Urban-rural contrasts in explanatory models and treatment-seeking behaviours for stroke in Tanzania.

Stroke is an emerging problem in sub-Saharan Africa, about which little is known since most research to date has been based on retrospective, hospital-based studies. This anthropological work, designed to complement a large community-based project on stroke incidence, focuses on local understandings and treatment-seeking behaviours in urban (Dar-es-Salaam) and rural (Hai) areas of Tanzania. Semi-structured interviews (n=80) were conducted with 20 stroke patients, 20 relatives of stroke patients, ten traditional healers, and 30 other local residents. In contrast to common expectations, and literature that finds witchcraft beliefs to be most common in rural areas, stroke in urban Dar was widely believed to emanate from supernatural causes (demons and witchcraft), while in rural Hai, explanations drew mostly on 'natural' causes (hypertension, fatty foods, stress). These different beliefs and explanatory models fed into treatment-seeking behaviours. The first option in Hai was hospital treatment, while in Dar-es-Salaam, where belief in demons led to hospital avoidance, it was traditional healers. In both sites, multiple treatment options (serially or simultaneously) were the norm. Analysis of patient and carer narratives suggested that causation beliefs outweighed other factors, such as cost and distance, in shaping effective treatment. Three policy implications are drawn. First, as other studies have also shown, it is important to engage with, rather than dismiss, local explanations and interpretations of stroke. Stroke awareness messages need to take into account the geographical and belief systems differences. Developing an understanding of explanatory models that recognizes that local beliefs arise from dynamic processes of social interaction will be critical to designing effective interventions. Second, there is a clear role for multiple healing systems with possibility of cross-reference in the case of a chronic, disabling condition like stroke, since biomedical treatment cannot offer a 'quick fix' while traditional healers can help people come to terms with their condition. Third, issues of communication between health services and their patients are particularly critical.

Consanguineous marriage among the Fulani.

The Fulani are a broad ethnic category of nomadic and seminomadic pastoralists and agropastoralists living in the semiarid Sahel region of sub-Saharan Africa. The Fulani are patrilineal, patrilocal, and moderately polygynous, with arranged first marriages accompanied by the payment of bridewealth, ideally in the form of cattle. Consanguineous marriage is frequent, with first or second cousin marriage preferred. In this paper we present data on levels of consanguineous marriage among the Fulani of northern Burkina Faso and test the hypothesis that inbreeding may be more frequent when there is a scarcity of cattle available, since bridewealth demands are thought to be reduced with close-kin marriage. Among 308 women's marriages, 203 (65.8%) were between kin up to and including second cousins, and 102 (33.1%) were between nonkin. Among 276 men's marriages, 196 (71.0%) were between kin up to and including second cousins, and 77 (27.9%) were between nonkin. The mean population inbreeding coefficient (alpha) was 0.0355 for women, and 0.0374 for men. No increase was found in population levels of inbreeding estimated from marriages contracted after the droughts of 1973 and 1984, which drastically reduced the Fulani's cattle stocks. However, a significantly higher rate of consanguineous marriage was found in families owning the fewest cattle.

Pastoralists, agropastoralists and migrants: interactions between fertility and mobility in northern Burkina Faso.

Seasonal rural to urban migration of young men is becoming an increasingly important part of the rural economy of the West African Sahel, yet little is known about how the short-term contact of men with urban centres might affect reproductive decisions and outcomes in sending areas. In northern Burkina Faso, substantial variation in short-term migration rates of young Fulani men to cities provides an opportunity to explore interactions between migration and fertility in this area. The groups most involved in seasonal labour migration experience substantially lower fertility than non-migrating groups. Fertility differentials arise largely from higher rates of secondary sterility among migrating groups, probably caused by an increased incidence of sexually transmitted diseases. Such mechanisms as changes in attitudes and knowledge regarding birth control, and the undermining of traditional practices of marriage, breastfeeding, and sexual abstinence are far less important.

Seasonal labour migration strategies in the Sahel: coping with poverty or optimising security?

PIP: This study examined the relationship between seasonal labor migration and poverty for various Fulani populations in the Sahel region of northern Burkina Faso, who represent the spectrum of production systems from pure pastoralism to agropastoralism to cultivation. There is a general trend of rising seasonal labor participation with increasing household wealth; limited financial and human resources mean that families belonging to the lower income population are excluded from this option. However, other ethnic and economic differences among the population compound this picture. Agriculturalists are more likely to migrate than pastoralists, and the Fulani subgroup Fulbe Djelgobe is unlikely to migrate at all unless desperate. The impacts of circular labor also differ. For a few agriculturalists and agropastoralists, migration to the cities is rewarding; for most the gains are small but are still essential. Pastoralists are more likely to experience negative outcomes than agriculturalists. Unless sufficient provision is made to fill in labor deficits in the migrants' absence, the cost of domestic production may seriously outweigh any benefits in the long run.^ieng