Geographical Variation in the Response of Visceral Leishmaniasis to Paromomycin in East Africa: A Multicentre, Open-Label, Randomized Trial

Visceral leishmaniasis (VL) is a fatal parasitic disease with 500,000 new cases each year according to WHO estimates. New and better treatment options are urgently needed in disease endemic areas due to the long courses, toxicity and development of resistance to current treatments. Recently, the antibiotic paromomycin was tested and registered in India to treat this disease. The current study describes a clinical trial to test the effectiveness of injectable paromomycin, either alone or in combination with the standard drug sodium stibogluconate in three East African countries—Sudan, Kenya and Ethiopia. The study showed that at the same paromomycin dose that was successfully used and registered in India, a far poorer outcome was obtained, particularly in Sudan, suggesting that there are either differences in the patients ability to respond to the drug or in the susceptibility of parasites in East Africa compared with those in India. However, no major safety concerns were noted with the treatment. Further research was initiated to see if a higher dose of paromomycin would perform better, especially in Sudan. The results of this and the performance of the combination arm will be reported later. Our study highlights the importance of considering geographical differences to treatment responses

Bespoke adaptation in rural Africa? An asset-based approach from Southern Ethiopia

Debates on adaptation in rural Africa rarely consider how responses to climate variability vary by wealth group. This study examines differences across wealth groups based on principal component analysis and cluster analysis triangulated with participatory methods. Results indicate that perceptions of weather variability and extreme events are detected by most households regardless of wealth status. The most common responses—using drought-resistant crops and changing planting dates—are also similar across groups. However, there are significant differences in the type of adaptation options adopted by wealthier and poorer farmers: the former intensify agriculture through improved seed varieties, fertiliser and manure; the latter depend on craft activities, seasonal migration and support from relatives and neighbours. Overall, our findings suggest that measuring asset holdings could allow a differentiated approach to supporting adaptation across socio-economic groups in rural regions in Ethiopia and Africa more broadly