Explore the vast range of titles available.

Countering the focus on crisis and irregularity that frames dominant representations of African migration to Europe, this article explores Gambian migrant women’s journeys of return. It is argued that Gambian women returnees’ financial resources, levels of education, kinship relations and social networks have positioned them in such a way that they can benefit from the opportunities and possibilities in The Gambia, thereby influencing their decisions to return. Significantly, their positions have helped them to negotiate and, in some instances, challenge gendered expectations and relations in their experiences on return. Further, the exchange of knowledge and their transnational networks and connections place the global South and the global North as co-constitutive elements in the development of their work and their gendered subjectivities. As such, I focus on the analytical purchase that the concept of return affords, as well as its political possibilities. The article contributes to existing scholarship on migration by highlighting the importance of returnees’ multiple subjectivities in both their decisions to return and their experiences on return. In addition, I foreground the contributions that returnees make to the places to which they have migrated, thereby challenging representations of African migrants as deficient and of Africa as a place of absence.

ObjectivesAlthough people living with HIV (PLWH) have been disproportionately affected by post-traumatic stress disorder (PTSD), the global prevalence of PTSD among PLWH is unknown. This study aimed to systematically review the prevalence of PTSD among PLWH worldwide and explore variation in prevalence across sociodemographic and methodological factors.DesignA meta-analysis using a random-effects model was conducted to pool the prevalence estimated from individual studies, and subgroup analyses were used to analyse heterogeneities.Setting, participants and measuresObservational studies providing PTSD prevalence data in an adult HIV population were searched from January 2000 to November 2019. Measurements were not restricted, although the definition of PTSD had to align with the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases diagnostic criteria.ResultsA total of 38 articles were included among 2406 records identified initially. The estimated global prevalence of PTSD in PLWH was 28% (95% CI 24% to 33%). Significant heterogeneity was detected in the proportion of PLWH who reported PTSD across studies, which was partially explained by geographic area, population group, measurement and sampling method (p<0.05).ConclusionPTSD among PLWH is common worldwide. This review highlights that PTSD should be routinely screened for and that more effective prevention strategies and treatment packages targeting PTSD are needed in PLWH.

During the 2010s, The Gambia came under the spotlight of the European migration regime because of the numbers of its citizens requesting asylum in Europe. Historically sensitive ethnography highlights the specificity of this phase of Gambian migrations and situates it in the country’s political history. The political energy that the “backway”—as undocumented migrations to Europe have been popularly known in The Gambia since the 2000s—manifested at different levels, often simultaneously, over the span of few years is considered in light of the reproduction of authoritarian rule until 2016, the following postdictatorship transition, and the evolving ambiguous relationship among the national government, young people’s desires of mobility, and European requests to reduce their outflow.

Numerous studies have reported that the prevalence estimates of post-traumatic stress disorder (PTSD) might be substantially high among people with HIV/AIDS (PLWHA) when compared to the general population. However, there are no previous systematic reviews and meta-analysis studies that reported the pooled prevalence of PTSD among PLWHA. To fill this gap in research, this study aims to analyze data from observational studies concerning the prevalence of PTSD among PLWHA and formulate a recommendation for future research and clinical practice. Three electronic databases (PubMed, EMBASE, and SCOPUS) were searched to identify relevant studies that reported the prevalence of PTSD among PLWHA. A comprehensive meta-analysis software was used to conduct the meta-analysis. Subgroup and sensitivity analysis was conducted the I2 test was utilized to evaluate heterogeneity. Publication bias was assessed by using Egger’s test and visual inspection of the symmetry in funnel plots. Nineteen-studies with 9094 participants were included in this systematic review and meta-analysis. The pooled prevalence estimate of PTSD among PLWHA was found to be 32.67% (95% CI; 25.29–41.01). The prevalence of PTSD was 25.17% (95% CI; 19.72–31.55) for studies that used diagnostic instrument to assess PTSD and it was 34.68% (95% CI; 25.42–45.26) for studies that used screening instruments. Furthermore, the prevalence of PTSD among PLWHA was comparable between high-income (31.19%) and low, and middle-income countries (34.87%). We also found that the pooled prevalence of PTSD was remarkably higher for moderate and low-quality studies (42.64%) than for high-quality studies (24.84%). The prevalence of PTSD among PLWHA in the current study showed a significant variation by the location of the studies, the instruments used to measure PTSD as well as the quality of the included studies. The present review demonstrated that the prevalence estimates of PTSD among PLWHA (32.67%) was notably high and requires clinical attention. The estimated prevalence of PTSD was found to be comparable between high income and low, and middle-income countries. In addition, we found that the prevalence of PTSD was notably lower when measured by the diagnostic instrument than the screening instrument, although the variation was not statistically significant. Early screening and treatment of PTSD among PLWHA is needed to alleviate suffering.

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

Following the disputed December 2016 presidential elections in The Gambia, ECOWAS managed to \"restore democracy\" in the country by using the threat of force, but without any use of direct physical violence. Both the African Union and the United Nations Security Council backed ECOWAS, which also gave ECOWAS legitimacy, for what was essentially ECOWAS's policy, and indeed an African solution to African problems. Only when the scenario of military invasion became credible did the Gambian regime accept the defeat. Four main factors explain the behaviour of ECOWAS and its success: ECOWAS had a clear legal mandate to threaten the use of force in order to protect democracy in one of its member states; there was consensus that ECOWAS forces could have coped with the relatively small Gambian army; the Gambian president could not rely on friends among his regional peers or some powerful ally from outside Africa; and regional leaders such as Nigeria and Senegal made a credible commitment to the regional intervention. While the intervention was a victory for pro-democratic activist regionalism, the specific West African conditions make a diffusion of the model to other parts of Africa unlikely. Nach den umstrittenen Präsidentschaftswahlen in Gambia im Dezember 2016 konnte die westafrikanischen Regionalorganisation ECOWAS die Demokratie im Land wiederherstellen, indem sie eine militärische Intervention androhte, ohne dass es tatsächlich zu Gewaltmaßnahmen kam. Sowohl die Afrikanische Union als auch der Sicherheitsrat der Vereinten Nationen hatten die Entscheidung der Regionalorganisation unterstützt und damit zur Legitimation dieser „afrikanischen Lösung für afrikanische Probleme“ beigetragen. Die gambische Regierung räumte ihre Wahlniederlage erst in dem Moment ein, als das Szenario einer Militärinvasion glaubhaft erschien. Vier Hauptfaktoren erklären das Vorgehen von ECOWAS und den Erfolg: Die Regionalorganisation verfügte über ein rechtlich eindeutiges Mandat, die Demokratie in einem ihrer Mitgliedsländer durch Androhung von Gewalt zu schützen; es bestand Konsens, dass die relativ kleine gambische Armee einer ECOWAS-Eingreiftruppe nicht gewachsen wäre; der gambische Präsident konnte weder auf befreundete Regierungen im regionalen Umfeld noch auf mächtige Alliierte außerhalb des afrikanischen Kontinents setzen; regionale Führungsmächte wie Nigeria und Senegal erklärten ihre Unterstützung einer regionalen Intervention. Die ECOWAS-Intervention in Gambia ist ein erfolgreiches Beispiel für einen aktiven demokratischen Regionalismus; ihr Erfolg beruht allerdings auf den spezifischen Bedingungen in Westafrika und es ist wenig wahrscheinlich, dass sie zum Modell für regionale Interventionen in anderen Teilen Afrikas wird.

Background: DNA methylation is an epigenetic control mechanism that may be altered by environmental exposures. We have previously reported that in utero exposure to the mycotoxin and liver carcinogen aflatoxin B1 from the maternal diet, as measured using biomarkers in the mothers’ blood, was associated with differential DNA methylation in white blood cells of 6-month-old infants from The Gambia. Methods: Here we examined aflatoxin B1-associated differential DNA methylation in white blood cells of 24-month-old children from the same population (n = 244), in relation to the child’s dietary exposure assessed using aflatoxin albumin biomarkers in blood samples collected at 6, 12 and 18 months of age. HM450 BeadChip arrays were used to assess DNA methylation, with data compared to aflatoxin albumin adduct levels using two approaches; a continuous model comparing aflatoxin adducts measured in samples collected at 18 months to DNA methylation at 24 months, and a categorical time-dose model that took into account aflatoxin adduct levels at 6, 12 and 18 months, for comparison to DNA methylation at 24 months. Results: Geometric mean (95% confidence intervals) for aflatoxin albumin levels were 3.78 (3.29, 4.34) at 6 months, 25.1 (21.67, 29.13) at 12 months and 49.48 (43.34, 56.49) at 18 months of age. A number of differentially methylated CpG positions and regions were associated with aflatoxin exposure, some of which affected gene expression. Pathway analysis highlighted effects on genes involved with with inflammatory, signalling and growth pathways. Conclusions: This study provides further evidence that exposure to aflatoxin in early childhood may impact on DNA methylation.

Background The virulent vector-borne disease, Gambian human African trypanosomiasis (HAT), is one of several diseases targeted for elimination by the World Health Organization. This article utilises human case data from a high-endemicity region of the Democratic Republic of Congo in conjunction with a suite of novel mechanistic mathematical models to address the effectiveness of on-going active screening and treatment programmes and compute the likely time to elimination as a public health problem (i.e. <1 case per 10,000 per year). Methods The model variants address uncertainties surrounding transmission of HAT infection including heterogeneous risk of exposure to tsetse bites, non-participation of certain groups during active screening campaigns and potential animal reservoirs of infection. Results Model fitting indicates that variation in human risk of tsetse bites and participation in active screening play a key role in transmission of this disease, whilst the existence of animal reservoirs remains unclear. Active screening campaigns in this region are calculated to have been effective, reducing the incidence of new human infections by 52–53 % over a 15-year period (1998–2012). However, projections of disease dynamics in this region indicate that the elimination goal may not be met until later this century (2059–2092) under the current intervention strategy. Conclusions Improvements to active detection, such as screening those who have not previously participated and raising overall screening levels, as well as beginning widespread vector control in the area have the potential to ensure successful and timely elimination.