Rapid ethnographic appraisal of community concepts of and responses to joint pain in Kilimanjaro, Tanzania

INTRODUCTION

Musculoskeletal disorders, experienced as joint pain, are a significant global health problem, but little is known about how joint pain is categorised and understood in Tanzania. Understanding existing conceptualisations of and responses to joint pain is important to ensure both research and interventions are equitable and avoid biomedical imposition.

METHODS

Rapid ethnographic appraisal was conducted in a periurban and rural community in Kilimanjaro, documenting language used to describe joint pain, ideas about causes, understandings of who experiences such pain, the impacts pain has and how people respond to it. We conducted 66 interviews with community leaders, traditional healers, community members and pharmacists.Photographs were taken and included in fieldnotes to supplement the interview data and develop thick descriptions. Data were analysed by constant comparison using QDA Miner software.

RESULTS

Across the sample, dominant concepts of joint pain were named ugonjwa wa baridi, cold disease; ugonjwa wa uzee, old age disease; rimatizim, disease of the joints; and gauti, gout. Causes mentioned included exposure to the cold, old age, alcohol and red meat consumption, witchcraft, demons and injuries/falls. Age, gender and occupation were seen as important factors for developing joint pain. Perceived impacts of joint pain included loss of mobility, economic and family problems, developing new health conditions, death, reduction in sexual functioning and negative self-perceptions. Responses to joint pain blended biomedical treatments, herbal remedies, consultations with traditional healers and religious rituals.

CONCLUSIONS

Conceptualisations of and responses to joint pain in the two communities were syncretic, mixing folk and biomedical practices. Narratives about who is affected by joint pain mirror emerging epidemiological findings, suggesting a strong 'lay epidemiology' in these communities. Anthropological methods can support the decolonisation of global health by decentring the imposition of English language biomedicine and pursuing synthetic, dignified languages of care.

P212 Understandings and responses to joint pain: preliminary findings from a rapid ethnographic assessment in Northern Tanzania

Background/Aims

Musculoskeletal disorders (MSKD) are an important global health problem, but we know little about how it is understood and explained in Tanzanian communities. This understanding is crucial for developing culturally competent interventions and services for MSKD which avoid unintended impacts. This study aims to examine how joint pain is understood, explained, and responded to in rural and peri-urban communities in northern Tanzania.

Methods

We conducted rapid ethnographic assessment (REA) in two communities in Kilimanjaro region (one peri-urban, one rural) to document the language used to describe joint pain, ideas about causes, understandings of who experiences such pain, the impacts the pain has and how people respond to it. The REA included 60 short interviews with community leaders, traditional healers, community members, and pharmacists. The research team also wrote detailed field notes and, with written consent, took photographs which were used to develop ‘thick descriptions’ of the phenomena in each community. Thematic analysis of interview notes, thick descriptions and photographs was conducted using QDA Miner (v5.0) software.

Results

The dominant concepts of joint pain and its cause were named as Ugonjwa wa baridi - cold disease; Ugonjwa wa uzee - old age disease; rimatizim - disease of the joints and gauti - gout. Causes mentioned included exposure to the cold - walking bare foot, working in cold conditions - old age, alcohol and red meat consumption, witchcraft, demons, settling in one position, sex, injuries/falls. Age, gender and occupation were seen as important factors for developing joint pain. The impacts of joint pain included loss of mobility, economic and family problems, death, reduction in sexual functioning, and negative self-perceptions. Responses to joint pain blend biomedical treatments, exercise, herbal remedies, consultations with traditional healers and religious ritual.

Conclusion

Understandings of and responses to joint pain in the two communities are ‘syncretic’ - mixing folk and biomedical practices. Narratives about who is affected by joint pain mirror emerging epidemiological findings, suggesting a strong ‘lay epidemiology’ in these communities. The impacts of joint pain are wide ranging, extending beyond the individual affected, and suggest that there are unmet needs which can be targeted by future interventions and services.

Disclosure

E.F. Msoka: None. C. Bunn: None. P. Msoka: None. N.M. Yongolo: None. E. Laurie: None. S. Wyke: None. E. McIntosh: None. B. Mmbaga: None.

How public health crises expose systemic, day-to-day health inequalities in low- and-middle income countries: an example from East Africa

BACKGROUND

The current Coronavirus disease pandemic reveals political and structural inequities of the world's poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania.

METHODS

We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences.

RESULTS

Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health outcomes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals.

CONCLUSION

Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in 'normal' circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges.