Primary Care Screening and Treatment for Latent Tuberculosis Infection in Adults:

JAMA
September 6, 2016, Vol 316, No. 9
http://jama.jamanetwork.com/issue.aspx

Editorial
The Challenge of Latent TB Infection FREE
Henry M. Blumberg, MD; Joel D. Ernst, MD

US Preventive Services Task Force
Recommendation Statement
Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement FREE

Evidence Report
Primary Care Screening and Treatment for Latent Tuberculosis Infection in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force FREE
Leila C. Kahwati, MD, MPH; Cynthia Feltner, MD, MPH; Michael Halpern, MD, PhD, MPH; Carol L. Woodell, BSPH; Erin Boland, BA; Halle R. Amick, MSPH; Rachel Palmieri Weber, PhD; Daniel E. Jonas, MD, MPH

Maternal Immunization: Secondary Analysis of a Randomized Clinical Trial

JAMA Pediatrics
September 2016, Vol 170, No. 9
http://archpedi.jamanetwork.com/issue.aspx

Editorial
Infant Protection Against Influenza Through Maternal Immunization: A Call for More Immunogenic Vaccines
Flor M. Munoz, MD

Original Investigation
Duration of Infant Protection Against Influenza Illness Conferred by Maternal Immunization: Secondary Analysis of a Randomized Clinical Trial
Marta C. Nunes, PhD; Clare L. Cutland, MD; Stephanie Jones, MD; Andrea Hugo, MD; Richard Madimabe, BTech; Eric A. F. Simões, MD; Adriana Weinberg, MD; Shabir A. Madhi, MD, PhD; for the Maternal Flu Trial Team
Abstract
Importance
Influenza immunization of women during pregnancy protects the young infants against influenza illness. The duration of this protection remains unclear.
Objective
To evaluate the duration of infant protection conferred by maternal immunization and its association with transplacental antibody transfer.
Design, Setting, and Participants
Infants born to women who participated in a randomized, double-blind, placebo-controlled clinical trial in 2011 and 2012 on the safety, immunogenicity, and efficacy of trivalent inactivated influenza vaccine (IIV3) during pregnancy were followed up during the first 6 months of life for polymerase chain reaction (PCR)–confirmed influenza illness. In a secondary analysis of a subset of infants, hemagglutination inhibition (HAI) antibodies were measured. The study was performed at a single center in South Africa. The secondary analysis was performed in October 2014.
Exposure
Maternal immunization for influenza.
Main Outcomes and Measures
The vaccine’s efficacy against PCR-confirmed influenza illness and the percentage of infants with HAI titers of 1:40 or more by age group.
Results
There were 1026 infants (47.2% female) born to IIV3 recipients and 1023 infants (47.3% female) born to placebo recipients who were included in the analysis of the vaccine’s efficacy. The vaccine’s efficacy against PCR-confirmed influenza illness was highest among infants 8 weeks of age or younger at 85.6% (95% CI, 38.3%-98.4%) and decreased with increasing age to 25.5% (95% CI, −67.9% to 67.8%) among infants 8 to 16 weeks of age and to 30.3% (95% CI, −154.9% to 82.6%) among infants 16 to 24 weeks of age. Similarly, in the IIV3 group, the percentage of infants with HAI titers of 1:40 or more to the influenza vaccine strains decreased from more than 56% in the first week of life to less than 40% at 16 weeks of age and less than 10.0% at 24 weeks of age.
Conclusions and Relevance
Maternal immunization conferred protection against infection in the infants for a limited period during early life. The lack of protection beyond 8 weeks of age correlated with a decrease in maternally derived antibodies.
Trial Registration
clinicaltrials.gov Identifier: NCT01306669

Journal of Human Trafficking – Volume 2, Issue 3, 2016

Journal of Human Trafficking
Volume 2, Issue 3, 2016
http://www.tandfonline.com/toc/uhmt20/current

research article
Child Sex-Trafficking Recognition, Intervention, and Referral: An Educational Framework for the Development of Health-Care-Provider Education Programs
23 Aug 2016
Cathy L. Miller, Gloria Duke & Sally Northam

research article
International Sporting Events and Human Trafficking: Effects of Mega-Events on a State’s Capacity to Address Human Trafficking
23 Aug 2016
Zack Bowersox

book review
Review of International Sex Trafficking of Women & Children – Understanding the Global Epidemic
02 Aug 2016
Yvon Dandurand

book review
Review of Global Human Trafficking: Critical Issues and Contexts
02 Aug 2016
Benjamin Thomas Greer

Journal of Immigrant and Minority Health – October 2016

Journal of Immigrant and Minority Health
Volume 18, Issue 5, October 2016
http://link.springer.com/journal/10903/18/5/page/1

Original Paper
Latent Tuberculosis Infection Among Immigrant and Refugee Children Arriving in the United States: 2010
Eboni M. Taylor, John Painter, Drew L. Posey…

Original Paper
Behavioral and Environmental Explanations of Elevated Blood Lead Levels in Immigrant Children and Children of Immigrants
Stan A. Kaplowitz, Harry Perlstadt…

Original Paper
Immunization Coverage in Migrant School Children Along the Thailand-Myanmar Border
Aiko Kaji, Daniel M. Parker, Cindy S. Chu…

Original Paper
HPV Vaccine and Latino Immigrant Parents: If They Offer It, We Will Get It
Abraham Aragones, Margaux Genoff…

Journal of Infectious Diseases – September 15, 2016

Journal of Infectious Diseases
Volume 214 Issue 6 September 15, 2016
http://jid.oxfordjournals.org/content/current

EDITORIAL COMMENTARIES
Editor’s choice: Dengue Vaccine: The Need, the Challenges, and Progress
Alan L. Rothman and Francis A. Ennis
J Infect Dis. (2016) 214 (6): 825-827 doi:10.1093/infdis/jiw068

Public Health Benefits of Routine Human Papillomavirus Vaccination for Adults in the Netherlands: A Mathematical Modeling Study
Suzette M. Matthijsse, Jan A. C. Hontelez, Steffie K. Naber, Kirsten Rozemeijer, Inge M. C. M. de Kok, Roel Bakker, Marjolein van Ballegooijen, Joost van Rosmalen, and Sake J. de Vlas
J Infect Dis. (2016) 214 (6): 854-861 doi:10.1093/infdis/jiw256

Journal of International Development – August 2016

Journal of International Development
August 2016 Volume 28, Issue 6 Pages 825–1010
http://onlinelibrary.wiley.com/doi/10.1002/jid.v28.6/issuetoc

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Research Articles
Training Professionals and Eroding Relationships: Donors, Aids Care and Development in Urban Zambia (pages 827–844)
Amy S. Patterson
Version of Record online: 26 APR 2016 | DOI: 10.1002/jid.3222

Research Articles
Determinants and Trends of Socioeconomic Inequality in Child Malnutrition: The Case of Mozambique, 1996–2011 (pages 857–875)
Vincenzo Salvucci
Version of Record online: 6 AUG 2015 | DOI: 10.1002/jid.3135

Field Report
Deregulation and Access to Medicines: the Peruvian Experience (pages 997–1005)
Joan Costa Font
Version of Record online: 10 APR 2015 | DOI: 10.1002/jid.3096
Abstract
How does the deregulation of medicine influence access to drugs? This paper provides an economic policy assessment of the effects of medicine deregulation drawing on the Peruvian experience between 1991 and 2006. As in other low-income countries, health insurance development is inadequate, drug expenditure is mostly paid out-of-pocket and approximately one third of the Peruvian population has limited access to ‘essential medicines’. Market deregulation in this context could have exerted an impact on prices and hence reduce access to medicines. Based on this evidence, we find that product and price deregulation of the medicines market appears to have reduced consumer trust of locally produced medicines and incentivised a switch to branded and more expensive drugs. The latter resulted in a drug price spike, which in turn further decreased access to medicines.

The Lancet – Series: HIV and related infections in prisoners

The Lancet
Sep 10, 2016 Volume 388 Number 10049 p1025-1128 e2-e3
http://www.thelancet.com/journals/lancet/issue/current

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Series
HIV and related infections in prisoners
Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees
Kate Dolan, Andrea L Wirtz, Babak Moazen, Martial Ndeffo-mbah, Alison Galvani, Stuart A Kinner, Ryan Courtney, Martin McKee, Joseph J Amon, Lisa Maher, Margaret Hellard, Chris Beyrer, Fredrick L Altice

HIV and related infections in prisoners
Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis
Josiah D Rich, Curt G Beckwith, Alexandria Macmadu, Brandon D L Marshall, Lauren Brinkley-Rubinstein, Joseph J Amon, M-J Milloy, Maximilian R F King, Jorge Sanchez, Lukoye Atwoli, Frederick L Altice

HIV and related infections in prisoners
Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners
Adeeba Kamarulzaman, Stewart E Reid, Amee Schwitters, Lucas Wiessing, Nabila El-Bassel, Kate Dolan, Babak Moazen, Andrea L Wirtz, Annette Verster, Frederick L Altice
1115

New England Journal of Medicine – September 8, 2016

New England Journal of Medicine
September 8, 2016 Vol. 375 No. 10
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
Need for a New Lyme Disease Vaccine
S.A. Plotkin
Despite the development of two vaccines against Borrelia burgdorferi, the bacterium that causes Lyme disease, there is no such vaccine currently on the market. But the problem of Lyme disease is large and growing. Fortunately, the future seems reasonably bright for new vaccines.

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Review Article
The Changing Face of Clinical Trials: The Primary Outcome Is Positive — Is That Good Enough?
S.J. Pocock and G.W. Stone
There is a natural tendency to simplify the findings of a clinical trial into a binary conclusion: “Was there a positive outcome — or not?” In order to address this question with some objectivity, attention is typically focused on whether the prespecified measure of success for the primary outcome has been met — that is, whether a P value of less than 0.05 has been achieved for the difference in treatments. In reality, a more nuanced interpretation requires a thorough examination of the totality of the evidence, including secondary end points, safety issues, and the size and quality of the trial. In this article, which focuses on the evaluation of “positive” studies — as in our previous article,1 which focused on the appraisal of “negative” studies — our intent is to facilitate a more sophisticated and balanced interpretation of trial evidence. Again, we make our points using examples from trials involving cardiovascular disease (our area of expertise), but the messages can be easily applied to other subject areas.

Isolation of Zika Virus Imported from Tonga into Australia

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 10 September 2016)

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Isolation of Zika Virus Imported from Tonga into Australia
September 7, 2016 · Research Article
Introduction: The globally emergent Zika virus (ZIKV) is a threat to Australia, given the number of imported cases from epidemic regions and the presence of competent mosquito vectors. We report the isolation of ZIKV from a female traveler who recently returned from Tonga to Brisbane, Queensland, Australia in 2016.
Methods: A specific TaqMan real-time reverse transcriptase polymerase chain reaction assay (RT-PCR) assay was used to detect ZIKV in serum and urine samples. Conventional cell culture techniques and suckling mice were employed in an attempt to isolate ZIKV from serum and urine.
Results: A ZIKV isolate (TS17-2016) was recovered from the serum sample after one passage in suckling mouse brains and harvested 11 days post inoculation. Phylogenetic analysis of complete envelope (E) gene sequences demonstrated TS17-2016 shared 99.9% nucleotide identity with other contemporary sequences from Tonga 2016, Brazil 2015 and French Polynesia 2013 within the Asian lineage.
Discussion: This is the first known report of successful isolation of ZIKV from a human clinical sample in Australia and the first from a traveler from Tonga. This study highlights the potential difficulties in isolating ZIKV from acute clinical samples using conventional cell culture techniques, particularly in non-endemic countries like Australia where access to samples of sufficient viral load is limited. The successful isolation of TS17-2016 will be essential for continued investigations of ZIKV transmission and pathogenicity and will enable the advancement of new preventative control measures extremely relevant to the Australian and Pacific region.

Sex Differences in Tuberculosis Burden and Notifications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 10 September 2016)
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Research Article
Sex Differences in Tuberculosis Burden and Notifications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis
Katherine C. Horton, Peter MacPherson, Rein M. G. J. Houben, Richard G. White, Elizabeth L. Corbett
| published 06 Sep 2016 PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002119

A Médecins Sans Frontières Ethics Framework for Humanitarian Innovation

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 10 September 2016)
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A Médecins Sans Frontières Ethics Framework for Humanitarian Innovation
Julian Sheather, Kiran Jobanputra, Doris Schopper, John Pringle, Sarah Venis, Sidney Wong, Robin Vincent-Smith
Health in Action | published 06 Sep 2016 PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002111
Summary Points
:: Humanitarian organisations often have to innovate to deliver health care and aid to populations in complex and volatile contexts.
:: Innovation projects can involve ethical risks and have consequences for populations even if human participants are not directly involved. While high-level principles have been developed for humanitarian innovation, there is a lack of guidance for how these should be applied in practice.
: Médecins sans Frontières (MSF) has well-established research ethics frameworks, but application of such frameworks to innovation projects could stifle innovation by introducing regulation disproportionate to the risks involved. In addition, the dynamic processes of innovation do not fit within conventional ethics frameworks.
:: MSF developed and is piloting an ethics framework for humanitarian innovation that is intended for self-guided use by innovators or project owners to enable them to identify and weigh the harms and benefits of such work and be attentive towards a plurality of ethical considerations.

Challenges of Estimating the Annual Caseload of Severe Acute Malnutrition: The Case of Niger

PLoS One
http://www.plosone.org/
[Accessed 10 September 2016]
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Research Article
Challenges of Estimating the Annual Caseload of Severe Acute Malnutrition: The Case of Niger
Hedwig Deconinck, Anaïs Pesonen, Mahaman Hallarou, Jean-Christophe Gérard, André Briend, Philippe Donnen, Jean Macq
Research Article | published 08 Sep 2016 PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0162534

Men’s status and reproductive success in 33 nonindustrial societies: Effects of subsistence, marriage system, and reproductive strategy

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 10 September 2016)
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Men’s status and reproductive success in 33 nonindustrial societies: Effects of subsistence, marriage system, and reproductive strategy
Christopher R. von Ruedena,1 and Adrian V. Jaeggib
Author Affiliations
Edited by Kristen Hawkes, University of Utah, Salt Lake City, UT, and approved July 19, 2016 (received for review April 28, 2016)
Significance
Much of human behavior results from a desire for social status. From an evolutionary perspective, answering the question of why we pursue status must consider how status affects reproduction, especially in nonindustrial societies with natural fertility. In a metaanalysis of 288 results from 33 nonindustrial populations, we find that status is significantly associated with men’s reproductive success, consistent with an evolved basis for status pursuit. Status hierarchies have changed dramatically throughout human history, yet we find that the association between status and reproductive success does not depend on subsistence category (foraging, horticulture, pastoralism, agriculture) or how status is measured. These findings suggest no significant increase in selection on status-enhancing traits with the domestication of plants and animals.

Abstract
Social status motivates much of human behavior. However, status may have been a relatively weak target of selection for much of human evolution if ancestral foragers tended to be more egalitarian. We test the “egalitarianism hypothesis” that status has a significantly smaller effect on reproductive success (RS) in foragers compared with nonforagers. We also test between alternative male reproductive strategies, in particular whether reproductive benefits of status are due to lower offspring mortality (parental investment) or increased fertility (mating effort). We performed a phylogenetic multilevel metaanalysis of 288 statistical associations between measures of male status (physical formidability, hunting ability, material wealth, political influence) and RS (mating success, wife quality, fertility, offspring mortality, and number of surviving offspring) from 46 studies in 33 nonindustrial societies. We found a significant overall effect of status on RS (r = 0.19), though this effect was significantly lower than for nonhuman primates (r = 0.80). There was substantial variation due to marriage system and measure of RS, in particular status associated with offspring mortality only in polygynous societies (r = −0.08), and with wife quality only in monogamous societies (r = 0.15). However, the effects of status on RS did not differ significantly by status measure or subsistence type: foraging, horticulture, pastoralism, and agriculture. These results suggest that traits that facilitate status acquisition were not subject to substantially greater selection with domestication of plants and animals, and are part of reproductive strategies that enhance fertility more than offspring well-being.

Sufficient trial size to inform clinical practice

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 10 September 2016)

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Sufficient trial size to inform clinical practice
Charles F. Manskia,1 and Aleksey Tetenovb,c
Author Affiliations
Contributed by Charles F. Manski, July 23, 2016 (sent for review May 20, 2016; reviewed by Keisuke Hirano and David Meltzer)
Significance
A core objective of trials comparing alternative medical treatments is to inform treatment choice in clinical practice, and yet conventional practice in designing trials has been to choose a sample size that yields specified statistical power. Power, a concept in the theory of hypothesis testing, is at most loosely connected to effective treatment choice. This paper develops an alternative principle for trial design that aims to directly benefit medical decision making. We propose choosing a sample size that enables implementation of near-optimal treatment rules. Near optimality means that treatment choices are suitably close to the best that could be achieved if clinicians were to know with certainty mean treatment response in their patient populations.

Abstract
Medical research has evolved conventions for choosing sample size in randomized clinical trials that rest on the theory of hypothesis testing. Bayesian statisticians have argued that trials should be designed to maximize subjective expected utility in settings of clinical interest. This perspective is compelling given a credible prior distribution on treatment response, but there is rarely consensus on what the subjective prior beliefs should be. We use Wald’s frequentist statistical decision theory to study design of trials under ambiguity. We show that ε-optimal rules exist when trials have large enough sample size. An ε-optimal rule has expected welfare within ε of the welfare of the best treatment in every state of nature. Equivalently, it has maximum regret no larger than ε. We consider trials that draw predetermined numbers of subjects at random within groups stratified by covariates and treatments. We report exact results for the special case of two treatments and binary outcomes. We give simple sufficient conditions on sample sizes that ensure existence of ε-optimal treatment rules when there are multiple treatments and outcomes are bounded. These conditions are obtained by application of Hoeffding large deviations inequalities to evaluate the performance of empirical success rules.

Maternal morbidity associated with violence and maltreatment from husbands and in-laws: findings from Indian slum communities

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 10 September 2016]

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Research
Maternal morbidity associated with violence and maltreatment from husbands and in-laws: findings from Indian slum communities
Jay G. Silverman, Donta Balaiah, Julie Ritter, Anindita Dasgupta, Sabrina C. Boyce, Michele R. Decker, D. D. Naik, Saritha Nair, Niranjan Saggurti and Anita Raj
Published on: 8 September 2016

Science – 09 September 2016

Science
09 September 2016 Vol 353, Issue 6304
http://www.sciencemag.org/current.dtl
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Editorial
Ebola and Zika: Cautionary tales
By Michael T. Osterholm
Science09 Sep 2016 : 1073
Summary
The emergence of Zika in the Americas is a stark reminder of how quickly public health challenges of infectious diseases can change. The need for a safe and effective vaccine is immediate. Yet, like the Ebola epidemic 2 years ago, we find ourselves without a vaccine to combat this latest threat. When surveillance points to a possible emergence of a new infectious disease of potential public health importance, we need procedural and funding mechanisms that can quickly identify candidate vaccines and drive research and development toward licensure and production. Even if such a vaccine is not yet licensed, having it ready for immediate large trials when a regional crisis occurs will be a major advantage over our current reactive system.

Editorial
Zika vaccine trials
By Marc Lipsitch, Benjamin J. Cowling
Science09 Sep 2016 : 1094-1095 Full Access
There are new and familiar challenges in the race for timely and effective vaccines
Summary
Promising data for candidate vaccines against Zika virus infection reported by Abbink et al. (1) on page 1129 of this issue raise hopes that one or more Zika virus vaccines may soon be ready for efficacy trials. Recent years have seen a barrage of emerging infectious diseases, including those caused by new pathogens such as Middle East respiratory syndrome (MERS) coronavirus, and those that are newly salient because of increased geographic spread, higher incidence, or genetic change, such as influenza A(H1N1)pdm09, Ebola virus, and Zika virus. Developing effective vaccines is a central goal for such pathogens.

Research Articles
Protective efficacy of multiple vaccine platforms against Zika virus challenge in rhesus monkeys
By Peter Abbink, Rafael A. Larocca, Rafael A. De La Barrera, Christine A. Bricault, Edward T. Moseley, Michael Boyd, Marinela Kirilova, Zhenfeng Li, David Ng’ang’a, Ovini Nanayakkara, Ramya Nityanandam, Noe B. Mercado, Erica N. Borducchi, Arshi Agarwal, Amanda L. Brinkman, Crystal Cabral, Abishek Chandrashekar, Patricia B. Giglio, David Jetton, Jessica Jimenez, Benjamin C. Lee, Shanell Mojta, Katherine Molloy, Mayuri Shetty, George H. Neubauer, Kathryn E. Stephenson, Jean Pierre S. Peron, Paolo M. de A. Zanotto, Johnathan Misamore, Brad Finneyfrock, Mark G. Lewis, Galit Alter, Kayvon Modjarrad, Richard G. Jarman, Kenneth H. Eckels, Nelson L. Michael, Stephen J. Thomas, Dan H. Barouch
Science09 Sep 2016 : 1129-1132
Abstract
Zika virus (ZIKV) is responsible for a major ongoing epidemic in the Americas and has been causally associated with fetal microcephaly. The development of a safe and effective ZIKV vaccine is therefore an urgent global health priority. Here we demonstrate that three different vaccine platforms protect against ZIKV challenge in rhesus monkeys. A purified inactivated virus vaccine induced ZIKV-specific neutralizing antibodies and completely protected monkeys against ZIKV strains from both Brazil and Puerto Rico. Purified immunoglobulin from vaccinated monkeys also conferred passive protection in adoptive transfer studies. A plasmid DNA vaccine and a single-shot recombinant rhesus adenovirus serotype 52 vector vaccine, both expressing ZIKV premembrane and envelope, also elicited neutralizing antibodies and completely protected monkeys against ZIKV challenge. These data support the rapid clinical development of ZIKV vaccines for humans.

Concepts and practices for the democratisation of knowledge generation in research partnerships for sustainable development

Evidence & Policy: A Journal of Research, Debate and Practice
Volume 12, Number 3, August 2016, pp. 405-430(26)
Concepts and practices for the democratisation of knowledge generation in research partnerships for sustainable development
Ott, Cordula1; Kiteme, Boniface2
Abstract:
In response to the development and climate crisis of the Anthropocene, world leaders at the 2015 UN Sustainable Development Summit in New York have reconfirmed the urgency of a sustainability transformation. This paper shows how a strong conceptualisation of sustainability can guide scientists in contributing to this transformation. The Eastern and Southern Africa Partnership Programme (1999–2015) offers experiences in framing and implementing research as a transdisciplinary future-forming process. Its procedural, reflexive programme design proved adequate to support the democratisation of knowledge generation. This fostered evidence-based contextualised knowledge and corresponding institutions, and strengthened the future-forming capacity of all partners involved.

Being Untaught: How NGO Field Workers Empower Parents of Children with Disabilities in Dadaab

Global Education Review
3(3), 2016
Being Untaught: How NGO Field Workers Empower Parents of Children with Disabilities in Dadaab
A Krupar
Abstract
Roughly 350,000 refugees, over 90% of them Somali, lived in five sprawling camps in Dadaab, Kenya in 2015. In the Dadaab refugee camps, families had unique experiences of disability, education, women’s roles, and involvement with International Non-Governmental Organization (INGO) programming. INGOs provided a variety of basic services including education such as the program analyzed here for parents of children with disabilities. Many children with disabilities in the refugee camps faced social stigma and lacked access to education. This research draws on practices and literature in family literacy and parental involvement programming to explore how one NGO training sought to empower women learners to send their children with disabilities to school in Kambioos, the smallest and newest refugee camp in Dadaab. Using ethnographic methods, one training program involving parents and children was video-taped. The video was used as a cue to interview field workers about how the training empowered parents, particularly mothers. The study found that empowerment of women through training for parents of children with disabilities centered on parents’ interaction with formal schools and engagement in their communities.