrichment activities, diversity of caregivers) were assessed. Participants in SA scored higher on all EF tasks, but children in both sites predominantly scored within the expected range for their age. There were no associations between EFs and household or familial variables in SA, except for a trend-level association between caregiver education and CF. Patterns were similar in GM, where there was a trend-level association between WM and enrichment activities but no other relationships. We challenge the postulation that children in low-income settings have poorer EFs, simply due to lower socioeconomic status, but highlight the need to identify predictors of EFs in diverse, global settings. RESEARCH HIGHLIGHTS: Assessed Executive Functioning (EF) skills and their psychosocial predictors among pre-school aged children (aged 3-5 years) in two African settings (The Gambia and South Africa). On average, children within each setting performed within the expected range for their age, although children in South Africa had higher scores across tasks. There was little evidence of any association between socioeconomic variables and EFs in either site. Enrichment activities were marginally associated with better working memory in The Gambia, and caregiver education with cognitive flexibility in South Africa, both associations were trend-level significance., (© 2023 The Authors. Developmental Science published by John Wiley & Sons Ltd.)

Background: A significant factor impacting the incidence of maternal and neonatal fatalities is the timely initiation of antenatal care (ANC) services in healthcare facilities. Despite the recommendations by the World Health Organization and the numerous benefits of timely initiation of ANC, studies have revealed that the overall prevalence of timely ANC initiation in 36 sub-Saharan African countries remains low and women in The Gambia also initiate ANC late. However, no known study in The Gambia has focused on assessing the factors associated with timely initiation of ANC at the time of writing this paper. Thus, this study aimed to assess the prevalence and factors associated with the timely initiation of ANC among reproductive-age women in The Gambia. Methods: A cross-sectional survey design was used in this study and conducted among 5,734 reproductive-age women using data from the 2019–2020 Gambia Demographic and Health Survey (GDHS). Using STATA version 14.0, we conducted the analysis using descriptive and inferential statistics. Multilevel logistic regression models were fitted to determine the factors associated with timely ANC utilization and adjusted odds ratios were used to present the results with statistical significance set at p < 0.05. Results: The overall prevalence of timely initiation of ANC services among reproductive-age women in The Gambia was 43.0%. We found that women aged 30–34 [aOR = 1.79, 95% CI = 1.30–2.47], those who were married [aOR = 2.69, 95% CI = 1.85–3.90] as well as women from the richest households [aOR = 1.63, 95% CI = 1.20, 2.20] had higher odds of seeking timely ANC services as compared to their counterparts. Also, those who had given birth to two children [aOR = 0.74, 95% CI = 0.6 -0.91] had lower odds of initiating timely ANC as compared to those who had given birth only once. Women who reside in rural areas [aOR = 1.72, 95%CI = 1.34, 2.20] also had higher odds of seeking timely ANC services than those residing in urban areas. Conclusion: Individual-level factors such as maternal age, marital status, parity, wealth status, place of residence, and religion were associated with the timely initiation of ANC services among reproductive-age women. These factors ought to be considered in efforts to increase the timely initiation of ANC among reproductive-age women in The Gambia. [ABSTRACT FROM AUTHOR]

At least 4.3 million Caper Whites Belenois aurota were observed at sea in the Atlantic Ocean offshore of Senegal and The Gambia between 14 and 18 October 2003. They were moving to the southwest, carried by the northeasterly wind. [ABSTRACT FROM AUTHOR]

This paper examines how large-scale fishmeal processing impacts women's work in The Gambia. Fishmeal factories use bonga (Ethmalosa fimbriata), a staple fish in The Gambia, to produce fishmeal for the global aquaculture industry. The Gambian government yearns for FDI in fishmeal factories to industrialise the fisheries sector, increase fisheries contribution to GDP and ultimately achieve sustainable development through South-South Cooperation with Chinese and Mauritanian capital. However, coastal communities, especially women who live and work within the vicinity of three relatively new Chinese-Mauritanian factories, have been protesting the operations of the factories since 2017. Communities complain about livelihood dispossessions such as the displacement and disruption of women's work, food insecurity, as well as environmental and health concerns engendered by the factories. Using ethnographic methods and ecofeminist as well as feminist political ecology approaches, I argue that the operations of the fishmeal factories, which are underpinned by capitalist, patriarchal logic, disrupt women's work as gardeners and fish vendors. Consequently, instead of promoting sustainable development, fishmeal processing undermines it. [ABSTRACT FROM AUTHOR]

Background: The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network is a new and broadly-based group of research scientists and health advocates based in the UK, Africa and North America. Methods: This paper describes the protocol that underpins the clinical research activity of the Network, so that the investigators, and broader global health community, can have access to 'deep phenotyping' (social determinants of health, demographic and clinical parameters, placental biology and agnostic discovery biology) of women as they advance through pregnancy to the end of the puerperium, whether those pregnancies have normal outcomes or are complicated by one/more of the placental disorders of pregnancy (pregnancy hypertension, fetal growth restriction and stillbirth). Our clinical sites are in The Gambia (Farafenni), Kenya (Kilifi County), and Mozambique (Maputo Province). In each country, 50 non-pregnant women of reproductive age will be recruited each month for 1 year, to provide a final national sample size of 600; these women will provide culturally-, ethnically-, seasonally- and spatially-relevant control data with which to compare women with normal and complicated pregnancies. Between the three countries we will recruit ≈10,000 unselected pregnant women over 2 years. An estimated 1500 women will experience one/more placental complications over the same epoch. Importantly, as we will have accurate gestational age dating using the TraCer device, we will be able to discriminate between fetal growth restriction and preterm birth. Recruitment and follow-up will be primarily facility-based and will include women booking for antenatal care, subsequent visits in the third trimester, at time-of-disease, when relevant, during/immediately after birth and 6 weeks after birth. Conclusions: To accelerate progress towards the women's and children's health-relevant Sustainable Development Goals, we need to understand how a variety of social, chronic disease, biomarker and pregnancy-specific determinants health interact to result in either a resilient or a compromised pregnancy for either mother or fetus/newborn, or both. This protocol has been designed to create such a depth of understanding. We are seeking funding to maintain the cohort to better understand the implications of pregnancy complications for both maternal and child health. [ABSTRACT FROM AUTHOR]

The recent experimental results illustrate that adding ivermectin to artemisinin-based combination therapy can target malaria parasite and its vector, which may be a new treatment option. In this paper, we present a new malaria transmission model, which incorporates spatial heterogeneity, general incidence rate and treatment plan with ivermectin. The basic reproduction number R 0 is introduced as a threshold parameter to determine whether malaria will eventually die out or not. Further, we propose and analyze the regional optimal control problem to minimize mosquito population, exposed and infectious humans as well as cost. Numerically, we investigate the transmission and control of malaria in The Gambia. Results show that the treatment plans with ivermectin and without ivermectin have the same contribution to R 0 , but have different effects on the epidemic level of malaria. This conclusion also holds for different incidence rates with some assumptions. Moreover, by comparing the cost and benefit of different strategies, the most cost-effective strategy is found. • A malaria model includes spatial heterogeneity, general incidence rate and ivermectin therapy. • Regional optimal control problem with terminal state in objective is investigated. • The transmission and control of malaria in The Gambia are discussed. • The effects of mosquito species distribution and incidence rate are explored. • The most cost-effective strategy is determined by comparing cost and benefit of eleven strategies. [ABSTRACT FROM AUTHOR]

Many Gambians have a strong desire to travel internationally, and often risk their lives embarking on the so-called 'back way'. But what of those with the strong desire but for whom foreign visas are elusive or next to impossible to acquire? For most West Africans, getting a visa to a western country is an extraordinarily difficult or even impossible feat. This paper is about the impacts of involuntary immobility in Essau, a small community in the Gambia, West Africa. But the case of this place extends beyond the borders of this one region, because this is the fate for increasing populations around the world. 'Totally napse' refers to the local vernacular that Gambians use to express their sense of hopelessness that often results from being rendered immobile. Youth who want to travel so desperately that they can't think of much else are referred to as having the 'nerves syndrome' or having 'nerves' or being napse. [ABSTRACT FROM AUTHOR]

Background: Menstrual health (MH) is a recognised global public health challenge. Poor MH may lead to absence from school and work, and adverse health outcomes. However, reviews suggest a lack of rigorous evidence for the effectiveness of MH interventions on health and education outcomes. The objective of this paper is to describe the methods used in a cluster-randomised controlled trial to estimate the effect of a multi-component intervention to improve MH and school attendance in The Gambia. Methods: The design ensured half the schools (25) were randomised to receive the intervention which comprised of the following components: (i) Peer education camps and menstrual hygiene laboratories in schools, (ii) Mother's outreach sessions, (iii) Community meetings, and (iv) minor improvements of school Water Sanitation and Hygiene (WASH) facilities and maintenance. The intervention was run over a three-month period, and the evaluation was conducted at least three months after the last intervention activity was completed in the school or community. The other 25 schools acted as controls. Of these 25 control schools one Arabic school dropped out due to COVID-19. The primary outcome was the prevalence of girls missing at least one day of school during their last period. Secondary outcomes included: Urinary Tract Infection (UTI) symptoms, biochemical markers of UTI in urine, Reproductive Tract Infection symptoms, self-reported menstruation related wellbeing, social support and knowledge, perceptions and practices towards menstruation and MH in target school girls. In addition, a process evaluation using observations, routine monitoring data, survey data and interviews was undertaken to assess dose and reach (quantitative data) and assess acceptability, fidelity, context and possible mechanisms of impact (qualitative data). Cost and cost-effectiveness of the intervention package will also be assessed. Conclusion: Results will add to scarce resources available on effectiveness of MH interventions on school attendance. A positive result may encourage policy makers to increase their commitment to improve operation and maintenance of school WASH facilities and include more information on menstruation into the curriculum and help in the reporting and management of infections related to adolescent menstruation. Trial Registration PACTR, PACTR201809769868245, Registered 14th August 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3539 [ABSTRACT FROM AUTHOR]

Across cultures, imitation provides a crucial route to learning during infancy. However, neural predictors which would enable early identification of infants at risk of suboptimal developmental outcomes are still rare. In this paper, we examine associations between ERP markers of habituation and novelty detection measured at 1 and 5 months of infant age in the UK (n = 61) and rural Gambia (n = 214) and infants' responses on a deferred imitation task at 8 and 12 months. In both cohorts, habituation responses at 5 months significantly predicted deferred imitation responses at 12 months of age in both cohorts. Furthermore, ERP habituation responses explained a unique proportion of variance in deferred imitation scores which could not be accounted for by a neurobehavioural measure (Mullen Scales of Early Learning) conducted at 5 months of age. Our findings highlight the potential for ERP markers of habituation and novelty detection measured before 6 months of age to provide insight into later imitation abilities and memory development across diverse settings. [ABSTRACT FROM AUTHOR]

This paper concerns mental health services in The Gambia. It describes local concepts, experiences and knowledge about mental illness and the implications of such beliefs and attitudes for access to mental health services. A pretested questionnaire and interview guide were administered to a sample of patients/family members. Barriers to accessing mental health services were identified. These included beliefs about the causes of mental illness; family decision-making; the scarcity and high cost of services. Obtaining access to mental health services in The Gambia is currently challenging. Importantly, increased community and family education about the causes and treatment of mental illnesses will be required to address these issues. [ABSTRACT FROM AUTHOR]

Copyright of International Interactions is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective of this paper is to assess the relationship between government support programs and performance of Small and Medium Enterprises (SMEs) in Brikama region of Gambia. Three dimensions of government support programs, namely, training assistance, financial assistance and marketing assistance are analyzed to examine the relationship between government support programs and performance (proxied by sales, return on asset, return on equity, assets turnover, net profit and debt ratio) of SMEs. Using a questionnaire, 80 SMEs are sampled via stratified sampling method. Percentages and Pearson chi-square techniques are utilized to analyze the data. Among others, the study finds a statistically significant relationship between sales and training assistance. In addition, the relationships between marketing assistance and sales as well as marketing assistance and return on assets are found to be statistically significant. Further, the relationships between financial assistance and return on equity as well as financial assistance and debt ratio are found to be statistically significant. Therefore, there is a need for increased government support in order to enhance the performance of SMEs in Gambia. [ABSTRACT FROM AUTHOR]

The unified theory of acceptance and use of technology (UTAUT) are used to investigate technology adoption. However, its application in Sub-Saharan Africa is rare and barely extended to the validation phase. In this paper, we introduce six new moderating factors for UTAUT core determinants and two other direct determinants of Internet adoption. The objective of this approach is to identify relevant elements of Internet adoption at the user level in The Gambia. Moderating factors are interacting terms used when the relationship between independent and dependent variable is weak, inconsistent or non-existent. A case study research design was employed and the data were gathered in Autumn of 2012. A total of 200 questionnaires were administered to randomly selected students from the University of the Gambia. The students represented all administrative regions of the country. Our results suggest that Internet adoption at the user level in The Gambia can be viewed as a three-layered pyramid. It consists of seven moderating factors (age, gender, experience, voluntary use, friends' influence, Internet service providers and regulators), four indirect determinants (performance expectancy, effort expectancy, social influence and facilitating conditions) and three direct determinants (education, behavioral intention and income). This paper proposes an Internet adoption framework. We recommend it to be tested and validated in other African countries in order to determine its applicability. [ABSTRACT FROM PUBLISHER]

Copyright of Journal of Universal History Studies is the property of Sabit Dokuyan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION Access to tobacco plays a strong role in smoking initiation among youth. This study aimed to quantify successful purchase of cigarettes and assess the factors associated with cigarette purchase access among students aged 11--17 years in The Gambia. METHODS We used the 2017 Global Youth Tobacco Survey (GYTS) of 12585 students, aged 11--17 years from The Gambia. The analysis was restricted to 2951 students aged 11--17 years who bought and/or attempted to buy cigarettes within the past 30 days regardless of smoking status. Our outcome was purchasing access, defined as successfully purchasing cigarettes within the past 30 days. We report a weighted prevalence of successful purchase attempt. Multivariable logistic regression assessed the factors associated with successful purchase of cigarettes and was adjusted for non-response and the complex survey design. RESULTS Most students (59.4%, 95% CI: 55.4--63.3) who attempted to purchase cigarettes were successful, most of whom were boys (61.3%, 95% CI: 57.8--64.6). However, there was no significant difference in successful attempts to purchase cigarettes between boys (59.3%, 95% CI: 54.2--64.2) and girls (59.4%, 95% CI: 55.4-- 63.3). Older age (AOR=2.45; 95% CI: 1.25--4.78), higher school grade (AOR=1.53; 95% CI: 1.09--2.16) and current cigarettes smoking (AOR=1.41; 95% CI: 1.08--1.85) were significantly associated with successful attempt to purchase cigarettes. Sex, parents' smoking status and students' weekly pocket money were not associated with successful cigarettes purchase attempt. Among students who currently smoke cigarettes, 55.6% (95% CI: 47.7--63.2) bought them from a store, shop, street vendor, or canteen; 12.2% (95% CI: 8.3--17.5) obtained them from someone else, and 6.7% (95% CI: 4.4--10.0) used other means the last time they smoked. CONCLUSIONS Students in The Gambia can purchase cigarettes without much hinderance despite the restrictions. Our research findings can guide the implementation of policies, programs, and public health strategies including more efforts toward implementing tobacco control laws and regulations that protect children from exposure and use of all forms of tobacco products. [ABSTRACT FROM AUTHOR]

In recent years, sexual exploitation of Nigerian and Gambian girls and women has become an increasing concern, particularly in the context of human trafficking. Many of these girls are enticed away from their homes by promises of a job or school, only to be pushed into prostitution once they arrive in Europe. This paper seeks to investigate the issue of Afro-Euro modern slavery in the twenty-first century in relation to the sex trafficking of girls from Nigeria and the Gambia into Europe by studying some noteworthy incidents and discussing the underlying elements that led to this situation. The information was taken from the interview guide and studies from prestigious research institutions. The technique of content analysis was used to analysed the data. Snowball and purposive sampling techniques were used to pick respondents and locations in Nigeria and Gambia, respectively. The findings of the study revealed that economic hardship and insecurity were among the issues identified by respondents as the reasons for the acts of sexual exploitation and prostitution in both countries. These reasons were also justified by scholars who have conducted similar research on sexual exploitation. However, there appears to be a gap in the body of literature concerning the underlying causes of sexual exploitation and its expressions, which have been traced back to decades of slavery and colonial institutions. This has resulted in cultural erosion and distorted values, among other things, in the study areas. This study has reinforced the idea that sexual exploitation in Africa is a result of institutional failure, moral deterioration, and the erection of artificial borders or governments. The study recommends increased dedication on the part of African and UN officials in the fields of study and the integration of African nations on the subject. [ABSTRACT FROM AUTHOR]

Global trends influence strategies for health-care delivery in low- and middle-income countries. A drive towards uniformity in the design and delivery of healthcare interventions, rather than solid local adaptations, has come to dominate global health policies. This study is a participatory longitudinal study of how one country in West Africa, The Gambia, has responded to global health policy trends in maternal and reproductive health, based on the authors’ experience working as a public health researcher within The Gambia over two decades. The paper demonstrates that though the health system is built largely upon the principles of a decentralised and governed primary care system, as delineated in the Alma-Ata Declaration, the more recent policies of The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria and the GAVI Alliance have had a major influence on local policies. Vertically designed health programmes have not been easily integrated with the existing system, and priorities have been shifted according to shifting donor streams. Local absorptive capacity has been undermined and inequalities exacerbated within the system. This paper problematises national actors’ lack of ability to manoeuvre within this policy context. The authors’ observations of the consequences in the field over time evoke many questions that warrant discussion, especially regarding the tension between local state autonomy and the donor-driven trend towards uniformity and top–down priority setting. [ABSTRACT FROM AUTHOR]

This paper applies the collective household model to allocate household resources among household members. With a Collective Quadratic Almost Ideal Demand System (CQUAIDS) estimated by a Feasible Generalized Nonlinear Least Squares (FGNLS) method, it studies the household demand for six categories of household goods using household income and expenditure survey data from The Gambia, directed to studying the allocation of resources among young and adult members of households in The Gambia. It establishes the sharing rule for children and adult members of the household and shows the effect of demographic, distributive factor, price and income elasticities on the shares of household resources. The results establish that a higher share of resources goes for children while the sharing rule varies for different household types. Also, the findings show significant effects of demographic, distributive factor, price and income on the allocation of the household resources of consumption goods by the household. [ABSTRACT FROM AUTHOR]

As a developing economy, three major economic problems witnessed in the Gambia are the growing unemployment rate, migration (immigration and rural–urban drift) leading to urban population growth and the growing semi-skilled working population in the face of unemployment. This study seeks to answer the question of how the Gambian economy can plan to overcome these problems, coupled with post-COVID-19 global economic shocks, through a technically planned capacity development. In this paper, the trends in variables representing capacity development indicators, migration, unemployment and working population in the Gambia are studied using the Autoregressive Integrated Moving Average (ARIMA) model. To project a system of interrelationship among these variables in the Gambia, the study employs the Vector Autoregressive (VAR) forecast analysis for the period between 1990 and 2019, thereafter generates a five-year forecast. The findings confirm that investment into the educational sector in developing economies is bound to yield increasing return to scale in the next five years. Investment into education, training and skill acquisition, if done, will attract the transfer of technical and managerial skills and technology for the purpose of building up general national capacity in such a developing economy. [ABSTRACT FROM AUTHOR]

This paper critically assesses The Gambia's New Education Policy (2004-2015), and by extension the Education Sector Strategic Plan (2006-2015). It is argued that The Gambia's current political and economic environments are not conducive to meeting these policy goals, and in fact, undermine them. We propose that a critical holistic educational pedagogy predicated on democratic foundations offers the best hope for realizing the goals of "Vision 2020," and the New Education Policy. The paper begins in section one with a backdrop of Gambia's political development, and in section two, we briefly discuss education, past and present. In the third and fourth sections, post-coup education policy and the New Education Policy are analyzed, respectively. Post-coup economics and "Vision 2020," along with the UN Millennium Development Goals (MDGs) are analyzed in sections five and six, respectively. In section seven, we propose a critical holistic educational model that is the crux of the paper and bring into sharper focus aspects of the New Education Policy. It is divided into several sub-sections, which spell out components of the model: (a) socio-cultural (b) economic growth and development, (c) distributive/social justice, and (d) political democracy. The paper concludes with our final thoughts in section eight. [ABSTRACT FROM AUTHOR]

This paper employs a stochastic production frontier model to assess the efficiency of the senior secondary schools in the Gambia. It examines their efficiency in using and mixing the educational inputs of average teacher salary, average teacher education, average teacher experience and students to teacher ratio in producing the number of students scoring credit and above in English and Mathematics. The schools are categorized into three types: the Government schools, the subsidized schools and the private schools. The paper finds no evidence that the private schools are different from the subsidized schools, but there is robust evidence that the private schools are significantly different from the Government schools. The average teacher salary is found to be irrelevant to the student performance, whereas high average teacher experience significantly improves student performance, and high student-to-teacher ratio significantly negates the student performance. Private schools appear to be the most efficient in 2006, but from 2007 to 2008, the performance of the schools in general is found to be highly volatile and unpredictable. Only one school emerges to consistently maintain a superior efficient performance throughout the three years studied. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to evaluate critically the meta-narrative that there is no alternative to capitalism. Building upon an emerging body of post-structuralist thought that has begun deconstructing this discourse in relation to western economies and post-Soviet societies, this paper further extends this critique to Sub-Saharan Africa by investigating the degree to which people in the Gambia rely on the capitalist market economy for their livelihood. Reporting the results of 80 household face-to-face interviews (involving over 500 people), the finding is that only a small minority of households in contemporary Gambian society rely on the formal market economy alone to secure their livelihood and that the vast majority depend on a plurality of market and non-market economic practices. The outcome is a call to re-think the lived practices of economic transition in Sub-Saharan Africa in general and the Gambia in particular, so as to open up the feasibility of, and possibilities for, alternative economic futures beyond capitalist hegemony. Design/methodology/approach - Some 80 households (involving over 500 people) were interviewed face-to-face on their livelihood coping strategies. Findings - Reporting the results of 80 household face-to-face interviews (involving over 500 people), the finding is that only a small minority of households in contemporary Gambian society rely on the formal market economy alone to secure their livelihood and that the vast majority depend on a plurality of market and non-market economic practices. Practical implications - The outcome is a call to re-think the lived practices of economic transition in Sub-Saharan Africa in general and the Gambia in particular, so as to open up the feasibility of, and possibilities for, alternative economic futures beyond capitalist hegemony. Originality/value - This research gives us an empirical understanding of the implications of lived experiences of people''s day-to-day livelihood coping strategies, which refutes the capitalist''s thesis and calls of a re-think on economic and sustainable development policies and strategies in Sub-Saharan Africa [ABSTRACT FROM AUTHOR]

Taking tourism as a metaphor for the complex and unequal relationship between the Majority World and the more affluent tourist-generating countries, this paper reports research into ways in which educational tourism can facilitate mutually beneficial exchanges between 'hosts and guests'. The empirical work is based on data collected as part of an innovative field-based education project on international tourism development and management with field-based activities conducted in The Gambia. The paper aimed to show that if the exchange, both culturally and pragmatically, was to benefit not only the visiting students but also the host country, then values, cross-cultural interaction, innovation and knowledge exchange would have to play key roles to ensure that this peer-to-peer capacity-building opportunity though educational tourism would contribute to sustainable (tourism) development in the chosen locality. [ABSTRACT FROM AUTHOR]

This paper looks at the ways that people living with HIV in the Gambia, as members of HIV support groups, engaged with the programmes available to them in this context. People living with HIV engage with the global in a variety of ways. Following Ong and Collier this paper analyses the way in which people in this context experience and negotiate with the “global assemblage” around international HIV work. This can be observed in everyday practice in the formation of networks and partnerships linking people and their activities into international structures. Using qualitative methods and a grounded theoretical approach, the research followed events around HIV treatment in the Gambia 2006–2007. Looking at the support societies and their members' struggles to gain some material support, findings show how support group members negotiated and expressed agency within the available structures. They make use of accepted frames of international action which bypass the state, presenting an internationally linked “biological citizenship” which brings associated opportunities to access resources. Through the intervention of the president and his “cure” programme, this case also illustrates that people's commitment to the value structures implicit in these funding streams may not be as strong as might be assumed. In these circumstances two alternate treatment programmes, linked to very different values, were on offer, both backed up by the powerful machinery of either the state or international funding. The negotiation by people living with HIV of these avenues through which to acquire benefits and so support and health, calls into question assumptions of a “buy in” to global ideas and values without further scrutiny of the ways in which such assemblages function in different contexts. [ABSTRACT FROM PUBLISHER]

This paper argues that whilst fieldwork continues to make an important contribution to the learning and teaching of geography, analysis of the present-day practice of UK universities taking students on long-distance overseas trips remains apolitical and, by and large, concerned with practicalities. If this practice is analysed by locating it within a postcolonial theoretical framework of ‘whiteness’ it is then possible to look at the differing standpoint and positionality of those doing the viewing and those being viewed, and to also see the connections between the imperialist history of geographical exploration and present-day overseas field trips, in particular to developing countries. Using personal experience of taking UK undergraduates to visit historic slave trading sites in The Gambia as an example, the paper argues that the potential of field study to contribute to the critical pedagogy of geographical fieldwork within UK institutions of higher education requires stronger political analysis. [ABSTRACT FROM AUTHOR]

Ocean governance is constituted by a range of institutions and actors across nation-states, markets, civil society and communities. As government-led management of commercial wild capture fisheries came under increased scrutiny following the rise of neo-liberalism and overfishing in the late 20th century, many non-governmental organizations and businesses turned to market and consumer-oriented approaches such as eco-labels and certification systems to define and reward sustainable fisheries and to incentivize change in others. However, our understanding of how small-scale fisheries in the Global South engage with these systems over time remains limited, particularly in the African context. This paper seeks to improve understanding by examining the interactions between diverse actors working to achieve Marine Stewardship Council certification for a small-scale fishery in The Gambia, West Africa, one of the earliest in Africa to engage the program. Situating the study within social science research on inequities and power imbalances in Southern engagements with Northern-led sustainability certifications, the case study analyzes qualitative data from documents and from 16 key-informant interviews. The data was organized using a social science approach which enables the analysis of factors promoting or hindering governance interactions and of who and what drives outcomes. Taking multiple factors into account, this paper argues that Southern interest in, and accessibility to, certification is dynamic, and influenced by the uneven distribution of regulatory resources, capacity, power and benefits. Promised but nebulous benefits clashed with arduous and recurring appraisals, exacerbating institutional factors leading the fishery to repeatedly fall short of certification. While important improvements can be gained from the pursuit of certification, Southern producers, managers and policy makers should have opportunities to be better informed about the diverse factors impacting: i) governance interactions and capacity building, ii) paths towards, and barriers to, improvements, and ii) the likelihood, or not, for achieving equitable access and social development benefits, especially for marginalized producers. The role and significance of sustainability certification in future ocean governance will be shaped fundamentally by such knowledge. • Sustainability certification remains an influential form of fisheries governance. • Responses to MSC certification in the Global South remain understudied. • Few studies have examined fisheries certification failures in African contexts. • Studying governance interactions can identify key capacities for change. [ABSTRACT FROM AUTHOR]

Instability in the movement of prices is a major concern in all countries. The rise in foreign exchange and prices of goods and services are among the key factors that causes fluctuation in the economic growth of a country. Thus, this paper adopted the ARDL model to examine whether real effective exchange rate, economic growth and money supply causes Inflation in the Gambia for the period 1985 to 2021. The finding reveals that all our variables causes inflation positively and negatively in the long run and short run respectively at a significant level of 1% except real effective exchange rate and money supply which is significant at 5% level in the long run. The recursive cumulative sum shows that the relationship was stable and the square recursive cumulative sum reveals instability in the relationship of our dependent and independent variables which could be as a result of exogenous shock in output and increase amount of public debts. The study recommends the Gambian government to be caution in taking increase amount of public debts and also the central bank of the Gambia to move from monetary targeting to inflation targeting so as to maintain economic growth and price stability. However, the central bank of the Gambia should assess the entire economy before implementing the policy. [ABSTRACT FROM AUTHOR]

Background Invasive bacterial diseases (IBD) cause significant mortality in young infants. There are limited population-based data on IBD in young infants in Sub-Saharan Africa. Methods We conducted population-based surveillance for IBD among infants aged 0-90 days in a demographic surveillance area in rural Gambia between 1 March 2011 and 31 December 2017. Infants admitted to health facilities within the study area had standardised clinical evaluation plus conventional microbiological investigation. We defined IBD as isolation of pathogenic bacteria from blood, cerebrospinal fluid, lung, or pleural aspirate. We determined incidence, aetiology and case-fatality of IBD. Results A total of 3794 infants were admitted and 3605 (95%) had at least one sample collected for culture. We detected 254 (8.0%) episodes of IBD (bacteraemia 241; meningitis 14; pneumonia seven). The incidence of IBD in infants aged 0-90 days was 25 episodes/1000 person-years (95% confidence interval (CI) = 22-28), the incidence in neonates was 50 episodes/1000 person-years (95% CI = 43-58) and the incidence in infants aged 29-90 days was 12 episodes/1000 person-years (95% CI = 9-15). The most common pathogens causing IBD were Staphylococcus aureus (n = 102, 40%), Escherichia coli (n = 37, 15%), Streptococcus pneumoniae (n = 24, 9%) and Klebsiella pneumoniae (n = 12, 5%). Case-fatality was 29% (95% CI = 23-37) in neonates and 19% (95% CI = 11-29) in infants aged 29-90 days. A minimum of 7.3% of all young infant deaths in the population were caused by IBD. Conclusions IBD are common in young infants in rural Gambia and have a high case-fatality. Strategies are needed to prevent IBD in young infants. Overcoming barriers to widespread implementation of existing vaccines and developing new vaccines against the most common pathogens causing IBD should be among top priorities for reducing the high mortality rate in young infants. [ABSTRACT FROM AUTHOR]

Background Clinical management of chronic hepatitis B virus (HBV) infection is complex and access to antiviral treatment remains limited in sub-Saharan Africa. International guidelines recommend monitoring at least annually for disease progression among HBV-infected people not meeting treatment criteria at initial diagnosis. This study aimed to assess the impact and cost-effectiveness of alternative strategies for monitoring. Methods We used a mathematical model of HBV transmission and natural history, calibrated to all available West African data, to project the population-level health impact, costs and cost-effectiveness of different monitoring strategies for HBV-infected individuals not initially eligible for antiviral treatment. We assumed that these patients were found in the year 2020 in a hypothetical community-based screening programme in The Gambia. Monitoring frequencies were varied between every 5 and every 1 year and targeted different age groups. Results The currently recommended annual monitoring frequency was likely to be not cost-effective in comparison with other strategies in this setting. 5-yearly monitoring in 15-45-year olds, at US$338 per disability-adjusted life year averted, had the highest probability of being the most effective cost-effective monitoring strategy. Conclusions Monitoring less frequently than once a year is a cost-effective strategy in a community-based HBV screening and treatment programme in The Gambia, with the optimal strategy depending on the cost-effectiveness threshold. Efficiencies may be gained by prioritising the 15-45-year age group for more intensive monitoring. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the implications of including tympanometry in the Rapid Assessment of Hearing Loss survey protocol. A comparative study design was employed, with findings from otoscopy compared with the results of tympanometry. Method: A population-based survey of the prevalence and causes of hearing loss among adults aged over 35 years in The Gambia was conducted. Clinical assessments included air conduction audiometry, otoscopy and clinical history. Otoscopy outcome was recorded and for those with hearing loss, a probable cause was assigned. Following otoscopy, tympanometry was completed. Otoscopy outcome was not changed as a result of tympanometry. Clinician assigned cause was compared to the results of tympanometry. The proportion of causes potentially misclassified by excluding tympanometry was determined. Results: Among people with hearing loss, including tympanometry led to a higher proportion diagnosed with middle-ear conditions. Conclusion: The value of adding tympanometry to population-based survey protocols is a higher estimated proportion of hearing loss being attributed to middle-ear disease rather than sensorineural causes. This can inform service needs as more people will be classified as needing medical or surgical services, and a slightly lower number will need rehabilitative services, such as hearing assistive devices. It is highly recommended that tympanometry is included in the protocol. [ABSTRACT FROM AUTHOR]

Background: A community’s cultural beliefs, attitudes and discourse can affect their responses in surveys. Knowledge of these cultural factors and how to comply with them or adjust for them during data collection can improve data quality. Objective: This study describes implications of features of Gambian culture related to women’s reproductive health, and mortality, when collecting data in surveys. Methods: 13 in-depth interviews of female interviewers and a focus group discussion among male interviewers were conducted in two rural health and demographic surveillance systems as well as three key informant interviews in three regions in The Gambia. Results: From the fieldworker’s viewpoint, questions relating to reproduction were best asked by women as culturally pregnancies should be concealed, and menstruation is considered a sensitive topic. Gambians were reluctant to speak about decedents and the Fula did not like to be counted, potentially affecting estimation of mortality. Asking about siblings proved problematic among the Fula and Serahule communities. Proposals made to overcome these challenges were that culturally-appropriate metaphors and symbols should be used to discuss sensitive matters and to enumerating births/deaths singly instead of collecting summary totals, which had threatening connotations. This was as opposed to training interviewers to ask standardised and precise verbatim questions. Contribution: This paper presents indigenous Gambian solutions by fieldworkers to culturally sensitive topics when collecting pregnancy outcomes and mortality data in demographic and health surveys. For researchers collecting maternal mortality data, it highlights the potential shortcomings of the sibling history methodology. [ABSTRACT FROM AUTHOR]

Gambian irregular migration is a phenomenon that is well known and discussed within this small African nation, yet little is understood of the deep personal and socio-cultural motives to embark on the perilous journey across the Sahara towards Europe. This paper explores the ambitions and capabilities of Gambians who embark on irregular migration, or the so-called 'backway'. [ABSTRACT FROM AUTHOR]

Background We investigated whether adding community scheduled malaria screening and treatment (CSST) with artemether-lumefantrine by community health workers (CHWs) to standard intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) would improve maternal and infant health. Methods In this 2-arm cluster-randomized, controlled trial, villages in Burkina Faso, The Gambia, and Benin were randomized to receive CSST plus IPTp-SP or IPTp-SP alone. CHWs in the intervention arm performed monthly CSST during pregnancy. At each contact, filter paper and blood slides were collected, and at delivery, a placental biopsy was collected. Primary and secondary endpoints were the prevalence of placental malaria, maternal anemia, maternal peripheral infection, low birth weight, antenatal clinic (ANC) attendance, and IPTp-SP coverage. Results Malaria infection was detected at least once for 3.8% women in The Gambia, 16.9% in Benin, and 31.6% in Burkina Faso. There was no difference between study arms in terms of placenta malaria after adjusting for birth season, parity, and IPTp-SP doses (adjusted odds ratio, 1.06 [95% confidence interval,.78–1.44]; P =.72). No difference between the study arms was found for peripheral maternal infection, anemia, and adverse pregnancy outcomes. ANC attendance was significantly higher in the intervention arm in Burkina Faso but not in The Gambia and Benin. Increasing number of IPTp-SP doses was associated with a significantly lower risk of placenta malaria, anemia at delivery, and low birth weight. Conclusions Adding CSST to existing IPTp-SP strategies did not reduce malaria in pregnancy. Increasing the number of IPTp-SP doses given during pregnancy is a priority. Clinical Trials Registration NCT01941264; ISRCTN37259296. [ABSTRACT FROM AUTHOR]