��Ī - Centre of Governance and Human Rights

Marking International Women’s Day at the ��Ī Festival

zs332 — Fri, 08 Mar 2024 09:21:59 +0000

From pre-eclampsia and its lasting impact on women’s health to inequitable distribution of domestic and caring labour in different-sex couples to an in-conversation with the Vice Chancellor: the ��Ī Festival counts a host of prominent female speakers in its programme.

Tackling COVID-19: Dr Sharath Srinivasan

jg533 — Thu, 25 Jun 2020 07:00:14 +0000

This article is part of a series in which we speak to some of the many ��Ī researchers tackling COVID-19. For other articles about our latest COVID-19-related research, click here.

I’ve spent most of the last few years in Kenya and eastern Africa. When I wasn’t there, I was usually scampering back and forth between the Alison Richard Building on ��Ī’s Sidgwick site and King’s College, somehow covering my daily steps quota. Now I’m working at the kitchen table, my son’s desk in his room, or the bedroom. I’m missing the study we never had!

I work on the ‘Risk Communications and Community Engagement’ part of the global pandemic response. This is about understanding the experience of the virus from a community perspective, then delivering trusted and effective messaging to support healthy behaviours as well as communicating feedback to public health actors and authorities.

My own expertise lies in understanding citizen-authority relations in developing countries, and how citizens engage with and hold to account decision-makers in policy-making and service delivery. Over the years I’ve also worked on innovations using media and communication technology to engage with and hear from hard-to-reach populations, and derive rapid social insights from large volumes of local language textual data. My work led to the spin-off Africa’s Voices Foundation, a non-profit I cofounded, based in Kenya. The team deploys our novel method combining local language radio and a free SMS channel to deliver governance and social change programmes.

As soon as COVID-19 hit, we were engaging populations in Kenya and Somalia. Two years ago, I was supported by the Wellcome Trust and UK DFID to evaluate the use of our interactive radio method for rapid social insights in health crises, as part of a global rethink following the West African Ebola outbreak. We’re now using this method and delivering insights to the wider national and international COVID-19 response.

I also work on improving socio-technical solutions for effective risk communication and community engagement, in collaboration with Luke Church in the Computer Laboratory. COVID-19 motivated us to rapidly build a communications tool for handling large volumes of one-to-one SMS conversations. If people raise urgent concerns, convey rumours, misinformation or stigma, or ask questions about COVID-19, the Africa’s Voices team needs to respond to each person quickly and empathetically but using an approved response protocol. A bot simply won’t do. We developed a tool called katikati that’s being used in Somalia right now, handling many thousands of interactions each week.

Trust is the biggest challenge of this pandemic. Who and what is trusted by people determines how they respond. How much do we trust in ourselves and our communities, in our social/religious leaders, in scientific expertise, and in people, nations, governments and international agencies globally? Without trust playing a very large role, we don’t flatten the curve through distancing and hygiene, achieve track and trace, protect the vulnerable, adopt new vaccines, reopen our businesses, institutions, even our borders, and ready ourselves to tackle a possible second wave.

Our research is about unearthing the worldviews and perspectives of communities, then thinking about the communications that will make sense for them. Imagine you’re a Somali forcibly displaced from your home due to drought and conflict, now in a crowded informal camp with no running water and limited sanitation, in the midst of a locust plague that is wreaking havoc on food production and livelihoods. Your life is precarious already, and you face a range of risks and anxieties. You are told by a government announcement that this new virus is sweeping the world, and to protect your community you must change the way you live in ways that are hard to achieve and put your livelihood in greater peril. You turn to your local Sheikh for guidance, as you always do - it’s what they say that matters, not what the government, or WHO, or UNICEF is saying.

Somehow this pandemic arrived when our communication technologies and data transmission capabilities were ready for global remote networked collaboration. We might all be a bit ‘Zoomed out’, but I’m amazed every day by how I can collaborate on a response in Somalia with multiple organisations and far flung individuals. Ten years ago cloud computing was in its infancy, and we could not have managed this.

I am more motivated and passionate than ever about the importance and value of applied interdisciplinary research that really harnesses expertise across social, biomedical and technological sciences. In ��Ī there’s a strong spirit of collaboration across departments and disciplines that’s very inspiring. I’ve seen this through the support given to me by initiatives such as ��Ī-Africa and ��Ī Global Challenges.

When the pandemic is over I’m looking forward to traveling back to Kenya and eastern Africa and meeting up again with the amazing Africa’s Voices team.

Sharath Srinivasan is David and Elaine Potter Lecturer in Governance & Human Rights and Co-Director of the Centre of Governance and Human Rights (CGHR), and Fellow of King's College, ��Ī. Read more about the Africa's Voices project on Somali views in the early days of COVID-19.

How you can support ��Ī’s COVID-19 research

“Without trust, we don’t flatten the curve,” says Sharath Srinivasan, whose work in developing countries has given him an acute insight into how people’s worldviews and perspectives affect who and what they choose to trust. Through a new communications tool he’s helping to engage communities in Somalia so that COVID-19 risks are communicated effectively and rumours are quashed.

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Under pressure: the battle to have a baby in Africa

lw355 — Thu, 16 Feb 2017 09:40:43 +0000

As a young doctor in Uganda a few years ago, Dr Annettee Nakimuli was told that nothing could be done about a complication of pregnancy that was putting thousands of pregnant women a year at risk of death.

She remembers the frustration: “I felt like we were accomplices in this war of sorts. People say we do not remember the words of our enemies but the silence of our friends. I did not want to accept that it was beyond hope.”

The disease is pre-eclampsia, a condition that is thought to be caused by the placenta developing abnormally. Women with pre-eclampsia often experience very high blood pressure, which can be fatal without medical intervention. Although the condition affects women worldwide, in African women it is more common and particularly severe. It also occurs earlier in pregnancy and can recur in subsequent pregnancies.

“What makes pre-eclampsia such a challenge is it has been impossible to predict or prevent,” explains Professor Ashley Moffett, from ��Ī’s Department of Pathology and Centre for Trophoblast Research, who is an expert on the disease.

“It’s been called the ‘silent killer’ because many women cannot feel the danger sign that their blood pressure is rising until it’s too late. Even when it is detected the only course of action is constant monitoring, and ultimately the only cure is delivery – sometimes at too early a stage for the baby to survive,” adds Moffett.

The silent killer

Nakimuli knows only too well the difficulties that African women face. Today she’s an obstetrician in Mulago Hospital, Kampala, where 33,000 babies are born each year. It has the highest number of live births of any hospital in the world (around 100 per day), and 15% of pregnancies develop life-threatening complications such as pre-eclampsia, haemorrhage, obstructed labour and sepsis. She describes herself and her colleagues as being “on the front line” in the battle against death in pregnancy and childbirth.

“I would often see women who had had four or more Caesarean sections with no living child – they continued exposing themselves to the danger until they had a baby,” says Nakimuli, who is also a lecturer at Makerere University. “I felt like not sitting back and just saying this is a disease with theories.”

Seven years ago, she began work with Moffett through the ��Ī-Africa Programme, first as a MUII PhD fellow registered at Makerere University, then as a MUII postdoctoral fellow and now as a research collaborator. Based in Kampala throughout, she would periodically travel to ��Ī to learn new techniques, analyse samples and spend time with Moffett trying to unravel why a complex disease is so much worse in Africa.

A few years earlier, Moffett had discovered that, when the placenta is formed, a remarkable ‘boundary-setting’ process occurs between the mother and the fetus deep within the lining of the womb.

“The placenta must invade the mother enough to access nourishment for the growing baby, yet not so much as to penetrate through the uterus,” she explains. “Placentation is a setting up of the territorial boundary between two genetically different individuals – the mother and her baby, who carries genes from the father. It needs to be in exactly the right place for both to survive and thrive.”

Moffett found that maternal immune cells called uterine natural killer cells mediate the compromise between mother and baby. These cells have unique proteins on their surface called killer-cell immunoglobulin receptors (KIRs), which recognise proteins called MHC on the invading fetal cells. Certain combinations of maternal KIR genes and fetal MHC genes are associated with pre-eclampsia, whereas other KIR genes appear to protect against the disease.

But why would women of African descent suffer so much more from pre-eclampsia than other women? “There was an assumption in Africa that there was a socioeconomic reason, like poverty,” says Nakimuli. “I was convinced that there was something biological.”

Nakimuli set about recruiting 750 mothers at Mulago Hospital to what is the largest genetic study of pre-eclampsia conducted in Africa. She collected blood and umbilical cord samples and, in ��Ī, ‘typed’ the DNA to look at all the genetic variation. “It was kind of a high-risk project, but my determination kept my hope alive. I wanted to find big things.”

Her hunch proved right. She found that the KIR genes that protect African women against pre-eclampsia are different from those that protect European women. Moreover, the risky combination of maternal KIR and fetal MHC proteins occurs at a much higher frequency in sub-Saharan Africa than anywhere else in the world.

We think that women of African ancestry may have these risk genes because of certain beneficial selective pressures, otherwise why would genes that kill mothers and babies be so common in the population?
Ashley Moffett

The findings immediately opened up new avenues of research into the biology of pre-eclampsia. The study also has implications for understanding infectious diseases, as Moffett explains: “We think that women of African ancestry may have these risk genes because of certain beneficial selective pressures, otherwise why would genes that kill mothers and babies be so common in the population? People with the gene that causes sickle-cell anaemia are able to fend off malaria – perhaps something similar is happening for KIR genes? And so now we are starting work to see whether the genes are protecting against infections such as measles, HIV and malaria.”

Africa's Voices

While Nakimuli and Moffett continue pinpointing the genetic basis of pre-eclampsia, and hope to bring out the first comprehensive textbook on African obstetrics, they are aware that one of the key issues surrounding pregnancy is that too many African women go to hospital too late, leaving it until their complications are advanced and dangerous.

“There’s a general lack of awareness and understanding,” explains Nakimuli. “There isn’t even an Ugandan word for pre-eclampsia. The closest people get to describing the condition is ‘having hypertension which is different from the other hypertension when you’re not pregnant’. It becomes a mouthful.”

Last year she took part in a series of radio programmes in Uganda as ‘Doctor Annettee’, the on-air doctor ready to answer questions from the audience. The programmes were part of an innovative ��Ī-led research project, ‘Africa’s Voices’, which uses interactive radio and mobile communications to gather and analyse the views of ordinary citizens.

“Because of the high rates of maternal mortality, a coping mechanism among Ugandan women is to consider pregnancy as being about bravery and fortitude,” says Nakimuli. “This way of coping might however lead to late self-diagnosis of the warning signs.”

“Sociocultural beliefs like coping mechanisms will determine how people behave,” says Dr Sharath Srinivasan, who is Head of ��Ī’s Centre of Governance and Human Rights and leads Africa’s Voices, “and so it’s important to understand a person’s thinking to support better maternal and neonatal health policies.”

However, the challenge has always been how to collect and assess all of the different ‘voices’ from hard-to-reach African communities. Srinivasan and colleagues realised that Africa’s digital revolution – particularly the widespread use of mobile phones and SMS messaging – could provide the answer when combined with the huge popularity of local radio stations and the team’s technical know-how.

The team developed a format in which a radio presenter would play a real-life testimonial – such as a woman relaying the complications of her pregnancy – and then invite listeners to reply to a related question by sending a text to a toll-free number. Each respondent would subsequently receive an SMS sociodemographic survey to complete.

“What makes this set-up so rich is the fact that ordinary citizens are encouraged to voice their views. They aren’t restricted by a poll-style yes/no answer,” says Srinivasan. “We’ve developed a methodology that can take this data, which is often complex, unstructured and in more than one local language, and analyse it with qualitative social science and computational techniques to draw out key themes and insights.”

During Africa’s Voices pilot phase, the team used this format in eight sub-Saharan countries, working with nine radio stations, and choosing radio presenters who have a good relationship with their audience. In these ‘social spaces’, they probed beliefs on HIV/AIDS, vaccination, women’s issues, agriculture and governance processes.

Now spun-out of the University as a non-profit organisation, Africa’s Voices works in East Africa with NGOs, health agencies and media organisations, and maintains strong links with researchers such as Nakimuli and Moffett.

An interactive radio project to shed light on pregnancy complications like pre-eclampsia was recently completed with three local language radio stations in Kampala, Uganda, and rich insights emerged into the perceived causes of complications in pregnancy. One finding is the difference in beliefs between men and women.

“Men, more than women, tend to think that the causes of complications are related to enduring traits of the mothers – their biology or their personality – but that the risk of complications is more likely to happen to other women, not their own partner,” explains Srinivasan.

“Women on the other hand are more likely to believe that complications arise because of factors that they can control – such as their lifestyle. Both women and men agree that insufficient health provision is the major reason women delay seeking healthcare.”

Srinivasan suggests from his experience that governments and service deliverers are keen to listen intelligently to what people are saying and to organise their work more attentively to the world views and collective beliefs of the populations they serve. “Sociocultural beliefs that limit the seeking of healthcare are addressable,” he says. “Interventions that engage women and communities in conversations can help change beliefs, opinions and norms, and thus behaviour patterns.”

"We needed to study the disease in Africa"

When Nakimuli is asked what her own research findings on the genetics of pre-eclampsia will mean for the mothers she sees every day on the wards at Mulago hospital, she is pragmatic.

“Can it help medically? We are still far from that,” she says. “Yes, theoretically we can predict risk by genotyping pregnant mothers, but we are in a low-resource setting – everything needs to be cost-effective. Really we need to develop a bedside test that doesn’t require costly and time-consuming laboratory analysis. Then we could know which women need to be monitored carefully.”

Sociocultural beliefs that limit the seeking of healthcare are addressable. Interventions that engage women and communities in conversations can help change beliefs, opinions and norms, and thus behaviour patterns

Sharath Srinivasan

In the seven years since Nakimuli first embarked on her studies to understand why so many women die in pregnancy, ��Ī-Africa research partnerships with Mulago Hospital have widened considerably. They now include pharmacist Dr Ronald Kiguba and Professor Sheila Bird OBE (Medical Research Council Biostatistics Unit, ��Ī) investigating how to report medication errors and adverse drug reactions; microbiologist Dr David Kateete and Professor Stephen Bentley (Wellcome Trust Sanger Institute) tracking how infections like MRSA spread through hospitals; and a group of obstetricians and midwives from ��Ī University Hospitals NHS Foundation Trust looking at best practice with their contemporaries in Kampala.

Meanwhile, a typical day at Mulago Hospital will bring around five pre-eclamptic pregnancies and several cases of obstructed labour, preterm birth and stillbirths; and a team of five doctors will be supervising 80–100 deliveries.

Funds are being sought by ��Ī-Africa to help set up an African Centre of Excellence in Pregnancy and Childbirth at Mulago Hospital, in partnership with Makerere University’s College of Health Sciences. “We would like to train more specialised staff who in turn will train the next generation, and we want to turn new understanding of pregnancy complications into clinical interventions,” explains Nakimuli.

Looking back to when she decided not to accept that nothing could be done about pre-eclampsia, Nakimuli says: “I was convinced that the reason we didn’t know much about the disease was because we’d been looking in the wrong place. We needed to study the disease in Africa. After all, if you want to study a disease properly, then you should look at the population most affected by it.”

Dr Annettee Nakimuli was funded by the Makerere University-Uganda Virus Research Institute Infection and Immunity Research Training Programme (MUII).

Inset images: Top: Dr Annettee Nakimuli; Bottom: radio interview with 'Dr Annettee' at Akaboozi FM in Kampala, Uganda, as part of the Africa's Voices study (credit: Rainbow Wilcox, Africa's Voices).

To keep up to date with the latest stories about ��Ī’s engagement with Africa, follow #CamAfrica on Twitter.

A complication of pregnancy that causes the mother’s blood pressure to rise – often fatally – is more common in women of African descent than any other. Research in Uganda by African and ��Ī researchers is helping to uncover why.

I felt like we were accomplices in this war of sorts. People say we do not remember the words of our enemies but the silence of our friends. I did not want to accept that it was beyond hope

Annettee Nakimuli

DFID

Suffering from pre-eclampsia, this young mother had to undergo a Caesarean to deliver her twin boys, seen here in the arms of her mother (Malawi)

Graduate, get a job … make a difference #6

��Ī graduates enter a wide range of careers but making a difference tops their career wish lists. Read about Kathryn Savage who now works in Uganda to improve health service delivery and increase utilisation by strengthening the leadership skills of health workers and district health teams. 'Graduate, get a job … make a difference' is a series in which inspiring graduates from the last three years describe ��Ī, their current work and their determination to give back.

The text in this work is licensed under a Creative Commons Attribution 4.0 International License. For image use please see separate credits above.

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Democratising the airwaves

bjb42 — Mon, 01 Nov 2010 14:03:42 +0000

In Africa, an estimated 90% of households own a radio. But for all its muscle in connecting with the masses, radio communication remains mostly one-way. If radio was more interactive, listeners could share information, communicate grassroots reactions to current affairs and mobilise change.

Now, a pioneering research collaboration between ��Ī’s Centre of Governance and Human Rights, in the Department of Politics and International Studies, and FrontlineSMS, a UK-based non-profit organisation, aims to help transform African radio into a two-way communications channel. In so doing, the project will assess the capacity of interactive radio for improved citizen awareness and greater citizen engagement.

Developing tools, investigating outcomes

FrontlineSMS provides free software to enable users to send and receive text messages with large groups of people – a particular advantage in the developing world where the use of mobile phones and text messaging is rapidly increasing but internet access is limited. At the core of the project is the tailoring and deployment of the software to community and local radio networks, enabling radio stations of any size to use a laptop to gather information from listeners via mobile phone text messaging, helping them to shape programming and communicate with their audiences in real-time.

Other project partners include Developing Radio Partners and Internews, each of which has a long-standing track record in media development in Africa and will be essential to help pilot test the software in Kenya, Zambia, Sierra Leone, South Africa, Tanzania and Malawi. A subsequent worldwide roll-out is planned for mid-2011.

Alongside this tangible goal of the project runs a sociopolitical investigation of how new communications technologies influence governance relations and practices, as the Centre’s Director Sharath Srinivasan explains: ‘Without question, ‘hybrid media’ that combine the interactive power of mobile SMS with the reach of radio have the potential to expand citizens’ political capabilities and enrich public sphere interactions. But a major challenge has been to develop an empirical sense of how transformative this can be in relation to public debate, political participation, accountability and governance.’

Understanding this impact is precisely the type of question that interests the Centre, which was launched in 2009 as an interdisciplinary hub for research, teaching and engagement with policy and practice on issues of human rights and governance in Africa and the global South. The project is harnessing interdisciplinary expertise across the University, from the Computer Laboratory, Judge Business School, Engineering, Social Anthropology and Psychology.

Social technology innovation meets academia

A collaboration between the University and FrontlineSMS makes sound sense, as Ken Banks, founder of FrontlineSMS, explains: ‘The impact of tools in the mobile-for-development field tends to suffer from a lack of rigorous academic scrutiny, and most impact assessment is carried out after the event rather than being an intrinsic part of the deployment process. As a result of the collaboration, from the outset and for the first time, this project will determine user behaviour, identify system design and monitor impact throughout the project life cycle.’

‘Imagine thousands of radio stations being able to interact with citizens on issues from agriculture to politics, health to human rights, and how this can change the nature of public discussion,’ adds Sharath Srinivasan. ‘This study is our entry point for looking at such issues more broadly. Our long-term vision is to evolve the programme into evaluating not just the mobile phone and radio but also a whole range of communication technologies and how they are reconfiguring governance relations in Africa and beyond.’

For more information, please contact Sharath Srinivasan (ss919@cam.ac.uk) at the Centre of Governance and Human Rights, or Karim Amijee (karim@radio.frontlinesms.com). The Centre was established through the David and Elaine Potter Foundation; this project is funded by The Cairns Charitable Trust with matching support from the Isaac Newton Trust.

A new research collaboration will investigate the capacity of radio to facilitate citizen-led governance in developing countries.

Without question, ‘hybrid media’ that combine the interactive power of mobile SMS with the reach of radio have the potential to expand citizens’ political capabilities and enrich public sphere interactions.

Sharath Srinivasan

Community radio volunteers, Breeze-FM, Chipata, Zambia

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Marking International Women’s Day at the �������������Ī Festival