Indiana University-Purdue University Indianapolis (IUPUI) / Artemisinin resistance was first observed in Southeast Asia (SEA) and could pose a threat to malaria treatment all over the world. Recently mutations in the propeller region of Pfkelch13 gene have been used as a genetic marker for resistance observed in SEA. We investigated the presence of mutations in the Pfkelch gene in children in Kampala, Uganda with severe malaria (SM) treated with intravenous quinine, or with asymptomatic P.falciparum infection (AP) treated with artemether-lumefantrine. We sequenced the Pfkelch gene (2178bp) in 157 children with SM and 49 children with AP infection. In children with SM and AP we identified 106 (60.8%) and 27 (55.1%) parasites with mutations upstream of the Pfkelch13 propeller region. The two most prevalent mutations were 142NN (26.1% in SM, 33% in AP) and K189T (16.5% in SM, 12.2% in AP). In SM, only a single infection had a mutation in the propeller region (A578S), while in AP, mutations in the propeller region included A578S (n=1) and S522C (n=1). In children with SM, parasites with 142NN insertion compared to 3D7 Pfkelch13 parasites had lower parasite density (p=0.02) and lower parasite biomass (p=0.03). Children with SM who either had 142NN or K189T mutation cleared parasites after quinine treatment faster than those with the 3D7 Pfkelch13 genotype (P<0.001 for both mutations compared to 3D7). In this cohort mutations, upstream of the Pfkelch13 propeller region were common. Future studies will assess the presence of Pfcrt and Pfmdr mutations in this cohort, and how these relate to the Pfkelch13 mutations and to parasite clearance.

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This research investigates what rural villagers perceive as important and develops recommendations for improved electrification project implementation centring on user-perceived values (UPVs). UPVs capture more than the basic definition of value in the sense that they include benefits, concerns, feelings and underlying drivers that vary in importance and act as the main motivators in the lives of project beneficiaries as perceived at a given time. Low access to energy continues in rural sub-Saharan Africa despite significant investment by the development community. One fundamental reason is that energy infrastructure adoption remains low, as evidenced by the lack of project sustainability. To counter this, the challenge for energy project developers is to achieve sustainable long-term interventions through the creation of value for beneficiaries, rather than the traditional approach of focusing on short-term project outputs. The question of what is valuable to people in rural communities has historically not played into the design and diffusion of energy infrastructure development projects. This research drew on design and marketing approaches from the commercial sector to investigate the UPVs of rural Ugandans. To better understand the UPVs of rural villagers a new method, consisting of a UPV game and UPV framework, was developed. This method is suitable for capturing, understanding and mapping what rural populations perceive as important. Case study analyses were carried out in seven villages across rural Uganda. The case studies included the UPV game supplemented by non-energy-specific and energy-specific interviews with villagers. Additionally, interviews with experts were conducted to verify the UPV framework and to identify the gap between experts’ opinion and villagers’ perception of what is important. The research demonstrates the effectiveness of the UPV game in deducing the values of rural villagers. The findings demonstrate a disconnect in the ability to accurately capture and design projects which resonate with and respond to the UPVs of recipients of rural electrification projects. A comparison between the villagers’ statements and experts’ opinion regarding what is most valuable to rural communities reveals striking differences that point to a fundamental misunderstanding of rural community UPVs which are likely to be contributing to widespread electrification project failure.