Health; Nutritional and Socio Cultural Status of the Nilotic Population in the Southern Sudan

This book presents the results of a large study realised between 1979 and 1984; in the Upper Nile State; on a significant sample of a southern Sudanese population belonging to three Nilotic tribes (Dinka; Nuer and Shilluk). In 1979; these populations still lived in a very traditional way and were subject to rapid changes due to the construction of the 365 km long Jonglei canal. The study was interrupted by the civil war; in February 1984. This book is divided into four distinct parts: The population and the environment are described in the first part. The objectives of the studies and their methodology are presented in the second part. The results of a cross-sectional study (300 children; men and women) and of a longitudinal study of 400 pregnant women and their newborn child until the age of three years are presented in the third part. The anthropometrical; clinical; biological and nutritional data are included.The traditional way of life; beliefs as well as the socio-cultural aspects (customs; social activities; magic; dreams; death; relationship and freedom; libido or sexual desires; diseases; and collective activities) are described in the fourth part. Genealogical trees of two families; one a Dinka and another Shilluk (from the 13th century); are presented in Annexe. This book can serves as a guide for medical doctors; public health workers; epidemiologists; NGO-s... and for comparatives studies in Africa

Talking past each other: Conceptual confusion in 'culture' and 'psychopathology'

This article offers a commentary on Hassim and Wagner's article; Considering the cultural context in psychopathology formulations; published in this issue of the South African Journal of Psychiatry (http://dx.doi.org/10.7196/SAJP.400). It clarifies aspects of the concepts of culture and psychopathology. A distinction is drawn between the content of culture and the demarcation of cultures. The former refers to socially acquired meanings and significances that condition subjective experience and the latter to specific; demarcated cultural groups. It is argued that these two meanings of culture must be kept apart; and that only the former is relevant to the project of understanding the range of cultural influences on mental health problems. This is premised on the idea; arising partially from anthropological critique; that while cultural designations (e.g. Maori or Muslim) might serve as important political and identity markers; they obscure rather than reveal the actual influences the subject is exposed to; and which condition subjective experience as seen through the modulation of distress or symptom formation

Rumours about Blood and Reimbursements in a Microbicide Gel Trial

A rumour that emerged during a microbicide gel trial tells the tale of clinic staff purchasing trial participants' blood. This paper documents the rumour and explores its divergent interpretations and meanings in relation to the context of the trial and the social and economic setting at two of the trial sites (Soweto and Orange Farm) in South Africa. The article is based on qualitative research conducted during the Microbicides Development Programme (MDP) 301 trial to evaluate a microbicide vaginal gel for HIV prevention in women. The research incorporated in-depth interviews with female trial participants and their male partners; focus group discussions with male and female community members; and participant observation in the trial clinic and community setting at the two sites. The article analyses the different perspectives among the clinic staff; community and trial participants in terms of which the rumour about the exchange of blood for cash is seen as: 1) the result of ignorance of the clinical trial procedures; 2) the exploitation of poor and vulnerable women; 3) an example of young women's desire for material gain; and 4) a reciprocal exchange of 'clean blood' for cash between women trial participants and the health services. We suggest that the rumours about selling blood verbalise notions of gender and morality while also providing an appraisal of the behaviour of young women and a critique of social relationships between foreign researchers and local participants. Through stories about the clinical trial procedures and its potential reimbursements; the participants were creating and reconfiguring social relationships. Ultimately; rumours are one way in which foreign enterprises such as a clinical trial are rendered local

Gendered Moral Dimensions of Childhood Vulnerability

Community; state; and international definitions of childhood and vulnerability play a central role in determining which people and families receive the limited resources available to support vulnerable children's survival and thriving. International definitions of childhood and vulnerability are often assumed by international development organizations (IDOs) to embody universal human rights and equality norms; and thus to serve as an appropriate basis for creating universal categorization frameworks to identify vulnerable children across communities and states. Community definitions; on the other hand; may be viewed as particular and potentially biased; embedded as they are in local power dynamics and social relations. Nonetheless; IDOs increasingly rely on communities to identify and distribute support to vulnerable children. This paper utilizes vertical ethnographic approaches to map and compare the gendered moral assumptions that shaped community; state; and international conceptions of childhood and vulnerability and responses to vulnerable children in border communities in Malawi and Mozambique. It argues that a gendered lens on childhood and vulnerability reveals both the gender inequitable assumptions underlying international and community childhood and vulnerability frameworks; and the urgent need for gendered analyses of childhood and vulnerability that engage honestly with people's lived realities; opportunities; and social relations. These analyses would explicitly link efforts to improve children's lives to gendered analyses of the local; national; and international social and political economic systems that differentially shape survival strategies and opportunities-and people's judgments of the morality of these strategies-for females and males

Mobilising Indigenous Resources for Anthropologically Designed HIV-Prevention and Behaviour-Change Interventions in Southern Africa

HIV prevention is often implemented as if African culture were either nonexistent or 4a series of obstacles to overcome in order to achieve an effective; gender-equitable; human rights-based set of interventions. Similarly; traditional or indigenous leaders; such as chiefs and members of royal families; have been largely excluded from HIV/AIDS responses in Africa. This qualitative study used focus group discussions and in-depth interviews with traditional leaders and 'ritual specialists' to better understand cultural patterns and ways of working with; rather than against; culture and traditional leaders in HIV-prevention efforts. The research was carried out in four southern African countries (Botswana; Lesotho; South Africa and Swaziland). The purpose was to discover what aspects of indigenous leadership and cultural resources might be accessed and developed to influence individual behaviour as well as the prevailing community norms; values; sanctions and social controls that are related to sexual behaviour. The indigenous leaders participating in the research largely felt bypassed and marginalised by organised efforts to prevent HIV infections and also believed that HIV-prevention programmes typically confronted; circumvented; criticised or condemned traditional culture. However; indigenous leaders may possess innovative ideas about ways to change individuals' sexual behaviour in general. The participants discussed ways to revive traditional social structures and cultural mechanisms as a means to incorporate HIV-prevention and gender-sensitivity training into existing cultural platforms; such as rites of passage; chiefs' councils and traditional courts

Teaching biopsychosocial competence and the principles of primary health care (PHC) at the patient's bedside

The importance of behavioural and social determinants in health was recognised long ago; yet we still grapple with the challenges of developing appropriate teaching pedagogies to bring these principles into routine clinical practice. A teaching pedagogy blending the biopsychosocial appro- oach and the principles of primary health care (PHC); as expressed in the Alma-Ata Declaration of 1978; is lacking in the literature. This report hopes to address this need.In 1994 the University of Cape Town (UCT); South Africa; adopted a PHC-based approach to health sciences education to equip its graduates with the necessary knowledge; skills and attributes required to meet the challenges of providing health care in a country with vast socio-political inequalities. This paper describes an educational pedagogy which weaves these principles into clinical practice in an undergraduate medical clerkship. The methodology uses real patient encounters linked to an interactive seminar and a portfolio of case studies.Students described the teaching pedagogy as interesting and informative. They recognised the importance of holistic; patient-centered care based on a biopsychosocial approach and the importance of the PHC principles. Barriers to implementing this approach were also highlighted. The pedagogy; in use for four years; is being adopted by another department; indicating the sustainability and success of the course

Health; Well-Being and Wellness: an Anthropological Eco-Systemic Approach

More than two decades ago; Fritjof Capra commended - and indeed advocated - a paradigm shift in health science and care. In his book The Turning Point (1982) he talks of a major shift from the preoccupation with micro-organisms to a careful study of the `host organism and its environment'; of `significant attempts to develop a unified approach to the mind/body system' in Western medicine; of `a new holistic paradigm' (as opposed to `the old biomedical paradigm') regarding the problem of health and healing; of `a holistic and humanistic approach to primary care'; and of `a holistic therapy' as opposed to `the traditional biochemical practice of associating a physical disease with a specific physical cause'. Our concern in this article is with the paradigm shift advocated by Capra in this book and the progress that has since been made

Socio-cultural Factors Influencing the Prevalence; Care and Support in HIV/AIDS among the Yoruba of Southwestern Nigeria

This paper is a part of a bigger ethnographic study conducted in two states from the Yoruba society of the Southwestern Nigeria to examine the social and cultural factors influencing the prevalence of HIV/AIDS and care and support systems in those states. This is in recognition of the need to arrest the increasing rate of the spread of the epidemic and the desire to create better care for People Living with HIV/AIDS (PLWAs) in those states. The study employed both qualitative and quantitative methods using key-informant interviews; in-depth interviews; focus group discussions and case-study analyses. The study engaged in intensive fieldwork; which lasted for 24 months. The study examined in historical perspective; the condition of health facilities in the study area before the outbreak of HIV/AIDS and how such facilities have coped with HIV/AIDS. The study revealed that the socio-cultural condition of the society is not conducive to fighting HIV/AIDS. Poverty; low literacy capacity; the urbanization process; inadequate health care facilities; the location of tertiary institutions; and certain contesting issues in HIV/AIDS were found to account for the continued prevalence of HIV/AIDS in the study-area. In addition to the above; is the neglect of rural communities in HIV/AIDS programmes; despite the fact that PLWAs often return to their rural communities after contracting HIV/AIDS in their urban residence. HIV/AIDS is seen as a disease associated with human development; hence; action against the disease should involve the overhauling of the entire development process in the community studied

Prolegomenes a une reforme des services de sante: de l'identification des dysfonctionnements a la definition d'outils efficaces

"Va rious institutions have developed healthcare programs to cope with the serious epidemiologic situation in many developing counties. Although these programs are indispensable; many are ""disconnected"" from the social context for which t h ey we re deve l o p e d. Pe rusal of a few anthro p o l ogical texts describing pro blems associated with providing healthcare servicesin Africa allows identification of the difficulties and modalities of interaction between caregivers and populations and a basis for proposing avenues for reflection about improvement."

"La lutte contre la tuberculose vue du ""terrain"" representations populaires de la maladie et acces aux soins a Conakry (Guinee)"

"Tuberculosis is a public health priority especially in developing countries. A variety of control programs have been implemented. The purpose of this survey was to study the perceptions and practices of the victims of this disease ""in the field"". The findings of this survey carried out in a cohort of 65 patients and their families in Conakry; Guinea underline the importance of popular perceptions of the disease in care-seeking behavior. This survey also shows that health care workers share the same perceptions as the general population; which constitutes a major impediment for screening and treatment."

Esthetique bucco-dentaire en milieu traditionnel au Senegal

La forte composante psycho-sociale de l'esthetique de maniere generale a stimule la recherche dans les habitudes socio-culturelles de la sous-region et la motivation esthetique des patients en dentisterie cosmetique. L'esthetique dentaire en milieu traditionnel au Senegal s'exprime a travers des habitudes culturelles et des artifices artisanaux. Cette esthetique exprime aussi le besoin d'embellissement et/ou de procedes magico-religieux. 70 a 80 pour cent de la population est rurale et reste fidele a ses traditions; ses coutumes et ses croyances (canons de beaute; pratiques initiatiques et artifices artisanaux). L'initiation constitue une exigence du groupe; une identification ethnique ou de hierarchie sociale dont l'individu a du mal a se liberer; leurs incidences biologiques et sanitaires sont souvent nefastes et parfois funestes. Le mode de vie citadin elimine de plus en plus la folklorisation de ces pratiques culturelles pour privilegier le confort et l'aseptie. L'odontologiste dispose de la dentisterie cosmetique; avec ses regles esthetiques occidentales; pour repondre aux besoins esthetiques du milieu. En l'informant et le sensibilisant; les praticiens contribueront a atteindre l'un des objectifs de la profession; l'esthetique

Influence of widow inheritance on the epidemiology of AIDS in Africa

The objective of this text is to investigate traditional behavior practices that could influence the transmission of Human Immunodeficiency Virus among the Luo of Kenya. The subjects were widows of Luo men who had died of a chronic illness between November 1991 and October; 1992. It is concluded that widow inheritance is a determinant of sex among the Luo and influences the spread of HIV due to the pattern of sexual networking whereby men who inherit widows have multiple sex partners; high frequency of exchange of these men among widows and low level of condom use. Considering that this practice is deeply rooted; and is practised by Luo groups in Uganda; Tanzania; Zaire and Sudan; community based AIDS education targeting the elders; women and the youth should be started with the aim of finding a solution of the AIDS pandemic

The anthropology of burns in Zimbabwe

Burns; especially of children are the most common severe household accidents and are almost always preventable. In Zimbabwe the most common aetiology of burns is scalding. The purpose of this article is to show the relationship between the incidence of burns and socio-economic status; by comparing the burns occurring in high-density and rural areas (poor environment) with those occurring in low-density areas (affluent environment)

Pronostic maternel et foetal et facteurs de risque lies au mode de vie

Les auteurs; dans une etude prospective; font ressortir le role des habitudes coutumes et traditions dans le deces maternel et la mortinatalite. Ils montrent que ces deux indicateurs apprecient bien la qualite de la surveillance de la grossesse et du travail d'accouchement. Ils insistent alors sur la place qui revient a l'education pour la sante dans la prevention de cette tragedie

Matieres minerales et animales utilisees dans la medecine traditionnelles [sic] au Bushi; Sud-Kivu; Est du Zaire

Au Bushi; en plus des extraits vegetaux; on utilise comme medicaments des substances minerales et animales qui entrent dans la fabrication des ingredients auxquels on attribue le pouvoir de guerir; de prevenir les maladies et les malefices et de vaincre l'ennemi. On attribue aux animaux une importance medico-magique car ils sont souvent frequentes par les esprits protecteurs des hommes. Certains sont des interdits et ne peuvent; par consequent; ni etre tues ni etre manges

La femme dans tous ses etats

Dans cette societe africaine inedite; a la fois laique; chretienne; musulmane et fetichiste; capitaliste et feodale; l'individu est naturellement fragile foncierement seul meme s'il est fait pour vivre en societe. Ceci pose la question des rapports de l'individu africain au groupe familial et social; question qui a ete largement traitee dans la plupart des travaux en sociologie; psychologie; psychiatrie et psychiatrie transculturelle; qui ont contribue a la la renommee de ce que l'on a appele Ecole de psychiatrie de Dakar

Tetanos et pratiques traditionnelles

Les pratiques traditionnelles participent grandement a la propagation du tetanos dans la mesure ou ces actes se font avec du materiel non sterile pouvant etre un facteur determinant de l'introduction du bacille de Nicolaier dans l'organisme

Prevention du tetanos en Afrique

Les taux de vaccination encore faibles meme dans les populations ciblees; la frequence des plaies mal traitees et la survivance de pratiques traditionnelles a risque sont autant de facteurs qui font du tetanos un probleme de sante publique en milieu tropical