Chasing spirits: Clarifying the spirit child phenomenon and infanticide in Northern Ghana.

In the Kassena-Nankana District of Ghana, researchers and health interventionists describe a phenomenon wherein some children are subject to infanticide because they are regarded as spirit children sent "from the bush" to cause misfortune and destroy the family. This phenomenon remains largely misunderstood and misrepresented. Based upon both ethnographic research and verbal autopsy data from 2006 to 2007 and 2009, this paper clarifies the characteristics of and circumstances surrounding the spirit child phenomenon, the role it plays within community understandings of childhood illness and mortality, and the variations present within the discourse and practice. The spirit child is a complex explanatory model closely connected to the Nankani sociocultural world and understandings surrounding causes of illness, disability, and misfortune, and is best understood within the context of the larger economic, social, and health concerns within the region. The identification of a child as a spirit child does not necessarily indicate that the child was a victim of infanticide. The spirit child best describes why a child died, rather than how the death occurred. In addition to shaping maternal and child health interventions, these findings have implications for verbal autopsy assessments and the accuracy of demographic data concerning the causes of child mortality.

"If he gives in, he will be gone...": the influence of work and place on experiences, reactions and self-care of heart failure in rural Canada.

Improving chronic disease management and outcomes is vital. However, greater understanding is needed of how aspects of context influence experiences and reactions to chronic disease and self-care. This is exemplified in relation to heart failure (HF), a common and severe chronic form of heart disease. Semi-structured interviews were undertaken with 42 male and female patients (Mean age 76 years) and 30 nominated lay caregivers. Interviews were guided by critical realist theory and examined experiences of and reactions to HF and aspects of self-care. Patients were recruited from three rural sites in Alberta, a province in mid-Western Canada, which varied in size, health services, and proximity to large urban settings. The influence of the rural context on accounts of HF and its self-care was evident principally in patients and caregivers through work and place. Work and place were seen to be indivisible with work seen as integral to life in the rural setting both historically (connecting to past generations) and contemporaneously. Accounts of HF and its self-care were framed around broader narratives of work, its benefits, and the threats and disruptions made to work by HF. Gender differences mainly existed around normal working patterns related to land work, domestic work, and community work. Work was seen to be pleasurable and vital to life in the rural setting and was continued by those with HF where possible either functionally or symbolically. Accounts of HF and its self-care were grounded in work and place-related dimensions of the rural setting. Approaches and interventions related to chronic disease must engage with place and work-related dimensions of context.

The potential of nursing to reduce the burden of heart failure in rural Canada: what strategies should nurses prioritize?

Chronic heart failure (CHF) is an increasingly common condition in high-income countries that has a large and negative impact on life quality and expectancy, and is associated with high financial costs. In Canada, CHF has an especially large impact on rural settings because of the higher proportion of older adults (aged >65 years) in these settings, and because care and outcomes tend to be more adverse in rural parts of the country compared to urban settings. Much can be done to reduce these burdens in terms of pharmacological, behavioural and health service strategies. However, rural patients tend to have worse care and outcomes than urban patients. Realizing the benefits of these strategies in Canada's rural settings requires consideration of underlying reasons for poor care and outcomes. We propose the main reasons for adverse outcomes are related to the nature of CHF and the combined influence of demographics, health services and the rural context. Nurses remain under-used in CHF management in Canada and can play a vital and influential role in reducing the burden of CHF in rural settings. To increase and improve nurses' roles, we recommend that nurses should support the development and adaptation of disease management programs in rural settings and promote the centrality of nursing in these programs. Nurses in or working with rural settings should seek to support and use tele-health technologies effectively and provide better support to lay caregivers. It will also be vital to increase the nursing capacity regarding specialist roles for CHF management.

Safety, tolerability, and lack of antibody responses after administration of a PfCSP DNA malaria vaccine via needle or needle-free jet injection, and comparison of intramuscular and combination intramuscular/intradermal routes.

Introduction of a new vaccine requires choosing a delivery system that provides safe administration and the desired level of immunogenicity. The safety, tolerability, and immunogenicity of three monthly 2.5-mg doses of a PfCSP DNA vaccine were evaluated in healthy volunteers as administered intramuscularly (IM) by needle, IM by jet injection (Biojector or IM/intradermally (ID) by jet injection. Vaccine administration was well-tolerated. Adverse events were primarily mild and limited to the site of injection (98%). Jet injections (either IM or ID) were associated with approximately twice as many adverse events per immunization as needle IM, but nevertheless were strongly and consistently preferred in opinion polls taken during the study. No volunteers had clinically significant biochemical or hematologic changes or detectable anti-dsDNA antibodies. In conclusion, the injection of Plasmodium falciparum circumsporozoite (PfCSP) DNA vaccine appeared to be safe and well-tolerated when administered by any of the three modes of delivery. However, despite improved antibody responses following both jet injection and ID delivery in animal models, no antibodies could be detected in volunteers by immunofluorescence antibody test (IFAT) or enzyme-linked immunosorbent assay (ELISA) after DNA vaccination.