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A girl with malaria in a hospital in eastern Uganda, where research is under way to find out why some children with the disease develop blackwater fever.Photograph: Jake Lyell/Alamy

By the age of six, Babirye Zainab had already contracted malaria several times. Her grandmother did not see it as a big problem though. “I would treat her with antimalarials and she would be all right,” she says.

But then she developed a fever and started to have convulsions. Her urine was the colour of tea, and her grandmother, who shares the same name, was worried enough to take her on a motorbike to the local health centre.

“We were discharged. A month later, she had another episode. Since then, she has experienced quite a number of episodes of passing tea-coloured urine,” she says.

Zainab is part of a medical riddle affecting rural Uganda. 

She has blackwater fever, a rare but increasing complication of malaria that researchers are trying to explain. So named because patients’ urine turns dark with blood, it can be deadly.

Blackwater fever happens when red blood cells break down, rapidly, in the bloodstream. They release haemoglobin and this is excreted in urine. It can result in anaemia and jaundice and require blood transfusion.

Prof Kathryn Maitland of Imperial College London, based in Kenya, was part of a team that noticed high numbers of children in eastern Uganda with blackwater almost a decade ago.

In a paper published in the journal Clinical Infectious Diseases they reported that the condition “according to local investigators, was rare until the last seven years” and speculated “that this might relate to the introduction of artemisinin-based combination therapies”, the most modern type of antimalarial drugs.

Since then, Maitland says, “we have been digging, digging, digging”, looking for an explanation.

 

Historically, blackwater fever was seen among European expatriates who took small doses of quinine as an antimalarial, and became less common when other drugs took over.

What is very interesting in African children is that once they’ve had one episode, they tend to get it again and again

Prof Kathryn Maitland

“It certainly wasn’t mentioned in the World Health Organization guidelines for severe malaria – it was recorded as a very rare occurrence. But it is increasing,” says Maitland.

Her research team has looked at possible genetic causes including whether genes linked to sickle cell or G6PD enzyme deficiency, which raises the risk of red blood cells rupturing, might be involved. Neither seemed to be the answer.

A theory that the drugs used for malaria in the affected part of Uganda might be substandard or fakes was debunked by thorough testing. “The drugs are good – so we’re back to the drawing board,” she says.

 

The best hypothesis, she says, based on the experience of doctors in affected areas, remains a link to artemisinin-based malaria treatments.

The presentation can be alarming, Maitland says. One child with blackwater fever was admitted to a hospital in the capital, Kampala. “They started to pass red and black urine. This was a time when there was Ebola around and it triggered an evacuation – all the mothers saw this, picked their kids up and ran out.”

Affected children “have a high risk of dying”, she says. They may need multiple blood transfusions, raising the risk of an adverse reaction, and requiring hospitalisation.

“What is very interesting in African children is that once they’ve had one episode, they tend to get it again and again,” she says. “Presumably every time they get reinfected with malaria parasites, they get blackwater fever.”

Zainab experiences blackwater fever every few months, her grandmother says. Since turning eight, she has been out of school because of anaemia.

 

“I often have to take her to the health facility due to her frail condition. She is out of school because of this,” says her grandmother, who has cared for her since she was six months old. “When she falls sick, I might even spend a week in the hospital.”

Sometimes there are no drugs, and the family have to find private supplies. If Zainab needs a transfusion and there is no blood available locally, they have to travel to the regional hospital “which is very costly”.

Zainab and her grandmother are now part of a research programme led by Jane Frances Zalwango of the Uganda National Institute of Public Health. She has a fellowship from a global healthcare company to track cases of blackwater fever in Uganda, and understand why some children develop the conditionand others do not.

Uganda is still building its surveillance system, says Zalwango, meaning numbers are not comprehensive, but the data they do have on cases indicates a rise.

The study has enrolled 400 children from Budaka district in eastern Uganda, where initial surveillance efforts recorded the highest numbers. Half have blackwater fever, while half have had malaria without developing the complication. They were followed for months, with blood samples taken to analyse immunological markers.

Dr Mary Rodgers, an associate research fellow at global healthcare company Abbott, whose programme is part of the Training Programs in Epidemiology and Public Health Interventions Network (Tephinet), said other theories under consideration included whether malaria in combination with a genetic factor, or “a co-infecting pathogen that might not otherwise make people sick” were involved.

Related: What is gene drive and how could it help in the fight against malaria?

Speaking to families during trial enrolment was “really devastating”, Zalwango says. “They’re always worried about the next episode.”

It had also revealed superstitions surrounding blackwater fever. “Some were not seeking help in time because of their traditional beliefs: thinking it’s maybe witchcraft or something.

“But they are starting to get the hang of it due to their interaction with the health workers, educating them about seeking early healthcare to prevent any death from this episode, so we are getting better.”

Zainab’s grandmother hopes the research will lead to treatment that can help her: “The health workers told me that it is malaria that causes this condition. However, Zainab was getting malaria before and not passing blood in urine.

“Maybe they will find ways to prevent other children from developing the condition,” she says. By Kat Lay, Global health correspondent, The Guardian

Two British nationals were arrested in Zimbabwe on suspicion of drug trafficking(Image: Getty Images)

Two British nationals reportedly from Birmingham have been arrested in Zimbabwe on suspicion of drug trafficking. The pair were arrested on May 1 at Robert Mugabe International Airport after authorities reportedly discovered a large quantity of cannabis.‌

According to state prosecutors, the accused pair arrived in the African country aboard an Ethiopian Airways flight.‌

Read More Harborne Carnival cancelled over 'national threat' and 'stringent requirements'

Upon collecting luggage from the carousel, they were summoned to the customs searching bay. Across four suitcases, 129 packets of cannabis was discovered worth an estimated street value of £506,499.

Find more about Moment Birmingham underworld gun and drug dealer called 'Wisehorse' captured by armed police

Moment Birmingham underworld gun and drug dealer called 'Wisehorse' captured by armed police

 
Find more about Armed police surround Birmingham street following 'suspicious vehicle' chase

Armed police surround Birmingham street following 'suspicious vehicle' chase

 
 

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The drugs were seized by authorities and weighed 66.9kg. After being arrested, the British citizens appeared before the Harare Magistrates Court on May 3 and will be remanded in custody until May 15.

It is reported the nationals are facing charges of unlawful possession of dangerous drugs. 

People found in possession of cannabis in Zimbabwe can face up to 12 years in prison.

The pair will be expected back in court on May 15 when the court will make its ruling regarding a bail application.

A spokesperson for the British Embassy in Zimbabwe said: "We are in contact with the local authorities following the arrest of two British nationals in Zimbabwe." By Robson McCallister, Birmingham Live 

Dr Selemani Jafo (centre, without hard hat) visiting the Saturn facility in May 2025 (Photo: Tanzanian Ministry for Industry and Trade)

More than 16 years have passed since Tyrepress.com first wrote about the troubles that General Tyre East Africa faced in Tanzania. Tyre manufacture ceased in 2007 as output from the company’s technologically outdated, cash strapped and poorly managed Arusha plant was unable to compete with imported products.

In the decade and a half since that first article in 2008 we’ve reported time and time again on attempts to revive tyre production, most recently the red carpet treatment given to potential investors from China in 2024.Today, we heard yet another plan for General Tyre. By  Stephen Goodchild, Tyres Press

NAIROBI, Kenya, May 13 Agriculture and Livestock Development Cabinet Secretary Mutahi Kagwe has firmly defended the government’s decision to lease state-owned sugar factories, assuring the National Assembly that no public assets have been sold.

Appearing before the Agriculture Committee, CS Kagwe clarified that the leasing process was conducted transparently and had received full parliamentary approval. 

The clarification comes amid mounting public concerns and political speculation over the fate of key sugar millers in the country. Some stakeholders have questioned whether due process was followed, with calls for full disclosure of agreements and the identities of leaseholders.

ICS Kagwe dispelled these claims and emphasized the government’s commitment to accountability and openness.

“No sugar factory has been sold. It’s leasing that has been done, and Parliament approved the whole process. I dismiss assertions that the process was opaque considering all stakeholders were involved,” said Kagwe.

“We are ready to submit any document for scrutiny by Parliament and the general public, as requested by Hon. Ruth Odinga, to assure the public on the lease process.”

Kagwe’s appearance before the House Committee followed sustained pressure from legislators seeking clarity on how the leasing decisions were reached.

There has also been concern over the level of public participation and whether local communities were adequately consulted or represented in the arrangements.

Committee Chair and Tigania East MP John Mutunga supported the CS’s statement, reiterating that the leasing process underwent legislative scrutiny and that Parliament was actively engaged throughout.

“The sugar leasing process was taken through Parliament; that’s why other members are not worried. The leasing process was not restricted and if you feel the lessees are not good enough, you could have tendered,” said Mutunga.

The leasing strategy was developed to revitalize country’s ailing sugar industry, which has long struggled with inefficiency, mismanagement, and financial losses.

The government has maintained that private sector participation through leasing would help bring in capital, improve operational capacity, and stabilize the industry without privatizing public assets.

CS Kagwe reassured Parliament that the government is prepared to furnish all relevant documentation and maintain transparency to allay any lingering doubts.

He insisted that no corners were cut and that the process was open to all qualified bidders. By Irene Mwangi, Capital News

As South Sudanese refugees struggle with trauma and aid shortfalls in northern Uganda, a Catholic sister from a missionary congregation offers rare, holistic care—combining mental health support, education, and faith.
 

Sister Linah Siabana, a mental health specialist with the Missionary Sisters of Our Lady of Africa, serves displaced South Sudanese communities in Uganda’s Arua Diocese.

As part of her congregation’s mission to be “a healing and consoling presence,” she brings care, education, and hope to some of the world’s most neglected refugees.

For the past five years, Sr. Linah has worked in settlements near the South Sudan border, helping rebuild lives uprooted by conflict.

Overstretched support

Uganda, hosting nearly 1.7 million refugees, is praised for its open-door policy. But chronic underfunding, overcrowding, and policy changes by aid agencies have strained the system.

“The settlements here are filled with women, children, and elderly people who have lost everything,” says Sr. Linah. Adjumani District alone shelters over 54,000 refugees.

“Families are falling through the cracks,” she warns.

Listening first

Sr. Linah arrived in 2019. In 2022, she led a year-long needs assessment in Maaji and Agojo settlements, working with local leaders and learning local languages to understand residents' struggles.

She uncovered widespread trauma, disrupted education, and fragile coexistence between refugees and host communities. In response, she secured scholarships, launched vocational training, and organized therapy sessions.

“Spiritual care rebuilds resilience,” she says. “It helps refugees process loss, find purpose, and reconnect with hope.”

On Sundays, she led communion services under a mango tree for those unable to reach a church. When food rations were cut, her team distributed emergency supplies to child-headed households and elders with disabilities.Sr. Linah Siabana, MSOLA (second from the right), visits the sick and elderly to provide essential food supplements

 

Healing the unseen

In a dim tent, Sr. Linah kneels beside a woman who hasn't slept in weeks. “The nightmares won’t stop,” the refugee whispers.

“It’s not just the war they’re fleeing,” Sr. Linah says. “It’s the daily stress of survival here.”

As the team’s mental health lead, she addresses emotional wounds from abandonment, hunger, and isolation. A recent UNHCR policy change excluded some refugees from food lists, worsening conditions. “When we provide basics like food, suicide rates drop. It’s that simple,” she says.

Working with the Refugee Welfare Council, Sr. Linah identifies vulnerable families through home visits. “They’re grateful just to be seen,” she says. “One elderly woman told me, ‘You remind me I’m still human.’”

Building peace and mentoring in crisis

Tensions persist between ethnic groups and with host communities. “We’re not just aid workers; we’re mediators,” Sr. Linah explains. Her team fosters peace through dialogue, though needs outpace available resources and partnerships.

Beyond the camps, Sr. Linah mentors young religious sisters in Adjumani Vicariate, offering workshops on mental health and spiritual formation.

“Young religious sisters crave guidance, but trained counselors are scarce,” she says. Travel challenges and limited infrastructure complicate the work, but she remains committed. “Every encounter is holy ground, a chance to reflect Christ’s love.”

A calling renewed

For Sr. Linah, the mission is personal. “We walk with refugees and see Jesus in their suffering,” she says. “The challenges, the hunger, the tears, rekindle our purpose: to heal, console, and rekindle hope.”

As the world’s attention drifts away, her message remains urgent: “These are not numbers. They are mothers, children, elders, people worthy of dignity. We cannot look away.”

Sr. Linah Siabana with the Holy Childhood group after a communion service. Vatican News

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