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Taverne B, Laborde-Balen G, Sow K, Ndiaye NB, Diop K. Treatment success or failure in children and adolescents born with HIV in rural Senegal: An anthropological perspective. Soc Sci Med 2023; 317:115628. [PMID: 36571886 DOI: 10.1016/j.socscimed.2022.115628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Due to the efficacy of antiretrovirals (ARVs), mortality and morbidity related to the AIDS epidemic has declined considerably in recent decades. Nevertheless in Africa, the persistence of new infections and the concerning development of ARV drug resistance reflect the challenges in preventing and treating HIV infection. These problems are especially affecting children and adolescents living with HIV (CALHIV). In 1998, Senegal was the first West African country to implement a government program for access to ARV drugs. However, care for CALHIV remains challenging. A national survey conducted in 2015 showed that 64% of CALHIV (0-19 years) in follow-up in sites outside of Dakar were in treatment failure. The article presents the results of an anthropological study that aims to examine the modalities of medical and social care for CALHIV, identify the various structural and social determinants of treatment failure or success, and ascertain their respective influence. The ethnographic survey was conducted between July 2020 and November 2021 in 11 of the 14 regions of Senegal and in 15 health facilities (11 health centers and 4 regional hospitals). The interviews and observations were conducted with 65 children and adolescents, 63 parents or guardians, and 47 health workers providing their care. The results show that situations of treatment failure or success are the result of favorable or unfavorable configurations that bring into play various actors-children, parents, health care professionals-and their interactions with and in varying sociocultural and structural contexts. This research underscores the contribution of anthropology to the analysis and understanding of care systems. From a public health perspective, our analyses argue for a differentiated approach to strengthening the skills of health facility staff, taking into account the specificity of each site.
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Affiliation(s)
- Bernard Taverne
- TransVIHMI (University of Montpellier, INSERM, IRD) 911, Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France.
| | - Gabrièle Laborde-Balen
- TransVIHMI (University of Montpellier, INSERM, IRD) 911, Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France.
| | - Khoudia Sow
- Regional Center for Research and Training in Fann Clinic; P.O. Box 45690, Dakar Fann, Senegal.
| | - Ndeye Bineta Ndiaye
- Division of AIDS/STI Control of the Ministry of Health, P.O. Box 7381, Dakar, Senegal.
| | - Karim Diop
- Regional Center for Research and Training in Fann Clinic; P.O. Box 45690, Dakar Fann, Senegal.
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Moyer E, Baas R, Shabalala F. Social complexities of informed consent and assent among young males undergoing voluntary medical male circumcision in Eswatini. BMJ Glob Health 2022; 7:bmjgh-2021-007918. [PMID: 35609919 PMCID: PMC9131107 DOI: 10.1136/bmjgh-2021-007918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/22/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction As part of an effort to meet ambitious male circumcision targets in Eswatini, programme implementers have increasingly focused on young males, raising questions about informed consent. Males aged 10–19 years account for more than two-thirds of those circumcised since 2008 when internationally funded circumcision campaigns began in Eswatini. The ethical guidelines of these programmes conform to international standards, requiring that informed consent or assent be obtained prior to surgery. This article examines clients’ levels of circumcision-related knowledge following the assent process, as well as how ethical guidelines were enacted in everyday practice in a setting where family dynamics and norms relating to autonomy and consensus make obtaining informed consent complex, especially when clients are incentivised with football kits and other material goods to encourage circumcision. Methods We conducted qualitative research in a health clinic where circumcision services for HIV prevention were being offered. Methods included focus group discussions, in-depth interviews, participant observation and informal interviews with young men undergoing circumcision in the clinic. Results Implementers paid little attention to risks, focusing more on benefits of circumcision. Incentives, usually in the form of sporting goods, increased participation, while also limiting autonomy. We also found that parental authority overpowers young males’ preferences regarding circumcision. Young males’ understanding of the risks associated with circumcision was poor. Most assumed HIV testing was obligatory. Conclusion The drive to eliminate HIV infections in Eswatini has opened the door for interventions such as targeted circumcision campaigns. In contradiction to international ethical guidelines and the policies of the Ministry of Health and voluntary medical male circumcision (VMMC) implementers, we conclude that, in practce, respect for young males’ rights and decision-making in the VMMC consent process is limited by complex social, economic and political realities.
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Affiliation(s)
- Eileen Moyer
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands .,Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Rufus Baas
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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Biruk C. The Politics of Global Health. POLAR-POLITICAL AND LEGAL ANTHROPOLOGY REVIEW 2021. [DOI: 10.1111/plar.12431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rasmussen SL, Sahay S. Engaging with uncertainty: Information practices in the context of disease surveillance in Burkina Faso. INFORMATION AND ORGANIZATION 2021. [DOI: 10.1016/j.infoandorg.2021.100366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Closser S, Mendenhall E, Brown P, Neill R, Justice J. The anthropology of health systems: A history and review. Soc Sci Med 2021; 300:114314. [PMID: 34400012 DOI: 10.1016/j.socscimed.2021.114314] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 12/17/2022]
Abstract
Ethnographies of health systems are a theoretically rich and rapidly growing area within medical anthropology. Critical ethnographic work dating back to the 1950s has taken policymakers and health staff as points of entry into the power structures that run through the global health enterprise. In the last decade, there has been a surge of ethnographic work on health systems. We conceptualize the anthropology of health systems as a field; review the history of this body of knowledge; and outline emergent literatures on policymaking, HIV, hospitals, Community Health Workers, health markets, pharmaceuticals, and metrics. High-quality ethnographic work is an excellent way to understand the complex systems that shape health outcomes, and provides a critical vantage point for thinking about global health policy and systems. As theory in this space develops and deepens, we argue that anthropologists should look beyond the discipline to think through what their work does and why it matters.
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Affiliation(s)
- Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Rm E5545, Baltimore, MD, 21205, USA.
| | - Emily Mendenhall
- Science, Technology and International Affairs Program, Edmund A. Walsh School of Foreign Service, Georgetown University, USA
| | - Peter Brown
- Department of Anthropology, Emory University, USA
| | - Rachel Neill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Judith Justice
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, USA
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dos Santos-Melo GZ, de Andrade SR, Meirelles BHS, Ortiga AMB. Integration in health: cooperation at triple international border Amazon. Rev Saude Publica 2020; 54:05. [PMID: 31939578 PMCID: PMC9586438 DOI: 10.11606/s1518-8787.2020054001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the scope and limitations of the main strategies of cooperation in health, adopted between 2005 and 2017, in the context of the triple border Brazil, Colombia and Peru. METHOD Single, explanatory, qualitative, integrated case study carried out in 2017, in the context of the triple Amazon border, Brazil, Colombia and Peru, in the city of Tabatinga, state of Amazonas, Brazil. Our sources of evidence were: documentary data; interviews with health managers of the State Health Secretariats of Amazonas and Municipal Health of Tabatinga, Municipal Health Council of Tabatinga and Consulate of Peru in Colombia; and direct observations in four health services of Tabatinga. Data were organized with MaxQDA12® software. RESULTS Data analyzed showed that, during the study period, the Brazilian federal government made several health cooperation agreements with both Peru and Colombia and that the state government of Amazonas undertook strategies to improve the health conditions of the dwellers of Tabatinga and the region of Alto Solimões, which indirectly reached the populations of neighboring countries, supporting the interrelationships between the countries of the region. Regarding the municipal government, we verified the existence of health integration agreements, established informally, to minimize the adversities of the local health. CONCLUSION The cooperation strategies in health adopted in the triple Amazon border have different purposes, benefits and limitations. It is noteworthy that the existence of cooperation agreements between the federal governments of Brazil, Colombia and Peru and the presence of informal cooperation agreements between the municipal governments of Tabatinga (Brazil), Leticia (Colombia) and Santa Rosa (Peru). The limitations of this study are the lack of knowledge of local managers about the cooperation agreements established between federal governments and the lack of legitimacy of the informal agreements established by the Tabatinga government.
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Affiliation(s)
| | - Selma Regina de Andrade
- Universidade Federal de Santa Catarina. Departamento de Pós-Graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil
| | | | - Angela Maria Blatt Ortiga
- Governo do Estado de Santa Catarina. Secretaria de Estado da Saúde de Santa Catarina. Florianópolis, Santa Catarina, Brasil
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When Is It Acceptable to Vaccinate Pregnant Women? Risk, Ethics, and Politics of Governance in Epidemic Crises. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00190-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Gogognon P, Godard B. [Health care research within international normative frameworks and the literature : assessment, stakes and recommendations]. ACTA ACUST UNITED AC 2019; 28:117-141. [PMID: 29561115 DOI: 10.3917/jib.281.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Research in health occupies a central place in the elaboration of public policies and the interventions that aim to reduce inequality and make the right to health effective. However, research in health remains marked by inequalities which particularly affect developing countries. The objective of this critical recension of the international normative frameworks and the scientific literature is to present a summary of the assessment, underline the challenges and identify the main recommendations as well as the ethical principles that aim to reduce inequalities in the field of health research. The normative frameworks included in this recension have been adopted by the United Nations Organisation through its agencies specialised in the field of health and scientific research. Particular attention has also been given to the scientific literature concerned with the inequalities in health research. The results of this recension show us that inequalities in health research can be an impediment to the equitable distribution of healthcare services and to human development. With regard to this, these inequalities raise concerns about justice and equity for research institutions, researchers and communities in developing countries. The recommendations and ethical principles analysed here are therefore designed to reduce them and to promote access for developing countries to research and the consequent benefits. Finally, this recension emphasises the need to undertake research to understand the role of research practices in countries of the South in the emergence and persistence of these inequalities.
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Sriram V, Topp SM, Schaaf M, Mishra A, Flores W, Rajasulochana SR, Scott K. 10 best resources on power in health policy and systems in low- and middle-income countries. Health Policy Plan 2018; 33:611-621. [PMID: 29471544 DOI: 10.1093/heapol/czy008] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/12/2022] Open
Abstract
Power is a critical concept to understand and transform health policy and systems. Power manifests implicitly or explicitly at multiple levels-local, national and global-and is present at each actor interface, therefore shaping all actions, processes and outcomes. Analysing and engaging with power has important potential for improving our understanding of the underlying causes of inequity, and our ability to promote transparency, accountability and fairness. However, the study and analysis of the role of power in health policy and systems, particularly in the context of low- and middle-income countries, has been lacking. In order to facilitate greater engagement with the concept of power among researchers and practitioners in the health systems and policy realm, we share a broad overview of the concept of power, and list 10 excellent resources on power in health policy and systems in low- and middle-income countries, covering exemplary frameworks, commentaries and empirical work. We undertook a two-stage process to identify these resources. First, we conducted a collaborative exercise involving crowdsourcing and participatory validation, resulting in 24 proposed articles. Second, we conducted a structured literature review in four phases, resulting in 38 articles reviewed. We present the 10 selected resources in the following categories to bring out key facets of the literature on power and health policy and systems-(1) Resources that provide an overarching conceptual exploration into how power shapes health policy and systems, and how to investigate it; and (2) examples of strong empirical work on power and health policy and systems research representing various levels of analyses, geographic regions and conceptual understandings of power. We conclude with a brief discussion of key gaps in the literature, and suggestions for additional methodological approaches to study power.
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Affiliation(s)
- Veena Sriram
- Center for Health and the Social Sciences, University of Chicago, 5841 S. Maryland Avenue, MC 1005, Suite M200, Chicago, IL 60637, USA
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Marta Schaaf
- Averting Maternal Death and Disability, Mailman School of Public Health, Columbia University, 722 West 168th St. New York, NY 10032, USA
| | - Arima Mishra
- Azim Premji University, PES Campus, Pixel Park, B Block, Electronics City, Hosur Road, Bengaluru 560100, Karnataka, India
| | - Walter Flores
- Center for the Study of Equity and Governance in Health Systems, 11 Calle 0-48 Zona 10, Edificio Diamond, Oficina 504. Guatemala City, Guatemala and
| | | | - Kerry Scott
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
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10
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Gray D, Mishtal J. Managing an epidemic: Zika interventions and community responses in Belize. Glob Public Health 2018; 14:9-22. [PMID: 29733243 DOI: 10.1080/17441692.2018.1471146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Implementing effective health interventions in recent epidemics has been difficult due to the potentially global nature of their spread and sociocultural dynamics, raising questions concerning how to develop culturally-appropriate preventive measures, and how these health threats are understood locally. In Belize, health policy makers have only been marginally effective in managing infections and mosquito vectors, and Zika has been declared endemic in certain regions, particularly on the island of Caye Caulker. Based on ethnographic research conducted primarily in 2017, we examine how perspectives of Zika-related health consequences are shaped, and how state interventions to manage Zika are understood. We argue that despite its declared endemic status, Zika is not perceived as a true health concern for community members due to numerous neoliberal structural challenges. Moreover, the state's restrictive form of reproductive governance which limits family planning services is forcing individuals to weigh conflicting conceptions of health consequences. This also contributes to an ambiguous healthcare environment for health practitioners, giving them an unclear picture of the scope of Zika as a public health concern. We also consider how critical medical anthropology and feminist analytical approaches are useful in exploring these questions and contributing to understandings of the health impacts of Zika.
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Affiliation(s)
- Deven Gray
- a Department of Anthropology , University of Central Florida , Orlando , USA
| | - Joanna Mishtal
- a Department of Anthropology , University of Central Florida , Orlando , USA
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Adams AK, Zamberia AM. "I will take ARVs once my body deteriorates": an analysis of Swazi men's perceptions and acceptability of Test and Start. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 16:295-303. [PMID: 29132279 DOI: 10.2989/16085906.2017.1362015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Swaziland has the highest HIV prevalence in the world. To mitigate the spread and devastation caused by HIV and to improve the wellbeing of people living with HIV, the country has adopted the latest available HIV prevention campaigns, including "Test and Start". Because evidence from randomised controlled trials has demonstrated a significant risk reduction in HIV transmission when HIV-positive people start antiretroviral therapy (ART) early, Swaziland aims to find these people and link them to treatment. This study presents findings regarding the perceptions of this promising HIV-prevention intervention among men aged 17-69 years. A combination of qualitative methods including focus group discussions (12), in-depth interviews (17), informal conversations and participant observation (21) were used to collect data in two peri-urban communities in 2013-2014. Findings illustrate that men still fear taking an HIV test because of a relatively high probability of a positive test which some still interpret as a death sentence. Other potential barriers to the effectiveness of Test and Start programmes include lack of hospitality in hospitals, fear of starting treatment early related to side effects of ART, poverty, and lack of trust in the financial stability of the Swazi government. We argue that several social factors need to be considered for the Test and Start programme to be more effective.
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Affiliation(s)
- Alfred K Adams
- a Amsterdam Institute of Social Science Research , University of Amsterdam , Amsterdam , the Netherlands
| | - Agostino M Zamberia
- b Department of Sociology and Social Work , University of Swaziland , Kwaluseni , Swaziland
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12
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RUMOURS, RIOTS AND THE REJECTION OF MASS DRUG ADMINISTRATION FOR THE TREATMENT OF SCHISTOSOMIASIS IN MOROGORO, TANZANIA. J Biosoc Sci 2017; 48 Suppl 1:S16-39. [PMID: 27428064 DOI: 10.1017/s0021932016000018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In 2008 in Morogoro region, Tanzania, mass drug administration (MDA) to school-aged children to treat two neglected tropical diseases (NTDs) - urinary schistosomiasis and soil-transmitted helminths - was suspended by the Ministry of Health and Social Welfare after riots broke out in schools where drugs were being administered. This article discusses why this biomedical intervention was so vehemently rejected, including an eyewitness account. As the protest spread to the village where I was conducting fieldwork, villagers accused me of bringing medicine into the village with which to 'poison' the children and it was necessary for me to leave immediately under the protection of the Tanzanian police. The article examines the considerable differences between biomedical and local understandings of one of these diseases, urinary schistosomiasis. Such a disjuncture was fuelled further by the apparent rapidity of rolling out MDA and subsequent failures in communication between programme staff and local people. Rumours of child fatalities as well as children's fainting episodes and illnesses following treatment brought about considerable conjecture both locally and nationally that the drugs had been either faulty, counterfeit, hitherto untested on humans or part of a covert sterilization campaign. The compelling arguments by advocates of MDA for the treatment of NTDs rest on the assumption that people suffering from these diseases will be willing to swallow the medicine. However, as this article documents, this is not always the case. For treatment of NTDs to be successful it is not enough for programmes to focus on economic and biomedical aspects of treatment, rolling out 'one size fits all' programmes in resource-poor settings. It is imperative to develop a biosocial approach: to consider the local social, biological, historical, economic and political contexts in which these programmes are taking place and in which the intended recipients of treatment live their lives. If this is not done, the world's poor will continue to be neglected.
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Abstract
To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered 'marginal' and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization. The promotion of facility birth as the new norm, in turn, generates a process of 're-marginalization', whereby public health officials morally disapprove of women who give birth at home, viewing them as non-compliers and a problem to the system. In rural Nicaragua, there is a discrepancy between the public health norm and women's own preferences and desires for home birth. These women live at the margins also in spatial and societal terms, and must relate to a health system they find incapable of providing good, appropriate care. Strong public pressure for institutional delivery makes them feel distressed and pressured. Paradoxically then, the aim of including marginal groups in maternal health programmes engenders resistance to facility birth.
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Affiliation(s)
- Birgit Kvernflaten
- a Centre for Development and the Environment , University of Oslo , Oslo , Norway
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Jaffré Y, Suh S. Where the lay and the technical meet: Using an anthropology of interfaces to explain persistent reproductive health disparities in West Africa. Soc Sci Med 2016; 156:175-83. [DOI: 10.1016/j.socscimed.2016.03.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
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Butcher F, Galanek JD, Kretschmar JM, Flannery DJ. The impact of neighborhood disorganization on neighborhood exposure to violence, trauma symptoms, and social relationships among at-risk youth. Soc Sci Med 2015; 146:300-6. [PMID: 26477854 DOI: 10.1016/j.socscimed.2015.10.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
Previous research has demonstrated that exposure to violence (ETV) is a serious concern across the north-south socioeconomic divide. While studies have found that social support is a protective factor for youth exposed to violence and trauma, little is known about the impact of trauma symptoms on forming and maintaining social relationships which are key to accessing a vital social resource that fosters resilience in youth experiencing trauma symptomatology. Building on previous models that examine the impact of neighborhoods on exposure to violence and trauma, the current study examines the impact of neighborhood disorganization on ETV among youth and ETV's effects on trauma symptoms and social relationships. Data were collected on 2242 juvenile justice-involved youth with behavioral health issues in 11 urban and rural counties in the Midwestern United States. Using structural equation modeling (SEM), our data demonstrated that living in highly disorganized neighborhoods was associated with higher levels of ETV and that ETV was positively associated with trauma symptoms. Mediational analysis showed that trauma symptoms strongly mediated the effect of ETV on social relationships. Freely estimating structural paths by gender revealed that hypothesized associations between these variables were stronger for females than males. Findings here highlight the need to provide trauma-informed care to help youth to build and maintain social relationships. Identification and treatment of trauma symptoms that is culturally informed is a critical first step in ensuring that identified protective factors in local contexts, such as social relations and social support, have opportunities to minimize the impact of ETV among youth across northern and southern nations.
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Affiliation(s)
- Fredrick Butcher
- Begun Center for Violence Prevention Research & Education, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States.
| | | | - Jeff M Kretschmar
- Begun Center for Violence Prevention Research & Education, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Daniel J Flannery
- Begun Center for Violence Prevention Research & Education, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States
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Storeng KT, Mishra A. Introduction. Politics and practices of global health: critical ethnographies of health systems. Glob Public Health 2015; 9:858-64. [PMID: 25203250 PMCID: PMC4166914 DOI: 10.1080/17441692.2014.941901] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Affiliation(s)
- Katerini T Storeng
- a Centre for Development and the Environment , University of Oslo , Oslo , Norway
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17
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Abramowitz SA, Bardosh KL, Leach M, Hewlett B, Nichter M, Nguyen VK. Social science intelligence in the global Ebola response. Lancet 2015; 385:330. [PMID: 25706852 DOI: 10.1016/s0140-6736(15)60119-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Kevin Louis Bardosh
- Centre of African Studies and Division of Infection and Pathway Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Barry Hewlett
- Department of Anthropology, Washington State University, Vancouver, WA, USA
| | - Mark Nichter
- School of Anthropology, University of Arizona, Tucson, AZ, USA
| | - Vinh-Kim Nguyen
- Collège d'études mondiales, Fondation Maison des Sciences de l'Homme, Paris, France
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Kenworthy NJ, Parker R. HIV scale-up and the politics of global health. Introduction. Glob Public Health 2014; 9:1-6. [PMID: 24555669 DOI: 10.1080/17441692.2014.880727] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nora J Kenworthy
- a Nursing and Health Studies Program , University of Washington Bothell , Bothell , WA , USA
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Bardosh K. Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases. Infect Dis Poverty 2014; 3:35. [PMID: 25320672 PMCID: PMC4197218 DOI: 10.1186/2049-9957-3-35] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 09/16/2014] [Indexed: 11/23/2022] Open
Abstract
Neglected Tropical Diseases (NTDs) are both drivers and manifestations of poverty and social inequality. Increased advocacy efforts since the mid-2000s have led to ambitious new control and elimination targets set for 2020 by the World Health Organisation. While these global aspirations represent significant policy momentum, there are multifaceted challenges in controlling infectious diseases in resource-poor local contexts that need to be acknowledged, understood and engaged. However a number of recent publications have emphasised the “neglected” status of applied social science research on NTDs. In light of the 2020 targets, this paper explores the social science/NTD literature and unpacks some of the ways in which social inquiry can help support effective and sustainable interventions. Five priority areas are discussed, including on policy processes, health systems capacity, compliance and resistance to interventions, education and behaviour change, and community participation. The paper shows that despite the multifaceted value of having anthropological and sociological perspectives integrated into NTD programmes, contemporary efforts underutilise this potential. This is reflective of the dominance of top-down information flows and technocratic approaches in global health. To counter this tendency, social research needs to be more than an afterthought; integrating social inquiry into the planning, monitoring and evaluating process will help ensure that flexibility and adaptability to local realities are built into interventions. More emphasis on social science perspectives can also help link NTD control to broader social determinants of health, especially important given the major social and economic inequalities that continue to underpin transmission in endemic countries.
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Affiliation(s)
- Kevin Bardosh
- Centre of African Studies, School of Social and Political Science, College of Humanities and Social Science, The University of Edinburgh, 58 George Square, Edinburgh, EH8 9LD UK ; Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
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David PM. Towards the embodiment of biosocial resistance? How to account for the unexpected effects of antiretroviral scale-up in the Central African Republic. Glob Public Health 2014; 9:144-59. [PMID: 24499050 DOI: 10.1080/17441692.2014.881521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
At the fringes of the unprecedented medication scale-up in the treatment of HIV, many African countries have experienced dramatic antiretroviral drug stock-outs. Usually considered the result of irrational decisions on behalf of local politicians, programme managers and even patients (who are stigmatised as immoral), these problems seem not to be so exceptional. However, ethnographic attention to the social consequences of the presence and absence of antiretroviral drugs in the Central African Republic (CAR) suggests that these stock-outs entail far more than logistical failures. In 2010 and 2011 in the CAR, major antiretroviral treatment (ARV) stock-outs resulted in the renewal of 'therapeutic' social ties and also significant social resistance and defiance. While this paper explores reasons for the shortage, its focus is on subsequent popular reactions to it, particularly among people who are HIV-positive and dependent on ARVs. The exceptional and ambiguous consequences of these drug stock-outs raise new concerns relevant to the politics of global public health.
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Affiliation(s)
- Pierre-Marie David
- a Department of Medication and Population Health, Faculty of Pharmacy , Université de Montréal , Montreal , Canada
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The context of formulation of India's Mental Health Program: implications for global mental health. Asian J Psychiatr 2014; 7:10-4. [PMID: 24524703 DOI: 10.1016/j.ajp.2013.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 09/10/2013] [Accepted: 09/13/2013] [Indexed: 11/22/2022]
Abstract
India, among the low- and middle-income countries, in the 1980s, made an early attempt at formulating a mental health program. India's National Mental Health Program (NMHP) intended to attend to the mental health needs of all her citizens. Some aspects of this program bear significant resemblance to what recent experts in global mental health (GMH) have been proposing. The paper uses India as a country-level example to review and critically analyze the contextual background culminating in the formulation of the NMHP. Literature searches from two bibliographic databases (PubMed and Google Scholar) with supplementary searches and manual search from Indian Journal of Psychiatry were made relating to the context of formulation of India's NMHP. The search helped isolate 12 peer reviewed journal articles, three chapters from books, and one policy group approach paper. This literature has been synthesized to enumerate the various contextual factors. The present analysis identifies two vital factors relevant for international health, viz. the primary health care movement and the changing concepts of institutional care/de-institutionalization in mental health. This then puts in perspective the opportunities allowed and challenges produced, for NMHP, by subsequent changes in public health services in India. The lessons for GMH movement are then pointed out.
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Familiar I, Sharma S, Ndayisaba H, Munyentwari N, Sibomana S, Bass JK. Community perceptions of mental distress in a post-conflict setting: a qualitative study in Burundi. Glob Public Health 2013; 8:943-57. [PMID: 23941217 DOI: 10.1080/17441692.2013.819587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There is scant documentation of the mental health characteristics of low-income communities recovering from armed conflict. To prepare for quantitative health surveys and health service planning in Burundi, we implemented a qualitative study to explore concepts related to mental distress and coping among adults. Mental distress was defined as problems related to feelings, thinking, behaviour and physical stress. Using free listing and key informant interviews with a range of community members, we triangulated data to identify salient issues. Thirty-eight free list respondents and 23 key informants were interviewed in 5 rural communities in Burundi using 2 interview guides from the WHO Toolkit for Mental Health Assessment in Humanitarian Settings. Based on these interviews, we identified four locally defined idioms/terms relating to mental distress: ihahamuka (anxiety spectrum illnesses), ukutiyemera (a mix of depression and anxiety-like syndrome), akabonge (depression/grief-like syndrome) and kwamana ubwoba burengeje (anxiety-like syndrome). Mental distress terms were perceived as important problems impacting community development. Affected individuals sought help from several sources within the community, including community leaders and traditional healers. We discuss how local expressions of distress can be used to tailor health research and service integration from the bottom up.
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Affiliation(s)
- Itziar Familiar
- a Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA
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Alvesson HM, Lindelow M, Khanthaphat B, Laflamme L. Coping with uncertainty during healthcare-seeking in Lao PDR. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:28. [PMID: 23777408 PMCID: PMC3693924 DOI: 10.1186/1472-698x-13-28] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 06/13/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Uncertainty is regarded as a central dimension in the experience of illness and in the processes of alleviating it. Few studies from resource-poor settings have investigated this and how it interacts with other factors. This study aims to shed light on how healthcare-seeking develops in the context of multiple medical alternatives and to understand what bearing uncertainty has on this process. METHODS The study was conducted in six purposively selected rural communities in Lao PDR. In each community, two focus group discussions were held: first with mothers and then with fathers of children younger than five years old. Eleven in-depth interviews with caregivers of severely sick children were conducted. Subsequently, traditional healers, drug vendors, community health workers, nurses and medical doctors were recruited for interviews or group discussions. The data were transcribed and key themes and similarities were identified. Additional readings were conducted to better understand the interactions of factors during which uncertainty was identified as one of several factors mentioned during interviews and focus group discussions. RESULTS Care-seekers expressed a strong preference for initially seeking local providers. Subsequently, multiple providers were consulted to increase the chances of recovery. This resulted in patients leaving the health facilities before recovery and in ending the recommended treatment regime prematurely. These healthcare-seeking decisions reflect the social significance of being a responsible caregiver and of showing respect for household norms. In general, healthcare-seeking was shrouded in uncertainty when it came to selecting the right provider, the likelihood of finding the real cause of the illness, spending savings on treatments and ultimately the likelihood of recovery. CONCLUSIONS Care-seekers' initial strong preference for local providers irrespective of the providers' legitimacy indicates the need for a robust primary healthcare system. Care-seekers' subsequent consultations must be understood in the light of their uncertainty regarding the skills of the available providers. The social connotations of seeking healthcare including the vulnerability of poor households in public health facilities were taken into account to only a limited extent by health workers. Health workers should have greater awareness of the social and cultural aspects of seeking care.
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Affiliation(s)
- Helle M Alvesson
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen, Stockholm, 18A 171 77, Sweden
| | - Magnus Lindelow
- Brazil Human Development Department, The World Bank, SCN, Quadra 2, Lote A. Ed. Corporate Center, 7th andar, 70712–900 DF, Brasilia, Brazil
| | - Bouasavanh Khanthaphat
- Indochina Research Laos Ltd, IRL Building, 282/17 Phontong-Savath, PO Box 1887 Chanthabouly District, Vientiane Capital, Laos
| | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen, Stockholm, 18A 171 77, Sweden
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Petersen I, Baillie K, Bhana A. Understanding the benefits and challenges of community engagement in the development of community mental health services for common mental disorders: lessons from a case study in a rural South African subdistrict site. Transcult Psychiatry 2012; 49:418-37. [PMID: 23008351 DOI: 10.1177/1363461512448375] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Against the backdrop of a large treatment gap for mental disorders in low- to middle-income countries (LMICs), the 2007 Lancet series on global mental health calls for a scaling up of mental health services. Community participation is largely harnessed as one strategy to facilitate this call. Using a participatory implementation framework for the development of mental health services for common mental disorders (CMDs) in a rural subdistrict in South Africa as a case study, this study sought to understand the benefits and challenges of community participation beyond that of scaling up. Qualitative process evaluation involving interviews with service providers and users was employed. The results suggest that in addition to promoting mobilization of resources and actions for scaling up mental health services, community participation can potentially contribute to more culturally competent services and personal empowerment of recipients of care. In addition, community participation holds promise for engendering community-led public health actions to ameliorate some of the social determinants of mental ill health. Challenges include that community members involved in these activities are mainly marginalized women, who have limited power to achieve structural change, including cultural practices that may be harmful to the mental health of women and children. We conclude that in addition to contributing to scaling up mental health services, community participation can potentially promote the development of culturally competent mental health services and greater community control of mental health.
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Affiliation(s)
- Inge Petersen
- School of Psychology, Howard College, University of KwaZulu-Natal, Durban 4000, South Africa.
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Wick L. The practice of humanitarianism: A village birthing clinic in Palestine. Glob Public Health 2011; 6:534-46. [DOI: 10.1080/17441692.2011.577750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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