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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. [ABSTRACT FROM AUTHOR]

Background and Aim: Globally, over 180,000 children develop cancers yearly, with about 80% residing in low‐ or middle‐income countries where cancer‐associated mortality is also high. In The Gambia, cumulative incidence rate of 27.6 childhood cancers/million population was reported between 2002 and 2011. The current study appraised newly‐established pediatric oncological services in The Gambia. Methods: In this prospective registry study, children with cancer who presented at the pediatric units, Edward Francis Small Teaching Hospital, Banjul, between November 2022 and October 2023 were assessed. Data on sociodemographic variables, mode of admission and presentation, tumor type, diagnostic methods, and challenges such as laboratory support, treatment, use of blood/blood products; and eventual outcome were analyzed. Results: The median (interquartile range, IQR) age at presentation of the 44 children was 36.0 (22.3–117.0) months. Wilms tumor was the most common tumor 12 (27.3%); followed by leukemia 11 (25.0%); germ cell tumor 8 (18.2%); lymphoma 6 (13.6%); retinoblastoma 4 (9.1%); rhabdomyosarcoma 2 (4.5%) and one central nervous system tumor (2.3%). The median(IQR) duration of symptoms before presentation was 48 (21–90) days, presentation to diagnosis 7.5 (3–20.8) days, and first symptom to diagnosis 62.5 (32–126.8) days. Treatment refusal and abandonment rates were 20.5% and 13.6%, respectively. Families of 93.8% of children could not procure cytotoxic drugs due to nonavailability, high cost, or both. Adequate laboratory monitoring was only available in 6.8%, and none had platelet concentrate transfusion or radiotherapy. The nine (20.5%) who completed treatment are currently being followed up, 10(22.7%) are still receiving chemotherapy, while 2(4.5%) were referred. Eight (18.2%) died, predominantly from metastasis (75%) and severe drug toxicities (25%). Conclusion: Late presentation and diagnosis, poverty, unavailability of drugs, suboptimal or lack of laboratory testing, blood product, adjuvant medications, and psychosocial supports contributed to high treatment refusal, abandonment, and mortality. These daunting challenges can be ameliorated with regular community sensitization, frequent cancer auditing, and strong political will. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions Human childrearing is cooperative, with women often able to achieve relatively high fertility through help from many individuals. Previous work has documented tremendous socioecological variation in who supports women in childrearing, but less is known about the intracultural correlates of variation in allomaternal support. In the highly religious, high‐fertility setting of The Gambia, we studied whether religious mothers have more children and receive more support with their children.We randomly sampled 395 mothers and 745 focal children enrolled in the Kiang West (The Gambia) Longitudinal Population Study cohort. Structured interviews asked mothers who and how often people invest in their children, and about their religious practices. Data were collected at participants' homes on electronic tablet‐based long‐form surveys and analyzed using the Bayesian hierarchical models.Religiosity was weakly associated with women's higher age‐adjusted fertility. Maternal religiosity was negatively related to maternal investment in focal children, but positively associated with total allomaternal support. Specifically, a woman's religiosity was positively associated with allomaternal support from matrilineal kin, other offspring, and affinal kin, but unrelated to paternal, patrilineal, and non‐kin investment.These results suggest that higher fertility among religious mothers may be supported by high levels of investment from biological and affinal kin. Matrilineal kin, other siblings, and affinal kin seem to be the most responsive to a woman's religiosity. Our findings cast doubt on interpretations of women's religious behaviors as signals of fidelity, and instead suggest they may be part of strategies to enable collective allomaternal resources and higher relative fertility. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcer is the most common complication causing lots of admissions among diabetic patients. Understanding patients' level of foot self‐care knowledge, practice and associated factors is important for planning interventions to control and prevent diabetic foot complications. This study aimed to assess the level of knowledge and practice of foot self‐care among diabetic patients attending diabetic clinics in The Gambia. Two hundred and seventeen patients attending diabetic clinics in two public hospitals were selected using a successive sampling technique. Data were collected using a validated interviewer‐administered questionnaire. Descriptive statistics were used to summarize the demographic and clinical data. Multivariate logistic regression was used to identify factors associated with foot self‐care knowledge and practice. The findings showed a poor level of foot self‐care knowledge (n = 114; 52.5%) and practice (n = 149; 68.7%). Patients' educational level was statistically significantly association with diabetic foot self‐care knowledge (p = 0.02). Diabetic foot ulcer history (aOR = 0.23, 95% CI: 0.08–0.63; p < 0.001), diabetic hospitalization (aOR = 2.41, 95% CI: 1.23–4.75, p = 0.01) and diabetic foot care education (aOR = 2.65, 95% CI: 1.39–5.06, p < 0.001) were statistically significantly associated with foot self‐care practice. The poor diabetic foot self‐care knowledge and practice among these patients emphasize the need for a diabetic health education program in these clinics. [ABSTRACT FROM AUTHOR]

Phenological mismatch is often cited as a putative driver of population declines in long‐distance migratory birds. The mechanisms and cues utilized to advance breeding ground arrival will impact the adaptability of species to further warming. Furthermore, timing of post‐breeding migration potentially faces diverging selective pressures, with earlier onset of tropical dry seasons favouring migration advancement, while longer growing seasons in temperate areas could facilitate delayed departures. Despite this, few studies exist of migration phenology on the non‐breeding grounds or on post‐breeding passage. Here, we use first arrival and last departure dates of 20 species of trans‐Saharan migratory birds from tropical non‐breeding grounds (The Gambia), between 1964 and 2019. Additionally, we use first arrival and last departure dates, as well as median arrival and departure dates, at an entry/departure site to/from Europe (Gibraltar), between 1991 and 2018. We assess phenological trends in pre‐ and post‐breeding migration, as well as individual species' durations of stay in breeding and non‐breeding areas. Furthermore, we assess the extent to which inter‐annual variation in these timings may be explained by meteorological and ecological variables. We find significant advances in pre‐breeding migration at both locations, while post‐breeding migration is delayed. At Gibraltar, these trends do not differ between first/last and median dates of migration. The combination of these trends suggests substantial changes in the temporal usage of the two continents by migratory birds. Duration of stay (of species, not individuals) within Europe increased by 16 days, on average, over the 27‐year monitoring period. By contrast, duration of species' stays on the non‐breeding range declined by 63 days, on average, over the 56‐year monitoring period. Taken together these changes suggest substantial, previously unreported alterations to annual routines in Afro‐Palaearctic migrants. [ABSTRACT FROM AUTHOR]

Thiamine deficiency disorders are associated with a variety of clinical symptoms affecting the nervous and cardiovascular systems. There is growing recognition that thiamine deficiency can occur in populations well beyond the classical region of South Asia, and at‐risk populations include those who receive a large proportion of their energy from polished white rice (or other low‐thiamine staple foods) and with low dietary diversity. Reports of thiamine deficiency in West Africa over the last century have suggested that this has historically been an issue in this population, but in more recent decades, these reports have been limited to prison populations. To understand if thiamine deficiency might be an unrecognized problem in the communities of this region, erythrocyte samples collected during the wet and dry seasons from 226 women of reproductive age (mean age = 28 years old) were assessed for thiamine status by measuring the erythrocyte transketolase activity coefficient (ETKac). Overall, 35.8% of the sample was at high risk of thiamine deficiency (ETKac ≥ 1.25). Risk of thiamine deficiency was significantly higher in the wet (47.9%) compared with the dry season (22.9%) (P < 0.001). To our knowledge, this is the first report of biochemical thiamine deficiency in a free‐living population in West Africa in the 21st century and suggests that further investigation is warranted. [ABSTRACT FROM AUTHOR]

In the context of transnational migration, many non‐migrant men in Guinea‐Bissau and The Gambia postulate a 'transcontinental' version of polygyny, wishing to have one wife in Europe and another in Africa. Such claims are made among competing notions of love based on romantic intimacy and monogamy. This article explores the ways in which people rationalise polygyny in transnational marriage, based on the notion of hegemonic masculinity. Whereas hegemonic masculinity is an ideal asserted discursively, through persuasion, and relies on common consent, some migrant men resort to the strategy of keeping the African wife secret from the European wife—they are only able to assert a 'one‐sided hegemonic masculinity' in transnational marriage. Ultimately, global economic inequalities and the demand for labour migration characteristic of contemporary neoliberal globalisation counter the trend towards romantic intimacy, necessitating transnational family forms and favouring polygyny. [ABSTRACT FROM AUTHOR]

Objective: We describe a new method for identifying and quantifying the magnitude and rate of short‐term weight faltering episodes, and assess how (a) these episodes relate to broader growth outcomes, and (b) different data collection intervals influence the quantification of weight faltering. Materials and methods: We apply this method to longitudinal growth data collected every other day across the first year of life in Gambian infants (n = 124, males = 65, females = 59). Weight faltering episodes are identified from velocity peaks and troughs. Rate of weight loss and regain, maximum weight loss, and duration of each episode were calculated. We systematically reduced our dataset to mimic various potential measurement intervals, to assess how these intervals affect the ability to derive information about short‐term weight faltering episodes. We fit linear models to test whether metrics associated with growth faltering were associated with growth outcomes at 1 year, and generalized additive mixed models to determine whether different collection intervals influence episode identification and metrics. Results: Three hundred weight faltering episodes from 119 individuals were identified. The number and magnitude of episodes negatively impacted growth outcomes at 1 year. As data collection interval increases, weight faltering episodes are missed and the duration of episodes is overestimated, resulting in the rate of weight loss and regain being underestimated. Conclusions: This method identifies and quantifies short‐term weight faltering episodes, that are in turn negatively associated with growth outcomes. This approach offers a tool for investigators interested in understanding how short‐term weight faltering relates to longer‐term outcomes. [ABSTRACT FROM AUTHOR]

Mitochondrial genes were sequenced from four specimens of the extinct Canary Islands Oystercatcher Haematopus meadewaldoi and compared with African Oystercatcher Haematopus moquini, Eurasian Oystercatcher Haematopus ostralegus and an old unidentified extralimital 'black' oystercatcher specimen from The Gambia. At these loci, H. meadewaldoi was approximately 99.65% identical to multiple Eurasian Oystercatcher samples and in phylogenetic trees fell within the range of genetic variation observed in that species. The mystery Gambian bird was resolved as an extralimital H. moquini. We conclude that H. meadewaldoi was most likely a recently diverged melanistic morph or subspecies of H. ostralegus, although further genomic studies will be required to determine whether there has been a period of isolation followed by introgression. [ABSTRACT FROM AUTHOR]

Increasingly designers from an array of different disciplinary backgrounds work in international and community development, yet design education rarely prepares them for the challenges and roles in this context. The article reflects on issues of power and representation during design research in The Gambia by adapting reflexivity and positionality which are key concepts established in development studies. Reflections are based on research carried out in The Gambia since 2010 which is comprised of phases of immersion, mapping and co‐design. They provide in‐depth insights currently lacking in design literature that demonstrate the value of reflexivity and positionality to iterate roles and methods in community‐based design. Whilst not suggesting particular teaching methods, the article proposes the integration of these concepts into existing structures to better prepare students for increasingly common futures in the workplace. Broader themes that emerge and can be adapted to different design contexts include building trust, entanglement in power dynamics between different actors, personal vulnerability, as well as the need to challenge problems as starting points for design interventions. [ABSTRACT FROM AUTHOR]

Background: Ensuring individual free and informed decision-making for research participation is challenging. It is thought that preliminarily informing communities through 'community sensitization' procedures may improve individual decision-making. This study set out to assess the relevance of community sensitization for individual decision-making in research participation in rural Gambia.Methods: This anthropological mixed-methods study triangulated qualitative methods and quantitative survey methods in the context of an observational study and a clinical trial on malaria carried out by the Medical Research Council Unit Gambia.Results/discussion: Although 38.7% of the respondents were present during sensitization sessions, 91.1% of the respondents were inclined to participate in the trial when surveyed after the sensitization and prior to the informed consent process. This difference can be explained by the informal transmission of information within the community after the community sensitization, expectations such as the benefits of participation based on previous research experiences, and the positive reputation of the research institute. Commonly mentioned barriers to participation were blood sampling and the potential disapproval of the household head.Conclusion: Community sensitization is effective in providing first-hand, reliable information to communities as the information is cascaded to those who could not attend the sessions. However, further research is needed to assess how the informal spread of information further shapes people's expectations, how the process engages with existing social relations and hierarchies (e.g. local political power structures; permissions of heads of households) and how this influences or changes individual consent. [ABSTRACT FROM AUTHOR]

Prenatal supplementation with protein-energy (PE) and/or multiple-micronutrients (MMNs) may improve fetal growth, but trials of lipid-based nutritional supplements (LNSs) have reported inconsistent results. We conducted a post-hoc analysis of non-primary outcomes in a trial in Gambia, with the aim to test the associations of LNS with fetal growth and explore how efficacy varies depending on nutritional status. The sample comprised 620 pregnant women in an individually randomized, partially blinded trial with four arms: (a) iron and folic acid (FeFol) tablet (usual care, referent group), (b) MMN tablet, (c) PE LNS, and (d) PE + MMN LNS. Analysis of variance examined unadjusted differences in fetal biometry z-scores at 20 and 30 weeks and neonatal anthropometry z-scores, while regression tested for modification of intervention-outcome associations by season and maternal height, body mass index, and weight gain. Despite evidence of between-arm differences in some fetal biometry, z-scores at birth were not greater in the intervention arms than the FeFol arm (e.g., birth weight z-scores: FeFol −0.71, MMN −0.63, PE −0.64, PE + MMN −0.62; group-wise p = .796). In regression analyses, intervention associations with birth weight and head circumference were modified by maternal weight gain between booking and 30 weeks gestation (e.g., PE + MMN associations with birth weight were +0.462 z-scores (95% CI [0.097, 0.826]) in the highest quartile of weight gain but -0.099 z-scores (−0.459, 0.260) in the lowest). In conclusion, we found no strong evidence that a prenatal LNS intervention was associated with better fetal growth in the whole sample. [ABSTRACT FROM AUTHOR]

Objectives To describe the spatial pattern in under-5 mortality rates in the Basse Health and Demographic Surveillance System ( BHDSS) and to test for associations between under-5 deaths and biodemographic and socio-economic risk factors. Methods Using data on child survival from 2007 to 2011 in the BHDSS, we mapped under-5 mortality by km2. We tested for spatial clustering of high or low death rates using Kulldorff's spatial scan statistic. Associations between child death and a variety of biodemographic and socio-economic factors were assessed with Cox proportional hazards models, and deviance residuals from the best-fitting model were tested for spatial clustering. Results The overall death rate among children under 5 was 0.0195 deaths per child-year. We found two spatial clusters of high death rates and one spatial cluster of low death rates; children in the two high clusters died at a rate of 0.0264 and 0.0292 deaths per child-year, while in the low cluster, the rate was 0.0144 deaths per child-year. We also found that children born to Fula mothers experienced, on average, a higher hazard of death, whereas children born in the households in the upper two quintiles of asset ownership experienced, on average, a lower hazard of death. After accounting for the spatial distribution of biodemographic and socio-economic characteristics, we found no residual spatial pattern in child mortality risk. Conclusion This study demonstrates that significant inequality in under-5 death rates can occur within a relatively small area (1100 km2). Risks of under-5 mortality were associated with mother's ethnicity and household wealth. If high mortality clusters persist, then equity concerns may require additional public health efforts in those areas. [ABSTRACT FROM AUTHOR]

Background Early childhood malaria is often fatal, but its impact on the development and education of survivors has not received much attention. Malaria impacts cognitive development in a number of ways that may impact later educational participation. Aims In this study, we examine the long-term educational effects of preventing early childhood malaria. Does intermittent preventive treatment ( IPT) during early childhood reduce the risk of dropout? If so, does this effect vary by school type - government school versus madrassa? Sample We use data from a 2001 follow-up of a 1985-1987 malaria prevention randomized controlled trial in the Gambia. The sample consists of 562 youth born between 1981 and 1986. Methods We use discrete-time survival analysis to identify the impact of the intervention on dropout risk over time. Results We find that IPT has a positive impact on dropout for government school students, but not for madrassa attendees. The difference was striking: in government schools, the odds of dropout in the treatment group were one third of those in the control group. Conclusions Our findings suggest that preventing early childhood malaria may reduce dropout at a relatively low cost. In this intervention, the drugs cost less than one dollar per year per child. While IPT is no longer practised in many countries due to concerns over drug resistance, these results support the conclusion that any type of effective malaria control programme protecting young children, such as consistent and correct use of bed nets, could improve educational attainment in areas where malaria is prevalent. [ABSTRACT FROM AUTHOR]

Objectives Urban areas are traditionally excluded from trachoma surveillance activities, but due to rapid expansion and population growth, the urban area of Brikama in The Gambia may be developing social problems that are known risk factors for trachoma. It is also a destination for many migrants who may be introducing active trachoma into the area. This study aimed to determine the prevalence and risk factors for follicular trachoma and trichiasis in Brikama. Methods A community-based cross-sectional prevalence survey including 27 randomly selected households in 12 randomly selected enumeration areas ( EAs) of Brikama. Selected households were offered eye examinations, and the severity of trachoma was graded according to WHO's simplified grading system. Risk factor data were collected from each household via a questionnaire. Results The overall prevalence of trachomatous inflammation-follicular ( TF) in children aged 1-9 years was 3.8% (95% CI 2.5-5.6), and the overall prevalence of trichiasis in adults aged ≥15 years was 0.46% (95% CI 0.17-1.14). EA prevalence of TF varied from 0% to 8.4%. The major risk factors for TF were dirty faces ( P < 0.01, OR = 9.23, 95% CI 1.97-43.23), nasal discharge ( P = 0.039, OR = 5.11, 95% CI 1.08-24.10) and residency in Brikama for <1 year ( P = 0.047, OR = 7.78, 95% CI 1.03-59.03). Conclusions Follicular trachoma can be considered to have been eliminated as a public health problem in Brikama according to WHO criteria. However, as the prevalence in some EAs is >5%, it may be prudent to include Brikama in surveillance programmes. Trichiasis remains a public health problem (>0.1%), and active case finding needs to be undertaken. [ABSTRACT FROM AUTHOR]

Dizygotic (DZ) twinning has a genetic component and is common among sub-Saharan Africans; in The Gambia its frequency is up to 3% of live births. Variation in PTX3, encoding Pentraxin 3, a soluble pattern recognition receptor that plays an important role both in innate immunity and in female fertility, has been associated with resistance to Mycobacterium tuberculosis pulmonary disease and to Pseudomonas aeruginosa infection in cystic fibrosis patients. We tested whether PTX3 variants in Gambian women associate with DZ twinning, by genotyping five PTX3 single nucleotide polymorphisms (SNPs) in 130 sister pairs (96 full sibs and 34 half sibs) who had DZ twins. Two, three and five SNP haplotypes differed in frequency between twinning mothers and those without a history of twinning (from P= 0.006 to 3.03e-06 for two SNP and three SNP haplotypes, respectively). Twinning mothers and West African tuberculosis-controls from a previous study shared several frequent haplotypes. Most importantly, our data are consistent with an independently reported association of PTX3 and female fertility in a sample from Ghana. Taken together, these results indicate that selective pressure on PTX3 variants that affect the innate immune response to infectious agents, could also produce the observed high incidence of DZ twinning in Gambians. [ABSTRACT FROM AUTHOR]

Objectives To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering. Methods In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space–time clusters of tuberculosis among permanent residents. Results Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space–time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space–time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region. Conclusions There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes. [ABSTRACT FROM AUTHOR]

Objective To determine whether epilepsy is caused by Taenia solium cysticercosis in The Gambia. Methods Case–control study testing samples collected from 210 people with epilepsy and 420 matched controls by sex and age ±5 years from 69 different places around the country during the period October 2008–March 2009. All serum samples were subjected to an antigen detection ELISA (Ag-ELISA) and electro-immunotransfer blot (EITB), and the seropositives were further CT-scanned to determine the presence of cysticerci in the brain. Results Although not significantly different ( P = 0.668), circulating Taenia antigen was found by Ag-ELISA in 1.4% (95% CI: 0.3–4.1) of people with epilepsy and in 1.9% (95% CI: 0.8–3.7) of the controls. A non-significant ( P = 0.4718) odds ratio of association 0.75 (95% CI: 0.13–3.15) between epilepsy and the presence of Taenia antigens was found. All 630 serum samples turned out seronegative by the EITB test. There were no intracranial cysts or cyst-like structures detected among the nine CT-scanned Ag-ELISA seropositives. Conclusion Epilepsy appears not to be caused by cysticercosis in The Gambia. [ABSTRACT FROM AUTHOR]

Objective. We determined the stillbirth rates among singleton births in Gambian hospitals. Contribution of severe obstetric complications was given special attention. Design. A multi-center retrospective review. Setting. Three obstetric referral hospitals. Sample. Fetal outcomes in 826 women with severe maternal morbidity out of 3,280 singleton deliveries. Methods. All women with severe maternal morbidity reported in the investigated hospitals between January and June 2006 were identified and their cases reviewed. For each case, information about fetal outcome and the mother's age, parity, obstetric complications and delivery mode was abstracted from maternity records. Main outcome measures. Stillbirth rates and the impact of health service factors. Results. There were excessively high stillbirth rates with an eight-fold increased risk among women with severe obstetric complications (310/1,000 births), compared to women without complications (51/1,000 births). Hemorrhage, anemia, sepsis and hypertensive pregnancy disorders were associated with higher stillbirth rates. Dystocia cases had a relatively lower stillbirth rate. In women with severe obstetric complications, vaginal delivery was associated with a four-fold increased risk of stillbirth compared to cesarean section. Conclusion. Severe maternal morbidity has significant impact on stillbirth rates. Better access to emergency obstetric care and improved intrapartum care will significantly reduce stillbirth rates in poor settings of the world, such as The Gambia. [ABSTRACT FROM AUTHOR]

Objective To retest our previous finding that the haptoglobin (Hp) 22 genotype is associated with seasonal anaemia, and to investigate the role of malaria in this effect. Methods Haemoglobin (Hb) and peripheral parasitaemia were assessed at pre- and post-malarial season cross-sectional surveys in rural Gambian children aged 10–72 months. Between the surveys, active longitudinal surveillance was conducted to detect febrile episodes. Results Unlike previously, no overall reduction in Hb was observed (Hb = 106.1 vs. 107.2 g/l, P = 0.13, n = 545). However, multi-variable linear regression revealed differences in Hb over the season by Hp and Hb-sickle (HbS) genotype (−2.20 g/l per copy of the Hp2 allele, P = 0.043; HbAS vs. HbAA + 3.13 g/l, P = 0.11, n = 536). There was no effect of malarial episodes during follow-up; this suggests that when effective treatment is given, Hb levels recover. The A61-C Hp promoter SNP, associated with the Hp2 allele, had no effect. Conclusion The effect of the Hp2 allele appears to be independent of effects on malaria incidence but may affect Hb levels through increased oxidant stress and red cell turnover. This may be supported by our previous observations that the effect of Hp22 was independent of markers of iron status and zinc protoporphyrin measured at the cross-sectional surveys and therefore also of iron availability for erythropoiesis. Objetivos: Evaluar de nuevo hallazgos previos de que el genotipo 22 “haptaglobin” (Hp) está asociado con anemia estacional, e investigar el papel de la malaria sobre este efecto. Métodos: Se evaluaron la hemoglobina (Hb) y la parasitemia periférica en estudios croseccionales durante la pre y post estación de malaria, en niños Gambianos de entre 10–72 meses, provenientes de áreas rurales. Entre los estudios, se realizó una vigilancia activa longitudinal para detectar episodios febriles. Resultados: A diferencia de los estudios previos, no se observó una reducción total de Hb (Hb=106.1 vs 107.2 g/l, P = 0.13, N = 545). Sin embargo, una regresión lineal multivariable reveló diferencias en Hb a lo largo de la estación por genotipo Hp y Hb-falciforme (HbF) (−2.20 g/l por copia de alelo Hp2, P = 0.043; HbAS vs HbAA + 3.13 g/l, P = 0.11, N = 536). No se observó un efecto sobre los episodios de malaria durante el seguimiento; esto sugiere que cuando se da un tratamiento efectivo, se recuperan los niveles de Hb. No tuvo efecto el SNP del promotor de Hp, A61-C, asociado al alelo Hp2. Conclusiones: El efecto del alelo Hp2 parece ser independiente del efecto sobre la incidencia de malaria, pero podría afectar los niveles de Hb a través de un aumento del estrés oxidativo y el recambio de eritrocitos. Esto podría confirmarse por nuestras observaciones previas de que el efecto del Hp22 era independiente de los marcadores del estado del hierro y protoporfirina de zinc medido durante los estudios croseccionales y por lo tanto, también de la disponibilidad de hierro para eritropoiesis. El efecto del alelo Hp2 parece ser independiente de los efectos sobre la incidencia de malaria pero podría afectar la Hb. [ABSTRACT FROM AUTHOR]

Purpose: We report on assessments of the needs for emergency obstetric care in 3 West African countries.Methods: All (or almost all) medical facilities were visited to determine whether there are sufficient facilities of adequate quality to manage the expected number of obstetric emergencies.Results: Medical facilities able to provide emergency obstetric care were poorly distributed and often were unable to provide needed procedures. Too few obstetricians and other providers, lack of on-the-job training and supervision were among the challenges faced in these countries. [ABSTRACT FROM AUTHOR]

Objectives One of the major barriers to the successful treatment of malaria is the non-adherence to drug regimens. Work till now has often been based on the assumption that most patients begin their treatment having received adequate or at least similar instructions and information about both the disease itself and the content and course of their treatment. This paper questions such an assumption. We ask whether people do not adhere to treatment in part because they have not understood the diagnosis and subsequent treatment from the outset. Methods This study was conducted in the North Bank district of The Gambia, West Africa where a convenience sample of 1337 caretakers with children under 10 years of age were interviewed immediately after their consultation about their recommended treatment. Results Findings show a mismatch between caretakers and healthcare providers’ (HCP) interpretations of a child's clinic visit, both in terms of the diagnosis and drug regimen. Less than a third of the caretakers’ responses matched the diagnosis that the HCP had written on the child's medical card. Results also showed a delay in the first important antimalarial dose. A common response was ‘I'm not sure what is wrong with the child but I will start the medicine when I get home’. Conclusions The findings from these exit interviews lend weight to the argument that the value of pre-packaged blisters could potentially provide far greater benefits than their additional cost, especially when coupled with improved communication by HCP. [ABSTRACT FROM AUTHOR]

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]

We investigated the ability of intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine/pyrimethamine to prevent anaemia and low birthweight in Gambian multigravidae. Between July 2002 and February 2004, 2688 multigravidae living in a rural area of The Gambia received SP (1346 women) or placebo (1342 women) up to four times during pregnancy and were followed until 6-weeks post-partum. Shortly after delivery, 10.7% of women in the intervention group and 8.8% in the control group were severely anaemic [Hb < 7 g/dl, risk difference = 0.02 (95% CI -0.01, 0.04), P = 0.17]. The overall mean birthweight of infants born to women who had received SP (3103 g) was very similar to that observed in infants born to women in the control group [3075 g; difference = 28 g (95% CI -11 g, 67 g), P = 0.16]. However, among women who did not use a bednet (either insecticide treated or untreated), infants born to women who had received SP weighed more than infants born to women in the control group [3147 g vs. 3044 g; difference 143 g (95% CI 53 g, 232 g), interaction test P < 0.001]. This study did not show that IPTp with SP benefited Gambian multigravidae overall but that it may benefit a sub-group of women who do not use a bednet. In areas such as The Gambia, provision of insecticide-treated bednets to multigravidae may provide an adequate means of protection against malaria in pregnancy without the need for additional IPTp. [ABSTRACT FROM AUTHOR]

Objectives To describe the characteristics of pneumococcal isolates obtained from patients with invasive pneumococcal disease in The Gambia. Methods Pneumococcal isolates were obtained from children aged ≤6 years with invasive pneumococcal disease during a Haemophilus influenzae vaccine effectiveness study (1997-2002) and from patients with invasive pneumococcal disease admitted to the MRC hospital, Fajara, for routine care (1996-2003). Isolates were identified, serotyped and tested for antibiotic susceptibility. Results Five hundred and thirty one pneumococcal isolates were obtained from 518 patients; 55 (10.6%) patients died; 415 isolates (79%) were from blood culture, 84 (16%) from CSF, and 42 (8%) from lung aspirates. Forty serogroups and serotypes were identified; six accounted for 64% and 16 for 86% of all episodes; 33.7% were of serotypes 1 and 5. 23.5% were of a 7-valent vaccine serotype, 57.1% were of a 9-valent vaccine serotype; 56% were of a 7-valent serogroup and 78% were of a 9-valent serogroup. There was a significant increase in the proportion of isolates of non-vaccine serogroup with increasing age ( P < 0.0001). Antibiotic resistance had not significantly increased over time; but intermediate non-susceptibility to penicillin had risen and resistance to chloramphenicol had fallen in isolates of vaccine serotype compared with those of non-vaccine serotype. Conclusions The majority of invasive pneumococcal disease in The Gambia is caused by pneumococci of relatively few serogroups. A conjugate vaccine would be expected to reduce the pneumococcal disease burden substantially and to have a beneficial effect on pneumococcal antibiotic resistance to penicillins. [ABSTRACT FROM AUTHOR]

Objective Hypoxia predicts mortality in children with acute lower respiratory infections (ALRIs). We investigated the prevalence and predictive value of hypoxia in ALRI and other acute infectious diseases. Methods We studied the spectrum of hypoxaemia in 4047 children admitted to a tertiary hospital in The Gambia. Oxygen saturation was measured shortly after admission. Severe hypoxaemia was defined as an oxygen saturation below 90%. Results 5.8% of all admissions had severe hypoxaemia. Prevalence of hypoxaemia varied between disease groups: it was 11.7% in ALRI cases, 16.5% in neonates; 2.9% in malaria cases overall but 6.5% in cerebral malaria patients; and 2.7% in children with meningitis. Hypoxaemia predicted a poor outcome; the odds ratio for death among paediatric admissions overall was 7.45 [95% confidence intervals (CI) 5.40–10.29]. Surprisingly, it was lowest for children with ALRI [OR 3.53 (95% CI 1.13–10.59)], and higher for those with malaria 9.90 [95% CI 4.39–22.35]. Conclusion Hypoxaemia is common among Gambian children admitted to hospital and it is often associated with a poor outcome. A similar situation is likely in many other developing countries. Thus, equipment for measuring oxygen saturation, and facilities and equipment for effective oxygen delivery need to be made available in developing countries. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether the trachoma vector Musca sorbens was breeding in household latrines in a trachoma-endemic part of The Gambia.Methods: Longitudinal study of flies emerging from 16 sentinel household latrines selected at random from a list of all latrines present in four Gambian villages. Latrines were surveyed and fly traps were set over the drop hole for 24 h once per month for a year.Results: All the sentinel latrines were of the 'Gambian improved household latrine' design, which has a cement slab but is not ventilated or fly-proofed. The latrines were all in regular use by a family, mean number of users per latrine 14.8 (SD 8.0, range 2-29). Of 55 351 flies caught in 192 catches 54 130 (97.8%) were Chrysomya albiceps, 690 (1.2%) Musca domestica, 466 (0.8%) Chrysomya regalis and 65 (0.1%) M. sorbens. Of the M. sorbens caught 61 (93.8%) were female.Conclusions: Gambian improved household pit latrines cannot be considered a source of the trachoma vector M. sorbens, and the promotion of pit latrines as a method to reduce M. sorbens is warranted. A large number of C. albiceps were caught emerging from the latrines, but this species is not considered to be of medical importance. [ABSTRACT FROM AUTHOR]

This article investigates the economic efficiency of farm households, with an application to The Gambia. The efficiency analysis is conducted not at the farm level but at the household level, thus capturing the importance of off-farm activities. Output-based measures of technical, allocative, and scale efficiency are generated using nonparametric measurements. An econometric analysis of factors affecting the efficiency indexes is then conducted using a Tobit model. Technical efficiency is fairly high indicating that access to technology is not a severe constraint for most farm households. The cost of scale inefficiency is modest. Allocative inefficiency by contrast is found to be important for the majority of farm households. On the basis of the Tobit results, imperfections in markets for financial capital and nonfarm employment contribute to significant allocative inefficiency. [ABSTRACT FROM AUTHOR]

The development of Taiwan's agricultural sector contributed significantly to the country's transformation from virtual poverty after World War II to a modern industrial nation. Success resulted from the use of appropriate technologies, developed through an exceptionally close working relationship between government, research and development institutions, extension services and farmers in Taiwan. As part of their overseas development aid programme, the Republic of China on Taiwan has established Technical Missions in those developing countries where it receives political recognition. Among these is The Gambia, West Africa, where one focus of Taiwan's current Technical Mission is the development of women's market gardens. Although the gardens have proved successful, there is doubt as to whether their achievements will be sustained once Taiwan's Technical Mission in The Gambia has ended. Field research in Taiwan and in The Gambia, based largely on participatory techniques, has revealed that the low-tech methods introduced from Taiwan are appropriate for the Gambian environment. However, much depends on whether women participating in the schemes can commit sufficient time and energy to the gardens, as at present this is a limiting factor. The potential of the gardens may also be constrained by a lack of appropriate institutional infrastructure, particularly the scope for profitable disposal of garden produce. A major conclusion of the article is that successful transfer of appropriate technology to The Gambia is likely to be impeded by poorly developed coordination between groups that proved to be key‘players’ in the development of agriculture in Taiwan: government, research and development institutions, extension services and producers. [ABSTRACT FROM AUTHOR]

Home treatment with antimalarials is a common practice in many countries, and may save lives by ensuring that more malaria cases receive prompt treatment. Through retrospective surveys we found that home treatment of young children with antimalarials was uncommon in rural Gambia. Few families kept medicines in the home in case of illness, 28% kept paracetamol and only 8% kept chloroquine. Less than 10% of cases of childhood 'malaria' had been treated with chloroquine at home, and 69% of those giving home medication did not know the correct dosage for a child. The most common course of treatment was the use of paracetamol and/or tepid sponging to reduce fever, before the child was taken to a government health facility. Treating a child with antimalarials at home was more costly than other forms of treatment. The low cost associated with the use of health services for children and the limited availability of antimalarials outside major towns contribute to the high use of government health services. This shows that that home treatment cannot be assumed to be the predominant mode of malaria treatment throughout Africa, and highlights the need for country-specific policies based on accurate local knowledge of treatment practices in both rural and urban areas. [ABSTRACT FROM AUTHOR]

Summary Background An inverse association between delayed type hypersensitivity to tuberculin and atopy has been observed in children, suggesting that exposure to mycobacteria may influence the immune response to allergens. Objective To investigate the relationship between tuberculin responses and atopy in children living in three different environments in The Gambia. Methods In this cross-sectional study a total of 507 school-aged children were recruited from rural, urban poor or urban affluent communities. They were assessed for skin responses to five common allergens and tuberculin, presence of bacille Calmette–Guérin (BCG) scar, presence of intestinal parasites, and total serum IgE. Atopy was defined as the presence of a skin prick test response ≥ 3 × 3 mm to at least one allergen. Results The overall prevalence of atopy was 33% but there was a significant variation among the three study groups. The prevalence of atopy was 22% in urban poor, 36% in urban affluent, and 43% in rural children. Controlling for potential confounding factors, children in the rural community had a significantly higher odds ratio, 3.3 (95% onfidence interval 1.8–6.0) of being atopic than children from the urban poor community. No association between atopy and tuberculin response or BCG scar was observed in any of the three groups. Serum IgE levels were higher among children of the urban poor group but were not associated with tuberculin response or BCG scar in any of the groups. Conclusion Environmental factors have an important influence on the development of atopy in children in The Gambia but delayed type hypersensitivity to tuberculin is not a protective factor. [ABSTRACT FROM AUTHOR]

House design may affect an individual's exposure to malaria parasites, and hence to disease. We conducted a randomized-controlled study using experimental huts in rural Gambia, to determine whether installing a ceiling or closing the eaves could protect people from malaria mosquitoes. Five treatments were tested against a control hut: plywood ceiling; synthetic-netting ceiling; insecticide-treated synthetic-netting ceiling (deltamethrin 12.5 mg/m2); plastic insect-screen ceiling; or the eaves closed with mud. The acceptability of such interventions was investigated by discussions with local communities. House entry by Anopheles gambiae, the principal African malaria vector, was reduced by the presence of a ceiling: plywood (59% reduction), synthetic-netting (79%), insecticide-treated synthetic-netting (78%), plastic insect-screen (80%, P < 0.001 in all cases) and closed eaves (37%, ns). Similar reductions were also seen with Mansonia spp., vectors of lymphatic filariasis and numerous arboviruses. Netting and insect-screen ceilings probably work as decoy traps attracting mosquitoes into the roof space, but not the room. Ceilings are likely to be well accepted and may be of greatest benefit in areas of low to moderate transmission and when used in combination with other malaria control strategies. [ABSTRACT FROM AUTHOR]

This article examines the case of the Catholic Relief Service’s (CRS) sesame support programme in The Gambia which has spanned more than 25 years. It outlines the transformation process from relief to development and the role that the production of an agricultural commodity, sesame, has played as a key building block. Following the drought of the 1980s, concerns to move away from dependence on food aid first led to agronomic trials of imported oilseed, then to the selection and dissemination of improved sesame varieties accompanied by an elaborate and costly support programme. This gradually developed into a long–term development–oriented intervention, paving the way for the development of a national women’s farmers’ organisation. The paper provides a case study of an intervention that has gone beyond the provision of seed to address agronomic research and extension, policy, marketing and institutional issues necessary for successful crop diversification. [ABSTRACT FROM AUTHOR]

Summary Background Severe respiratory syncytial virus (RSV) infection in early childhood has been associated with subsequent wheezing and atopy. The aim of this study was to test if severe RSV infection in early life was associated with an increase in type 2 cytokine production and atopy in Gambian children 5 years later. Methods A cohort of children with severe RSV infection during the first year of life (‘cases’, n = 66) and without (‘controls’, n = 122) was followed-up at 5 years of age. Immediate hypersensitivity to common allergens, airway reactivity, serum IgE concentration and the production of IFN-γ, IL-5 and IL-13 by lymphocytes activated in vitro with RSV F-G or control antigens was determined. Results After adjustment for confounders, cases produced significantly higher concentrations of IL-13 in response to RSV F-G and of IL-5 and IL-13 in response to tuberculin. Cases were more likely to have presented with a wheezy lower respiratory tract infection in the first 3 years of life (adjusted odds ratio = 9.9; 95% CI 1.6–61.0), but not thereafter. Cases and controls had similar skin response to allergens, airway reactivity and serum IgE concentrations. Conclusion Severe RSV infection in early life is associated with a higher production of type 2 cytokines in Gambian children at 5 years of age. However this does not appear to result in increased risk of atopy or clinical allergy at that age. [ABSTRACT FROM AUTHOR]

Abstract. The fly Musca sorbens Wiedemann (Diptera: Muscidae) apparently transmits Chlamydia trachomatis, causing human trachoma. The literature indicates that M. sorbens breeds predominantly in isolated human faeces on the soil surface, but not in covered pit latrines. We sought to identify breeding media of M. sorbens in a rural Gambian village endemic for trachoma. Test breeding media were presented for oviposition on soil-filled buckets and monitored for adult emergence. Musca sorbens emerged from human (6/9 trials), calf (3/9), cow (3/9), dog (2/9) and goat (1/9) faeces, but not from horse faeces, composting kitchen scraps or a soil control (0/9 of each). After adjusting for mass of medium, the greatest number of flies emerged from human faeces (1426 flies/kg). Median time for emergence was 9 (inter quartile range = 8–9.75) days post-oviposition. Of all flies emerging from faeces 81% were M. sorbens. Male and female flies emerging from human faeces were significantly larger than those from other media, suggesting that they would be more fecund and live longer than smaller flies from other sources. Female flies caught from children's eyes were of a similar size to those from human faeces, but significantly larger than those from other media. We consider that human faeces are the best larval medium for M. sorbens, although some breeding also occurs in animal faeces. Removal of human faeces from the environment, through the provision of basic sanitation, is likely to greatly reduce fly density, eye contact and hence trachoma transmission, but if faeces of other animals are present M. sorbens will persist. [ABSTRACT FROM AUTHOR]

Objective: To determine the influence of prematurity and low birthweight (LBW) on transplacental antibody transfer.Method: In a physician-blinded, cross-sectional study of 213 mother--baby pairs in the labour ward of Bansang Hospital, The Gambia, paired maternal and cord serum samples were tested for specific IgG antibody titres for measles virus (MeV), herpes simplex virus type 1 (HSV1), respiratory syncytial virus (RSV), varicella-zoster virus (VZV), tetanus toxoid (TT) and diphtheria toxoid (DT) antigens using enzyme linked immunosorbent assay (ELISA).Results: Prematurity was significantly associated with reduced placental antibody transfer for MeV, HSV1, TT, DT, RSV and VZV. Maternal antibody transfer for MeV, HSV1, TT, DT, RSV and VZV was significantly lower in neonates with LBW than in babies with adequate birthweight (ABW).Conclusion: Materno--foetal transfer of antibodies is impaired in prematurity and LBW babies in this Gambian population. Reduction in antibody transfer may further predispose these already vulnerable neonates to bacteria and viral infections. Therefore, alternative vaccination strategies, including earlier vaccination schedules, are needed to provide better protection to these young infants. [ABSTRACT FROM AUTHOR]

To test the hypothesis that widespread treatment with artemisinin derivatives can reduce malaria transmission, a mass drug administration (MDA) campaign was undertaken in an area of The Gambia in 1999. Coverage of 85% of the target population was achieved, but the intervention did not reduce overall malaria transmission. We studied the perceptions, knowledge and attitudes of the community to the MDA campaign. A validated questionnaire was administered to randomly selected MDA participants (n = 90) and MDA refusers (n = 71). Individuals who believed in the importance of the MDA (adjusted OR 58.3%; 95% CI 17.4-195.8) and those who were aware that a high level of participation was needed for the MDA to be successful (adjusted OR 28.1; 95% CI 10.3-75.9) were more likely to participate. Understanding that the purpose of the MDA was to reduce malaria (adjusted OR 13.9; 95% CI 5.5-35.1) and knowledge of the fact that malaria is transmitted by mosquitoes and of the clinical signs of malaria (adjusted OR 3.4; 95% CI 3.1-9.0) were associated with participation. Individuals who discussed the MDA with other villagers (adjusted OR 5.5; 95% CI 2.2-13.5) and those who attended the sensitization meeting (adjusted OR 2.6; 95% CI 1.1-6.0) were also more likely to participate. Women were significantly more likely to participate in the MDA than men (adjusted OR 3.1; 95% CI 1.5-6.2). Individuals who refused to participate were unlikely to plan participation in future MDAs. One of the most difficult challenges in the implementation of a malaria control strategy such as an MDA is to convince villagers to participate and to make them aware that a high level of participation by the community is needed for success. We found that our sensitization meetings could be improved by giving more information on how the MDA works and finding means to generate small group discussions after the meeting. [ABSTRACT FROM AUTHOR]

The study aim was to compare three formulations, tablet deltamethrin, liquid deltamethrin and liquid permethrin, for their impact on vector behaviour and persistence. Product acceptance, perceived side-effects and user's perceptions of effectiveness were also investigated. At the beginning of the 1998 rainy season, 255 nets in a Gambian village were dipped in one of the three insecticides. Chemical residue analysis immediately after dipping showed that the target doses were reached for the liquid insecticides, but tablet deltamethrin deposited significantly less. Insecticide persistence at 5 months, however, was highest for the tablet formulation. Susceptibility tests established that Anophelines in this area were sensitive to both insecticides. All three formulations appeared effective as very few live Anophelines, or other mosquitoes, were caught under the treated nets. This conclusion was supported by the bioassay data with both deltamethrin formulations giving over 90% mortality soon after dipping and at 3 months, and at 5 months 70.8 and 79.6% were obtained for deltametrin liquid and tablet, respectively. Permethrin appeared less effective at all times (72.4, 86.8, 59.0%). There were no serious side-effects reported by the villagers following dipping. All three treatments were perceived as effective by the majority (92%) of users and most (93%) wanted to use the insecticide again. Deltamethrin tablets thus appear as good as permethrin for treating bednets in The Gambia. In addition, a tablet formulation is considerable easier to pack and distribute. [ABSTRACT FROM AUTHOR]

Summary Permethrin-treated bednets reduce mortality and morbidity from malaria in Gambian children. However, it is not certain how this effect is achieved, as neither mosquito numbers nor the human blood index of indoor-resting female Anopheles gambiae Giles sensu lato (Diptera: Culicidae) mosquitoes have been reduced when treated bednets were introduced into a community. One possibility is that insecticide-treated bednets divert mosquitoes from children to adults. To investigate this hypothesis, a cross-over trial with insecticide-treated bednets was undertaken in two small Gambian villages. To differentiate mosquitoes that had fed on children from those that had fed on adults, all children in the study villages were immunized with rabies vaccine before the trial. Using the detection of rabies antibody in a bloodmeal as an indicator that a mosquito had bitten a child, it was found that the percentage of blood-fed mosquitoes caught indoors that had bitten a child fell significantly from 30.8% to 9.2% and from 28.0% to 6.9% in each village after insecticide-treated bednets were introduced. To investigate the possibility that some diversion to animals had occurred, a PCR analysis for human β-globin DNA was undertaken on selected samples. The results of this investigation were confusing, as some rabies-antibody positive bloodmeals were negative for human DNA. This may have been due to cross-reacting antibodies in animal sera and/or DNA degradation by digestion in the mosquito. Although good evidence for diversion of mosquitoes away from children was obtained, it remains uncertain whether diversion was mainly to adult humans, to animals or to both. [ABSTRACT FROM AUTHOR]

AbstractOpportunistic sightings were made of an introduced, free-ranging population of sitatunga (Tragelaphus spekei gratus) in the Abuko Nature Reserve for 5.5 years. The sitatunga used more habitat types than the sympatric bushbuck (T. scriptus), were most active during the coolest times of the day, retreated into shade during the hottest times of the day and their diet consisted mostly of mature leaf parts. In terms of social behaviour, the sitatunga spent most of the time on their own, females gave birth during the dry season, and males engaged in horn wrestling and vegetation horning. Today, this population has disappeared and the wild Senegambian population has never been studied or surveyed. The numbers are probably dwindling throughout the area. [ABSTRACT FROM AUTHOR]

There is evidence that season of birth may predict adult mortality from infectious diseases in rural Gambia. Using data collected over a five-year period from the rural, eastern region of the Gambia, we examined whether the season of birth influences mortality in childhood. 26 894 births and 3776 deaths among children under the age of five years were recorded in this region during the period 1989-1993. The estimated 1-4 year population was 95 355. In children aged 1-4 years, the mortality rate per 1000 per year was 16.1 (95% CI 14.9, 17.2) for those born in the 'harvest' season (January to June), which was not significantly different from the rate of 17.9 (95% CI 16.7, 19.0) recorded for those born in the 'hungry' season (July to December) (age-stratified Mantel-Haenszel mortality ratio 0. 91, 95% CI 0.83, 1.01; p = 0.08). Nearly all deaths of 1-4 year olds were attributed to infectious diseases, with malaria accounting for over 40%. None of the cause-specific child mortality rates differed significantly according to the season of birth. These data suggest that beyond infancy, when it is easier to separate the effect of season on cause of death from that of the season of birth, there is no marked difference in the rate of death between Gambian children born in the harvest season and those born in the hungry season. [ABSTRACT FROM AUTHOR]

The protection provided by BCG against pulmonary tuberculosis ranges from nil to over 90%. While BCG protects against the more serious forms of tuberculosis, it is not known whether or not it protects patients with pulmonary tuberculosis from death. In a study designed to look at the effects of immunotherapy with M. vaccae as an adjunct to chemotherapy in 285 adult Gambian patients treated for proven pulmonary tuberculosis, we examined the association between the presence or absence of a BCG scar and mortality. The data showed that subjects who had a BCG scar were significantly younger than those who did not, and were less likely to have nutritional oedema. During the course of treatment, none of the 85 patients who had a BCG scar died compared to 35 of 200 patients (17.5%) who did not (P < 0.001). In these Gambian patients with pulmonary tuberculosis, prior vaccination with BCG may have provided substantial protection against death. However, there is the possibility that this finding is the result of confounding by other factors or has arisen from bias. Researchers with similar data need to investigate this question as this association, if true, could have major implications for BCG vaccination. [ABSTRACT FROM AUTHOR]

Using data from a longitudinal study conducted in 40 villages by the UK MRC in the North Bank Division of The Gambia beginning in late 1981, we examined infant and child mortality over a 15-year period for a population of about 17 000 people. Comparisons are drawn between villages with and without PHC. The extra facilities in the PHC villages include: a paid Community Health Nurse for about every 5 villages, a Village Health Worker and a trained Traditional Birth Attendant. Maternal and child health services with a vaccination programme are accessible to residents in both PHC and non-PHC villages. The data indicate that there has been a marked improvement in infant and under-five mortality in both sets of villages. Following the establishment of the PHC system in 1983, infant mortality dropped from 134/1000 in 1982-83 to 69/1000 in 1992-94 in the PHC villages and from 155/1000 to 91/1000 in the non-PHC villages over the same period. Between 1982 and 83 and 1992-94, the death rates for children aged 1-4 fell from 42/1000 to 28/1000 in the PHC villages and from 45/1000 to 38/1000 in the non-PHC villages. Since 1994, when supervision of the PHC system has weakened, infant mortality rates in the PHC villages have risen to 89/1000 in 1994-96. The rates in the non-PHC villages fell to 78/1000 for this period. The under-five mortality rates in both sets of villages have converged to 34/1000 for 1994-96. When the PHC programme was well supported in the 1980s, we saw significantly lower mortality rates for the 1-4-year-olds. These differences disappeared when support for PHC was reduced after 1994. The differential effects on infant mortality are less clear cut. [ABSTRACT FROM AUTHOR]

SummaryThe efficiency of strategic and strategic/selective applications of flumethrin spray formulation for controlling ticks were assessed, respectively, in two groups of fourteen N’Dama cattle (Group S and Group S/S) by comparison of the number of feeding ticks with thirteen untreated N’Dama cattle (Group U) over a period of 11 months (June 1996 to April 1997). During the expected peak of tick abundance, acaricide was applied fortnightly on the whole body in animals in Group S and only on the most infested body areas in cattle in Group S/S. Weight changes and skin lesions, directly associated with tick attachment, were recorded in cattle in the three groups. The costs of the two tick control schemes were estimated. Maximum level of ticks, all species together, feeding on cattle was observed in the rainy season. Both in Group S/S and Group S, cattle carried a lower (P < 0.001) number of feeding ticks than animals in Group U over the whole study period. Percentage of tick control, over the entire period of tick investigation, was satisfactory in both acaricide-treated groups, reaching 61.2 and 75.2% in Groups S/S and S, respectively. However, the proportion of control varied according to tick species or genus. Significantly lower prevalence of skin lesions was observed on the ano-genital and udder region in cattle in Group S/S (P < 0.05) and Group S (P < 0.01) in comparison with cattle in Group U. Mean amount of acaricide solution used and relative estimated cost of treatment in cattle in Group S/S were, respectively, 25- and 14-fold lower than those in cattle in Group S. At the end of the study, animals in Groups S/S and S were, respectively, 7.2 and 15.9 kg heavier than animals in Group U. The difference was statistically significant (P < 0.02) only between Groups S and U. However, the efficiency, low cost and derived benefits of the strategic/selective acaricide application scheme indicated that it might be the most cost effective. [ABSTRACT FROM AUTHOR]

Infants in low‐resource settings are at heightened risk for compromised cognitive development due to a multitude of environmental insults in their surroundings. However, the onset of adverse outcomes and trajectory of cognitive development in these settings is not well understood. The aims of the present study were to adapt the Mullen Scales of Early Learning (MSEL) for use with infants in a rural area of The Gambia, to examine cognitive development in the first 24‐months of life and to assess the association between cognitive performance and physical growth. In Phase 1 of this study, the adapted MSEL was tested on 52 infants aged 9‐ to 24‐months (some of whom were tested longitudinally at two time points). Further optimization and training were undertaken and Phase 2 of the study was conducted, where the original measures were administered to 119 newly recruited infants aged 5‐ to 24‐months. Infant length, weight and head circumference were measured concurrently in both phases. Participants from both phases were split into age categories of 5–9 m (N = 32), 10–14 m (N = 92), 15–19 m (N = 53) and 20–24 m (N = 43) and performance was compared across age groups. From the ages of 10–14 m, Gambian infants obtained lower MSEL scores than US norms. Performance decreased with age and was lowest in the 20–24 m old group. Differential onsets of reduced performance were observed in the individual MSEL domains, with declines in visual perception and motor performance detected as early as at 10–14 months, while reduced language scores became evident after 15–19 months of age. Performance on the MSEL was significantly associated with measures of growth. [ABSTRACT FROM AUTHOR]