Chronic diseases and health inequalities in older persons in Botswana (southern Africa): a national survey.

OBJECTIVES: To evaluate the health status of older persons in Botswana, to report on the prevalence of common health conditions--typically chronic diseases, to assess the socio-demographic correlates of morbidity in this population, and to assess the associations between physical functioning and self-reported health and the common health problems presented. DESIGN: National, cross-sectional survey (12 rural areas, 3 urban centres), inclusive of clinical examinations. SAMPLE: 372 individuals (183 females, 189 males) aged 60-109 years. RESULTS: 68% of respondents reported musculoskeletal pain in two or more locations; 42% were found to be hypertensive; 36% reported dental problems; 32% had dermatological problems; 11% were blind (as defined); 9% had cognitive impairment; 7% were depressed. Multinomial regression analyses showed poor self reported health to be significantly associated with musculoskeletal pain (OR = 15.5), depression (OR = 9.7), incontinence (OR = 3.9), dermatological problems (OR = 3.0) and dental problems (OR = 2.3); hypertension, blindness and cognitive impairment did not show significant associations. CONCLUSION: A large number of older persons in Botswana suffer from one or more age-associated chronic diseases that may impair function and quality of life. Several of the conditions may be diagnosed and treated to optimise the individuals' functioning. Poor self reported health was associated with "painful conditions" which are commonly poorly managed or untreated.

[Health--people's perspective]. / Helse--slik folk ser det.

In 1997--2000, we conducted a study of people's concept of health. 80 persons aged 16 - 93 years were invited to a qualitative interview taken on five different locations in Norway. Included in the material was a group of former and present top athletes. We identified six essential elements in people's conceptualization of health: well-being, function, nature, a sense of humour, coping, and energy. The lay perspective on health is characterized by three qualities: WHOLENESS: Health is a holistic phenomenon. Health is related to all aspects of life and society. PRAGMATISM: Health is a relative phenomenon. Health is experienced and evaluated according to what people find reasonable to expect, given their age, medical condition and social situation. INDIVIDUALISM: Health is a personal phenomenon. Every human being is unique, and health and strategies for health must be individualized.

Morbidity and health care utilisation among elderly people in Mmankgodi village, Botswana.

OBJECTIVE: To evaluate the health status among the elderly in a village in Botswana and their pattern of health care utilisation. DESIGN: A descriptive study where all persons 60 years and older were invited to participate, including a medical examination, laboratory testing and a questionnaire aiming at gathering sociodemographic data. SETTING: Mmankgodi village of Botswana. SUBJECTS: 419 persons were identified as elderly in the village, out of which 337 were included. MAIN OUTCOME MEASURES: The general medical examination also included eye status, vision and hearing tests, nutritional status, blood pressure and registering of physical disabilities. Laboratory tests included haemoglobin, blood glucose, HIV antibodies and serum lipids. The questionnaire contained questions regarding family and civil status, self assessed general health, health problems experienced during the previous month, and health care utilisation. Questions also pertained to smoking, taking snuff, and alcohol consumption. RESULTS: A majority (75%) of the elderly experienced good or only somewhat reduced health, while one quarter suffered more serious health problems. The most frequent health problems were related to the musculoskeletal system. Eye diseases, including cataract and blindness, were also common. The concentration of serum lipids is lower than the one found in the elderly population of Norway. Nutritional status indicated a relatively high prevalence (7%) of malnutrition. The majority of men were still married (87%), while most women were widowed (71%). Women reported more health problems than men, and they also reported more worries regarding their own life situation. There is a tendency for the elderly to seek assistance from the established clinics and other health facilities for their health problems. Worries are either kept to themselves or advice is sought from relatives. Traditional healers were not often consulted for health problems or worries. CONCLUSIONS: Major health problems were identified among the elderly in this geographical area of Botswana. There is presently no health programme in Botswana aimed at the elderly. Some of the diseases and conditions found in this study could easily be identified and treated in the present health system through a health care programme.

Help for people with disabilities: do cultural differences matter?

Since the Year of the Disabled (1981) and the Decade for Disabled Persons (1983-1992), many questions have arisen about how to understand and deal with disability in a multicultural world. To what extent can programmes developed in one place be successfully implemented elsewhere? What kinds of cultural and social differences matter and how can they be taken into account?

[When physicians become ill. Difficult choices]. / Når leger blir syke. Vanskelige valg.

39 Norwegian physicians have been interviewed and another 49 have either written down or dictated the history of their illness. In this article we focus on the doctors' dilemmas during the various stages of their illness. The general trend is to postpone seeking help, and to try to deny or hide, from themselves and others, the fact that they are seriously ill. The reasons for this are discussed. Some have difficulty in abandoning the role of doctor for that of patient; while others, who would prefer to be just a patient, are often not allowed this. Often, the doctor's doctor also experiences a conflict of roles. These dilemmas can tell us something of general interest about the role of the patient, the role of the doctor, and the patient/doctor relationship in society.

Aids and the elderly Tswana: the concept of pollution and consequences for AIDS prevention.

A study of elderly people in a village in southern Botswana is presented in this article. An argument is made for more in depth understanding of the role of elderly people in relation to the HIV/AIDS epidemic. It is demonstrated how Tswana indigenous medical ideology is behaviourally expressed in ways that identify elderly people as a group that may be at risk of catching and spreading HIV/AIDS. Through their position as respected members of the community, elderly people may also be a resource group in the struggle for AIDS prevention.

The struggle of weaning: factors determining breastfeeding duration in east Bhutan.

This paper presents the qualitative part of a project in a traditional community in East Bhutan, which, among other items, investigates the effects on child health of breastfeeding, weaning and subsequent pregnancy of the mother. Quantitative data from the project have shown that children who are weaned during a subsequent pregnancy of the mother have a reduced weight gain and an increased incidence of infectious diseases during weaning, while this is not so for children weaned from non-pregnant mothers. In-depth interviews with 35 women with experience from breastfeeding were carried out in the local language in order to obtain qualitative data regarding the processes underlying the mothers decisions during weaning. Breastfeeding was found to fulfil a valuable social function in addition to its biological and emotional properties. The breastfed child had an undebatable "right of access" to the mother's care, not only her breast, whenever it wanted. This child also assumed a status in the family in which both its vulnerability, its special needs and its value were clearly recognized. The mothers expressed a basic motivation to breastfeed "as long as possible". There were, however, important limitations as to how this was manifested in the practical weaning process. If the mother was pregnant at the time of weaning, these limitations tended to be mother-centred. Most of the women had experienced tenderness of the breasts and a reduced milk production from the start of the next pregnancy. It was believed that the breast milk of a pregnant woman could "rot" and cause disease in the child. In spite of this belief, concurrent breastfeeding and pregnancy were common, but a pregnant mother whose breastfed child got ill, e.g. with diarrhoea, would immediately stop breastfeeding. The child would thereby abruptly loose the most important protection against the negative effects of the disease, when this protection was most needed. Concurrent pregnancy and lactation are common in many areas of the poor world. This has important consequences for the health of mothers and children, and has only recently been given the attention it derserves.

Care for the elderly, care by the elderly: The role of elderly women in a changing Tswana society.

With increasing urbanization and migration in Botswana and an increasing number of children born to unwed mothers, the grandmother (especially maternal) has become a key figure in many households. She is often the main care provider for children of absent daughters: a phenomenon observed elsewhere in Africa. But what happens when the grandmother herself is in need of care? There are indications that the elderly, especially old women, may have less access to modern health care facilities than the rest of the population. This article focuses on the family and resources available for care of the elderly, and presents preliminary results from an ongoing multidisciplinary project.

[Medical anthropology]. / Medisinsk antropologi.

This article presents medical anthropology as an inter-disciplinary and multi-disciplinary field, in which anthropologists and biomedically trained professionals may find fruitful cooperation. Some aspects of international health care are discussed with special reference to anthropological contributions in this area. The author also touches on various problems encountered during the meeting between Norwegian clinicians and immigrant patients.

The disabled person in the community: social and cultural aspects.

This article deals with the situation of disabled persons and their families in the local community, with special reference to developing countries. The article reviews various 'myths' about the situation of disabled people in Europe in the old days and in developing countries of today. Cultural and social factors influencing the situation of disabled persons in developing countries are then considered in the light of this review. Finally, case material from Botswana is presented in order to demonstrate how parents' attitudes may easily be misinterpreted as negative if not seen in their proper socio-cultural context.

Coping behaviour of disabled persons and their families: cross-cultural perspectives from Norway and Botswana.

In this article a model for analyzing the coping behaviour of families with disabled children is presented. It is demonstrated how this model, through its holistic perspective, may be used for including culture as an important variable in studies of reactions to crisis and coping behaviour in such families. Some cross-cultural perspectives, based on studies from Norway and Botswana are presented, and the universality of reactions to critical events, as established in prominent theories of crisis are questioned.

Assistance to families with handicapped children.

The article deals with the problem of developing models for assistance to families with handicapped children in developed and developing countries. In order to avoid unintended and undesirable effects, it is necessary to gain a thorough insight into local conditions and the families own experience of their needs. The example of Norway is used to illustrate this. An interdisiplinary project, a cooperation between a social anthropologist and a child psychiatrist, has studied "handicapped families" and the effects of the aid programs on their ability to cope with the problems of daily life. 171 families with pre-school children with nine different handicaps were interviewed about their life situation, their needs and the aid they received. In Norway one of the main problems in giving aid to "handicapped families" is the underutilisation of the aid that is available. More information must be gathered of the processes that influence the coping ability of the "handicapped family" in both developed and developing countries. Further assistance programs should be based on such knowledge.